A CASE OF NEGATIVISTIC (PASSIVE-AGGRESSIVE) PERSONALITY
By: THEODORE MILLON
et al.
Notes:
(1) Numbers mark aspects of the case most consistent with DSM
criteria as follow, and
do not necessarily indicate that the
case “meets” diagnostic criteria in this respect.
(2) Patient's name has been changed in respect to
confidentiality, and names mentioned are not of a real existent person.
Case of Kim
At
the beginning of the clinical interview, it was obvious that Kim, age 23, was
dissatisfied with her life. When asked what she would most
like to change, Kim exclaimed, “You’re the doctor, how would I know what’s
going on!” As the interview wore on, a basic pattern became clear. Kim would
over-elaborate anything irrelevant to the treatment process, and under-elaborate
anything relevant. (1)
Her
claim of ignorance about her problems eventually proved to be a setup. As soon
as the doctor would offer an interpretation of her problem, Kim would argue
that that could not possibly be the case, or produce contradictory biographical
information that had been previously withheld, all while blaming the doctor. “I
guess you don’t understand me any better than anyone else,” she sighed. (2) Sometimes her expression was more
obviously sullen; sometimes her oppositionalism was concealed with a smile. (3)
Because
Kim obviously felt ambivalent about therapy, it was important to determine if
she had been somehow “coerced” into coming. At this point, her manner abruptly
changed. She acknowledged that she was not too happy at present and supposed
she wanted therapy, to “make amends for being a such a bitch.” (7) As
Kim gained some control over her emotions and allowed her resistance to subside
somewhat, she stated that the first order of business would be fixing her
relationship with her husband. She claimed that she needed more emotional
space. “I must drive him crazy, but that’s me,” she said. “He’s so damn
controlling. He’s such an idiot and he doesn’t even know it and I resent it.
(4) He doesn’t appreciate me, and he doesn’t understand me, he just wants
me to fake nice,” she continued, obviously hostile. (2) “I’m like
everyone else would be if they didn’t feel tied to social protocol and bogus
civility. (1) And he seemed so perfect and lovable at first!”
When
asked directly about her family relationships, Kim noted that these had always
been a problem, except when she was very young. As a little girl, she was
regarded as adorable and cute. At family gatherings, her mother and father showed
her off, referring to her as “our pride and joy.” But at age 10, life changed.
Her mother became pregnant, and announced that because Kim was becoming a woman,
she would have to pull her weight in the household, sharing the washing,
ironing, cooking, and dishwashing. If she neglected her chores, harsh punishment
followed. “I supposed they did what they thought was right for me,” Kim
reflected, “but what they felt was right turned me into a slave, while they
treated my sister like a goddess. She got away with everything. I got them
back, though. I knew just where to make a mistake.” (5)
Apparently,
Kim has no insight into the connection between her early development and
current problems in her marriage. In fact, she quickly becomes resistant and defensive whenever anything is asked of her,
even where it furthers her own larger plan. Toward the end, the session
degenerated into a “gripe session,” with Kim refusing to “own” any of her
difficulties. Others were overly controlling, she was only reacting to the injustices
forced upon her. At the end of the interview, she asks in a covertly accusing
tone, “I’m supposed to feel better, right?
(3)
DSM-IV Criteria
A. A pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:(1) passively resists fulfilling routine social and occupational tasks
(2) complains of being misunderstood and unappreciated by others
(3) is sullen and argumentative
(4) unreasonably criticizes and scorns authority
(5) expresses envy and resentment toward those apparently more fortunate
(6) voices exaggerated and persistent complaints of personal misfortune
(7) alternates between hostile defiance and contrition
B. Does not occur exclusively during Major Depressive Episodes and is not better accounted for by Dysthymic Disorder.
References
(1) Personality Disorders in Modern Life, second edition,
2000, 2004 by John Wiley & Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright
1994 American Psychiatric Association.
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