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.

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The negativistic, passive-aggressive personality disorder is not yet recognized by the committee that is cobbling together the diagnostic and statistical manual. People diagnosed with a negativistic passive-aggressive personality disorder resemble narcissists in some important respects. Despite the obstructive role they play, passive-aggressives feel unappreciated, underpaid, cheated, discriminated against, and misunderstood. Passive-aggressives may be sullen, irritable, impatient, argumentative, cynical, skeptical, and contrarian.

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.

Hermit: Schizoid Personality Disorder

Schizoids are individuals with a personality disorder who are indifferent to social relationships and have a limited range of emotions and affect. They are incapable of intimacy and rarely express feelings. Schizoids are loners who prefer solitary activities and are inflexible in their reactions to changing life circumstances. They are creatures of habit and frequently succumb to rigid routines and schedules.

DANGER: Paranoid Ex

To minimize the danger of a paranoid ex, it is important to put physical distance between yourself and them, change contact details, and not inform them of your whereabouts. It is also important to be prepared for violence and to alert law enforcement officers, check out domestic violence shelters, and consider owning a self-defense weapon. Paying attention to unusual patterns and events can help identify if a paranoid ex is monitoring you. It is important to teach children to avoid the ex and report any contact. Appeasing the ex is futile, and it is important to use the law to obtain restraining orders and ensure they spend time in jail.

Asperger's Disorder Misdiagnosed as Narcissistic Personality Disorder (NPD)

Asperger's Disorder can be diagnosed in toddlers as young as three years old, while Narcissistic Personality Disorder cannot be safely diagnosed until late adolescence. However, Asperger's Disorder is often misdiagnosed as Narcissistic Personality Disorder. Both types of patients are self-centered and engrossed in a narrow range of interests and activities, with severely hampered social and occupational interactions. The gulf between Asperger's and pathological narcissism is vast, with the narcissist switching between social agility and social impairment voluntarily, while the Asperger's patient's social awkwardness is an inevitability.

DANGER! Crazymaking Drama in YOUR Relationship

Drama, crazy making, and chaos are defining features of mental health disturbances, particularly in cluster B personality disorders. The reasons behind such behavior vary depending on the disorder, but they often involve a need for attention, a sense of vulnerability, or a misapprehension of limitations. The drama and crazy making are intended to support the self-perception of the individual, whether it be grandiosity, invincibility, or a need for attention. Those in relationships with individuals with these disorders should be aware of the potential risks and dangers.

Mistaken for Shyness

Emotions are composites and can be broken down into more basic emotions, cognitions, or states of mind. Shyness is often mistaken for other processes, such as paranoid ideation, depression, body dysmorphia, strong inhibitions, passive aggression, fear of intimacy, and hypermazochistic psychosexuality. Psychopaths and covert narcissists can also appear shy due to early childhood experiences of rejection and ridicule. These composites emotions are easily mislabeled and misinterpreted by observers.

Narcissist Father: Save Your Child

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Passive Aggressive Or Covert Narcissist?

Covert narcissists and passive-aggressive individuals share some traits, but there are key differences between them. Covert narcissism involves hidden grandiosity, while passive aggression is about internalizing negative emotions and expressing them indirectly. Both can be emotionally invested in failure and have a negative impact on others. However, passive-aggressive individuals focus more on frustrating and undermining others, while covert narcissists are more invested in their own grandiosity.

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