The Negativistic (Passive-Aggressive) Patient - A Case Study

Disclaimer

The Negativistic (Passive-Aggressive) Personality Disorder appears in Appendix B of the Diagnostic and Statistical Manual (DSM), titled "Criteria Sets and Axes Provided for Further Study."

Notes of first therapy session with Mike, male, 52, diagnosed with Negativistic (Passive-Aggressive) Personality Disorder

Mike is attending therapy at the request of his wife. She complains that he is "emotionally absent" and aloof. Mike shrugs: "We used to have a great marriage, but good things don't last. You can't sustain the same levels of passion and interest throughout the relationship." Isn't his family worth the effort? Another shrug: "It doesn't pay to be a good husband or a good father. Look what my loving wife did to me. In any case, at my age the future is behind me. Carpe Diem is my motto."

Does he consider his wife's demands to be unreasonable? He flares: "With all due respect, that's between me and my spouse." Then why is he wasting his time and mine? "I didn't ask to be here." Did he prepare a list of things he would like to see improved in his family life? He forgot. Can he compile it for our next meeting? Only if nothing more urgent pops up. It would be difficult to continue to work together if he doesn't keep his promises. He understands and he will see what he can do about it (without great conviction).

The problem is, he says, that he regards psychotherapy as a form of con-artistry: "psychotherapists are snake oil salesmen, latter-day witch doctors, only less efficient." He hates to feel cheated or deceived. Does he often feel that way? He laughs dismissively: he is too clever for run-of-the-mill crooks. He is often underestimated by them.

Do other people besides crooks underestimate him? He admits to being unappreciated and underpaid at work. It bothers him. He deserves more than that. Obsequious intellectual midgets rise to the top in every organization, he observes with virulent envy. How does he cope with this discrepancy between the way he perceives himself and the way others, evidently, evaluate him? He ignores such fools. How can one ignore one's co-workers and one's superiors? He doesn't talk to them. In other words, he sulks?

Not always. He sometimes tries to "enlighten and educate" people he deems "worthy". It often gets him into arguments and he has acquired a reputation as a cantankerous curmudgeon but he doesn't care. Is he an impatient or irritable person? "What do you think?" - he counters - "During this session did I ever lose my cool?" Frequently. He half rises from his chair then thinks better of it and settles down. "Do your thing" - he says sullenly and contemptuously - "Let's get it over with."