Passive-aggressive personality disorder. Treatment implications of a clinical typology

Patients with passive-aggressive personality disorder or personality traits represent a very difficult group on which surprisingly little is written. The authors delineate four patterns of passive-aggressive behavior that pose different problems in learning and adaptation. These are the anxiety-inhibited, environmentally inhibited (masochistic), and resentful-vindictive patients and patients inhibited by existential choice. All four types meet the DSM-III criteria for passive-aggressive personality disorder; they may also occur as significant personality traits apart from the fully developed personality disorder. The difficulties that these patients present are the same for clinicians of every theoretical perspective. Using one treatment approach, assertiveness training, the authors offer specific suggestions in the treatment of each type of passive-aggressive patient. These suggestions should aid the clinicians in avoiding premature termination, and fostering both a positive therapeutic alliance and a successful treatment outcome.