DSM-II

In DSM-II, this disorder is called Passive-aggressive personality

This behavior pattern is characterized by both passivity and aggressiveness. The aggressiveness may be expressed passively, for example by obstructionism, pouting, procrastination, intentional inefficiency, or stubborness. This behavior commonly reflects hostility which the individual feels he dare not express openly. Often the behavior is one expression of the patient's resentment at failing to find gratification in a relationship with an individual or institution upon which he is over-dependent.

DSM-III

Diagnostic Criteria

The following are characteristic of the individual's current and long-term functioning, and are not limited to episodes of illness.

A. Resistance to demands for adequate performance in both occupational and social functioning.

B. Resistance expressed indirectly through at least two of the following:

  1. procrastination
  2. dawdling
  3. stubbornness
  4. intentional inefficiency
  5. "forgetfulness"

C. As a consequence of A and B, pervasive and long-standing social and occupational ineffectiveness (including roles of housewife or student), e.g., intentional inefficiency that has prevented job promotion.

D. Persistence of the behavior pattern even under circumstances in which more self-assertive and effective behavior is possible.

E. Does not meet the criteria for any other Personality Disorder, and if under age 18, does not meet the criteria for Oppositional Disorder.

Differential Diagnosis

Oppositional Disorder

In Oppositional Disorder there may be a similar clinical picture and this diagnosis preempts the diagnosis of Passive-Aggressive Personality Disorder if the individual is under 18.

Passive-aggressive maneuvers

Passive-aggressive maneuvers that are used in certain situations in which assertive behavior is discouraged or actually punished and that are not part of a pervasive pattern of personality functioning do not warrant this diagnosis.

DSM-IV

Research Criteria

A. A pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  1. passively resists fulfilling routine social and occupational tasks
  2. complains of being misunderstood and underappreciated by others
  3. is sullen and argumentative
  4. unreasonably criticizes and scorns authority
  5. expresses envy and resentment toward those apparently more fortunate
  6. voices exaggerated and persistent complaints of personal misfortune
  7. alternates between hostile defiance and contrition

B. Does not occur exclusively during Major Depressive Episodes and is not better accounted for by Dysthymic Disorder.

Differential Diagnosis

In DSM-IV, individuals whose presentation meets these research criteria would be diagnosed as having Personality Disorder Not Otherwise Specified.

Oppositional Defiant Disorder

In Oppositional Defiant Disorder, there is a similar pattern of negativistic attitudes and problems with authority figures, but Oppositional Defiant Disorder is usually diagnosed in children, whereas this proposed disorder should be considered only in adults.

Depressive Disorders

This pattern should not be considered if the symptoms are better accounted for by Dysthymic Disorder of if they occur exclusively during Major Depressive Episodes.

Normal passive-aggressive traits

Passive-aggressive behaviors are frequently encountered in everyday life, particularly among those in authoritarian situations (e.g., work, military, prison) that do not tolerate other forms of assertiveness. Only when these passive-aggressive personality traits are inflexible, maladaptive, and cause significant functional impairment or subjective distress do they constitute a disorder.

DSM-5

See Other Specified Personality Disorder

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