Passive-aggressive personality disorder

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Passive-aggressive personality disorder is a mental disorder that is accompanied by psychological resistance to external demands. Without treatment, the condition can lead to antisocial behavior, dismissal from work, and destruction of family ties and business contacts.

Therapy is based on individual or group psychotherapeutic sessions. In severe cases, drug therapy is used. Dr. Isaev’s psychiatric clinic offers treatment for passive-aggressive disorder in Moscow. Traditional approaches to psychocorrection and innovative developments of scientists are used here.

General information about the disease

Social conflicts and communication difficulties can occur in any person. They do not indicate any personality deviations. But in some cases these manifestations become pathological. Passive-aggressive personality disorder is characterized by the following features:

a person tends to think in a negative way, he is pessimistic, gloomy, set up for failure;
there is a belief that people around him are negatively opposed to him;
the patient denies his own role in certain circumstances where he is guilty, tends to refer only to external factors;
he has a fear of disapproval of his own words and actions from society;
the patient is convinced that his personal freedom is being limited, and often considers himself offended and insulted.

To assert themselves, people with passive-aggressive personality disorder tend to assert their rights through irritation and aggression. At the same time, they may not express their dissatisfaction for a long time, hiding it from others.

Why does a man behave this way?

A man comes to this behavior due to a deeply hidden fear of becoming dependent himself, as well as the fear of being uncompetitive. Emotional intimacy, which presupposes the interaction of different sides of the human psyche, for such a man is a step into madness and hell. He is painfully afraid and resists this rapprochement in every possible way.

Such men are aggressive and hostile towards women. They tend to distort gender roles, assessments, and their behavior, and even manipulate facts for the purpose of justifying their flawed opinion about the world order.

Since our society is not accustomed to seeing such behavior as an attack, this role of men has been studied very poorly, but it is very widespread and corrodes society from the inside, like slowly spreading corrosion.

An aggressor man disguises his true needs under the guise of naivety and passivity in actions (everything is decided for him, he himself does not decide anything that destroys his masculine essence). He goes with the flow, is overly generous, and loose-lipped, but he can easily be a gigolo and does not try to provide for himself.

A passive-aggressive man behaves this way because he gives up his basic need the moment his aggression comes out.

For example, at moments when a man needs to be healthy and active and, for example, go and earn 1,000 rubles to buy food for his family for dinner, the man will prefer to hide from his problems in philosophy and experiences. There will be no food in the house, but aggression, a push for action, irritation and an attempt to demonstrate one’s masculine viability, energy that has not found a way out, will quite neatly be released into the heat of a family quarrel. And then the suppressed energy will be looped into destructive action. The man will get it back in the form of the emotions that his wife splashed out. Plus the situation will resolve itself. Thus, a man, without making his own efforts, realizes his actions outside in a distorted version. Rakes the heat with someone else's hands.

Causes of the disorder

Experts believe that a negative example of such behavior in parents becomes a serious risk factor in the development of passive-aggressive disorder in a child. Other reasons may be:

chronic stress arising from conflicts in the family and at work;
the emergence of transference and identifications. A person can identify with an aggressive person due to strong emotions, transferring to himself the character traits of a complete stranger;
upbringing with authoritarianism, total control, overprotection.

Passive aggression is provoked by constant demands from parents to contain emotions. As a result of this, a person is unable to express them and can translate feelings into aggression towards other people. Very often, outwardly pleasant and reserved people, brought up in this way, are internally overstrained, filled with the desire to restore a certain justice to them alone.

Symptoms of Passive-Aggressive Personality Disorder

Passive-aggressive disorder is easy to recognize in everyday life. It manifests itself in the following acts of behavior:

frequent complaints about loved ones, friends, colleagues;
writing reviews in the book of complaints and suggestions in the absence of objective reasons;
drawing up reports to superiors, which highlight the guilt of employees, because of which the patient considers himself to be a victim.

People with this disorder are characterized by the appearance of automatic thoughts and ideas that are negative in nature. Patients always choose the path of least resistance and move away from their colleagues around them. They negatively interpret any events in life and extend negativism to all their behavior.

They follow the path of minimal resistance - they put things off until later, do them poorly, with a long delay. In any difficulties, a person expresses his dissatisfaction with his boss and other people in power. As a rule, outbursts of anger occur rarely. Most often, dissatisfaction manifests itself passively. People sabotage activities and subtly persuade others to do the same.

The predominant emotions in a person with passive-aggressive personality disorder are anger and irritation. They arise from a constant feeling of being undervalued. At the same time, the person himself cannot achieve professional and personal goals, which confirms his feelings. Patients do not understand that their attitudes lead to this. They do not feel responsible for personal failures.

Story

Although the concept of a passive-aggressive personality style has been described in earlier works, the term was not used before World War II. In 1945, "immature reaction" was described by the War Department as a reaction to "ordinary military stress, manifested by helplessness or inappropriate reactions, passivity, obstructionism, or outbursts of aggression." Later, in 1949, the US Armed Forces Technical Bulletin used the term "passive-aggressive" to describe soldiers who exhibited this pattern of behavior. In the DSM-I (APA, 1952), the category of passive-aggressive disorders was divided into three subtypes: passive-aggressive, passive-dependent, and aggressive. The passive-dependent type, consistent with the current diagnosis of dependent personality disorder, was characterized by helplessness, indecisiveness, and a tendency to cling to other people.

Early theorists of psychopathology described a personality type that apparently has several characteristics of PPD. For example, both Kraepelin (1913) and Bleuler (1924) described people who always reacted negatively to everything. Kraepelin described both extreme mood swings and overreaction to negative experiences, while Bleuler additionally described a group of people who quickly become frustrated and irritable after their usual negative interpretation of situations.

Some psychoanalytic theorists have also described this type of character. Reich (1945), for example, described a masochistic personality type in which the person constantly complains 209. and tends to be passive aggressive towards others. These people cannot tolerate unpleasant feelings and stimulation of the autonomic nervous system. Millon (1981) suggests that PARL does not have a complex intrapsychic structure. Instead, the person experiences feelings without the benefits of intrapsychic modification. This explanation is consistent with the indecision of the passive-aggressive personality.

A variation of this disorder was described by Berne (1964) in transactional analysis. Berne describes a pattern in which a person is slightly destructive (for example, spilling a drink at a party) but still deserves forgiveness. In this pattern or game, called schlemiel, the passive-aggressive person gets satisfaction from both being destructive and being forgiven.

Possible complications

The main negative consequence of passive-aggressive disorder is social maladjustment. People around the patient, due to constant negativism, attempts at sabotage and denial of responsibility, begin to move away from communicating with him. This confirms his confidence in his own thoughts and leads to increased symptoms.

Depressive patterns occur in 50-60% of patients. They tend to constantly progress and significantly worsen the prognosis. Alcoholism and drug addiction develop against the background of a negative perception of the world around us. Patients use them to avoid reality. The ability to hide behind an imaginary euphoria allows them to break out of the vicious circle, at least for a while.

Psychosomatic disorders are characterized by the occurrence of symptoms of diseases of internal organs against the background of psychological disorders. Patients with passive-aggressive behavior complain of discomfort, chest pain, frequent headaches, dizziness, and sensory disturbances in the extremities. When examined by a neurologist or performed an instrumental examination, there are no organic disorders, which confirms the psychosomatic nature of the symptoms.

Diagnostics

The International Classification of Diseases (ICD-10) classifies passive-aggressive disorder as “other specific personality disorders” (F60.8). To be diagnosed, a person must have at least 5 of the following symptoms:

constantly postponing work until later;
gloominess, gloominess and irritability that arise when asked to do something;
taking on obligations, but not fulfilling them due to “forgetfulness”;
useful advice from others that can increase work productivity causes dissatisfaction and indignation;
people in power are criticized, and their success is explained by a trivial coincidence of circumstances;
disagreement with the assessment of one’s own work, despite its objectively low quality;
performing tasks slowly or deliberately introducing inaccuracies in them. This refers to work that a person does not want to do.

All patients with personality changes are advised to consult a neurologist. An examination by a specialist makes it possible to exclude organic causes of disorders, for example, tumor pathology, the consequences of cerebral ischemia, and others. To do this, the patient undergoes an EEG (electroencephalography), computed tomography or magnetic resonance imaging.

When making a diagnosis, differential diagnosis is carried out with other personality disorders, primarily with borderline and hysterical. The main difference is the lack of drama and entertainment, as well as the passive nature of aggression towards people.

Publications in the media

Personality disorders are long-term and persistent disorders of various spheres of mental activity, devoid of productive psychotic symptoms and manifested by behavior from which either the patients themselves or society suffer. The disorders usually begin in childhood or adolescence and continue throughout later life. In foreign psychiatry, since the 70s of the 20th century, the term “psychopathy”, “which has become not a clinical diagnosis, but a synonym for the asociality of the subject,” has been replaced by the concept of “personality disorder.”

To make a diagnosis of personality disorder, it is necessary to exclude organic brain damage, which can cause similar behavioral disorders. If a somatic and/or neurological disease (for example, a brain tumor) leading to central nervous system dysfunction is detected, a diagnosis of “organic personality disorder” is made. In Russian psychiatry, starting from the 30s and until now, the doctrine of personality disorders (psychopathy), belonging to P.B., is most recognized. Gannushkin (1933). In accordance with the teachings of P.B. Gannushkin use the following provisions: • disorders are so pronounced that they lead to disruption of the patient’s adaptation to society; • totality of disorders; in this case, we are not talking about individual abnormal character traits, but about the fact that the personality as a whole is woven from pathological characterological properties; • persistence, stability and low reversibility of disorders throughout the patient's life. Frequency : 6–9% of the population. Classification and clinical picture The classification of personality disorders is conditional, because in most cases we are talking about mixed types, including symptoms of different types of personality disorders. • Paranoid personality disorder (paranoid psychopathy) •• Patients experience unreasonable suspicions that others are using, deceiving, or harming them. They are unkind to others, unable to forgive insults or disrespect, and express unreasonable doubts about the fidelity of their spouse or sexual partner. Patients persistently believe that they are right in all situations •• Patients with paranoid personality disorder seem unemotional and lack warmth. They are impressed only by strength and power, only in these cases do they pay attention to people, while those whom they consider weak, sick, infirm, inferior, they deeply despise •• In case of decompensation under the influence of emerging conflicts, systematic persecution begins “ offenders,” endless complaints are written to state, public and judicial authorities, in which any minor miscalculations of opponents are qualified as malicious and criminal, and defamatory anonymous letters are sent. The circle of persecuted persons is constantly expanding due to all those who took part in the analysis of conflicts and who, in the patient’s opinion, did not show due integrity and impartiality. In such situations, the development of overvalued delusions is possible, incl. delirium of jealousy. Patients with overvalued delusions are dangerous because they are prone to committing aggressive actions against their “enemies” or a sexual partner suspected of adultery. • Schizoid personality disorder (schizoid psychopathy) •• Patients are characterized by a reluctance to have close relationships with others and a lack of joy from such relationships. As a child, they like to play quiet and calm games alone, most often at home, never share their experiences with their parents, and cannot find a common language with their peers •• Schizoid individuals remain cold and distant, do not take part in everyday life, are uncommunicative, silent, do not follow fashion. They have no or poorly developed need for emotional contact with other people, no close friends, but at the same time they can be strongly attached to animals •• Patients strive for individual activities that do not require competition, and are able to spend an unusually large amount of effort and time on studying abstract sciences, such as mathematics, astronomy, philosophy •• Characterized by reduced interest or absence of interest in sexual relations. Men often don't get married because... they are unable to maintain intimate contact; women sometimes passively submit to an aggressive man, agreeing to marry him if he wants •• Patients are indifferent to praise or criticism. They respond to most threats, real or imaginary, by fantasizing about omnipotence and withdrawing from real life •• Despite social isolation and detachment from the outside world, patients can think and develop so far that they are able to give the world truly original, creative ideas. • Dissocial (antisocial) personality disorder •• Patients are prone to lies and impulsive actions; unable to plan. Patients are often irritable and aggressive. Ignoring personal safety or the safety of others is typical; irresponsible attitude towards one's responsibilities; indifference •• Lying, truancy, running away from home, theft, fighting, drug use and illegal activities are typical manifestations that begin in childhood. Antisocial personalities do not have depression or anxiety, which is surprising given the situation they are in, and their own explanations for what is happening to them seem crazy •• They like to manipulate others and often involve others in plans for easy money or achievement fame or notoriety, which in the end almost inevitably leads to financial ruin. A notable feature is the lack of regret about one's actions. • Emotionally unstable personality disorder (excitable psychopathy) •• In situations that do not meet the interests of patients, they give violent reactions of irritation, dissatisfaction and anger. Outside of situations that are emotionally significant for patients, reactions are often quite adequate. Outbursts of intense anger can lead to violence, especially if the patient's wishes and actions are resisted and criticized by others. Conflictful relationships with loved ones often lead to auto-aggression, including suicide attempts and self-harm •• Patients are desperately trying to avoid loneliness. They form unstable interpersonal relationships with people with alternating fluctuations between extreme idealization and extremely negative assessment •• Characterized by a violation of self-awareness (pronounced and long-lasting instability in the self-image) and a lack of adequate assessment of their reactions and behavior. Patients try to find reasons and circumstances that justify such behavior •• Patients are prone to impulsive actions that are committed without sufficient logical assessment, without taking into account their possible consequences and are associated with potential risks (wasting money, promiscuity in sexual relations, disregard for traffic rules) • • Mood is unpredictable and capricious (episodic dysphoria, irritability, short temper, anxiety) •• ICD-10 distinguishes two types of disorder: the impulsive type, characterized primarily by emotional instability and lack of emotional control, and the borderline type, which is additionally characterized by a disorder of self-perception and goals and internal aspirations, a chronic feeling of emptiness, tense and unstable interpersonal relationships and a tendency towards self-destructive behavior, including suicidal gestures and attempts.

• Histrionic personality disorder (hysterical psychopathy) •• Characterized by a feeling of discomfort in situations where the patient is not the object of attention. Patients try to evoke sympathy, an attitude of admiration, and surprise. This is achieved by extravagant appearance, boasting, deceit, fantasy, inappropriate sexual charm in appearance or behavior •• Patients are capricious and inconsistent. Their emotional reactions are labile, superficial and theatrical. The mood is extremely changeable. They are characterized by suggestibility, susceptibility to the influence of people or circumstances •• A low level of self-awareness does not allow them to objectively assess their behavior: they see themselves as people capable of self-sacrifice for the sake of their loved ones and friends, not noticing their actual selfish attitude towards them •• Being sweet and flirtatious with people on whom they want to make a good impression, they become tyrants in the family, showing callousness and even cruelty towards their loved ones •• In an effort to attract attention to themselves with their weakness and helplessness, such people become regular visitors to medical institutions, making complaints about unbearable physical and mental suffering •• Psephologists (pathological liars) predominate among men. Characterized by a tendency to fantasize, stories about extraordinary events in which they assign themselves a spectacular role, about meeting outstanding people, trying to present themselves as a more significant person than they actually are. Among them there are many petty scammers, imaginary psychics, and marriage swindlers.

• Anancastic personality disorder (anancastic psychopathy, obsessive-compulsive personality disorder) •• The basis of a psychasthenic personality is anxiety and self-doubt. Since childhood, such individuals have been characterized by shyness, increased impressionability, and constant fear of doing something wrong •• Patients are absorbed in organizing or planning their activities to such an extent that the main goal of the work is not achieved. They strive for improvement, which prevents them from completing the task. Patients are busy working and achieving results to such an extent that relationships with other people are sometimes very difficult for them •• They are not characterized by impulses or spontaneous impulses. Before taking any step, they evaluate it for a painfully long time, doubt its expediency •• Characterized by excessive conscientiousness, scrupulousness and lack of flexibility in matters of morality, ethics or moral values •• Patients are unable to get rid of worn-out or unnecessary things, even if they not associated with sentimental memories •• They are unwilling to share responsibilities or work with others unless others perform the work to the fullest extent of the patients' requirements •• Possible intrusive thoughts and actions that do not reach the severity of obsessive-compulsive disorder.

• Anxious (avoidant) personality disorder (inhibited type psychopathy) •• These patients are usually considered “complex people” in everyday life. The central clinical feature of this disorder is increased sensitivity to criticism, disapproval and dissatisfaction from others, as a result of which patients avoid contact with people. They are reserved in intimate relationships due to fear of reproaches or ridicule from a sexual partner •• Patients are afraid to speak in public or make requests of others (the disorder is often combined with social phobia). They sometimes misinterpret people's statements as demeaning or ridiculing them. Refusal of any request is accompanied by withdrawal on their part, and they feel insulted •• In the professional sphere, such patients often avoid taking on responsibilities or participating in new activities for fear of being in a difficult situation, and rarely achieve great success or earn authority . On the contrary, at work they show themselves to be shy and try to please everyone in everything •• Failure of social support can lead to anxiety and depression. • Dependent personality type disorder •• The core manifestation of the disorder is self-doubt, low self-esteem. Patients avoid responsibility; the need to perform leadership functions causes severe anxiety. In relationships with others, patients play only auxiliary, subordinate roles, are humiliated in order to be accepted and are often unfairly exploited in the interests of others. The loss of a meaningful relationship with a dominant person is fraught with the subsequent development of a depressive episode •• They find it difficult to do some work for themselves, but it is easy to do similar tasks for someone else. Patients find it difficult to make decisions in everyday life without outside help or reassurance. Characterized by fear of loneliness. Patients seek care and support from others, going so far as to voluntarily perform activities that are not enjoyable. Patients can endure insults, infidelity or drunkenness of their spouse for a long time. In the event of the loss of a close relationship, there is a need to find a new close connection as a source of care and support.

• Narcissistic personality disorder. Patients tend to exaggerate their own achievements and talents. They are characterized by preoccupation with fantasies of unprecedented success, unlimited power, brilliance, beauty or ideal love. Patients are convinced of their own uniqueness and ability to communicate or be related to other special or high-status people (or institutions). They easily develop a need for excessive admiration from others, unreasonable expectations of very good treatment or unquestioning submission to demands. Patients often use others to achieve their own goals. Patients with narcissistic disorder are characterized by an inability to show empathy; envy of others and the belief that others are jealous of him. • Passive-aggressive personality disorder •• The core feature of the disorder is a constant attitude towards passive resistance to management. Patients cannot stand up for themselves or speak directly about their needs and desires. At the same time, they are always dissatisfied, irritated and disappointed with someone or something. Patients constantly look for flaws in the authoritarian figures to whom they are subordinate and do not make any attempts to free themselves from their dependent position. Passive-aggressive individuals are envious and spiteful towards those who are more fortunate. Patients believe that they work much better than others think about it, reacting with indignation to the suggestion that their productivity could be higher •• When forced to achieve success at work, they experience severe anxiety. Those with whom patients are in close relationships are rarely calm and happy. Patients can, for example, ruin a party with their complaints and claims, without making, with some excuses, their positive contribution to it •• Patients often even find it difficult to formulate what a situation should look like in which they would be satisfied. Such patients often threaten to commit suicide, but as a rule, things do not go as far as suicide attempts. •• The disorder is often complicated by alcoholism, depression and somatization disorder.

Accentuations of character Accentuated personalities (K. Leonhard) occupy an intermediate position between mentally healthy people and patients with personality disorders. They adapt in life more easily than psychopathic ones, and their adaptation is more stable, however, even in unfavorable conditions, states of decompensation may arise in them. In their characteristics, they differ from ordinary people, and these characteristics (emphasis) are not considered as a manifestation of the disease, although in difficult conditions for the individual, failure of adaptation and disruption of interpersonal relationships may be possible. The leading signs of character accentuations may resemble reduced manifestations of the corresponding psychopathy. For example, accentuated personalities of the hysterical type are similar to those suffering from histrionic personality disorder: they are prone to theatricality, self-affirmation in the eyes of others, etc. However, these manifestations are not so vivid in them and the general disharmony of personality is much less pronounced. Within the framework of accentuated states, mixed variants are often noted, including signs of different types of character accentuations. The diagnosis of a personality disorder is invalid if there are only isolated characterological deviations that are well compensated and lead to pathological behavioral disorders only during relatively short periods of decompensation associated with mental trauma. In this case, a diagnosis of character accentuation is made. Research methods • EEG • MRI/CT • Psychological methods (MMPI, thematic apperception test, Rorschach test).

Differential diagnosis • Paranoid personality disorder differs from delusional disorder in the absence of delusional ideas. This disorder can be differentiated from paranoid schizophrenia on the basis that in paranoid personality disorder there are no hallucinations, emotional-volitional and thinking disorders. Patients with borderline personality disorder differ from this type in their ability to form strong emotional relationships with others. Paranoid personality disorder differs from antisocial personality disorder in that there is no history of antisocial behavior. They are similar to schizoid psychopaths by limited emotionality, but are distinguished by dominant suspicion and distrust. It is most difficult to distinguish paranoid disorder from schizotypal disorder, for which suspiciousness is also a characteristic feature. Unlike schizotypal patients, patients of this type do not have such a bizarre complex of behavioral, sensory and mental disorders; they are characterized not so much by the absence of distortions in communication skills, but by their characteristic orientation (eccentricity, eccentricity). • Schizoid personality disorder. Unlike schizoid disorder, patients with schizotypal disorder are characterized by more pronounced emotional-volitional and thinking disorders, subpsychotic episodes and less successful social adaptation. Patients of the emotionally unstable and anxious (evasive) type have a richer and more emotional social life, are sensitive to their loneliness, are more interested in interpersonal relationships and rarely resort to autistic fantasy. Patients with paranoid disorder are able to establish stable and emotionally rich relationships with others; they more often use psychological defense in the form of projection.

• Antisocial personality disorder. An antisocial psychopath differs from a mentally healthy criminal in that the criminality of his behavior is only one of the parameters of globally impaired personality functioning. When assessing antisocial behavior, it is very important to take into account the social norms of the cultural group to which the patient belongs. • Borderline personality disorder. Differential diagnosis with schizophrenia is based on the presence or absence of prolonged psychotic episodes of characteristic negative symptoms. Schizotypal individuals are characterized by strange behavior and fragmentary delusional ideas about relationships. Paranoid individuals are characterized by strong suspicion. Borderline individuals experience a chronic feeling of emptiness, impulsivity, short-term psychotic episodes, and suicidal attempts to manipulate others. • Histrionic personality disorder. It is most difficult to determine the difference between histrionic and borderline personalities. Suicides and subpsychotic episodes are more typical for the latter type. Brief reactive psychoses and dissociative disorders may coexist with a diagnosis of histrionic personality disorder. • Narcissistic personality disorder. Borderline, histrionic, and antisocial personality disorders are often comorbid with narcissistic disorders. Patients with narcissistic personality disorders are less anxious than patients with borderline disorders and their lives are less chaotic; Suicide attempts are more common in borderline than narcissistic personality disorders. Unlike the antisocial type, narcissistic patients are less impulsive, less likely to abuse alcoholic beverages and break the law. Hysterical personalities, like narcissistic ones, often display traits of exhibitionism and try to manipulate others, but they are more capable of warm emotional relationships. • Obsessive-compulsive personality disorder. Unlike obsessive-compulsive personality disorder, obsessive-compulsive disorder is characterized by true obsessions and compulsions. If the latter are present, a diagnosis of obsessive-compulsive disorder should be made. • Avoidant personality disorder. Avoidance of communication with other people is characteristic of both the schizoid and anxious types, but the schizoid patient is distinguished by the desire and lack of desire to communicate, while the anxious patient is distinguished by the desire to communicate, uncertainty and fear. The clinical pictures of the anxious and dependent types are similar, but with the anxious type, communication difficulties manifest themselves in the fear of communication, with the dependent type - in the fear of being left alone. The borderline and hysterical type are distinguished from the anxious type by the tendencies to manipulate other people, irritability and unpredictable behavior characteristic of these patients.

• Dependent personality disorder. Addiction features are found in many types of mental disorders, making differential diagnosis difficult. The clinical pictures of the anxious and dependent types are similar, but with the anxious type, communication difficulties manifest themselves in the fear of communication, with the dependent type - in the fear of being left alone. Dependence on others is also characteristic of the hysterical and borderline types, but dependent individuals usually maintain a long-term connection with the same person on whom they depend, and not with a group of people, and they have no tendency to manipulate others. Patients of the schizoid type and with schizotypal disorder tend to be isolated rather than dependent. Dependent behavior can be found in patients with agoraphobia, but agoraphobic patients also have a higher level of general anxiety or the possibility of developing panic attacks. • Passive-aggressive personality disorder. Despite the known external similarity, behavior in passive-aggressive disorder is less spectacular, dramatic, emotional and aggressive than in cases of hysterical and borderline disorders.

TREATMENT Psychotherapy and drug therapy are used to treat personality disorders. These treatments should not be pitted against each other. With the right combination of psychotherapy and drug treatment, an enhanced effect is noted. Drug therapy plays a small role in the treatment of patients with personality disorders • Antipsychotic drugs in small doses are prescribed for aggressive behavior, psychomotor agitation, decompensation of paranoid personality disorder (for example, levomepromazine 25–75 mg/day, haloperidol 5–15 mg/day) • Anxiolytic drugs (for example, diazepam, bromodihydrochlorophenylbenzodiazepine) reduce anxiety and improve the well-being of patients, but these drugs should be prescribed with extreme caution (if possible, do without them) due to the high risk of developing addiction and dependence in patients with personality disorder • With the development of depressive conditions antidepressants are used (for example, amitriptyline 75–150 mg/day). Antidepressants (especially clomipramine) are also effective in decompensating obsessive-compulsive personality disorder, manifested by symptoms of obsessive-compulsive disorder. Psychotherapy (group, family, individual, psychoanalysis) is the most preferred method of treatment. With the help of psychotherapy, they change the patient’s attitudes, his idea of his “I”, and help find ways to build correct interpersonal relationships.

Course and prognosis. • Personality disorders usually begin in childhood or adolescence and continue throughout later life. The ability to adapt to personality disorders depends on the severity of the behavioral disorder and external factors. Patients can be adapted under conditions favorable to them (compensation) and maladapted with pronounced manifestations of their characteristic psychopathic manifestations under unfavorable conditions (decompensation). Decompensating factors can be somatic and infectious diseases, intoxication, and emotional stress. The dynamics of psychopathy are closely related to age. The most dangerous periods in terms of decompensation are puberty and involution. A common feature of all pathological conditions is non-progress. After decompensation, the patient's personality returns to its original state. • Patients tend to avoid treatment. The course is chronic and progressive, leading to social and labor decompensation, but some patients may experience improvement. Synonyms • Pathological personality development • Character anomaly • Pathological character • Psychopathy

ICD-10 • F68 Other personality and behavior disorders in adulthood •• F69 Personality and behavior disorder in adulthood, unspecified

Treatment of passive-aggressive personality disorder in Moscow

Treatment of the disease is difficult, since the patient does not consider his behavior to be the cause of social maladaptation, which reduces adherence to treatment. Many patients perceive visiting doctors as their own humiliation. At the same time, they retain internal hostility towards specialists.

The main method of treating passive-aggressive personality disorder in Moscow at the psychiatric department of Dr. Isaev’s clinic is psychotherapy. Various areas of psychotherapeutic assistance are used here. The work begins with individual sessions, when the psychotherapist helps the patient understand the pathological nature of his thinking and attitude to the surrounding reality.

Regular meetings with a psychologist and psychiatrist are helpful. Working with attitudes allows you to change many of the patient’s values and foundations and return his thinking to a positive direction. After individual sessions, group psychotherapy is indicated to consolidate the results of treatment. It lasts from one year or more.

During sessions with a doctor, the patient becomes aware of the negative consequences of his behavior. Working on the nature of thinking and creating new mechanisms for responding to stress eliminates the pathological symptoms of a personality disorder. The most effective are social skills training and group work through dangerous moments.

Medications are rarely used for passive-aggressive personality disorder. Antidepressants (Fluoxetine and other serotonin reuptake inhibitors) are used for severe depression, which independently worsens the patient’s social and professional adaptation. In addition to them, doctors can prescribe adaptogens that increase the overall tone of the body.

Principles of treatment for impulsive disorder in adults

In most cases, therapy is carried out on an outpatient basis. Treatment begins with the prescription of benzodiazepine drugs and lithium-based drugs. For frequent attacks of rage, doctors at the Leto clinic recommend inpatient therapy using high doses of antipsychotics.

After eliminating internal tension and stabilizing the general psycho-emotional status, the patient is transferred to antidepressants and non-benzodiazepine sedatives. At the same time, a course of psychotherapy is started. A specialist helps a person control emotions, restrain attacks of rage, and respond adequately to the words and actions of other people.

Various muscle relaxation techniques and breathing exercises are effective. For some patients, strength sports, boxing, wrestling are a good way to relax; others are more suited to yoga or Pilates, or morning jogging.

Don't try to cope with impulsive disorder on your own! Call our medical center on a 24-hour anonymous phone number 8(969)060-93-93 and make an appointment for a consultation. Our specialists know very well how to treat the syndrome and have extensive experience working with such patients!

Prevention of the disorder

Prevention of passive-aggressive personality disorders is based on general recommendations that are recommended for all parents and loved ones to follow:

Provide the patient with a positive emotional atmosphere, acceptance of the child at all stages of growing up.
Avoid overprotection and authoritarianism in decision making. Infantilism and other characteristic signs of a personality disorder develop due to the child’s inability to independently solve emerging difficulties and make choices in everyday affairs.
Avoid stressful situations. Children often experience stress: when studying at school, adapting among their peers. Parents should support the child and help him make the right decisions without exerting psychological pressure.

The development of passive-aggressive behavior is facilitated by bad habits - drinking alcohol and taking drugs. Teenagers and adults are advised to completely exclude them from their lives.