Cognitive style

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Passive-aggressive individuals are cynical, sceptical, hypercritical, and mistrustful. Disillusioned with life, discouraged, discontented with themselves and with others, they are also pessimistic about the future. They persistently complain and blame others for their own bad luck, feeling themselves to be misunderstood martyrs and victims of destiny.

Typical defence mechanisms of passive-aggressive personalities are centred around repression and manifested as turning their anger against themselves, sadomasochistic behaviour, denial, rationalization, and acting-out.

Comorbidity and differential diagnosis

Passive-aggressive personality disorder is frequently comorbid with major depression, dysthymic disorder, anxiety, panic disorder, and hypochondriasis. Patients with depressive disorders are more aware of their feelings of inferiority and more likely to feel guilty, and their depressed mood is continuous rather than erratically hostile and moody, as in passive-aggressive personality.

Comorbidity with many personality disorders (histrionic, borderline, obsessive-compulsive, dependent, narcissistic) is also frequently observed. People with these personality disorders may use passive aggression as a defence mechanism. Suicide attempts are not as frequent as in histrionic and borderline personality disorders, and features of passive-aggressive personality are less dramatic, affective, openly aggressive, and severe.

Course and prognosis

There are insufficient data on the course and prognosis of passive-aggressive personality disorder. When passive-aggressive people are able to control their anger, they may experience anxiety, panic states, depressive episodes, chronic depression, and psychosomatic disorders. They are prone to alcohol abuse, and their careers are erratic and stunted despite their abilities (frequent changes of jobs are common). Suicide attempts may complicate this disorder.

Treatment

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