Passive-Aggressive Personality Disorder Fast Facts

Passive-aggressive personality disorder (PAPD) is a condition in which a person does not directly express negative feelings, but instead expresses them indirectly and subtly.

Like all personality disorders, PAPD is generally not diagnosed in people under the age of 18.

Personality disorders like PAPD are characterized by long-term patterns of behavior that remain consistent over time.

United Brain Association

Personality disorders like PAPD are characterized by long-term patterns of behavior that remain consistent over time.

What is Passive-Aggressive Personality Disorder?

Passive-aggressive personality disorder (PAPD) is a mental health-related issue characterized by a tendency to indirectly express negative emotions rather than confronting them directly and openly. People with PAPD often have a consistently negative worldview but do not express their negative emotions overtly in their interactions with other people. Unfortunately, their unwillingness to honestly present their feelings often gets in the way of having healthy relationships.

There is a lack of consensus about whether PAPD is a distinct personality disorder, a personality trait that plays a role in other personality disorders, or merely a pattern of behavior. PAPD is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a unique personality disorder. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) published by the World Health Organization includes PAPD in its “other specific personality disorders” category.

Symptoms of Passive-Aggressive Personality Disorder

A core symptom of PAPD is a tendency to outwardly agree with the requests and opinions of others only to fail to follow through on these requests, often indirectly expressing anger or resentment in the process.

Other common symptoms of PAPD include:

  • Excessive stubbornness
  • Procrastination
  • Complaining about being underappreciated
  • Being critical of authority
  • Intentionally making mistakes or missing deadlines after agreeing to undertake a task
  • Persistent argumentativeness or resistance to cooperation
  • Refusing to take responsibility for one’s actions
  • Blaming others for one’s failures
  • Consistent sullenness, cynicism, or emotional coldness
  • Being envious of others’ good fortune

What Causes Passive-Aggressive Personality Disorder?

The exact cause of PAPD has not yet been discovered. Several factors, however, seem to put an individual at increased risk of PAPD.

  • Family history and genetics. People with PAPD often have a family history of the same disorder. Therefore, scientists suspect a genetic component to PAPD, but no definite association with any gene or group of genes has yet to be made.
  • Childhood experiences. Children at risk for PAPD may increase the risk if they experience abuse or neglect during childhood.
  • Drug or alcohol abuse may increase the risk of PAPD.

Is Passive-Aggressive Personality Disorder Hereditary?

Scientists have not yet identified a specific genetic component that increases the risk of PAPD. Inherited genes may increase an individual’s susceptibility to PAPD, but the disorder’s actual development may result from external triggering circumstances.

How Is Passive-Aggressive Personality Disorder Detected?

People with a passive-aggressive pattern of behavior typically avoid direct confrontations and express their negative feelings in other ways. Their behavioral patterns often disrupt healthy relationships and lead to conflict despite their attempts to prevent it.

Signs of passive-aggressive behavior include:

  • Sulking or using “the silent treatment” when upset
  • Claiming not to be angry when they actually are
  • Not following through after agreeing to do something
  • Preferring indirect communication (e.g., texts, social media) over face-to-face interactions

How Is Passive-Aggressive Personality Disorder Diagnosed?

PAPD is not included in the DSM, so mental health professionals who use that diagnostic manual will not officially diagnose PAPD as a distinct disorder. However, a person with passive-aggressive behavior patterns may be diagnosed with a “personality disorder trait specified” if the behavior causes significant impairment. The behavior may also be considered a manifestation of another diagnosable disorder.

The World Health Organization’s ICD-10 includes PAPD under the “other specific personality disorders” heading and gives diagnostic criteria for the disorder. The ICD criteria for PAPD include:

  • Resistance to the demands of social or occupational performance.
  • Opposition to authority or expectations which are expressed covertly.


How Is Passive-Aggressive Personality Disorder Treated?

Because PAPD is not a diagnosable condition in itself, no standard treatment is available. However, mental health professionals will often prescribe treatment for other co-existing mental health conditions, and those treatments may help to alleviate the symptoms of passive-aggressiveness.

Common treatment approaches include:

  • Cognitive-behavioral therapy
  • Group therapy
  • Antidepressant medications
  • Anti-anxiety medications
  • Anti-psychotic medications
  • Mood stabilizing medications
  • Attention-deficit medications

How Does Passive-Aggressive Personality Disorder Progress?

People with PAPD risk physical and social consequences stemming from their behavior.

Long-term adverse effects of PAPD can include:

  • Problems at work or school
  • Lack of healthy relationships
  • Social isolation
  • Substance abuse
  • Other mental health issues

How Is Passive-Aggressive Personality Disorder Prevented?

There is no sure way to prevent PAPD, but early intervention when a person exhibits passive-aggressive behavior may improve the long-term outlook.

Passive-Aggressive Personality Disorder Caregiver Tips

Many people with passive-aggressive personality disorder also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with PAPD:

Passive-Aggressive Personality Disorder Brain Science

Scientists don’t know how the brains of people with PAPD differ from those of healthy people, but PAPD’s occasional association with narcissistic personality disorder (NPD) may offer some clues. Some researchers have been looking for clues to the underlying neurological causes of NPD by examining brain function and structure in people with NPD. One study has discovered that the brains of participants with NPD were smaller in an area called the anterior insular cortex. This part of the brain is responsible for a wide range of functions, but research has suggested that it plays a role in emotional regulation and the sense of self. It also seems to be crucial in the development of empathy.

In the study, people with NPD had less brain tissue (called gray matter) in the left anterior insula and other parts of the brain than people without the disorder. The researchers also found that the size of the left anterior insula in all participants was directly related to self-reported measures of empathy.

Passive-Aggressive Personality Disorder Research

Title: A Study of Children at Risk for Disruptive Behavior Disorders

Stage: Completed

National Institute of Mental Health (NIMH)

Bethesda, MD 

This study investigates the characteristics of children and their environments that place them at risk for developing disruptive behavior disorders and co-morbid internalizing problems (anxiety and mood disorders). Children ages 4-5 with moderate (subclinical) and high (clinical) rates of misconduct during the preschool period are compared with low-risk children. Children and their families are studied again at four later time points: (a) early childhood (6-7 yrs.), (b) middle childhood (9-10 yrs.), (c) early adolescence (13-14 yrs.), and (d) mid-adolescence (15-16 yrs.). Assessments of children include dimensions of biological, cognitive, affective, emotional, and behavioral functioning, that have been identified in research with older children as putative risk and protective factors in the development of conduct problems. Socialization experiences within and outside the family, also hypothesized to influence developmental trajectories, are examined. Currently, Time 4 assessments are being conducted, with three-quarters of the research subjects tested. Behavior problems show significant stability across the first three time periods. However, some children improve over time, changes that result, in part, from more optimal environmental conditions. Different patterns of emotion dysregulation, ANS, and HPA activity in antisocial preschool children predict different types of externalizing problems at later time points. Behavior problems and their correlates differ for young disruptive boys and girls: Oppositional, aggressive girls are more likely to have co-morbid internalizing problems and emotion regulation patterns that may decrease the risk for continued antisocial behavior; however, they increase the risk for depression and anxiety later in development.


Title: Psilocybin Therapy for Depression in Bipolar II Disorder (BAP)

Stage: Recruiting

Principal investigator: Joshua D. Woolley, MD, PhD

University of California San Francisco

San Francisco, CA 

The primary goal of this study is to examine the safety, tolerability, and feasibility of psilocybin therapy in people with Bipolar II Disorder (BD II). Fourteen participants, ages 30 to 65 with clinically diagnosed BD II with active depression, in active outpatient mental health treatment, and who meet all other inclusion and exclusion criteria at screening will be enrolled. After baseline assessments, participants will engage in preparatory visits with trained facilitators, followed by an initial drug administration of oral psilocybin, supervised by the facilitators and a clinician who will conduct safety monitoring throughout. Participants will complete assessment and integration sessions with the facilitators subsequently to help process the experience. Participants who tolerated the first dosage may be asked to complete a second psilocybin dosing session, involving the same preparation, procedures, integration, and supervision as the first. Primary outcome measures will assess the safety, tolerability, and feasibility of study procedures. Efficacy will be measured by the change in depression as measured by the MADRS three weeks after the final psilocybin administration. Exploratory outcome measures will assess changes in sleep, quality of life, and therapeutic engagement.


Title: Dialectical Behavior Therapy Rutgers University Research Program (DBT-RU)

Stage: Recruiting

Contact: Shireen L Rizvi, PhD

Rutgers University

Piscataway, NJ 

This protocol establishes a research-oriented psychological treatment clinic within the Graduate School of Applied and Professional Psychology (GSAPP), called the Dialectical Behavior Therapy Rutgers University Research Program (DBT-RU). The overall aim of the proposed research is to find ways to improve therapist training in existing treatments for complex and difficult-to-treat problems (e.g., DBT, prolonged exposure), develop new and more effective treatments, and improve understanding of severe psychopathology. Consequently, this proposed research will have four branches: (1) training of research clinicians and evaluation of training methods; (2) training of clinical evaluators for the research studies and evaluation of assessment training methods; (3) assessment of treatment outcome, including assessment of mediators and moderators of change (both clinician and client data); (4) assessment and analyses of the psychopathology of subject populations who participate in the DBT-RU.

You Are Not Alone

For you or a loved one to be diagnosed with a brain or mental health-related illness or disorder is overwhelming, and leads to a quest for support and answers to important questions. UBA has built a safe, caring and compassionate community for you to share your journey, connect with others in similar situations, learn about breakthroughs, and to simply find comfort.

United Brain Association

Make a Donation, Make a Difference

We have a close relationship with researchers working on an array of brain and mental health-related issues and disorders.  We keep abreast with cutting-edge research projects and fund those with the greatest insight and promise.  Please donate generously today; help make a difference for your loved ones, now and in their future.                                                                 

The United Brain Association – No Mind Left Behind

Share Your Story

If you have an experience, a story, or someone in your life you want to recognize for their strength and willpower, please share it with us. We want to hear from you because listening is part of healing.

Connect With Us

Receive news on Brain Awareness, the Latest Research, and Personal Stories