The Surprising History of Passive-Aggressive Personality Disorder

The history of passive-aggressive personality disorder (PAPD) reveals many things about American psychiatry, including how its use and understanding of diagnostic categories have in recent decades changed. The disorder is thus a useful litmus test for establishing whether categories in the Diagnostic and Statistical Manual of Mental Disorders (DSM) have undergone a type of “diagnostic bracket creep” (Peter Kramer's term) with significant effects on the wider culture. The history of PAPD also allows us to assess whether psychiatry has encroached on routine traits and everyday practices, pathologizing behavior that was once considered normal. While the expansion of the DSM has generated widespread commentary and analysis, less has been written about PAPD, including how it came to be recognized and why its diagnostic parameters expanded so dramatically in each edition of the DSM. After tracing its roots to World War II, the essay reveals how the disorder came to be applied to ever-larger numbers of the civilian population. Original research drives the argument: previously unpublished memoranda from the American Psychiatric Association's archive that not only reveal the back-story to the disorder's expansion, but also cast new light on the organization's methodology, including its practical and theoretical difficulties in differentiating normal from pathological behavior.