301.9 Personality disorder NOS
Passive-Aggressive personality disorder (negativistic personality disorder)—provided for further study.
This disorder is characterized by a pervasive pattern of passive resistance, expressed indirectly rather than directly, to demands for adequate social/occupational performance, with the individual viewing the future as negatively as they view the present.
These clients are unaware that ongoing difficulties are the result of their own behaviors. They experience conscious hostility toward authority figures but do not connect their ownpassive-resistant behaviors with hostility or resentment. They do not trust others, are not assertive, are intentionally inefficient, and try to “get back” at others through aggravation. Anger and hostility are released through others, who become angry and may suffer because of the client’s inefficiencies. This disorder can lead to more serious psychological dysfunctions such as major depression, dysthymic disorder, and alcohol and other drug abuse/dependence.
These behaviors, although not disturbing to the client, are disturbing to those in the environment who interact with the client. Therapy is not usually sought, but the client is generally referred for help by family members.
Personality disturbance is attributed to constitutional abnormalities. There may be a biological base to behavioral and emotional deviations, and researchers hope to demonstrate a correlation between chromosomal and neuronal abnormalities and a person’s behavior.
Theories of development implicate environmental factors occurring in the very early years of the child’s life. Feelings of rejection or inadequate nurturing by the primary caregiver result in anger that is then turned inward on the self. Depression is common.
CLIENT ASSESSMENT DATA BASE
Feels cheated, unappreciated, misunderstood
Chronically complains to others
Blames others for failures
Covert aggressive behaviors chosen over self-assertive behaviors
Passive resistance to demands (to increase or maintain certain level of performance) through behaviors such as dawdling, stubbornness, procrastination, and “forgetfulness”
Behavior: May not appear uncomfortable in social situations but is cold and indifferent, reflecting stiff perfectionism; superficial bravado
Mood and Affect: Displays a seriousness with difficulty expressing warm feelings, may sulk and pout, passively acquiesce/conform; harbors unspoken resentment
Emotion: Displays/reports anxiety, depression; expresses sense of low self-worth, lack of self-confidence; may be dependent and passive
Thought Processes: Views world in a negativistic manner but fails to connect behavior to others’ reactions; feels resentful, and believes others are being unfair; sees the world as a hostile and unfair environment
Habitually “forgets” commitments, arrives late for appointments
Authority figures (e.g., parents, teachers, superiors at work) may be focus of discontent-criticizing/voicing hostility with minimal provocation
Demands for adequate performance are met with resistance expressed indirectly (e.g., procrastination, forgetfulness, intentional inefficiency)
Pervasive social/occupational ineffectiveness
Strained interpersonal relationships; difficulty adjusting to close relationships
Envious/resentful of peers who are successful
Drug Screen: Identifies substance use.
1. Assist client to learn methods to control anxiety and express anger appropriately.
2. Promote effective, satisfying coping strategies.
3. Promote development of positive self-concept.
4. Encourage client/family to become involved in therapy/support programs.
1. Feelings of anger, hostility resolving.
2. Assertive techniques being learned and used.
3. Self-esteem increased.
4. Client/family involved in therapy programs.
5. Plan in place to meet needs after discharge.