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Passive-Aggressive Behavior

Q. My husband and I have been married for almost 27 years and have been going to a female marriage therapist for about 7 years. She has described my husband as being passive-aggressive. He has also been diagnosed with chronic depression and attention deficit disorder without hyperactivity.

He exhibits the typical behavior of a passive-aggressive person. For example, he would promise to live up to his word on things and to meet another person's needs, then he always lets the person down. If he is given a deadline to accomplish something by, the deadline always passes without the task being done, yet he always has excuses and blames everything else except himself.

I am considering suggesting to him that perhaps a male therapist would help him more individually. Can a passive-aggressive person ever change? I know he has to want to change his own behavior, but can he really turn this behavior around in a positive way?

A. The term "passive-aggressive" has been dropped from the official lexicon of psychiatry, because it is doesn't usually point to a specific disorder. Thus, the diagnosis of passive-aggressive personality disorder is no longer found in the main portion of the diagnostic manual of psychiatric disorders (DSM-IV)--it has been relegated to the appendix of the book, designated as requiring more study.

That said--we all know individuals who sound a lot like your husband! The usual take on personality disorders is that they are very resistant to treatment, as your comment about "wanting to change" implies. Most people with true personality disorders do not perceive that there is anything particularly wrong with them--and, like your husband, usually find fault with others.

So, other than mildly coercive inducements to change (for example, withholding a passive-aggressive employee's pay check), it's difficult to motivate personality-disordered folks to do the hard work of psychotherapy. At least, that's the conventional wisdom.

On the other hand, studies in adolescents with personality disorders (Grilo et al, Compr Psychiatry. 2001 Sep-Oct;42(5):364-8) suggest that there is some improvement over the long-term, even in those with passive-aggressive symptoms, and that these younger individuals can benefit from treatment. I think that the longer passive-aggressive traits are entrenched, the harder they are to treat--but that doesn't mean your husband wouldn't benefit from individual therapy.

I'm not sure it would matter much if the therapist were male or female. There is also evidence that even within the passive-aggressive personality type, there are subtypes that may have different outcomes (Perry & Flannery, J Nerv Ment Dis. 1982 Mar;170(3):164-73). For example, some people with this personality style may, deep-down, be anxious and inhibited--and cover their anxiety by procrastinating. This subtype may benefit from assertiveness training, or (in theory) from anti-anxiety
medication.

I think it's also important that your husband has been diagnosed as having chronic depression. Many depressed individuals may behave in a passive-aggressive manner, but not have a true personality disorder. And when their depression is successfully treated--lo and behold!--the passive-aggressive traits melt away.

Whether this would hold true with your husband, I can't say. But I think a thorough psychiatric evaluation would be a good start for him--that is, if you can get him to go!

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October 2003

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