What is "passive-aggressive?"

May 30, 2003

Dear Cecil:

What exactly does it mean to say that someone is "passive-aggressive"? I hear this term used frequently, usually with reference to a coworker, child, parent, etc, who is being a pain in the ass. Surely there's a more rigorous clinical definition than that.

You might get some argument there, Frank. It's true that if you look under "passive-aggressive personality disorder" (PAPD) in the Diagnostic and Statistical Manual of Mental Disorders (the older editions--more about that below), you find the syndrome solemnly described as a "pervasive pattern of passive resistance to demands for adequate social and occupational performance." But once you delve into the history of the term, you realize that--at least in the eyes of its critics--it's mostly useful as a high-flown way to call someone a pain in the ass.

The term "passive-aggressive" was introduced in a 1945 U.S. War Department technical bulletin, describing soldiers who weren't openly insubordinate but shirked duty through procrastination, willful incompetence, and so on. If you've ever served in the military during wartime, though, or for that matter read Catch-22, you realize that what the brass calls a personality disorder a grunt might call a rational strategy to avoid getting killed.

After the war the term found its way into civilian psychiatric practice and for many years was listed in the Diagnostic and Statistical Manual, the bible of the mental health trade. According to the revised third edition (DSM-III-R, 1987), someone had PAPD if he displayed five or more of the following behaviors: (1) procrastinates, (2) sulks or argues when asked to do something he doesn't want to do, (3) works inefficiently on unwanted tasks, (4) complains without justification of unreasonable demands, (5) "forgets" obligations, (6) believes he is doing a much better job than others think, (7) resents useful suggestions, (8) fails to do his share, or (9) unreasonably criticizes authority figures.

You may say: I know a lot of people like that. Or even: I'm that way myself sometimes. Exactly the problem. From the outset skeptics argued that passive-aggressive behavior is an ordinary defensive maneuver and shouldn't be considered symptomatic of a mental disorder. Reacting to such criticism, the authors of previous versions of the DSM had defined PAPD narrowly: in DSM-III (1980), they'd said PAPD shouldn't be diagnosed in the presence of any other disorder (you can see how depression might contribute to procrastination or sulkiness, for example). The idea apparently was to curb careless use of the term--though shrinks weren't likely to say somebody was mentally ill if he was just a PITA, if he had some other psychiatric problem, they'd throw in PAPD too. Sure enough, after DSM-III diagnoses of PAPD declined sharply, to the point that some researchers felt the category should be abolished. Others, however, thought the exclusivity criterion was unnecessarily limiting and persuaded the editors of DSM-III-R to drop it. PAPD diagnoses shot back up. Conclusion: If we define PAPD rigorously, almost nobody has it; if we define it loosely, just about everybody does.

Recognizing that the definition as then formulated wasn't working but uncertain how to fix it, the compilers of DSM-IV (1994) dumped PAPD from the list of official disorders and relegated it to an appendix. The most telling complaint, in my opinion, was that merely being passive-aggressive isn't a disorder but a behavior--sometimes a perfectly rational behavior, which lets you dodge unpleasant chores while avoiding confrontation. It's only pathological if it's a habitual, crippling response reflecting a pervasively pessimistic attitude--people who suffer from PAPD expect disappointment, and gain a sense of control over their lives by bringing it about. Some psychiatrists have suggested that PAPD be merged into a broader category, called negativistic personality disorder. Diagnostic criteria: passive-aggressive plus (a) mad at the world, (b) envious and resentful, (c) feels cheated by life, and (d) alternately hostile and clingy.

We'll let the specialists work out the details. For now, though, we lay folk should strive to use the term "passive-aggressive" more precisely in everyday life. Say for instance that a coworker cheerfully agrees to refrain from a specified uncool act, then does it anyway. Is this passive-aggressive behavior? No, this is being an asshole. Comforting as it can be to pigeonhole our tormentors with off-the-shelf psychiatric diagnoses, sometimes it's best just to call a jerk a jerk.

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