Background

Passive-Aggressive (Negativisitic) Patient Therapy Notes

Uploaded 3/9/2011, approx. 3 minute read

My name is Sam Vaknin. I am the author of Malignant Self-Love, Narcissism Revisited.

The negativistic, passive-aggressive personality disorder is not a formal diagnosis in the psychiatric community. It appears in Appendix B of the Diagnostic and Statistical Manual 4, an appendix titled Criteria Sets and Access provided for further study.

Despite this fact, passive-aggressive or negativistic personality disorder is widely diagnosed by many health practitioners and also treated.

So here is the simulation of a first therapy session with Mike, a male 52 years old diagnosed with negativistic or passive-aggressive personality disorder by his therapist.

Mike is attending therapy at the request of his wife. She complains that he is emotionally absent and aloof.

Mike shrugs, we used to have a great marriage, but good things don't last. You can't sustain the same levels of passion and interest throughout the relationship. Isn't his family worth the effort as a therapist?

Another shrug. He doesn't pay to be a good husband or a good father. Look what my loving wife did to me.

In any case, at my age, the future is behind me. Carpe diem is my motto.

The therapist tries to probe. Does Mike consider his wife's demands to be unreasonable? And Mike flairs. With all due respect, that's between me and my spouse.

Then why is he wasting his time in the therapist? I didn't ask to be here, protest Mike. Did he prepare a list of things he would like to see improved in his family life?

He forgot. Can he compile it for the next meeting? Only if nothing more urgent pops up.

It would be difficult to continue to work together if he doesn't keep his promises, says the therapist.

Mike understands, and he will see what he can do about it.

But he says it without great conviction.

The problem is, Mike says, that he regards psychotherapy as a form of conartistry.

Psychotherapists, he says, are snake oil salesmen. Later-day witch doctors.

Only far less efficient.

He hates to feel cheated or deceived. Does he often feel cheated or deceived as a therapist?

Mike laughs dismissively. He is too clever for run-of-the-mill crooks. He is often underestimated by them. He always has the upper hand.

Do other people besides crooks underestimate him?

He admits to being unappreciated and underpaid at work. It bothers him.

He believes that he deserves more than that.

Obsequious intellectual midgets rise to the top in every organization, Mike observes, with virulent envy and rage.

How does he cope with this discrepancy between the way he perceives himself and the way others evidently evaluate him?

Mike says he ignores the fools. How can one ignore one's co-workers and one's superiors?

Mike simply doesn't talk to them. He says, in other words, does he sulk?

Mike refuses to answer. His rage, barely suppressed, rises to the surface.

Finally, after some additional pressure, Mike admits that he does sulk but not always.

He sometimes tries to enlighten and educate people he deems worthy of his efforts. He often gets him into arguments.

And he has acquired the reputation as a cantankerous curmudgeon, but he doesn't care.

Is he impatient or is he an irritable, irascible person? What do you think, Mike counters?

During this session, did I ever lose my cool? Frequently, says the therapist, Mike half rises from his chair, then thinks better of it and settles down.

Do your things, he says solemnly and contemptuously. Let's get it over with.

This has been the simulated first therapy session with Mike, a passive-aggressive male, 52 years old.

If you enjoyed this article, you might like the following:

Narcissists and Negativistic (Passive-Aggressive) Personality Disorder

Negativistic, passive-aggressive personality disorder is characterized by chronic pessimism, resistance to authority, and a tendency to undermine others in social and workplace settings. Individuals with this disorder often exhibit behaviors such as procrastination, neglect, and sabotage, while feeling unappreciated and victimized by their circumstances. They display a range of negative emotions, including irritability and envy, and often react to perceived slights with sulking or the silent treatment. Despite their obstructive behavior, they may seek forgiveness and promise change when confronted, but these promises typically go unfulfilled.


Pathologizing Rebellious Youth: Oppositional Defiant Disorder (ODD)

The Diagnostic and Statistical Manual (DSM) labels rebellious teenagers with oppositional Defiant Disorder, which is a pattern of negativistic, defiant, disobedient, and hostile behavior towards authority figures. The DSM's criteria for this disorder are arbitrary and subject to the value judgments of adult psychiatrists, psychologists, social workers, and therapists. The diagnosis of oppositional Defiant Disorder seems to put the whole mental health profession to shame, and it is a latent tool of social control. If you are above the age of 18 and you are stubborn, resistant to directions, unwilling to compromise, give in or negotiate with adults and peers, you stand a good chance of being diagnosed as a psychopath.


Body Language of the Personality Disordered

Patients with personality disorders have a body language specific to their personality disorder. The body language comprises an unequivocal series of subtle and not-so-subtle presenting signs. A patient's body language usually reflects the underlying mental health problem or pathology. In itself, body language cannot and should not be used as a diagnostic tool.


Shyness or Narcissism? Avoidant Personality Disorder

Avoidant personality disorder is characterized by feelings of inadequacy, inferiority, and a lack of self-confidence. People with this disorder are shy and socially inhibited, and even constructive criticism is perceived as rejection. They avoid situations that require interpersonal contact and find it difficult to establish intimate relationships. The disorder affects 0.5 to 1% of the general population and is often co-diagnosed with mood and anxiety disorders, dependent and borderline personality disorders, and cluster A personality disorders.


Normal Personality and Personality Disorders

Personality is a complex pattern of deeply embedded psychological characteristics that are expressed automatically in almost every area of psychological function. Personality traits are enduring patterns of perceiving, relating to and thinking about the environment in oneself that are exhibited in a wide variety of social and personal contexts. Our temperament is the biological genetic template that interacts with our environment. Our character is largely the outcome of the process of socialization, the acts and imprints and edicts of our environment and nurture, and how they work on our psyche during the formative years, 0 to 6 and in other lists. Personality disorders are dysfunctions of our entire identity, tears in the fabric of who we are.


Over-sexed: Histrionic Personality Disorder and Narcissism

Histrionic personality disorder is more commonly diagnosed in women, leading to questions about whether it is a real mental health problem or a reflection of a patriarchal society. Histrionics crave attention and are uncomfortable when not at the center of it, similar to narcissists. They are preoccupied with physical appearance and sexual conquests, and often act flirtatious and seductive. Histrionics are enthusiastic and emotional, but their behavior can be exhausting and off-putting to others.


Personality Disorders Gender Bias

The Diagnostic and Statistical Manual (DSM) confesses to gender bias, with personality disorders such as borderline and histrionic being more common among women, while narcissistic, antisocial, schizotypal, passive compulsive, schizoid and paranoid disorders are more prevalent among men. The reason for this gender disparity may be due to culture-bound syndromes, with personality disorders reflecting biases and value judgments of the prevailing culture. Upbringing, environment, socialization, cultural mores, and genetics may also play a role in the pathogenesis of personality disorders. Ultimately, the ambiguity and equivocation of the diagnostic criteria may be the problem, with gender bias being everywhere in the psychiatric profession.


Borderline's Miracle Healing

Borderline personality disorder (BPD) is less prevalent than commonly believed, affecting about 1-2% of the general population, yet it accounts for a significant portion of mental health treatment cases due to crises. The prognosis for BPD is generally positive, with many individuals experiencing spontaneous remission or significant improvement through therapies like Dialectical Behavior Therapy (DBT), leading to a high percentage of patients no longer meeting diagnostic criteria over time. While symptoms related to impulsivity and behavior tend to remit more quickly, some underlying traits and dysfunctional behaviors may persist even after the disorder itself has resolved. Effective treatment should not only address the core symptoms of BPD but also focus on helping individuals develop functional skills for social and vocational success, particularly in younger populations.


Psychosexuality of the Personality Disordered

Sexual behavior can reveal a lot about a person's personality, including their psychosexual makeup, emotions, cognitions, socialization, traits, heredity, and learned and acquired behaviors. Patients with personality disorders often have thwarted and stunted sexuality. For example, paranoid personality disorder patients depersonalize their sexual partners, while schizoid personality disorder patients are asexual. Histrionic personality disorder patients use their sexuality to gain attention and narcissistic supply, while somatic narcissists and psychopaths use their partners' bodies to masturbate with. Borderline personality disorder patients use their sexuality to reward or punish their partners, while dependent personality disorder patients use it to enslave and condition their partners.


Morally Insane Psychopath: A Brief History of Psychopaths and Antisocials

The concept of personality disorders began less than a hundred years ago, with the French psychiatrist Pinel coining the phrase "mal de son" to describe patients who lacked impulse control and were prone to outbursts of violence. The term "moral insanity" was widely used for almost a century, but physicians sought to replace it with something more objective and scientific. The diagnosis of psychopathy has been expanded to include people who harm and inconvenience themselves, as well as others. Today, most practitioners rely on either the Diagnostic and Statistical Manual or the International Classification of Diseases to diagnose personality disorders.

Transcripts Copyright © Sam Vaknin 2010-2024, under license to William DeGraaf
Website Copyright © William DeGraaf 2022-2024
Get it on Google Play
Privacy policy