NCP Passive Aggressive Personality Disorder

DSM-IV

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.

ETIOLOGICAL THEORIES

Psychodynamics

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.

Biological

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.

Family Dynamics

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

Ego Integrity

Feels cheated, unappreciated, misunderstood

Chronically complains to others

Blames others for failures

Neurosensory

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”

Mental Status:

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

Overtly ambivalent

Social Interactions

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

DIAGNOSTIC STUDIES

Drug Screen: Identifies substance use.

NURSING PRIORITIES

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.

DISCHARGE GOALS

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.