Is It the Silent Treatment or Passive-Aggressive Personality Disorder?

A lot of people exhibit passive-aggressive behavior from time to time. Has anyone not had a roommate leave passive-aggressive sticky notes in the kitchen? However, if passive-aggressive behavior becomes more of a permanent trait than an occasional response to being stressed out or frustrated, it can take a toll on your life and relationships. In fact, there even used to be a formal mental health diagnosis of passive-aggressive personality disorder (PAPD), which referred to this type of behavior. Here’s what you need to know about passive-aggressive behavior, the defunct diagnosis, the causes of passive-aggressiveness, and how to cope. 

What is passive-aggressive personality disorder?

First, it’s important to note that PAPD is no longer recognized as a personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association, says Charlie Health Clinical Supervisor Tracye Freeman Valentine, LPC.

However, the general consensus was that this personality disorder was characterized by, you guessed it, chronic passive-aggressive tendencies. Expressing negative emotions like frustration or anger indirectly, continuously procrastinating or “forgetting” things, blaming others, and complaining that people don’t appreciate them were all behavior patterns that once fell under the symptom category of PAPD. 

However, there was controversy surrounding this diagnosis, with some mental health professionals arguing that passive-aggressive behavior in and of itself may be too broad and subjective –– and it could be seen as a cluster of symptoms relating to other personality disorders rather than its own personality disorder. For example, Valentine says that many symptoms of the deleted PAPD diagnosis now fall under the diagnostic criteria for narcissistic personality disorder (NPD).  

Mental health conditions related to passive-aggressive behavior

Although PAPD is no longer considered a mental health diagnosis, passive-aggressiveness can be linked to other personality disorders. Let’s take a deeper look at related disorders.

Narcissistic personality disorder (NPD)

People with narcissistic personality disorder (NPD) do not have empathy for others, require constant attention and praise, and desire excessive admiration. They may feel self-important, believing they’re better than everyone else and deserve special treatment. 

There are different types of narcissism, and the one that’s commonly linked to passive-aggressive behavior is covert narcissism. Covert narcissists have typical NPD symptoms, but it may be less outwardly obvious that they are narcissists. For example, they can be anxious, shy, hypersensitive to criticism, and jealous of other people. Covert narcissists are likely to engage in passive-aggressive behavior when they are frustrated, angry, or threatened. 

Borderline personality disorder (BPD) 

Borderline personality disorder (BPD) is marked by an extreme fear of abandonment, unstable relationships, impulsive tendencies, and intense, overwhelming emotions that are difficult to control. This difficulty in emotional control can sometimes manifest as passive-aggressive behavior. People with BPD may resort to passive-aggressive behavior (like the silent treatment) as a response to an intense negative emotion since it offers an outlet for their struggles. However, this can further negatively impact relationships. There is a specific subtype of BPD that appears in popular literature known as petulant BPD, which is most frequently associated with passive-aggressive tendencies (though it’s not considered an official diagnosis). 

Personality disorder not otherwise specified 

Valentine says “other specified personality disorders” or “unspecified personality disorders” are also linked to passive aggressiveness. These conditions are defined by personality disorder symptoms that don’t meet the criteria of any specific disorder. Instead, they may include a mix of symptoms from other personality disorders, like antisocial personality disorder, histrionic personality disorder, and more. Passive aggressive behavior may be a symptom of these conditions. 

Potential causes of passive-aggressive behavior 

Many factors play into the development of passive-aggressive behavior, especially when it is an ongoing, persistent pattern. “Research has shown that factors include childhood development, culture, low self-esteem, neglect, abuse, and being in a family that does not express and communicate directly and clearly,” Valentine says. “People may also learn behaviors of bitterness, cynicism, procrastination, and blaming others.” Some other risk factors and potential causes of personality disorders in general include genetics and trauma, specifically including childhood abuse.

How to cope with passive aggression and passive-aggressive behavior

According to Valentine, the best way to cope with passive aggression is to treat the conditions that contribute to the behaviors in the first place, like personality disorders. For instance, personality disorder therapy can help people process negative feelings, like anger, that may be contributing to passive-aggressive behaviors. With therapy, a person can eventually learn to express their feelings instead of resorting to passive-aggressiveness, like silent treatment. Valentine says some examples of therapy used to treat personality disorders are as follows: 

Dialectical behavior therapy (DBT)

DBT involves mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. With DBT, people will learn to regulate their intense, difficult negative emotions, tolerate distress, and engage in more healthy communication, resulting in healthier relationships. 

Cognitive behavioral therapy (CBT) 

CBT helps people understand how their feelings, thoughts, and behaviors are interconnected and affect one another. This therapy will allow individuals to identify negative, unhealthy thoughts and beliefs and create healthier thought patterns and behaviors. 

Transference-focused psychotherapy (TFP)

This specialized modality zeroes in on the relationship between the patient and therapist. Many times, the feelings and behaviors someone with a personality disorder has towards their therapist serve as a reflection of their interpersonal relationships in the outside world. This can help a therapist and the individual gain a better understanding of behaviors and relationships –– in turn, giving the power to make positive changes from there. 

Schema-focused therapy (SFT)

SFT addresses deep-rooted negative thought patterns or beliefs, AKA schemas, that individuals develop early in life. These schemas, often formed during childhood, influence how individuals perceive themselves and others throughout their lives, even as they grow older because the beliefs are so deeply ingrained. SFT aims to challenge and change these negative schemas, resulting in positive changes in self-perception and interpersonal relationships.

How Charlie Health can help

If passive aggression impacts your mental health and relationships or a young person in your life, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for young people dealing with complex mental health conditions. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, feeling better is possible. Fill out the form below or give us a call to start healing today.