What Was Passive-Aggressive Personality Disorder?

Passive-aggressive behavior can be subtle, indirect expressions of displeasure instead of more to-the-point methods of communicating one's feelings. Passive aggression is a communication style that many people employ, and it may not signify a mental health condition. However, before the release of the DSM-5, people who exhibited extreme forms of passive-aggressive tendencies frequently may have been diagnosed with a mental health condition known as passive-aggressive personality disorder (PAPD). 

Although not listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the framework of PAPD may still help others understand the potential challenges of someone who exhibits passive-aggressive behavior frequently.

What was passive-aggressive personality disorder?

According to the American Psychological Association, passive-aggressive personality disorder (PAPD) was "a personality disorder of long standing in which ambivalence toward the self and others was expressed by such means as procrastination, dawdling, stubbornness, intentional inefficiency, "forgetting" appointments, or misplacing important materials." 

Also once referred to as negativistic personality disorder, passive-aggressive personality disorder was characterized by behavior meant to subtly express disapproval, irritation, or anger with someone or a situation. No longer a valid diagnosis, passive-aggressive personality disorder was removed from the DSM after the DSM-3. It was added to the appendix of the DSM-4 and removed entirely from the DSM-5, the current version.  

People diagnosed with passive-aggressive personality disorder might have been agreeable and personable face to face but struggle with lying about these experiences. If someone interacted with them or asked for a favor, they may have readily agreed or accepted whatever plans or ideas were brought up. However, they might have felt less agreeable on their own, potentially leading to conflict and tension.

Now that PAPD is no longer a diagnosable condition, it is considered a loose framework formed by a group of symptoms related to other conditions rather than a separate disorder. For example, many of the symptoms of narcissistic personality disorder—purposefully completing tasks slowly and stonewalling—are considered passive-aggressive. If you were previously diagnosed with PAPD, consider contacting your diagnosing physician or mental health professional for guidance. 

Symptoms of passive-aggressive personality disorder in the DSM-3

Below are a few of the symptom criteria listed in the DSM-3 for PAPD, which are no longer symptom criteria due to the removal of the disorder from the DSM-5: 

• A frequent criticism of the ideas or actions of others
• Consistent procrastination or forgetfulness
• Inefficiency in performing assigned tasks
• Cynicism or hostility toward others
• Stubbornness when asked for help or ideas
• Frequent blame of others
• Complaints about lack of appreciation for the tasks they complete
• Resentment toward others for their needs or demands
• Disagreeableness or irritability when someone needs them 
• Pessimism over outcomes of events or situations
• Intentionally making mistakes that inconvenience others

These symptoms may have caused difficulty for the individual experiencing them, as they may have struggled to express themselves and make requests. It could also have been challenging for friends, family, and acquaintances, who may have felt confused or upset by passive-aggressive behaviors. 

Causes of passive-aggressive personality disorder in the DSM-3

As PAPD is no longer a diagnosable mental health condition, no causes exist. However, passive-aggressive behavior and symptoms of other personality disorders may have causes. Often, it is thought that genetic and environmental factors play a part in the development of personality disorders. 

In addition, passive aggression as a trait may develop during childhood. For example, a child who grew up in a family that did not express themselves directly may learn to do the same. According to one study, children often develop passive-aggressive tendencies due to a failure to "navigate hierarchical relationships," which can cause them to struggle to assert themselves. Low self-esteem, abuse, neglect, and substance use may influence the development of challenges such as these. 

If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available 24/7 for support. Call 1-800-799-SAFE (7233) or text "START" to 88788. You can also use the online chat. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

What treatments were and are available for passive-aggressive behavior?

There are various ways passive-aggressive personality disorder is treated. In current times, as a behavioral concern and not a personality disorder, it may still be able to be treated in these ways, including the following. 

Treating related conditions first 

Before treating PAPD, psychologists may have looked at whether one's symptoms could be described by another mental illness first. If someone was experiencing a co-occurring condition, their symptoms may have contributed to signs of PAPD. Today, psychologists might treat passive-aggressive behavior similarly or consider whether symptoms of a past PAPD diagnosis fit the current symptoms of a DSM-5 diagnosis for another condition. 

Therapy 

Therapy is a standard treatment method for passive-aggressive behavior, and research shows that specific therapy modalities, like cognitive-behavioral therapy, can decrease symptoms of personality disorders, including passive-aggressive traits. Working with a therapist can help you discover underlying thoughts and emotions that may keep you from asserting yourself and engaging with others more constructively. A therapist may also provide outlets to express your emotions and communicate directly. 

Assertiveness training 

Assertiveness training may also be a valuable resource for someone with passive-aggressive tendencies. This type of training teaches you how to express your thoughts and ideas more effectively. During assertiveness training, you may be put in mock social or workplace situations to practice communicating directly and learn how to identify and moderate passive-aggressive behavior before you utilize it. 

Self-work 

In some cases, an individual may be able to address passive-aggressive behaviors on their own at home. To address passive aggression in your own time, try to recognize how and when you exhibit passive-aggressive behavior. Do you show up late to work meetings you don't think are necessary or intentionally put off doing favors your family asked you to complete? Knowing how passive-aggressive behavior shows up in your life can help you address it.

When you communicate with others, work on being as thorough and transparent in your desires as possible. For example, if you're already overwhelmed with projects at work, but your boss has given you another task, consider being honest. You can say, "I want to ensure I'm doing my best work, and I'm concerned I won't be able to if I'm given more projects," or, "Would it be possible for me to get an extension on this project?" By stating these needs, you're clearly expressing your feelings and potentially avoiding a more passive-aggressive response, such as handing in work past the expected deadline, or about which you are not confident.     

Counseling for passive-aggression 

Although PAPD is no longer a mental illness in the current DSM-5, some of the symptoms that people with other personality disorders or conditions experience, may include passive-aggressive tendencies. In addition, passive-aggressive behavior can be challenging with which to live. In these cases, therapy might be beneficial, and there are a few forms of therapy from which to choose, including in-person and online counseling. 

An increasingly significant body of evidence shows that online therapy can alleviate symptoms of mental health conditions, including those related to personality disorders. For example, in a review of 11 studies, researchers found that online therapy could significantly reduce symptoms of various personality disorders. The review also discussed the ability of online therapy to circumvent many common barriers to treatment, including time constraints and a lack of mental health providers. 

If you're looking for a therapist to help you with passive-aggressive behavior or a similar mental health concern, consider utilizing an online therapy platform like BetterHelp. With online therapy, you can work with a therapist remotely through video calls, voice calls, or in-app messaging, which can be helpful if you're not yet comfortable with specific interactions due to a personality disorder. Online therapy is an affordable option, as well. A licensed therapist can give you the tools to communicate better, limit passive-aggressive behavior, and improve your mental health.