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The Passive-Aggressive (Negativistic) Personality Disorder (PAPD)


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Posted 21 January 2006 - 05:56 PM

The Passive-Aggressive (Negativistic) Personality Disorder (PAPD)

Essential Feature

The passive-aggressive (negativistic) personality disorder is located in Appendix B: "Criteria Sets and Axes Provided for Further Study" of the DSM-IV. It is being considered for inclusion in future revisions but was removed from the Axis II Personality Disorders (DSM-IIIR) because there is controversy regarding the category. Kantor (1992, p. 177) notes that the term passive-aggressive clearly describes a discrete behavior, but it is not certain that it describes a discrete diagnostic category. Millon (1996, p. 198) proposes a more comprehensive concept of a negativistic personality that is not so narrowly focused upon the one essential passive-aggressive trait of resistance to external demands. He believes that the negativistic personality reflects both this general contrariness and disinclination to do as others wish but also presents with a capricious impulsiveness, an irritable moodiness, and an unaccommodating, fault-finding pessimism.

The DSM-IV (1994, p. 733) describes the PAPD essential feature as a pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance in social and occupational settings. The pattern must not occur exclusively during periods of major depression nor can it be accounted for by dysthymia.

The ICD-10 lists the passive-aggressive (negativistic) personality disorder in Annex 1. To be diagnosed with this disorder, individuals must meet the general criteria of a personality disorder and at least five of the following: procrastination and delay in completing essential tasks -- particularly those that others seek to have completed; unjustified protests that others make unreasonable demands; sulkiness, irritability or argumentativeness when asked to do something that the individual does not want to do; unreasonable criticism or scorn for authority figures; deliberately slow or poor work on unwanted tasks; obstruction of the efforts of others even as these individuals fail to do their share of the work; and avoidance of obligations by claiming to have forgotten them (ICD-10, 1994, pp. 329-330).

The passive-aggressive personality disorder was first introduced in a U.S. War Department technical bulletin in 1945. The term was coined by wartime psychiatrists who found themselves dealing with reluctant and uncooperative soldiers who followed orders with chronic, veiled hostility and smoldering resentment. Their style was a mixture of passive resistance and grumbling compliance (Stone, 1993, p. 361).

In early literature, individuals similar to those covered by the designation of passive-aggressive personality disorder were referred to as:

* dissatisfied people who acted as if they were perpetually wounded (Aschaffenburg, 1922);
* fussy people with sour dispositions (Hellpach, 1920);
* depressives with ill tempers who were spiteful, malicious, and pessimistic (Schneider, 1923);
* people with irritable moods (Bleuler, 1924); and
* people who took everything hard and felt the unpleasantness in every situation (Kraepelin, 1913). (Millon & Radovanov, Livesley, ed., 1995, pp. 314-316).

The current criteria for the passive-aggressive personality disorder as proposed by the Personality Disorders Work Group for the DSM-IV includes:

* passive resistance to fulfilling social and occupational tasks through procrastination and inefficiency;
* complaints of being misunderstood, unappreciated, and victimized by others;
* sullenness, irritability, and argumentativeness in response to expectations;
* angry and pessimistic attitudes toward a variety of events;
* unreasonable criticism and scorn toward those in authority;
* envy and resentment toward those who are more fortunate;
* self-definition as luckless in life and an inclination to whine and grumble about being jinxed;
* alternating behavior between hostile assertion of personal autonomy and dependent contrition (Millon & Radovanov, Livesley, ed., 1995, p. 321).

Millon suggests that the most essential features of PAPD are irritable affect; behavioral contrariness, obstructiveness, and sulking; discontented self-image, e.g. feels unappreciated and misunderstood; deficient regulatory control, i.e. poorly modulated emotional expression; and interpersonal ambivalence. They are noted for their interpersonal conflict, verbal aggressiveness, and manipulative behavior. Suicidal gestures and a lack of attention to everyday responsibilities are common (Millon, 1996, p. 198).

PAPD resistance to external demands is manifested in oppositional and obstructive behaviors. These individuals resent having to conform to the standards set by others. On the other hand, they fear direct confrontation. The combination of resentment and fear leads to passive, provocative behavior (Beck & Freeman, 1990, p. 333) and defiant compliance (Benjamin, 1994, p. 276).

Stone (1993, p. 362) suggests several subtypes of PAPD:

1. those with anxiety or depression (about one third);
2. those who are self-defeating and locked into punishing relationships;
3. those who are vindictive; and
4. those who begrudgingly put their lives on hold to care for others, e.g. an ill parent.

Individuals with OCPD and PAPD share a deeply rooted ambivalence about themselves and others. While people with OCPD resolve their ambivalence by compliant behavior and holding tension within, those with PAPD have virtually no resolution. As a result, they are characterized by vacillating behavior. They are indecisive; they fluctuate in their attitudes, oppositional behaviors, and emotions. They are generally erratic and unpredictable (Millon, 1981, p. 244).

The passive-aggressive (negativistic) pattern is similar to that of the Oppositional Defiant Disorder. ODD should be considered for children. PAPD is limited to adults (DSM-IV, 1994, p. 734). Individuals with PAPD are also prone to anxiety disorders, depressive disorders with agitation, and chronic pain disorders. Correctional settings may have many individuals with PAPD who have committed explosive acts of violence (Richards, 1993, p. 260). Alcoholism and drug dependence are associated with both PAPD and PAPD families of origin (Oldham & Morris, 1990, pp. 215-216) (Beck & Freeman, 1990, p. 336).

Self-Image

Individuals with PAPD view themselves as self-sufficient but feel vulnerable to control and interference from others (Pretzer & Beck, Clarkin & Lenzenweger, eds., 1996, p. 60). They believe that they are misunderstood and unappreciated, a view that is exacerbated by the negative responses they receive from others for their consistent defeatist stance. They expect the worst in everything, even situations that are going well, and are inclined toward anger and irritability (Beck & Freeman, 1990, p. 339) (DSM-IV, 1994, p. 734).

Individuals with PAPD are often disgruntled and declare that they are not treated as they should be. On the other hand, they are just as likely to express feeling unworthy of good fortune. They have a basic conflict concerning their self-worth; they oscillate between self-loathing and entitlement or moral superiority. Either side of this oscillation can be projected onto the environment. The chaotic nature of this experience of self and others often leads to people beginning to avoid or minimize contact with people with PAPD out of self-protection (Richards, 1993, p. 259). View of Others

Individuals with PAPD see others as intrusive, demanding, interfering, controlling, and dominating. They believe that other people interfere with their freedom. They experience control by others as intolerable; they have to do things their own way (Pretzer & Beck, Clarkin & Lenzenweger, eds., 1996, p. 60). These individuals are determined that they will not be subject to the rules of others (Beck & Freeman, 1990, p. 227). They resent, oppose, and resist demands to meet expectations from others in a behavioral pattern seen in both work and social settings (DSM-IV, 1994, p. 733). Their main coping strategies are passive resistance, surface submissiveness, evasion, and circumventing of rules (Pretzer & Beck, Clarkin & Lenzenweger, eds., 1996, p. 60).

Relationships

Individuals with passive-aggressive (negativistic) personality disorder are ambivalent within their relationships and conflicted between their dependency needs and their desire for self-assertion. They waver between expressing hostile defiance toward people they see as causing their problems and attempting to mollify these people by asking forgiveness or promising to do better in the future (DSM-IV, 1994, p. 734).

These individuals are noted for the stormy nature of their interpersonal relationships. They engage in a combination of quarrelsomeness and submissiveness. Their affect is sullen and they engage in deliberate rudeness. They are resentfully quarrelsome and irritable. They often feel like a victim. Central to the disorder is a pervasive pattern of argumentativeness and oppositional behavior with defeatist and negative attitudes (Millon & Radovanov, Livesley, ed., 1995, p. 317). Richards (1993, p. 260) believes that PAPD may be the most miserable personality disorder. These individuals inflict a great deal of discomfort on others through the use of their anxiety and emotional symptoms. They can become so destructive in their attitudes and so unable to provide rewards to others that they become socially isolated.

Individuals with PAPD struggle between their desire to act out defiantly and their awareness that they must curtail their resentment. They engage in grumbling, moody complaints, and sour pessimism; these behaviors serve as both a vehicle for tension discharge (relieving them of mounting anger) and as a means of intimidating others and inducing guilt (providing them with a sense of retribution for the wrongs they believe they have experienced). These socially maladaptive behaviors result in inevitable interpersonal conflict and frustration. After a time, the sullen moodiness and complaining of individuals with passive-aggressive (negativistic) personality disorder alienates others (Millon, 1996, pp. 198-199). These individuals are able to sense the exasperation and growing animosity that others feel toward them; they use their awareness to become even more aggrieved -- without corresponding acceptance that their behavior has contributed to the situation.

For individuals with passive-aggressive (negativistic) personality disorder, being difficult, quixotic, unpredictable, and discontent produces certain rewards and avoids certain discomforts. These individuals can control others by forcing them into an uncomfortable anticipatory stance. People in relationships with PAPD individuals are perpetually waiting for the next struggle, the next grievance, the next round of volatility and carping criticism. Passive-aggressive individuals are able, within their relationships, to trap people into situations wherein whatever they do is wrong. Relating to individuals with PAPD becomes a tense, edgy experience where great caution must be employed to avoid precipitating an angry incident (Millon, 1981, p. 258).

Issues With Authority

For individuals with PAPD, authority figures can become the focus of their discontentment. They often criticize and voice hostility toward authority figures with minimal provocation. Their resistance toward authority is expressed by procrastination, forgetfulness, stubbornness, and intentional inefficiency. These individuals are also envious of and resentful toward peers who succeed or are viewed positively by authority figures (DSM-IV, 1994, pp. 733-734).

Authority figures are seen by individuals with passive-aggressive (negativistic) personality disorder as arbitrary and unfair. When they are faced with the consequences of not adequately meeting obligations, these individuals will become angry at those in authority rather than seeing how their own behavior has contributed to the situation (Beck & Freeman, 1990, p. 339). Authority figures are defined as intrusive, demanding, interfering, controlling, and dominating. On the other hand, individuals with PAPD also see authority figures as capable of being approving, accepting, and caring. A key issue for individuals with PAPD is the desire to get benefits from authority figures while exerting their freedom and autonomy (Beck & Freeman, 1990, p. 45).

The conflict is intense. Individuals with PAPD have a tendency to see any form of power as inconsiderate and neglectful. They are also likely to believe that authorities or caregivers are incompetent, unfair, and cruel. Nevertheless, these individuals are not inclined to rebel directly. They will agree to comply with demands or suggestions but will often fail to perform (or they will perform while experiencing increasing resentment). Then, when there is trouble, these individuals will complain of unfair treatment. They envy and resent others who manage authority situations and who are able to relate to authorities with less difficulty. These individuals believe that their suffering indicts the negligent caregiver or authority figure. They fear control in any form but long for nurturing restitution from those they perceive as having power (Benjamin, 1993, p. 272).

PAPD Behavior

Origin of PAPD behavior:

Stone (1993, p. 361) suggests that the contrary, sulking, and verbal nitpicking behaviors of PAPD appear to have their origin in unending power struggles with parents. The comparative helplessness of youth made it impossible to win in these struggles so the face-saving technique of passive resistance was employed. Parental overcontrol, neglect, or favoring of a sibling can all contribute to the development of the silent protest and grudging obedience associated with PAPD (Stone, 1993, p. 361).

Behavioral Features of PAPD Include:

* sullen contrariness with little provocation;
* restlessness, unstable and erratic feelings;
* inclination to be easily offended by trivial issues;
* low frustration tolerance and chronic impatience and irritability unless things go their way;
* vacillation from being distraught and despondent to being petty, spiteful, stubborn, and contentious;
* short-lived enthusiasm and cheer with ready reversion to being disgruntled, critical, and envious;
* begrudging the good fortune of others;
* quarrelsome reactions to indifference or minor slights from others;
* emotions close to the surface; they may burst into tears at a small upset;
* discharging anger or abuse at others with minimal provocation;
* impulsivity and explosive unpredictability -- making others uncomfortable;
* ability to be pleasantly social with expression of warm affection but then easily provoked into hurt obstinacy and cruel, nasty interaction (Millon, 1981, p. 254).

PAPD Ambivalence:

PAPD ambivalence is expressed behaviorally by vacillation between negativism/autonomy and dependency/conformity. However, even when conforming, these individuals tend to be contrary, unaccommodating, sulking, pessimistic, and complaining (Kubacki & Smith, Retzlaff, ed., 1995, p. 175). People with PAPD will behave obediently one time and defiantly the next. They will be self-deprecating and express guilt for failing to meet expectations in one situation and express stubborn negativism and resistance in another. They fluctuate between deference and defiance, between obedience and aggressive negativism. Their behavior will go from explosive anger or stubbornness to periods of guilt and shame (Millon & Davis, Clarkin & Lenzenweger, eds., 1996, p. 309).

PAPD Anger:

PAPD anger may be expressed directly or indirectly. Whether these individuals communicate their anger by omission or commission, they justify their rage with a lofty motive -- making a perfect cover for malicious intent (Kantor, 1992, p. 178).

Indirect expression of anger can take the form of chronic, seething hostility or sadistic carping criticism (Kantor, 1992, p. 179). Irritating, oppositional, and resentful behavior can be demonstrative of a pervasive pattern of passive resistance (Sperry & Carlson, 1993, p. 335). If there is a PAPD pattern of chronic hostility and resistance, no situational provocation may be needed for these individuals to engage in preaching behavior; excusing self by accusing others; bumbling behaviors when competence is actually possible; and using a positive gesture as a vehicle for a negative message, e.g. including relationship grievances in a Christmas card (Kantor, 1992, p. 177).

Other individuals with PAPD will express their rage overtly and directly. Aggressive PAPD behavior is intended to inflict discomfort, hurt, harm, injury, or destruction. These individuals have a disposition toward anger and aggression -- referred to irritability (Lish, et.al., Costello, ed., 1996, p. 32). They may have temper tantrums that release pent-up aggression; if their victim is aggressive in response -- so much the better. That response is then used to vindicate the initial attack. Anger expressed by commission is usually justified by laudable motives, e.g. concern for the well-being of the victim. The expression of the anger is dictated by the desire to wound while concealing the intention to wound -- even the existence of the anger. This is not to spare the feelings of the victim but to wound them more effectively. The intent is to provoke counteranger with such subtlety that the victim blames himself and believes his anger is not justified. That way, people with PAPD can assume the role of innocent victim (Kantor, 1992, pp. 178-180). They may make directly hostile statements because they fail to perceive their own motivating attitude, perceive their hostility too late, or believe that their attitude can be concealed. They may remain unaware of the implications of their behavior or words (Kantor, 1992, p. 178). PAPD avoidance of taking responsibility for the provocative consequences of anger produces paranoid overtones. These individuals are often surprised at the response they provoke; they typically deny having given cause for the angry responses they receive or they accuse others of overreacting. Many of these individuals will endure growing isolation rather than alter or give up what they believe to be their right to free expression (Kantor, 1992, p. 182).

Obstructive and Contrary PAPD Behavior:

Individuals with PAPD actively obstruct others (Kubacki & Smith, Retzlaff, ed., 1995, p. 175) by failing to do their share. Still they complain, feel cheated, unappreciated, and misunderstood. They blame their failures or difficulties on others. They are inclined to be sullen, irritable, impatient, argumentative, cynical, skeptical, and contrary (DSM-IV, 1994, p. 733). These individuals engage in specific retaliation for wrongs that they perceive have been done to them via obstructionistic, petty, difficult behaviors designed to discomfort the recipient, e.g., the wife who points out several similar errors on an occasion when the husband completes an activity successfully (Kantor, 1992, pp. 177-178).

Oldham & Morris (1990, pp 213-215) suggest that individuals with PAPD raise contrariness to an art form. They stall, complain, oppose, forget, and feel cheated by life. They experience life as dark and unpleasurable. To these individuals, thwarting the expectations of others is a victory even if they sabotage their own lives. They are difficult, angry and needy. They see compliance as submission, and submission as humiliation.

PAPD behavior is basically oppositional and provocative. While these individuals may seem, on occasion, to be compliant and agreeable, they are judgmental, irritable, and easily frustrated. They resist adequate performance through stubbornness, forgetfulness, lateness, deliberate inefficiency, and procrastination (Sperry & Carlson, 1993, p. 336). The opposite of the behavior appropriate to a given situation is the one most likely to be expressed by individuals with PAPD -- hence the negativistic personality. Another name for this pattern might be the oppositional personality. Individuals with passive-aggressive (negativistic) personality disorder maintain a consistent attitudinal set toward themselves and others. It is a spoiler attitude that is used to justify fatalism and nihilism. This behavior is often well tolerated in highly conflicted family systems. They will also find a place in work settings where there are relatively few consequences to nonproductive behavior and there are either few rewards or rewards are distributed arbitrarily (Richards, 1993, p. 259).

It is typical for passive-aggressive individuals to be cynical, doubting, and untrusting. They approach most events in their lives with a measure of disbelief and skepticism. Future possibilities are approached with trepidation. Most tend to be whiny and grumbling in their approach to life and voice disdain and caustic comments toward people who are experiencing good fortune (Millon & Davis, 1996, p. 551). These individuals tend to be quite articulate in describing their discomfort but rarely explore or seek to understand what is wrong. They do not recognize their own inner conflicts as contributing to their difficulties. They are often preoccupied with personal inadequacies, body ailments, and guilt; this alternates with equal preoccupation with social resentment, frustration, and disillusionment. They complain about the sorry state of their lives; they would like to feel better but seem unable or unwilling to find a solution to their difficulties (Millon, 1981, p. 255).

Affective Issues

Individuals with PAPD are vulnerable to anxiety, somatoform disorders, and depression. Major depressive episodes are not uncommon. In the PAPD depressive cycles, there is evidence of a tendency to blame others, a demanding and complaining attitude, and low self-confidence. These individuals are most likely to experience chronic dysthymia. Typically, individuals with PAPD display an agitated dysphoria, shifting between anxious futility and self-deprecation to demanding irritability and bitter discontent (Millon, 1996, pp. 198-199).

Individuals with PAPD experience an undercurrent of perpetual inner turmoil and anxiety. They appear unable to manage their moods, thoughts, and desires internally which results in emotional instability. They suffer a range of intense and conflicting emotions that surge quickly to the surface due to weak controls and lack of self-discipline. They have few unconscious processes they can employ to manage their feelings which emerge into behavior unconcealed, untransformed, and unmoderated. Without self-management skills, PAPD affect tends to be expressed in a pure and direct form, no matter what the consequences (Millon, 1981, p. 256).

PAPD implies, by definition, some level of hostility. Passive-aggressive (negativistic) individuals typically become angry about deprivation; they feel they do not have enough of and are deprived of what they need (Kantor, 1992, p. 179). They also believe they are trapped by their own fate; nothing ever works out for them. They feel envy and resentment over the easy life led by others. They are critical and cynical regarding what others have attained, yet covet what they have achieved. Life has been unkind to them; they feel cheated and unappreciated. They believe that their motives and behaviors have been misunderstood by others. Their pessimism and obstructiveness is merely a reflection of what sensitive people they are to the inconsiderateness of others or the medical concerns they have. They may, on occasion, express feeling remorseful because they have a bad temper. The struggle between their guilt and their resentment permeates their lives (Millon, 1981, p. 255).

The passive-aggressive personality disorder might be described as a compulsive personality with an attitude. These individuals express an irritable or sour mood; aggression is usually pouting and complaining. They are frequently depressed or sulking and gain perverse pleasure in raining on everyone's parade -- even their own (Richards, 1993, p. 258). These individuals focus on the negative; they are moody and pessimistic (Beck & Freeman, 1990, p. 334).

Defensive Structure

Individuals with passive-aggressive (negativistic) personality disorder utilize three main strategies to defend themselves: displacement, externalization, and opposition. The most consistent PAPD defense mechanism is displacement. These individuals shift their anger away from more powerful targets to those of lesser significance. They express their hostility toward others who are less likely to be able to retaliate or reject them. They often vent their resentment by substitute means such as acting inept or being forgetful. They can be both stubborn and exasperating. They have a very thin veneer of resentful compliance that masks their aggression toward others and disdain toward themselves. Passive-aggression and displacement, both defenses, involve overidealization of the self and devaluation of others (Millon & Davis, 1996, p. 552) (Kubacki & Smith, Retzlaff, ed., 1995, p. 175) (Richards, 1993, p. 259).

People with PAPD externalize their focus and cannot accept blame for any of their shortcomings (Stone, 1993, p. 361). They deny or refuse awareness of their own provocative behavior, the serious negative consequences of their maladaptive responses, and responsibility for the behavioral choices they make. Instead, they focus on the many grievances they have toward others. They focus on the behavior of others and externalize responsibility for their destructive actions.

Individuals with PAPD frequently employ the strategy of opposition; they fortify their autonomy through devious opposition to authority figures while overtly seeking favor from them (Beck & Freeman, 1990, p. 46). They attempt to keep their rebellion covert enough to maintain a sense of safety and allow themselves to deny malicious intent.

Table of Contents

Treating the Passive-Aggressive (Negativistic) Personality Disorder

The Passive-Aggressive (Negativistic) Personality Disorder Coming Into Treatment

There are two major ways for individuals with PAPD to enter treatment. The first, and most common, is externally leveraged treatment for those individuals who do not see themselves as having a problem. Someone forced them into treatment, e.g., family, employers, or the legal system. These clients with PAPD have minimal insight; they fail to admit that they are a major factor in the problems they have. The second method for individuals with PAPD to enter treatment is via self-referral for vague complaints, e.g. "I'm just not getting anywhere" (Turkat, 1990, pp. 87-88).

All of the personality disorders are composed mostly of abrasive traits that are negative in nature. Maladaptive traits are usually favored over adaptive traits (though there are adaptive traits within all personality disorders) (Kantor, 1992, p. 10). PAPD is a particularly abrasive personality and interpersonal problems are readily identifiable. However, individuals with PAPD do not frequently seek treatment for relationship issues as they consistently blame others for the problems they have. Even if they do come in for treatment for a marital or parent and child problem, they will uniformly demand that the treatment providers "fix" the other person or persons who are at fault for the problems within the relationship.

Medication Issues

Medication has not been found to be helpful for PAPD unless there is also anxiety or depression (Stone, 1993, p. 363).

Treatment Provider Guidelines

Passive-aggressive behaviors often brought forth in the treatment setting:

* Intrusive and unnecessary phone calls.
* ole reversal with evaluation of the treatment providers -- discussing their good and bad points (usually with the balance being on the inadequate side).
* Projection of anger and then criticism of that anger.
* Absorbing nothing; responses to identification of passive-aggressive behaviors being denial, minimization, changing the subject, or denying hostile motivation.
* Absorbing everything and refusing to apply it.
* Doing the opposite of what the service providers expect.
* Using insight against both themselves and the service providers (Kantor, 1992, pp 183-185).

Consequently, service providers should not allow themselves to feel apologetic for setting and enforcing limits or reinforcing boundaries between clients with PAPD and staff (Ries, TIP #9, 1994, p. 72). In treatment, these individuals are inclined to skip sessions, pay late, arrive late, and then announce that they are leaving treatment because not much is happening anyway (Stone, 1993, p. 363). While limits and requirements of the treatment process may well elicit PAPD outrage and protestations of mistreatment, these individuals must learn to manage expectations in a positive manner if they are to be successful in changing their most maladaptive behaviors. They may engage in a sit-down strike against parents, spouses, or other authority figures (including service providers) -- refusing to progress in any direction. That defeats the parents or authority figures but also defeats their own ambitions or dreams. Young individuals with PAPD have actually refused to progress in any area of their lives to win the battle with their parents by disappointing them totally (Stone, 1992, p. 362). In treatment, the consequences of self-destructive choices can be pointed out and reflected upon. However, pressure to be more constructive is likely to provoke intensified passive-aggressive resistance.

Transference and Countertransference Issues

The classic passive-aggressive transference pattern is to comply (sort of) with the therapeutic recommendation, and then to declare triumphantly that it was a very poor suggestion and failed miserably. These individuals are programmed to ask for help and then both to defy it and to suffer from it. Clients with PAPD expect to be injured by a negligent and cruel caregiver (Benjamin, 1993, pp. 282-285).

A common countertransference issue with these clients is outrage or punitive anger. They are manipulative individuals who are consistently stubborn, demanding, help-rejecting, critical, and inclined to ridicule both the treatment process and the service providers. It can be quite difficult to maintain a sense of balance in the face of such willful maliciousness. Consultation, supervision, or peer supervision can be quite helpful in venting emotional responses to these individuals and planning a realistic and appropriate treatment approach. It is imperative that service providers do not become so angry that they use limits to punish, e.g. discharging from treatment when it is not clinically appropriate to do so. It takes considerable therapeutic resilience to reflect limits, maintain expectations, and facilitate a cooperative response to the environmental pressures faced by these individuals. On the other hand, service providers must also ascertain when therapeutic empathy becomes permission for these individuals to be interpersonally abusive to program staff. This is neither acceptable behavior nor does permissiveness of this kind foster more adaptable client behavior at home or work. Treatment may need to be terminated if clients with PAPD will not curtail their spiteful behavior. The reason for doing so must be direct, clear, and stated without counter aggression.

Treatment Techniques

When assessing individuals with PAPD, address the following areas:

* survival skills and self-care
* use of OTC drugs
* all other providers being seen for treatment
* psychosocial and AOD history
* mental status
* coexisting anxiety disorders
* medication evaluations for antidepressants
* identification of typical passive-aggressive maneuvers (Ries, TIP #9, 1994, p. 71).

Treatment for individuals with PAPD involves openly exploring the ways they indirectly and unassertively express aggression and neediness toward others by being contrary. Understanding this aggression can allow discovery of the depressive and invalidating experiences underneath -- which lead to a fear of loss of autonomy when others want to be close and a fear of loss of connectedness when others want to be alone (Kubacki & Smith, Retzlaff, ed., 1995, p. 175). Determine which situations or experiences are most difficult for individuals with PAPD in the direct expression of their feelings or beliefs. Identify all avoidance and anxiety-arousing situations. Address these issues with anxiety-management behavioral intervention techniques (Turkat, 1990, pp. 88-89). Cognitive therapy can help these individuals understand that they expect the worst from others and then proceed to behave in such a way that brings out the worst from these same people (Stone, 1993, p. 363).

Group therapy provides individuals with PAPD with an opportunity to learn how to manage their hostility. When their hostility emerges, group leaders can comment on hostile behavior and encourage other group members to respond. The group leader can assist these individuals to process what it is they want or need at that moment and to rehearse appropriate behavior within the group context (Ries, TIP #9, 1994, p. 72). However, clients with PAPD will not do well in group if they refuse to accept responsibility for their hostility and alienate the other group members. When that happens, these individuals often leave or become isolated within the group (Stone, 1993, p. 363).

Whether clients with PAPD are in group or individual treatment, it is important to identify and highlight examples of passive-aggressive behavior. Reflect on how the behavior is more maladaptive than adaptive. Give examples of how It creates more problems than it solves. Use illustrations from within the immediate treatment process as these individuals will use oppositional techniques and devalue treatment providers in response to real or perceived expectations (Kantor, 1992, p. 183).

Treatment Goals

Several treatment goals effectively address areas of concern for individuals with passive-aggressive (negativistic) personality disorder. These include:

* providing these individuals with a benign experience with authority figures (treatment providers) who are genuinely concerned about their welfare and who are not determined to emerge and remain superior to the clients with PAPD (Stone, 1993, p. 363);
* addressing the issue of control by teaching these individuals that they can attain one type of control by giving up another, maladaptive type of control (Ries, TIP #9, 1994, p. 72);
* assisting individuals with PAPD who are parents to diminish the destructiveness of their overcontrolling, unpredictable, and hostile behavior with their children (Ries, TIP #9, 1994, p. 72);
* addressing behavior in all relationships, e.g., contrary, stubborn, devaluing behavior toward others (Ries, TIP #9, 1994, p. 73); and
* encouraging these clients to give up their agenda of suffering and work toward achieving and sustaining greater contentment and personal efficacy (Benjamin, 1993, p. 290).

As with any of the personality disorders, individuals with PAPD cannot achieve a personality style that does not fit them temperamentally, nor is it realistic to work toward a personality change that is extraordinarily different than what they already are. Oldham & Morris (1990. pp. 195-202) suggest that the leisurely personality style is the non-personality disordered version of the passive-aggressive or negativistic individual. The traits of the leisurely personality style are:

* the belief that these individuals have a right to enjoy themselves on their own terms in their own time;
* the inclination to deliver what is expected of them and no more; "enough is enough;"
* resistance to exploitation; comfortable refusal to meet unreasonable demands;
* relaxed attitude toward time; and
* resistance to feeling awe toward authority figures.

Individuals with a leisurely personality style hold the independence of self as a first priority. They are comfortable with themselves and skeptical of others, especially authorities. They are watchful of people asking too much of them and skilled at saying no. They own their own time and use time as they want. They do not put the needs of others first nor do they go too far out of their way to please people. These are functional behaviors and would be compatible with the basic attitudes and beliefs of individuals with PAPD. As such, they could form the basis of treatment goals directed at behavioral change.

Table of Contents

Dual Diagnosis Treatment:
Treating The Addicted Passive-Aggressive (Negativistic) Personality Disorder

Incidence of Co-Occurring Substance Abuse Disorders

The incidence of co-occurring substance abuse with PAPD is high. Both Beck & Freeman (1990, p. 336) and Oldham & Morris (1990, p. 216) note the frequent association of substance abuse with this personality disorder.

Individuals with PAPD are prone to use drugs to regulate mood states; it is consistent with their general attitudes and beliefs that they see themselves as entitled to an external solution to problems. These individuals are likely to display their addictions in a loud uproar, rather than keeping it a secret. They use their addictions interpersonally to justify their angry or violent behavior or to provide a rationale for nonperformance, incapacitation, or inaccessibility. Substance abuse in individuals with passive-aggressive (negativistic) personality disorder may trigger a change from stubborn minimal compliance to aggressive defiance or self-loathing (Richards, 1993, p. 261).

Drugs of Choice for the Passive-Aggressive (Negativistic) Personality Disorder

Milkman & Sunderwirth (1987, p. xiv) propose that the drug of choice for anyone is actually a pharmacologic defense mechanism; it is chosen by how well it fits with individuals' usual style of coping and how effectively it bolsters already established patterns for managing psychological threat. However, Richards (1993, p. 260) suggests that almost any of the drug classes will suit individuals with a passive-aggressive (negativistic) personality disorder. Prescribed pain killers and antianxiety agents, in combination with alcohol, is probably the most common pattern of abuse. In fact, individuals with PAPD may come into treatment needing to be detoxed from benzodiazepines and other sedative-hypnotics (Ries, TIP #9, 1994, p. 71).

Dual Diagnosis Treatment for the Passive-Aggressive (Negativistic) Personality Disorder

Richards (1993, pp. 261-278) suggests that treatment failures for the dually diagnosed are often a result of neglecting to consider the function of the addiction, including the drug of choice, within the context of the psychopathology dominant in the individual. Dual diagnosis treatment must involve recognition of needs, behaviors and attitudes that foster addictive behavior. Individuals with PAPD will feel entitled to recovery but will refuse to work toward it because they either believe that they are owed normalcy or that the treatment staff are flawed and incompetent. Because of these attitudes, these individuals are extremely difficult to motivate or maintain in substance abuse treatment. They are easily demoralized and may feel entitled to relapse because they have been tempted by the cruel forces of fate.

Individuals with passive-aggressive (negativistic) personality disorder may complicate their recovery with compulsive eating or spending. Ongoing monitoring for compulsive behaviors and use of alcohol, prescribed medication, and OTC drugs is important. Verifying all prescribed medications and working with all prescribing physicians can prevent medical emergencies for these individuals. Addicted clients with PAPD must be urged to inform their physicians of their involvement in AOD or dual diagnosis treatment. As they are willing to do so, they begin the process of accepting personal responsibility for their recovery (Ries, TIP #9, 1994, p. 71).

Individuals with PAPD can benefit from 12-Step Groups, but they must be encouraged to avoid romantic involvement to escape existing bad relationships. If they will join same-sex support groups, they may better be able to avoid relationships built on a mutual need to avoid recovery (Ries, TIP#9, 1994, p. 72). Also, involvement in self-help groups will be self-defeating without assistance on how to use these groups without alienating everyone (Richards, 1993, p. 262).

In treatment groups, clients with passive-aggressive (negativistic) personality disorder engage in exploiting other group members without reciprocity or mutuality. They often do not report or show progress and engage others in a destructive manner. They can undermine the efforts, morale, and good faith of both staff and group members (Richards, 1993, p. 261). If these individuals will not accept limits on their behavior and they substantially reduce the effectiveness of the group for all participants, termination from the group should be considered.

Coercion or legal leverage is often needed to establish compliance with treatment for clients with PAPD. Clear consequences and specific limits are necessary. Drug testing is of crucial importance -- these individuals are second only to people with antisocial personality disorders in insisting they are abstinent when they are using daily. Care must be taken to be in touch with all sources of medication. Attendance in treatment should be carefully monitored. Low credibility should be given to self-reports regarding behavior (Richards, 1993, p. 262).

Confrontation will appear to be necessary to breach the sullen non-compliance in individuals with PAPD. However, they are inclined to use confrontation as proof that they are being treated badly and that the staff are incompetent. It is more likely to be effective to calmly state expectations, clearly define consequences, and enforce program policies. The impact of negative consequences will likely also be blamed on treatment staff but it is the most promising method to achieve compliance with treatment expectations.

Source:-Reprinted from The Dual Diagnosis Pages
http://www.toad.net/...s/dd/ddhome.htm
Courtesy of Bob and Sharon Ekleberry
arcturus@toad.net

References:- PD BIBLIOGRAPHY

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#2 viper420

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Posted 11 March 2006 - 12:57 AM

My Dr. diagnosis to me was that i am bipolar type 2, and i think he is right ,somewhat. I really think after reading more about passive-aggresive that it fits me more. Cause i look back on my present relationship , and past ones and see alot of traits of P.A. in the way i delt and deal with things, and it is taking a toll on my present relationship now. it just seems like when i try to do something good i've actually done something wrong, or it was not good enough.then the depression sets in and i just don't whant to be here no more and continue creating the living hell that i have caused my girlfriend nomore. :hearts:

#3 ados

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Posted 11 March 2006 - 11:45 AM

(((((viper)))))

The fact that you are sharing shows that you have a desire to change the negative aspects of your life. Work with your doctor; maybe you can share some of this info you are finding about variations of mental/emotional illness that will help you and your doc work together in healing you.

Karen
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#4 chaku

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Posted 11 March 2006 - 09:54 PM

Reading this made me wonder if I have some of these problems too. There were a lot of things that fit for me like skepticism, argumentiveness, critical thinking, depression, anxiety, and procrastination. There were quite a few that didn't like self idealization, never accepting blame, disrespecting authority, believing that bad things will always happen to me, resenting those more fortunate, and manipulating others.

I have always viewed passive-aggressiveness as a skill that could be used well or abused and didn't realize there was such an in-depth explanation of it. An example I used for what I thought was passive-aggressive behavior was making fashion decisions with the intent to keep certain people at bay.

So is this behavior always limited to the negative actions described in this article, or is it more complicated than that? Is a calculated decision that is judgemental towards others but made for a positive reason passive-aggressive?

Edited by chaku, 12 March 2006 - 01:05 AM.


#5 ithomas

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Posted 19 October 2006 - 12:38 PM

This is totally me... I just posted in another thread regarding this. The "Assertiveness Training" one, I believe.

I have started by trying to bite back the sarcastic comments that I often make, especially to my boyfriend. Why would I put down someone I love so much? Because of hidden resentment, because I find it almost impossible to talk about my problems, because I think the things that upset me are so inconsequential that they're not worth trying to fix.

After we almost broke up last night, I've decided that no matter how small the problem is, I am going to say how I feel. If I feel hurt that my boyfriend wants to spend the evening at his friend's house after not seeing me all day, I am going to tell him.

I know that kind of thing won't get a good reaction from him, but... at this point there is nothing left to lose. I think it would help me if he were a bit more patient, but he is so fed up now... it's almost too late.

#6 Jasper123

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Posted 28 November 2006 - 12:18 AM

I feel like this is something that describes my husband to a T. Such a helpful article.

We are currently separated and I hope that he can find the help that he needs, whether we stay together or not. I'm usually the optimistic one but I'm not feeling that way with his ability to seek help and find the right care for his mental health.

#7 nhsnotp2scratch

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Posted 11 December 2006 - 03:43 PM

Hi,

Thanks for the info! Had never heard of it before!

Wondering if you had any thoughts on the positive/negative effects that diagnosis has?

Thanks for the info!

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#8 Karjn

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Posted 31 December 2006 - 08:54 PM

Wow. I just read this whole thing and I could have written it. no only does this describe me to a t, but i am aware of it and when it's in play, i simply cannot control it...when i'm through with these depressed, manipulative and angry stages, I can remember them..but not really like it was me doing it. its awful. I have spent the weekend thinking whether or not i should get divorced. if marriage is for me and can i ever live with anyone again..

but thats only becuase i never do what is expected of me around here and then attack. it's awful. I need badly to stop this.
I don't recall suffering from this bahaviour so badly. it's been a stuggle for about 3 years.

thank you for posting this. i'm am quite glad i have this to read to remind myself that it's a behaviour..and it can be dealt with.
problem is, i don't want to do that work.
i want the result, not the process.
glad i know that much, though.

#9 EvinLejonhjarta

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Posted 03 January 2007 - 04:22 PM

I have some of these things, but not everything, and not as severe as it seems to be in the text, but I think it has to do a lot with feeling depressed, but anyway, I think this was interesting and its good to know about it and understand it more.

Evin
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#10 thought_crime2600

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Posted 04 January 2007 - 01:27 AM

lol my ex wife use to call me passive aggressive but it seems to me a lot of those symptoms are the same as depression. How could you accurately diagnose PAPD?

#11 EvinLejonhjarta

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Posted 07 January 2007 - 03:16 PM

lol my ex wife use to call me passive aggressive but it seems to me a lot of those symptoms are the same as depression. How could you accurately diagnose PAPD?



Good question! I think you are right about your comment, many of these things would fall into the category of depression. Hopefully someone with more knowledge can explain to us how you know which is which!

Evin
Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.
--- Kahlil Gibran


You have to be strong. Strength of heart will carry you through the hardest of trials.

#12 vogborn

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Posted 25 August 2008 - 06:53 PM

This really describes my husband. He refuses outside help and there is not way forcing the issue will help him. He has got to want help for himself...until then I need to get some coping skills. All of this has totally exhausted me and I need help now too.

#13 Used To Be Me

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Posted 23 September 2008 - 09:52 AM

Eek

I have blamed so many events rather than people in my life, and had almost given up in everything i do, i thought it would just fail, and bothering to o it grew more and more difficult. I know i can be negative, but like an earlier post i get so lost in my head, and say things instantly see as completely wrong, and afterwards try to reexplain them, and sometimes end up making it worse. I thought i was some sort of insane masochist.

I do not have the self idealization, but just about everything else seems about right, i do get jealous people get traumas but seem to just sack it off and move on, and when a great idea for good falls flat on its face i am strangely more happy about it.

I just thought 19 dead friends, a flesh eating virus that cooked my brain, my self hateful job in telesales and a life that seemed going nowhere, and finally a girlfriend who shouted at me over everything till i seeked to be approved of was enough to lead me to this complete agrophobic, self hating image with all my passions destroyed, but she is the one who called me passive aggressive, and to shout back i looked this up and realised, not only i think i am one, but i realise how much i can sort out other peoples problems, and although seeing all my own ways out of it, close off the options, or simply do not apply it.

Now i'm more freaked and realise that what i have done is worse, and even worse than that, it was perhaps intentional, i rarely see the outcomes of things, and even things i am apprehensive of i think, well we'll see where this leads.

Sorry for venting, its har to get my head round it and think that i am, there are so many contributing factors

Chris
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#14 Ev13

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Posted 08 February 2010 - 06:38 AM

Holy crap!

I came to the forums tonight on a google search for support- I was profoundly depressed and didn't know what to do next.

I looked through a few threads and found this PAPD page, and it blew my mind. 95% of this description fits me perfectly.
Now I guess I have bad news / good news. On the one hand, I feel a little bit of hope because I feel like I've maybe found something specific to pin my troubles to, something to take to my therapist and discuss, and maybe focus on some specific steps. There's a certain sense of power in finding the name for your ill.

The downside is, this sounds deep and difficult to change. Are there positive outcomes possible? Are there people out there who can say they completely changed their core personality and feel relaxed and healthy now?

One positive component, is that I'm older and have dealt with the negative consequences so long, and come close to some of these realizations on my own; such that I don't think I'll be as susceptible to some of the avoidance and shirking blame mentioned in the cautionary parts. I'm definitely ready to get better, and I have been moving on my own, toward accepting that my behaviors (even the very subtle ones) must be causing or at least contributing to some of my own problems.

I guess I'm just scared of how to get started and if it's somehow "too late". I've ingrained so much this acceptance that I'm depressed and lazy, and that leads to procrastination, and then panic and then despair. In a very direct and specific sense, I'm in a lock-step school program that is only 2 years long. I'm worried that I've already gotten so far behind this semester that I'll never be able to catch up- and the thought of dropping out or even falling a year behind is just too much to bear.

I have a little hope now that maybe I can do it with some hard work; but I'm afraid, getting out of old habits is really hard, and motivation is the hardest component to change. I'm going to call my therapist as soon as the office is open and try to make much more frequent appointments, and see what we can do about this.

I would be very interested in any "follow up" literature related to this PAPD segment. Success stories, what to expect and hope for, anything along those lines.

(This is also my first post, so I hope I haven't made a huge transgression)

-Ev

#15 Trace

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Posted 09 February 2010 - 05:24 AM

Holy crap!

I came to the forums tonight on a google search for support- I was profoundly depressed and didn't know what to do next.

I looked through a few threads and found this PAPD page, and it blew my mind. 95% of this description fits me perfectly.
Now I guess I have bad news / good news. On the one hand, I feel a little bit of hope because I feel like I've maybe found something specific to pin my troubles to, something to take to my therapist and discuss, and maybe focus on some specific steps. There's a certain sense of power in finding the name for your ill.

The downside is, this sounds deep and difficult to change. Are there positive outcomes possible? Are there people out there who can say they completely changed their core personality and feel relaxed and healthy now?

One positive component, is that I'm older and have dealt with the negative consequences so long, and come close to some of these realizations on my own; such that I don't think I'll be as susceptible to some of the avoidance and shirking blame mentioned in the cautionary parts. I'm definitely ready to get better, and I have been moving on my own, toward accepting that my behaviors (even the very subtle ones) must be causing or at least contributing to some of my own problems.

I guess I'm just scared of how to get started and if it's somehow "too late". I've ingrained so much this acceptance that I'm depressed and lazy, and that leads to procrastination, and then panic and then despair. In a very direct and specific sense, I'm in a lock-step school program that is only 2 years long. I'm worried that I've already gotten so far behind this semester that I'll never be able to catch up- and the thought of dropping out or even falling a year behind is just too much to bear.

I have a little hope now that maybe I can do it with some hard work; but I'm afraid, getting out of old habits is really hard, and motivation is the hardest component to change. I'm going to call my therapist as soon as the office is open and try to make much more frequent appointments, and see what we can do about this.

I would be very interested in any "follow up" literature related to this PAPD segment. Success stories, what to expect and hope for, anything along those lines.

(This is also my first post, so I hope I haven't made a huge transgression)

-Ev


Hi and Welcome Ev

I am so glad that you have found us. You are definitely not alone.
I am glad that you are in therapy and it sounds like you know yourself well, which is a huge step in working through everything, reaching acceptance and understanding.
You may want to have a look in the Personality Disorders Room here, as you are definitely not alone in this.

Trace
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True beauty must come, must be grown, from within.... - Ralph W Trine.



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#16 christyharts

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Posted 18 June 2010 - 01:56 PM

Holy crap!

I came to the forums tonight on a google search for support- I was profoundly depressed and didn't know what to do next.

I looked through a few threads and found this PAPD page, and it blew my mind. 95% of this description fits me perfectly.
Now I guess I have bad news / good news. On the one hand, I feel a little bit of hope because I feel like I've maybe found something specific to pin my troubles to, something to take to my therapist and discuss, and maybe focus on some specific steps. There's a certain sense of power in finding the name for your ill.

The downside is, this sounds deep and difficult to change. Are there positive outcomes possible? Are there people out there who can say they completely changed their core personality and feel relaxed and healthy now?

One positive component, is that I'm older and have dealt with the negative consequences so long, and come close to some of these realizations on my own; such that I don't think I'll be as susceptible to some of the avoidance and shirking blame mentioned in the cautionary parts. I'm definitely ready to get better, and I have been moving on my own, toward accepting that my behaviors (even the very subtle ones) must be causing or at least contributing to some of my own problems.

I guess I'm just scared of how to get started and if it's somehow "too late". I've ingrained so much this acceptance that I'm depressed and lazy, and that leads to procrastination, and then panic and then despair. In a very direct and specific sense, I'm in a lock-step school program that is only 2 years long. I'm worried that I've already gotten so far behind this semester that I'll never be able to catch up- and the thought of dropping out or even falling a year behind is just too much to bear.

I have a little hope now that maybe I can do it with some hard work; but I'm afraid, getting out of old habits is really hard, and motivation is the hardest component to change. I'm going to call my therapist as soon as the office is open and try to make much more frequent appointments, and see what we can do about this.

I would be very interested in any "follow up" literature related to this PAPD segment. Success stories, what to expect and hope for, anything along those lines.

(This is also my first post, so I hope I haven't made a huge transgression)

-Ev


Hi and Welcome Ev

I am so glad that you have found us. You are definitely not alone.
I am glad that you are in therapy and it sounds like you know yourself well, which is a huge step in working through everything, reaching acceptance and understanding.
You may want to have a look in the Personality Disorders Room here, as you are definitely not alone in this.

Trace



I too came across this forum last night on a google search for irritability and depression. This is the first topic I read, simply because the title jumped out at me. The majority of this fits me to a "T". I don't have the negativism or I don't go against authority figures. But the majority of rest is me.
I've been on/off anti-depressants for about 20 years. They don't work. I'm irritable all the time, take it all out on husband. I procrastinate, I sit around house, not wanting to go anywhere or do anything. The outbursts I have is mainly towards husband. Other things, I let others "control" what I do, without speaking up for self, then I get mad at self for that. Internalize it, then explode for minor things at home.

Without going into how all this fits me, I'm glad I was "led" to it.
I copied some of it to print out to take to my next counseling session. I now believe there is help for me

#17 Kalla

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Posted 18 June 2010 - 03:02 PM

This fits my mom in a lot of ways...Wish she would just get diagnosed with something and get some help already! Thanks for posting this.

"Happiness can be found, even in the darkest of times, if one only remembers to turn on the light."


#18 theblues

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Posted 08 July 2010 - 08:27 AM

Whoa this sounds like me. Geesh, I sound like a terrible person to be around.

I don't have problems with authority though. And I know that I do all these things- I don't try to avoid responsibility and I'm aware that I'm doing these awful things. It doesn't stop me from doing them, and when I'm lashing out or wallowing I don't realize it until the spell has passed. I don't think that more successful people are that way because of unfair advantage either but I'm still jealous about it. And yes, it seems like stupid bad stuff is constantly happening to me, but when I take a step back I see that this isn't any more true to me than any one else.

I guess what I mean is it describes my behavior, the effects on my life, and my relationships PERFECTLY. But it doesn't describe what I feel and think exactly- it's hit and miss.

Anyway, I've always just called it "adult temper tantrums". It's terrible and embarrassing but just like when a toddler is throwing a fit, in the moment I don't realize that I'm doing it. It all seems really justified. The anger is exhausting and the resentment feels really real. My husband says it is like walking around on eggshells. That bit about alternating between dependency and feeling like you need to assert yourself- that's me too. Yikes.

If this is really me than I don't want to be around me either.

#19 japanlover

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Posted 18 July 2010 - 02:26 PM

Every single example is me!! :shocked:

I know im passive-aggressive. I also know when im extremely frustrated i either hear a high pitch noise or popping in my ear. Not the popping of an ear drum, but someone taking their finger, put it in the side of their cheek and push out the finger. That makes sense why I had the extremely destructive relationship before my wife. I cried for a week after that one.

But I thought this personality disorder was accepted in society and you even see it in movies like anger management. I think

Are there any drugs for this kind of personality. But... again this doesn't seem like a disorder. If psychologists wanted to they can make a perfectly normal person sound insane.

Edited by japanlover, 18 July 2010 - 02:30 PM.


#20 phillygirl

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Posted 03 January 2011 - 12:06 PM

All I can say is wow! I came upon this forum because I have been feeling a bit depressed as of late. I know part of it has to do with my current relationship with my sister and this disorder describes her perfectly. I actually suffer from GAD and every so often have bouts of depression and one of the things I am currently trying to learn how to do, is draw boundaries wit my sis. I love her to death and would do anything for her, but it is just so darn difficult to deal with her sometimes. I wish I could send this to her to read, but that would cause more problems than are already there. I know because I have tried to get her help and it never ends well!

#21 Bloshka

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Posted 10 January 2011 - 04:10 AM

Hi!

I found this in a google search and I'm very, very impressed.

To the author of the initial description: Kudos. Your description is far more comprehensive than most anything else I've seen online, and you set out treatments as well, which is something I had not seen online.

To the people who posted here who recognize themselves as PAPD, you have my sincere admiration. It takes a great deal to recognize PA behavior in one's self.

I'm here because I'm married to a man with PAPD. We're separated and have been so for a year. As bad as the negative behavior gets, he is a good guy and I recognize that his personality was formed this way because of what was done to him as a child. It's not as though his goal in life was to grow up and be passive-aggressive.

In the year I've been separated, I have tried very hard to wrap my mind around the problem. Prior to the separation, we were engaged in an ongoing "now we like each other, now we don't" in which I sure played a part. I ran into something on the Internet that helped me tremendously to begin to change: the advice was to look at exchanges with my husband as if I were in a movie, at a distance. When I saw that I was taking his passive-aggressive bait, I stopped doing it. That, by itself, was tremendously helpful to me, as I was no longer arguing like a crazy person.

The relationship I have with my husband has changed in that I don't engage in arguments, but from here to a friendly, collaborative relationship seems like a very long way, and one that doesn't depend on me. I can't control the way my husband sees me. And he sees me as an enemy hell bent on controlling him. If he's around me too long, his fight-or-flight response is activated, and he will either lash out or run away. It's impossible to have a friendly relationship and to solve problems mutually when my husband can barely stand to be in the same room with me. At the same time, he loves me. I can tell because he buys me gifts and helps me financially.

I don't know how things will come out. I don't believe in throwing people away, so my goal thus far has been to make it clear I'd like to reconcile. But who knows? It's not up to me, or so I'm thinking now. I wish there were a magical way that he and I could get along. To his credit, my husband is in therapy, I guess I need to face that he may never come home. And that's very hard.

Thanks for being here and for reading my musings.
  • lindylou likes this

#22 Bloshka

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Posted 11 January 2011 - 06:35 PM

I'm going to test your indulgence and reply to myself.

On the one hand, I am yearning for a man who thinks I am so awful that I want to control him and that I'm a monster. On the other hand, I am putting up with very bizarre behavior. To wit: He acts as though he doesn't like me. I don't know that he does like me, actually. Most everything in the world holds interest for him, except me. The window shopping, the "projects" he has with his computer and other electronic toys. And so on. He is so afraid of my entrapment that he has refused to have sex with me for years and, indeed, made himself impotent over this. He has outbursts of anger that are not in line with the events that preceded them. He's not fun to be around, since he starts to disconnect very quickly and even falls asleep rather than converse with me. In ten years, he has shown very little interest in my life prior to him. For example, he will not watch things that have to do with where I grew up. All of these actions leave me feeling very small indeed. I wonder why I would put up with a person who so clearly does not enjoy my company. I know the Freudian answer. And then I don't know how to stop.

#23 ISOpeace4all

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Posted 02 February 2011 - 05:02 PM

Hello Bloshka...I do hope you are still around the forums and are finding what you need to make the daily steps towards your happiness. Please update so we know you're on your journey.
I am new here and am wanting to peruse everything in an effort to heal and evolve. Like many have responded, there are definite behaviors within this type that I display.

I'm very sick in bed with the flu but so happy to be; if not for this illness, I would not be started on this new path to wellness. I look forward to sharing with this community, accepting help and giving help as well. There is more errored wiring to me than just the aspects of PA which I have identified. I am off to discover more information along with all of you and I wish us peace.

#24 MudaHeart

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Posted 03 April 2011 - 01:40 AM

I read this and a lot of contradictory emotions come up to me.

First of all, I think I have this disorder. I think this is me. But not the whole time, I mean... When something really bad happens to me, I act like this towards people, toward anyone that approach to me. Uusually I'm not like that. For example, I don't have problems with autority figures. Teachers, parents, bosses, you can ask anyone and I've always had an excelent behavior at work/school/home.

When I'm with friends, the times when I got jelous and/or envy where weird because I felt good with myself, I knew I was doing a good work at life and that I was trying my best. It never paid me well but I was happy thinking it would one day.

Still I had those thoughts in my mind. Deep inside when I was a little upset and someone did something bad to me (or so I believed) I always got mad at them. The point is that I never showed it. Never. I always kept it to myself, if anything I stopped talking to them a couple of hours but when I felt better I came back to my normal self.

But right now I have a crisis. My family was torn apart and I feel extremely betrayed and cheated and... humilliated.

And I don't keep it to myself anymore. I have the tremendous urge to hurt others. My parents... I have hold my hatred for my father for years, always trying to be a grown up, even when I was a child but I don't think I can do it anymore. I hate him. I loathe him. And I let him know every time I see him in a sutile agressive kind of way. My mother, I don't see a figure of autority in her anymore.

My friends, I fought with all of them. I erased their numbers of my cellphone, I erased them from Facebook, I don't take calls... everytime I want to talk to them all the times that I felt cheated by them come to my mind and I just can't... I feel furious, I feel like I'm the victim of some kind of destiny desing.

And then I think I'm just a self-centered jerk.

And I get angry at myself for being an egocentrical moron. And I say to myself "Girl you should act better, not everyone is here to hurt you..." and then "But didn't you just see what happened?! They erased me from this, they put me aside, they neglected me, they abused me, they cheated on me, they... destroyed everything I cared about..."

And when I think about it... I'm not the only one that thinks like this. People that know me and know what I've been through (but I haven't talked to them, so I don't feed them lies or my own sickness) understand that I have strong reasons to be mad.

The problem is that when I get mad I get mad at everyone for the most stupid things! And I don't want that...

I feel ashamed that I hurt others that didn't deserve it but I can't do any better because when I see them... when I see them I can only remember the times I was hurt by them, even if it was a long time ago.

And it's stupid, and I'm stupid and I should do better but right now... agh.

I feel I can no longer trust in anybody, trust scares the hell out of me, I really want to be loved but I don't want to lose my d*** freedom and... and I want to be taken cared of but anytime I get to be taken cared of I feel like a stupid dependent burden and I think "I should be stronger, I should be smarter but... God, I really, really need this..."

At this point I think the worst of everyone that comes near me and sometimes I'm right (a LOT of times) but now I wonder if I caused this... if I should be more... flexible, still the posibility that they betray me like my father did, like many friends did scares me because I don't feel strong enough to bare another deception and I isolate myself from others and I know that doesn't help and oh well, you can figure it out it's a darn circle.

.... help me?

#25 FeelinBlueAllTheTime

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Posted 06 October 2011 - 12:25 PM

Sometimes my husband says that I'm passive-aggressive.

While I do have my faults, as everyone does, I'm a bit reluctant to accept this nasty label. It seems like just another way to condemn people for being different.

It is true that I resent people trying to control me. I tend to be a free-spirited individual. I believe in the motto "live and let live". Essentially a person should be able to do what they wish as long as nothing is harmed...people, animals, the environment. I'm pretty much a hippie in many respects.

My husband is 14 years older than me. He is a teacher. He often tells me what to do and there are times when I don't like it. I am his wife and partner, not his child. I respect him but I also want to be respected in return. No one likes being pushed around.

He tends to apply the term "passive-aggressive" to me when I don't do things his way. It hurts my feelings, to be honest, because he doesn't clearly state what can be improved. It just feels like nasty criticism.

I have no issue with authority in general, as long as it is understood that they can't be abusive or disrespectful towards me just because they are in a position of power/authority. I am a person with basic human rights and I have feelings, too.

I've been in a few situations where certain individuals thought they could walk all over me because they viewed me as a lesser being.

As to the part about having an "attitude"...I've been accused of this. I believe that some people misinterpret my actions/words as hostile when in reality, I mean no harm. I'm not perfect but I try to treat others the way I want to be treated.

I tend to be painfully shy and introverted in most situations. I'm pretty introspective. I find it draining to be around most people. And I do feel misunderstood all the time. I will make an innocent comment and the other person's reaction will be completely bizarre. They will respond in a very angry or coldly critical way. Sometimes they will respond with cutting sarcasm that is intended to hurt my feelings and embarrass me. It seems like an overreaction to nothing of real significance. I tend to withdraw from most people because I'm tired of being judged and misunderstood.

I don't envy or resent others for what they have, but sometimes I wish that my life were better than it is. I know that there will always be somebody prettier and/or with more money. Sometimes I wish I had a really good job, a beautiful home, and a brand-new car. I wish that my father had been around when I was growing up. I wish I had kind, caring friends. I wish I could afford all of the things I want and need. But I don't hate other people for the things that they possess...although some people are horrible and they really don't deserve their good fortune because they are unkind to others. My cousin is shallow and mean, yet she always seems to be blessed with good luck in life.

Maybe I do have some passive-aggressive traits, but I don't think I *am* actually passive-aggressive. Hopefully that makes sense.

Calling somebody passive-aggressive simply seems like another way to make a person feel bad about who they are. I believe that behavior is shaped and influenced by environment. We all cope with the world as best as we can. Instead of seeing a person as passive-aggressive, with all that it entails, the focus should be on why they are that way. Maybe they resist some types of authority because of a difficult childhood or the unrealistic demands of others. Maybe they feel deprived and generally unhappy because life has disappointed them.








#26 wisty

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Posted 07 November 2011 - 01:04 PM

Sometimes my husband says that I'm passive-aggressive.

While I do have my faults, as everyone does, I'm a bit reluctant to accept this nasty label. It seems like just another way to condemn people for being different.

It is true that I resent people trying to control me. I tend to be a free-spirited individual. I believe in the motto "live and let live". Essentially a person should be able to do what they wish as long as nothing is harmed...people, animals, the environment. I'm pretty much a hippie in many respects.

My husband is 14 years older than me. He is a teacher. He often tells me what to do and there are times when I don't like it. I am his wife and partner, not his child. I respect him but I also want to be respected in return. No one likes being pushed around.

He tends to apply the term "passive-aggressive" to me when I don't do things his way. It hurts my feelings, to be honest, because he doesn't clearly state what can be improved. It just feels like nasty criticism.

I have no issue with authority in general, as long as it is understood that they can't be abusive or disrespectful towards me just because they are in a position of power/authority. I am a person with basic human rights and I have feelings, too.

I've been in a few situations where certain individuals thought they could walk all over me because they viewed me as a lesser being.

As to the part about having an "attitude"...I've been accused of this. I believe that some people misinterpret my actions/words as hostile when in reality, I mean no harm. I'm not perfect but I try to treat others the way I want to be treated.

I tend to be painfully shy and introverted in most situations. I'm pretty introspective. I find it draining to be around most people. And I do feel misunderstood all the time. I will make an innocent comment and the other person's reaction will be completely bizarre. They will respond in a very angry or coldly critical way. Sometimes they will respond with cutting sarcasm that is intended to hurt my feelings and embarrass me. It seems like an overreaction to nothing of real significance. I tend to withdraw from most people because I'm tired of being judged and misunderstood.

I don't envy or resent others for what they have, but sometimes I wish that my life were better than it is. I know that there will always be somebody prettier and/or with more money. Sometimes I wish I had a really good job, a beautiful home, and a brand-new car. I wish that my father had been around when I was growing up. I wish I had kind, caring friends. I wish I could afford all of the things I want and need. But I don't hate other people for the things that they possess...although some people are horrible and they really don't deserve their good fortune because they are unkind to others. My cousin is shallow and mean, yet she always seems to be blessed with good luck in life.

Maybe I do have some passive-aggressive traits, but I don't think I *am* actually passive-aggressive. Hopefully that makes sense.

Calling somebody passive-aggressive simply seems like another way to make a person feel bad about who they are. I believe that behavior is shaped and influenced by environment. We all cope with the world as best as we can. Instead of seeing a person as passive-aggressive, with all that it entails, the focus should be on why they are that way. Maybe they resist some types of authority because of a difficult childhood or the unrealistic demands of others. Maybe they feel deprived and generally unhappy because life has disappointed them.








I'm not a shrink, but you sound more passive than passive-aggressive. Passive-aggressive is really overused in pop psychology. It's taken to mean "cowardly", rather than "cowardly and nasty". Avoidant personality is the word for super-shy people. Dependent personality is someone who is afraid of making decisions for themselves. Maybe those are more like you (though simply being a little shy or hesitant isn't a disorder - as long as it's in moderation any personality type can be OK).

I like to think I'm cowardly like an elephant - I won't make a big deal of anything unless I have a D*** good reason to. It's probably some deep guilt thing, or because I used to have a *terrible* temper until I learnt to control it (at the age of about 12, I think). Sometimes I get mad, after bottling up a lot of anger, but that's pretty much the opposite of a passive-aggressive (who blows up all the time, if they think they can get away with it). I don't obey powerful people, then pick on weaklings, if anything I try to do the opposite.

Edited by wisty, 07 November 2011 - 01:46 PM.


#27 FeelinBlueAllTheTime

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Posted 27 November 2011 - 04:16 AM

Hi wisty...

I do have a temper, but it takes a lot to bring out that side of me. You're right...I'm more passive than aggressive, which is why I shock people (and myself) when I finally lose control.

When my husband calls me passive-aggressive, I can't always tell if he is just kidding or if he really feels that way. I don't nag or belittle him. I treat him with respect. I'm not sure why he says that because to me, it implies that I'm a terrible person to live with. I'm not perfect but I'm not that bad.

I can be a b*tch if pushed to that point (sorry for my language)...but I generally hate fights and arguments. I'm a pretty peaceful person. I will blow up if I've been holding in a lot of anger and somebody pushes my buttons, but I'm very gentle most of the time.

I tend to shout when I get extremely angry. I will raise my voice and call the other person names that would make your hair stand on end. I've only hit people in anger on a few occasions. But this is rare behavior for me. I'm generally in control of my emotions because I know that it would be hard to stop if I crossed that line.


#28 Anathema1982

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Posted 01 December 2011 - 10:07 AM

Oh man, does this ever fit me. Every bit of it. The sad part is I'm fully aware of it yet have no motivation to rectify the problems. It's really hard when you feel constantly alone and you feel like there is no one to talk to, and even worse, no one that truley understands you. The constant depression coupled with ever growing loneliness and social isolation is almost to much to handle. The cost of therapy is another issue. I simply cannot afford it. My relationship is on the downward spiral, yet I refuse to acknowledge it. I honestly don't know what to do. Even if I did, I'm not entirely sure I would make an effort. What the hell is wrong with me? I feel suicidal at times, yet I would never follow through. It's almost like my sane side sees the insane side of me and it's a constant battle for control. I've tried the meds, they make me a completely different person, so I've stopped using them completely. I could use some good advice. : /

#29 soxy

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Posted 02 December 2011 - 07:33 AM

Hello Anathema and everyone who has posted their very moving stories on this forum. Having been diagnosed with cml, a form of chronic leukaemia on my 40th birthday (Happy Birrrthdayy!) three years ago and I went to seek psychological help to cope with this devastating news. I then found out that not only was I seriously ill, but I'm also aggressive in a passive way. The jackpot!


Three years on things have improved. The CML is controlled with drugs and I am still in therapy and improving all the time.

Anathema, this lack of motivation is only part of your symptoms from the papd. Have you tried meds at a mild dose? Escitalopram for example. This may give you a break from these
negative feelings and give you a chance to be creative to find solutions. Ofcourse therapy is very helpful. Perhaps may I suggest that you look at what you can afford to pay and approach therapists in your area with your budget. There may be someone out there who is willing to work with you for a reduced price.

In the meantime there are websites and self-help groups. My advice first would be to look at alternatives to being aggressive. This was the first step for me - assertivity. It's a tough nut to hole, but once you truly understand what it entails it takes some of the pressure off.

I still feel mightily p***** off with people from time to time and it really takes alot of effort to be assertive, say how I feel and make clear certains limits with intrusive people. But it works - and how! No more conflict - just assertively saying how you feeling and how you would prefer things to be. It is so effective! People have a tendancy to listen more to this type of communication, whereas if you don't say anything and let the anger grow inside, it's bad for you, and if you let rip it only creates conflict.

Anyway, PM me for a couple of websites which may help. The very best of luck in becoming the happy, joyful person you can be - I'm thinking of you and send you much love - sincerely!

Edited by nocturneangel, 07 January 2012 - 05:33 PM.
Removed links


#30 Anathema1982

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Posted 03 December 2011 - 07:03 PM

Thank you so much. This was incredibly helpful and strangely enough what my girlfriend has been hinting at for the past couple years. I still can't believe I allowed this to drag on as well as drag her down, but there is nothing I can do about it. I still feel absolutely guilt stricken and am placing blame fully upon myself, which in turn adds to the self-loathing; but I do realize that I have to fix myself before I can repair what's left of my relationship. It's just extremely hard knowing you're going to be forced out of your comfort zone and also knowing you're not going to be allowed back in. I'm having an anxiety attack as I type this actually. Go figure. I'm going to stop venting now. Not sure if this is the proper channel. Thanks again.

Edited by Anathema1982, 03 December 2011 - 07:10 PM.


#31 soxy

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Posted 06 December 2011 - 02:25 PM

Hi Anathema

Ofcourse it's the right channel to vent! Go for it!! If you can't let rip on a blog, then where can you?!

In saying " I am placing blame fully upon myself " you are, in fact, taking responsibility for how you are and letting yourself know you wish to change. For this you can be well pleased with yourself because you want to give yourself, and your girlfriend, a break. A highly positive thing, I would say, so no need for self loathing. Actually, judging by your reply you seem to be a really nice guy, so the first thing to do ( in my opinion, and I am a lowly high school music teacher, not a psy) is stop putting yourself down and look at the situation from a purely scientific point of view. Something like, "I am passive agressive for certain reasons, these may be: my parents were this way and I reproduced their behaviour; I was badly treated as a kid and have trouble getting over that; I remain dependant on my parents "(this may be unconscious) etc..
And by the way, the change is gradual, so you leave your "comfort zone" little by little. After three years I have a little visit now and again! If I can get rid of my wife for the weekend I stay in bed 'til 1pm and think "**** 'em all!" It's great.

Maybe your problem isn't so serious. I was acting like a teenager even though I was 40, and was completely unconscious of the fact. It was amazing. And a real blow when my psy told me how I was behaving! It took me a year to get over it and accept it. It is a hard journey sometimes but well worth it. WELL worth it!

Oh, and get the "Cognitive therapy for dummies" book - it's great! If you live in the u.k. you can get CBT for free on the national health service. In the states there may be charitable organisations to help people financially.
You'll enjoy it, don't worry. All the best,
Ian

#32 soxy

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Posted 06 December 2011 - 05:08 PM

Sorry, that's "Cognitive Behavioural Therapy for dummies" - excellent!
Hope to blog with you soon!

Edited by soxy, 06 December 2011 - 05:17 PM.


#33 soxy

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Posted 07 December 2011 - 05:19 AM

Hey Anathema!

I've been thinking so much about you over the last couple of days and we don't even knpw each other and yet have so much in common.
If I am being intrusive, feel free to tell me to f. off and give you some space. The last thing I want to do is swamp you with ideas and become a royal pain in the ***!
I guess I just felt suddenly overcome with compassion for someone who is going through what I am going through.
May I suggest some music to listen to, both pieces I heard on the radio this morning and made me think of you.
The first is "Beatitudes" by Arvo Part. This should help you to feel and to realise that you are a human being with your faults and positive sides and help you to accept yourself as you are now - and that you are wonderful.
Talking of wonderful the second piece is by the utterly incredible Sarah Vaughan - Mr Wonderful. She is singing about you, my friend.
You should be able to hear both pieces on youtube.
Look after yourself and greetings from sunny Spain! The weather today is lovely!
Ian

P.S. by the way I'm not a christian or anything - it's just very beautiful music- beatitudes meaning blessings.




Edited by soxy, 07 December 2011 - 05:23 AM.


#34 soxy

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Posted 07 January 2012 - 03:33 PM

Not that there's anything wrong with being a christian if you are one, tough. Happy New Year!

#35 soxy

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Posted 07 January 2012 - 03:36 PM

Hi member who is reading this. Hope you are well and happy. Have a good year.

#36 Norlaminis

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Posted 27 March 2012 - 09:24 AM

Interesting Find on this. I actually from all the listed above, suffer. I would like to say one thing before my final note, Treatments, what are they ?
And last but not least.

Help.

#37 Trace

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Posted 28 March 2012 - 02:41 AM

Interesting Find on this. I actually from all the listed above, suffer. I would like to say one thing before my final note, Treatments, what are they ?
And last but not least.

Help.


Hi Norlaminis

You may want to take a look in The Personality Disorders Room here for info on treatments and others experiences. Therapy may help and various medications.

Trace
Listen in deep silence. Be very still and open your mind.... Sink deep into the peace that waits for you beyond the frantic, riotous thoughts and sights and sounds of this insane world. - A course of miracles.

True beauty must come, must be grown, from within.... - Ralph W Trine.



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#38 _S_

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Posted 03 April 2012 - 04:47 AM

I'm new here ... I found the forums when I was looking for help with my own dysthymia but this describes my father *perfectly*.

I think I'll be spending a lot of time here reading and trying to understand the many aspects of depression and how what's going on in the family might be affecting me.

#39 sparkareno

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Posted 22 June 2012 - 12:00 PM

I don't know where to begin. I fell in love with a man about 9 months ago & occasionally would see glimpses of hostile behavior but I was so blinded & touched by his apologies after that I chose to ignore it. Now it has escalated to the point where it was making me crazy so I did some research. He is a textbook classic example of PAPD right down to the causes stemming from his childhood. When we are good it is bliss & love like I have never felt before but then come the irrational outbursts, the withdrawal, the lies, blaming and the not following through (probably the most frustrating to me). We broke up a couple days ago and now he wants to give it another try. I certainly see how I was co-dependant & my role in keeping this craziness going & am willing to work on it. But I wonder if he can. Does anyone have experience with getting someone else to change? I am not sure how to even approach telling him what I think his problem is--no one wants to be told they have a personality disorder. But he does know that getting back together is not an option unless changes are made. He is a brilliant man & with such wonderful qualities EXCEPT for this biggie...& it could be a deal breaker.
I am so touched by everyone's stories here and the more I read, the more I cry. It must be hell to live with those demons. Parents need to realize that what they expose their kids to affects their whole life.
Suggestions on how to approach this? What I can do to not "feed the beast"?

#40 leeanna

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Posted 13 August 2012 - 09:30 PM

My doc told me i was passasive aggressive about two years ago and since just writes my script. I am now getting a divorce from a 12 yr marriage and dont want to take all the anger with me to my new relationships. I am happy about my independence but i see after the fact where i need to change just in an everyday conversation. I see this but dont know how to change this. Help




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