Passive-aggressive personality disorder (PAPD) causes people to express negative feelings and emotions subtly or passively rather than directly.

This often creates a contradiction between what they say and do.

Read on to learn what PAPD is, what causes it, what its symptoms are, and how healthcare professionals can diagnose and treat it.

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According to the American Psychological Association (APA), PAPD is “a personality disorder of long standing in which ambivalence toward the self and others” is expressed by passive expressions of underlying negativism.

This means that PAPD is a chronic, generally inflexible, condition.

In the APA definition, the term “ambivalence” means that a person has contradictory feelings or attitudes toward themselves or a situation, event, or person.

In other words, an individual with PAPD may enthusiastically agree to meet up for lunch only to “forget” about the meeting or fail to show up without explanation.

People with PAPD express their thoughts and feelings passively or indirectly rather than address them directly. These thoughts and feelings often represent negative thought patterns, or negativism.

According to the APA, negativism is “an attitude characterized by persistent resistance to the suggestions of others […] or the tendency to act in ways that are contrary to the expectations, requests, or commands of others […], typically without any identifiable reason for opposition.”

People with PAPD tend to continue their passive behaviors despite the ability to adapt and learn new behaviors. Depending on how severe it is, PAPD can greatly interfere with a person’s success with interpersonal relationships, education, and work.

PAPD is not an actual medical diagnosis. Over time, passive aggression has been considered to be a:

  • personality trait
  • dynamic behavioral pattern
  • personality syndrome

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition included the term “PAPD” as a proposed diagnosis and described it as negativistic personality disorder.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, however, does not include the proposed disorder as a diagnosis and instead classifies it as an example of other specified personality disorder.

In childhood and adolescence, a moderate amount of resistance to others, especially authorities, tends to develop naturally and subside over time.

That said, it remains unclear exactly why PAPD occurs. Research shows it likely develops due to some combination of:

  • genetics
  • growing up in an abusive environment or where there was substance abuse
  • being punished as a child for expressing anger or negative emotions or opposing thoughts or feelings
  • not having learned how to assert oneself during childhood
  • disruptions in a child’s relationship to authority figures, such as parents, caretakers, or teachers

Some people may experience PAPD in addition to another mental health condition, such as:

People with PAPD tend to experience a disconnect between what they say and do. While PAPD can manifest in a variety of ways, common symptoms include:

  • putting off completing tasks a person initially volunteered to do or seemed to wish to do
  • intentionally making mistakes or missing deadlines for projects, tasks, or events
  • purposefully not showing up for meetings, appointments, or social events or gatherings
  • acting excessively stubborn
  • intentionally misplacing important documents to avoid work projects, travel, medical appointments, or family gatherings
  • excessively complaining about a personal misfortune or being undervalued
  • resisting routine social or occupational tasks for no clear reason
  • expressing scorn for or criticizing authority
  • feeling envy and resentment toward the relatively fortunate
  • being argumentative
  • alternating between hostility and contrition
  • having an aggressive, pessimistic, or cynical demeanor
  • blaming others for one’s own feelings or actions
  • experiencing feelings of inadequacy or low self-esteem
  • acting cold or vindictive toward others without explaining why

Because PAPD is not an actual medical condition, there is no specific way to diagnose it.

However, a psychiatrist, psychologist, or doctor who is familiar with mental health conditions may be able to help people identify their destructive behaviors and distorted thought patterns and adjust them.

Healthcare professionals may also use assessment tools to identify or diagnose other mental health conditions that may be present along with PAPD.

To do this, they may ask questions or use questionnaires to better understand an individual’s:

  • perceived general personality traits and behaviors
  • characterization of daily life interactions and relationships or roles
  • level of emotional awareness
  • past or current interpersonal conflicts
  • feelings of hopelessness
  • suicidal thoughts
  • personal or family history of mental health conditions
  • substance use or abuse
  • ability to function in everyday life, such as the workplace or school
  • ability to form and maintain healthy relationships
  • sensitivity to interpersonal behaviors
  • interpersonal values
  • social cognition or awareness

If there is a relation between PAPD and a diagnosable mental health condition, healthcare professionals can often effectively treat PAPD using a combination of therapy and medication.

Therapies and medications that healthcare professionals typically use to treat common conditions associated with PAPD include:

  • antianxiety medications
  • attention deficit medications
  • mood stabilizers
  • antipsychotics
  • cognitive behavioral therapy
  • harm reduction therapy
  • inpatient- or community-based substance abuse programs
  • peer support or group therapy

Therapies used to treat other mental health conditions, including other personality disorders, may be useful in treating PAPD.

During treatment, psychiatrists, psychologists, or counselors may help people learn how to identify and address their negative emotional and behavioral patterns and reduce the impact of PAPD.

Goals of treatment for PAPD include:

  • increasing self-efficacy and self-esteem
  • improving a person’s ability to express negative emotions, such as anger
  • improving the ability to effectively engage in conflict directly
  • developing neutral feelings toward others, especially those in power or considered more fortunate
  • forming more realistic expectations of oneself, others, and interpersonal relationships
  • addressing negative feelings or perceptions and learning ways in which to think about them more objectively or neutrally
  • identifying potential reasons PAPD may have developed and trying to determine how to address or move forward from them
  • addressing and resolving past interpersonal conflicts effectively
  • improving a sense of self-control and reducing feelings of hopelessness
  • eliminating or reducing suicidal thoughts

PAPD causes people to subtly express negative thoughts and feelings in ways that seem to contradict what they say or do.

There is no specific treatment for PAPD. However, a psychologist or counselor may often help people learn ways to identify, address, and stop engaging in these contradictory behaviors and actions.

People who think they may have PAPD should consult a healthcare professional as soon as possible. Working with a counselor or psychiatrist, for example, may help them develop safe and effective coping strategies that will allow them to enjoy a more satisfying life.