Even though this disorder is not included in DSM-IV-TR, we have found that a significant number of patients have behaviors and beliefs indicative of this disorder. Individuals with passive–aggressive personality disorder have an oppositional style, which belies the fact that they do want to get recognition and support from authority figures. The chief problem is a conflict between their desire to get the benefits conferred by authorities on the one hand and their desire to maintain their autonomy on the other. Consequently, they try to maintain the relationship by being passive and submissive, but, as they sense a loss of autonomy, they are inclined to resist or even to subvert the authorities.

Self-view: They may perceive themselves as self-sufficient but vulnerable to encroachment by others. (They are, however, drawn to strong figures and organizations because they crave social approval and sup-port. Hence, they are frequently in a conflict between their desire for attachment and their fear of encroachment.)

View of others: They see others—specifically, the authority figures— as intrusive, demanding, interfering, controlling, and dominating, but at the same time capable of being approving, accepting, and caring.

Beliefs: Their core beliefs have to do with notions such as “Being controlled by others is intolerable,” “I have to do things my own way,” or “I deserve approval because of all I have done.”

Their conflicts are expressed in beliefs such as “I need authority to nurture and support me” versus “I need to protect my identity.” (The same kind of conflicts are often expressed by borderline patients.) The conditional belief is expressed in terms such as “If I follow the rules, I lose my freedom of action.” Their instrumental beliefs revolve around postponing action that is expected by an authority, or complying superficially but not substantively.

Threat: The main threat or fears revolve around loss of approval and abridgement of autonomy.

Strategy: Their main strategy is to fortify their autonomy through devious opposition to the authority figures while ostensibly courting the favor of the authorities. They try to evade or circumvent the rules in a spirit of covert defiance. They are often subversive in the sense of not getting work done on time, not attending classes, and so on—ultimately self-defeating behavior. Yet, on the surface, because of their need for approval, they may seem to be compliant and cultivate the goodwill of the authorities. They often have a strong passive streak. They tend to follow the line of least resistance; they often avoid competitive situations and are interested more in solitary pursuits.

Affect: Their main affect is unexpressed anger, which is associated with rebellion against an authority’s rules. This affect, which is conscious, alternates with anxiety when they anticipate reprisals and are threatened with cutting off of “supplies.”