Most of us would say we know someone who behaves in a passive-aggressive manner. We may even wonder if we’re looking at that someone in the mirror. But do we really know what it is? I mean, maybe it’s a good idea to bone-up on some facts. Passive-aggression: what you need to know…
It’s so easy to refer to someone as, say, a narcissist or “borderline.” Identifying someone as their disorder is unfair and hurtful in and of itself. But if we’re short on facts, things can turn even uglier. And so it is with passive-aggression. As always, education is huge.
Let’s roll up our sleeves and get after it…
What is passive-aggression?
Passive-aggression (PA, also for passive-aggressive) is a way of expressing hostile feelings – anger, annoyance, disgust, etc. Now, expressing negative feelings is a good thing when it’s handled with consideration – and directly. However, with PA the expression is indirect, often in an effort to hurt and confuse the target. As you can imagine, the behaviors associated with PA can destroy relationships.
Because of its variety and subtlety, PA behavior is extremely difficult to nail down. However, many emotional and mental health experts agree that these are the most common behaviors: refusing to talk about concerns openly and directly, avoiding responsibility, and being deliberately inefficient.
To paint a picture, the PA individual often leaves a job undone or all but complete. They frequently run late and are pros at subtly sabotaging others when they disagree with a plan. Finally, the PA individual often resorts to the silent treatment or a backhanded compliment to get their point across.
How ’bout we go with this list of common PA behaviors…
Avoiding responsibility for tasks
Procrastinating – even to the point of missing deadlines
Withholding vital information
Frequent underachieving relative to one’s ability
Giving the silent treatment
Diminished eye contact
Ignoring targeted individuals during group activity
Persistent forgetting
Stonewalling
Let’s go to the next level with PA. Though you won’t find it as a diagnosis in the DSM-5, many professionals believe in the validity of passive-aggressive personality disorder (PAPD). Being a personality disorder, we’re dealing with a chronic and inflexible PA. The American Psychological Association (APA) describes it as “a personality disorder of long standing in which ambivalence toward the self and others is expressed by passive expressions of underlying negativism.”
What is negativism? According to the APA: “an attitude characterized by persistent resistance to the suggestions of others…or the tendency to act in ways that are contrary to the expectations, requests, or commands of others…typically without any identifiable reason for opposition.”
What causes passive-aggression?
Most often, troubling PA stems from deep anger, hostility, and frustration. The bottom-line cause of the feelings and behavior varies on a per case basis. However, it’s really all about the PA individual being terribly uncomfortable with expressing themselves directly.
It’s important to note that many PA individuals have no idea they’re behaving in an objectionable manner. They’ve pushed their anger, sadness, etc. down so deeply that they’ve truly lost awareness.
How is passive-aggression treated?
“There must be a way to express my feelings directly – the right way.”
The first step in treating PA is gaining insight into the fact that a problem exists. That means someone has to break the news to the individual. Of course, the individual may know they’re behaving inappropriately and really want to do something about it.
If the insight is there, as well as the desire to change, therapy is a great intervention. What better way to identify PA behavior and come to know more acceptable methods of expressing feelings?
Even better, a therapist can help with working through the anger, resentment, or low self-esteem that may be generating the PA behavior. And then it’s about learning to solve problems in a healthy way.
Something known as assertiveness training can be very helpful in managing PA behavior. One learns how to express thoughts and feelings effectively. And it can assist with negative behaviors caused by underlying misery such as anger and frustration.
Whether or not one participates in therapy, here are some things that can be done on a daily basis to rid oneself of PA behavior…
Be aware of the behavior
Identify possible reasons for the behavior
Think clearly before acting
Take a break before reacting to situations that are upsetting
Stay optimistic
Be honest with others and strive to express feelings in a healthy manner
No doubt, with insight and hard work, PA behavior can be changed.
How to interact with a passive-aggressive person?
When it comes to interacting with a PA individual, job-one is understanding the nature of the behavior. As we know, it stems from underlying anger, sadness, insecurity, etc. And the individual may not be consciously aware of the problem.
That said, reacting to the PA individual with your own PA behavior, or direct expressions of anger and frustration, won’t cut it.. So as difficult as it may be, somehow showing that you value the PA individual’s perspective may help, especially if you’re trying to address an underlying sense of insecurity.
You may choose to limit the time you spend with the PA individual. But if you decide to engage, be sure to set clear boundaries. And if you elect to confront PA behavior, do your best to avoid being accusatory, as you calmly express how the behavior makes you feel.
But don’t apologize for supposed offenses or in any way placate the PA individual. And don’t forget, they may want you to respond to their PA behavior with your own. Don’t play the game.
PA individuals are to be held accountable.
That’ll do it
Passive-aggression: we think we know what it means. And we may be right. Still, it’s always best to get the facts straight. Only then can we effectively manage relationships with the PA individuals in our life – and lend a hand, if we choose.
And hey, that PA individual may be looking at us in the mirror.
Borderline personality disorder is grossly misunderstood. And the stigmatic consequences wreak havoc on the lives of the diagnosed and those who won’t risk being labeled. It’s wrong, so let’s get it right.
BPD has traditionally been viewed as difficult to treat. However, with newer, evidence-based treatments, hopeful prognoses are common.
We have tons to cover, so I’ll make a brief opening statement.
I have personal reasons for setting the record straight on borderline personality disorder.
‘Nuff said. Let’s get busy…
What is borderline personality disorder?
Borderline personality disorder (BPD) is an emotional/mental illness characterized by an ongoing pattern of shifting mood, fluctuating self-image, and dicey behavior.
Those with BPD may experience intense episodes of anger, depression, and anxiety that can last from a few hours to many days.
Other common BPD characteristics include quickly changing interests and values, impulsivity, uncertainty about one’s role in the world, viewing things in extremes, seesawing opinions of others, and intense and unstable relationships.
To help us better understand BPD, here are edited portions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria.
According to the manual, meeting five or more qualifies for a diagnosis…
Frantic efforts to avoid real or imagined abandonment
A pattern of unstable and intense interpersonal relationships
Identity disturbance
Self-damaging impulsivity
Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior
Affective instability
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger
Transient stress-related paranoid ideation or severe dissociative symptoms
An individual is most often “officially” diagnosed with BPD at or above the age of 18. Now, there’s no rule saying it can’t be diagnosed before; however, practitioners typically avoid it.
The issue is, many of the presenting “BPD” symptoms come with the adolescent mind. And in the majority of cases, they don’t stick around. But if a pattern of symptoms lasts for at least a year, a diagnosis is justified.
Finally, as many as 6% of adults are believed to have been affected by BPD at some time in their lives.
It was believed that women were three times more likely to be diagnosed with BPD than men. More recent studies indicate that number is decreasing.
Comorbidity
BPD co-occurs with other emotional/mental disorders in 85% of cases. And that means a BPD diagnosis is frequently missed, bipolar disorder often being the wrongly chosen diagnosis.
Here are the numbers on BPD comorbidity (co-occurrence)…
Persistent depressive disorder (dysthymia): 70%
Major depressive disorder: 60%
Self-injury: 55%-85%
Substance abuse: 35%
Eating disorders: 25%
Narcissistic personality disorder: 25%
Antisocial personality disorder: 25%
Bipolar disorder: 15%
What causes borderline personality disorder?
“I can’t handle the abuse anymore. I’m outta’ here.”
Not near enough is known about the cause and risk factors of BPD. Sadly, research is in its infancy.
As long as we’re talking about cause, let’s quickly review something known as the diathesis-stress model (DSM).
The DSM suggests that predispositional vulnerabilities (diatheses) combine with stress from life experiences to generate, in our case, mood and anxiety symptoms and disorders.
So it’s this grand convergence of what was already in place and what was acquired.
The cause of BPD is no exception…
Environmental
Environmentally, childhood events play a significant role in the development of BPD. Included are emotional, physical, and sexual abuse, loss, neglect, abandonment, adversity, bullying, and being exposed to unstable and invalidating relationships, as well as hostile conflicts.
Genetics
Genetics (predispositional) appears to be involved, as having a close family member, such as a parent or sibling, with a BPD diagnosis points to higher risk.
Biology
Studies have shown that people with BPD may have structural and functional changes in the brain, especially in areas that control impulses and emotional regulation (predispositional). But, of course, are they contributors or caused by the wear and tear of BPD?
How is borderline personality disorder treated?
BPD has traditionally been viewed as difficult to treat. However, with newer, evidence-based treatments, hopeful prognoses are common.
One of the keys to a successful outcome is receiving specialized treatment from a qualified therapist. Getting along with, and trusting, that therapist is crucial. If there isn’t the right feel, the individual won’t be motivated to fully engage in treatment.
Therapy
Yes, psychotherapy is the first-line treatment for BPD. The most frequently used is a form of cognitive behavioral therapy (CBT) known as dialectical behavior therapy (DBT), which was developed specifically for BPD.
DBT incorporates concepts of mindfulness and acceptance – being aware of and attentive to the current situation and one’s emotional state.
It also teaches skills that can aid in controlling intense emotions, reducing self-destructive behaviors, and improving relationships.
Also used in the treatment of BPD is cognitive behavioral therapy. CBT can assist with identifying and changing core beliefs and behaviors that underlie inaccurate perceptions of self and others, which helps with social interactions.
CBT may also help reduce a number of mood and anxiety symptoms, and reduce the quantity of suicidal or self-harming behaviors.
As long as we’re talking about therapy, significant others may benefit from it. In fact, some BPD therapies include them.
Meds
Medications aren’t used specifically for BPD; however, they may be prescribed to address mood swings, depression, anxiety, and other comorbid conditions.
BPD treatment is most often conducted on an outpatient basis. However, inpatient treatment may be indicated.
Self-harm and suicide
Given BPDs higher incidence of self-harming and suicidal behaviors, it’s important for those diagnosed to seek immediate help if either make the scene. Those close to them need to be prepared to intervene.
Again, misunderstanding borderline personality disorder has stigmatic consequences. And that’s incredibly harmful to diagnosed individuals and those who won’t risk a diagnosis.
I couldn’t possibly include all there is to know about BPD, so do all you can to learn…
It’s never your turn, you’ve given ‘til you’re empty, you’re an ornament, but never radiant enough. The symptoms of narcissistic personality disorder destroy souls. What you need to know…
‘A persistent manner of grandiosity, a continuous desire for admiration, along with a lack of empathy…’
It all began in Greek mythology with a handsome hunter named Narcissus.
According to one version of the story, he turned away the romantic advances of the nymph, Echo. So the gods punished him by making him fall in love with his reflection in a pool of water.
When he discovered that the object of his love couldn’t return the favor, he pined away and died.
The “God-complex”
The term narcissism was coined in 1899 by German psychiatrist Paul Näcke. Several years later Welsh psychoanalyst Ernest Jones called it the “God-complex.”
Narcissism, narcissistic, narcissist – if we’re going to toss words around, especially of that intensity and impact, we need to make sure we know what we’re talking about.
Tons of info here, so you may want to favorite the piece for ongoing reference.
Let’s dig in…
What is narcissism?
As we get started, it’s important to know that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) doesn’t recognize narcissism as a disorder. So we’ll use narcissistic traits to paint our picture.
How ’bout these…
Arrogance, conceit, argumentativeness, vanity, frustration, obsession with appearance, fretfulness, cycling between superiority and inferiority, selection of a partner with similar background and characteristics, striving to be better than their friends.
Keep in mind, these are traits, not disorder criteria. And as much as any of the above may make someone unpleasant to be around, there are tons of folks who possess several of them. Not all are pathological.
But, then…
What is narcissistic personality disorder?
“I’m empty and I can’t take this anymore. He’s destroying my soul.”
So what is narcissistic personality disorder? Well, NPD comes down to grandiosity, seeking excessive admiration, and a lack of empathy.
The keyword with NPD, as with any personality disorder, is persistent.
Those with NPD act with an air of entitlement and control, are dismissive of others, and exhibit a condescending attitude.
Keep in mind, those are the externals.
On the inside
Internally, those with NPD wrestle with intense feelings of inadequacy and low self-esteem. No wonder someone with NPD is often incapable of dealing with disapproval or any measure of pushback.
Enter the DSM-5, which recognizes NPD. Its definition, with diagnostic criteria, goes like this…
A persistent manner of grandiosity, a continuous desire for admiration, along with a lack of empathy. It starts by early adulthood and occurs in a range of situations, as signified by the existence of any five of the next nine standards…
A grandiose logic of self-importance
A fixation with fantasies of infinite success, control, brilliance, beauty, or idyllic love
A credence that he or she is extraordinary and exceptional and can only be understood by, or should connect with, other extraordinary or important people or institutions
A desire for unwarranted admiration
A sense of entitlement
Interpersonally oppressive behavior
No form of empathy
Resentment of others or a conviction that others are resentful of him or her
A display of egotistical and conceited behaviors or attitudes
Anybody you know? Maybe you?
Interesting tidbits
Here are some tidbits worth knowing…
Some 18% of males present with NPD, compared to 6% of women. Within the general population, the prevalence rate of NPD is less than 1%, but rises to 2-16% within the clinical population.
A good number of those with narcissistic traits hit the psychiatrist’s office. Thing is, they’re often pursuing treatment for other issues such as mood and anxiety disorders.
Major depressive disorder is seen in 45-50% of those with NPD and bipolar disorder in 5-11%. But the biggie is substance use. 24-64% have substance use disorders.
It makes sense that NPD shares characteristics with the other cluster B (dramatic, overly emotional or unpredictable thinking or behavior and interactions with others) personality disorders. So there has to be a thorough diagnostic process. The other “B’s” are antisocial personality disorder, borderline personality disorder, and histrionic personality disorder.
Interesting, don’t you think?
Malignant narcissism
Before we move on, we need to take a quick look at malignant narcissism. The combination of NPD and antisocial personality disorder makes it the most severe type of narcissism.
So much involved and so little space. I’ll turn you over to verywell health.
Treatment for narcissistic personality disorder
When it comes to treatment for NPD, it’s all about therapy.
Individual psychoanalytic therapy is often at the core; however, other therapies may be utilized – cognitive behavioral therapy (CBT), family and couples therapies, and group work.
Of note is the CBT schema-focused therapy, which emphasizes addressing narcissistic schemas, as well as dicey moods and coping mechanisms.
Combination strategy
In general, when it comes to therapy for NPD a combination strategy is often recommended.
That means direct confrontation with the goal of eliminating or weakening grandiosity and encouraging a measure of grandiosity in an effort to strengthen a naturally deficient self-image. It’s a matter of balance on a per case basis.
Meds
Meds aren’t used to directly address NPD. However, they may be used to treat accompanying issues such as depression, bipolarity, and anxiety.
Final notes
It’s important for someone with NPD to receive close long-term monitoring because of the potential for suicide. This is especially important if depression and/or mania are involved.
I might add that it would be a good idea for those intimately involved with someone with NPD to have a safety plan handy based on personal experience.
Finally, though there is help available for NPD, it isn’t pursued nearly as much as is indicated. And that’s because many with NPD have no idea a problem exists – with them. So why seek treatment?
Beyond tossing words around
Narcissistic personality disorder can be hell on earth for those involved with someone who has it. Believe it or not, in many cases, it can be hell for that someone as well.
That’s why we needed to go beyond tossing words around and really get down to the facts.
I think we pulled it off.
Tip of the hat to Dr. Helen Okoye, MD, MBA, MS-Epi for the resource material, which appeared on theravive.
Not appearing in a diagnostic manual doesn’t make a disorder any less real. Consider what’s being called borderpolar, a combination of borderline personality disorder and bipolar disorder…
Borderpolar patients reported more episodes of depression, more anger, suicidal ideation, history of suicide attempts, childhood trauma…
Bumped into an interesting article on Psychiatric Times. “Borderpolar: Patients with Borderline Personality Disorder and Bipolar Disorder” was written by Brown University Professor of Psychiatry and Human Behavior, Mark Zimmerman, MD.
It’s important that you have this information because you, or someone close to you, may be dealing with borderpolar – and not have a clue.
That would sure make relief tough to come by, so we need to take a look.
“Borderpolar: Patients with Borderline Personality Disorder and Bipolar Disorder”
Dr. Zimmerman kicks things off by emphasizing the seriousness of bipolar disorder (BD) and borderline personality disorder (BPD), both associated with high rates of impaired functioning, substance use disorders, and suicidality.
He goes on to say BD and BPD are frequently under-diagnosed, which calls for improved recognition. And that’s what we’re doing here.
Harmful disagreement
It’s not as though the strong relationship between BD and BPD hasn’t been known, as some experts have suggested BPD can be found somewhere along the bipolar spectrum.
However, pros from the other side of the fence believe there isn’t such a spectrum (I disagree), and BD and BPD are distinct entities.
That disagreement can make life difficult for the patient because the first-line intervention for BD is meds. For BPD it’s therapy.
Borderpolar: Comorbidity
Dr. Zimmerman explains that the most frequently researched aspect of the relationship between BD and BPD is their comorbidity (co-occurrence).
Several studies report a diagnostic frequency overlap right at 20%. And though the number isn’t over-the-top, it’s still significant.
Why either-or?
Dr. Mark Zimmerman
The diagnostic either-or perspective continues. Zimmerman believes framing the discussion as such underplays the fact that one-fifth of patients have both BD and BPD.
Indeed, having to make a choice can discourage clinicians from noting both diagnoses when indicated, which ignores an important comorbidity in patients with the greatest need.
Zimmerman cites a specific literature review addressing the clinical impact of one disorder on the other. The study reveals that there have been far more studies comparing patients who have BD with and without BPD than the other way around.
Also, among patients with BD, those with comorbid BPD reported more mood episodes, earlier age of BD onset, greater suicidality, greater hostility, and a higher prevalence of substance use disorders.
Sadly, the reviews found little research pertaining to treatment response, psychosocial functioning, length of unemployment, disability payments, or prognosis.
Dr. Zimmerman’s research
Believing that patients with borderpolar are at elevated risk for marked impairment and suicide, Dr. Zimmerman and colleagues did their own research utilizing the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project.
The team compared psychiatric outpatients with borderpolar to patients with BPD without BD and patients with BD without BPD.
The team hypothesized that the borderpolar patients would exhibit significantly more psychosocial risks and negative life realities than patients with only one of the disorders.
Research results
The results were telling. Here are a few….
Significantly more borderpolar patients had three or more diagnoses than BD patients.
Borderpolar patients reported significantly more diagnoses of PTSD, OCD, substance use disorders, and somatic disorders compared to BD patients. Borderpolar patients reported significantly more OCD diagnoses than the BPD patients.
Borderpolar patients had the most psychopathology in their first-degree relatives.
Borderpolar patients had a significantly higher risk of being diagnosed with depression, BD, PTSD, specific phobia, and substance use disorders compared to BD patients. Similar results were found compared to the BPD patients.
Borderpolar patients reported more episodes of depression, more anger, suicidal ideation, history of suicide attempts, childhood trauma, chronic and persistent unemployment, impaired social functioning, and psychiatric hospitalizations. They were more likely to receive disability payments and exhibited significantly more psychosocial risks and negative life realities than the patients with BPD.
And now you know
Bottom-line: Dr. Zimmerman believes the importance of diagnosing comormid bipolar disorder and borderline personality disorder – borderpolar – has gotten lost in the dialogue.
Given what we’ve reviewed, that’s unfortunate.
Okay, if you didn’t know what borderpolar was, you do now. Best part is, if you believe you, or someone close to you, may have it, help can be pursued in an educated manner.
Acceptance: it doesn’t come without a ton of personal examination and insight. And I don’t see how anyone can live peacefully with their emotional or mental circumstances without it. Our guest post writer, J.D., brings the point home with his story of insight, acceptance – and solitude…
I preferred a sort of emotional solitude and, once I accepted this fact, I was then completely free to be my true self.
Man, those guest post requests. I get ’em all the time, and 99% of them get turned away. But, every so often…
Jaron (J.D.) Vail dropped me a line asking if he could contribute to Chipur. J.D. is a Master of Fine Arts in Writing and refers to himself as a creative journalist. All well and good, but you’re about to read what he has to say because J.D. endures an emotional/mental disorder and is willing to share. I’ll set you up with his website at the end.
‘Nuff said. Let’s get into J.D.’s work…
For Me, Life With SPD Is a Choice
When we are young – at least for me, grown-ups and society instill in us the value of relationships and community. Making friends. Turning acquaintances into future friends. Love. But, why? Why this need for constant feedback and approval from others?
I knew there was something going on mentally after losing my mother in 2016. My father died 12 years before her. My oldest brother a year before that. And, my uncle – a second father really – four years before my mother passed in 2012.
These four people were my rock. My inspiration. The ones I went to with any problem and the first people I contacted for all my successes. They took care of me. Nurtured me. And, most of all, listened to me. Now, my circle is gone. Where do I go from here?
J.D. Vail
By the time my mother died, I had gotten married and a year later I had a daughter. That same year in 2017, I got so drunk one night that I contemplated suicide. I had everything planned. A large ceiling fan hangs in our living room. My plan was to hang myself with a belt but I passed out.
When I woke several hours later, I was scared out of my mind. How could I contemplate something so horrible? What would have happened to my daughter? My wife? I knew then, I needed help.
Behavioral talk therapy is where I discovered I had been suffering from depression and the isolation I was feeling was due to the trauma I experienced losing the people closest to me and the anxiety of not being able to trust anyone outside of my “circle”, that was now all dead.
I was diagnosed with schizoid personality disorder (SPD). But, as I continued to see my therapist, I discovered that my current suburban existence, the friends and the seeking of gratitude from others that encompassed this stage in my life was a mask. In fact, without the masks, I was totally immune from praise or criticism of others.
I preferred a sort of emotional solitude and, once I accepted this fact, I was then completely free to be my true self. This meant that I had to reorganize my life and my relationships. What I have discovered so far about myself, my true self, is that the only relationships that matter are with the two people I am responsible for: my daughter and my wife.
I am responsible for my daughter’s emotional, physical and financial wellbeing, and my wife and I are partners in this journey. For that, I am grateful. Outside of these two relationships, everyone else are just outsiders looking in. Therefore, I ask nothing of the other individuals in this world and/or in my family and I hope they request nothing of me.
Because of my new found freedom, I am exceling at my career. I take risks that I wasn’t able to take before and I take ownership for every action I make and how I respond to issues put before me. I am my own master. The future is in my hands alone.
However, this has put a strain on my marriage and other relationships. I am so dedicated to my mental and emotional solitude that I have become emotionless to the rest of the world – even to the sufferings of those close to me. But, I would rather have total independence of thought and action than a variety of intimate relationships.
Where the future goes from here? I’m still figuring that out. What is a life without connection and emotions, other than what you can self-regulate? I don’t know. But, I do know this: this is the first time I can look myself in the mirror and be happy with who I am.
No, SPD is not a disease that needs to be cured. It is part of me. The sum of who I am. Therefore, I will learn to live with it and expect those close to me to live with it too.
The real. Me.
Thanks, J.D.
Insight and acceptance, which happened to manifest in chosen solitude for J.D. And the best part is, when he looks in the mirror he feels happy with who he is. Doesn’t get much better than that, right?
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