Contemporary concepts

Passive-aggressive personality survived though DSM-II and DSM-III, despite resistance towards its inclusion in these classifications. The original descriptions were relatively narrow yet descriptively clear and clinically relevant. According to Kernberg (62) this diagnosis has been a useful grab-bag for personality disorders that do not fit easily into any other major category.

There has been much debate as to whether passive aggression constitutes a personality disorder, a defence mechanism, or a specific maladaptive personality trait (coping style).(19Z) Surprisingly, empirical literature on the subject is scarce, although passive-aggressive behaviour has been widely recognized by clinicians. An overlap with other personalities has been shown, and it has never been included as a separate category in the International Classification of Diseases. The passive-aggressive dimension, as assessed by self-reports, is always high in depressed patients and is state-dependent. (!08) Perhaps it would be best to conceptualize passive aggression as a continuum: a passive-aggressive defence mechanism may be normal in some situations, it could be a trait of many personality disorders, and when pronounced and long-lasting it should be designated as passive-aggressive personality disorder.

Epidemiology

The population prevalence ranges from 0.9 to 3 per cent, but in those cases in which a secondary co-occurring diagnosis was assigned, the secondary frequency of passive-aggressive personality disorder was about 10 per cent. (1.06) Some studies found a higher prevalence in women and others in men.

Aetiology

The cause of the disorder is multidimensional, comprising biological, psychoanalytical, behavioural, interpersonal, and social learning perspectives. Biological issues

Early authors, such as Kraepelin, Bleuler and Schneider, considered passive-aggressive personality to be constitutionally determined. Millon (!°9) has noted that oppositional disorder of childhood and adolescence may be related to passive-aggressive personality disorder in adulthood, suggesting that there may be specific genetic and/or metabolic factors contributing to a lifelong pattern of erratic moods and angry irritability. However, this interesting hypothesis of a psychopathology continuum is still speculative and should be supported by empirical research.

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