Journal of Personality Assessment ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/hjpa20 Evaluating Stable and Situational Expressions of Passive-Aggressive Personality Disorder: A Multimethod Experience Sampling Case Study Katie C. Lewis , Jeremy M. Ridenour , Seth Pitman & Michael Roche To cite this article: Katie C. Lewis , Jeremy M. Ridenour , Seth Pitman & Michael Roche (2020): Evaluating Stable and Situational Expressions of Passive-Aggressive Personality Disorder: A Multimethod Experience Sampling Case Study, Journal of Personality Assessment, DOI: 10.1080/00223891.2020.1818572 To link to this article: https://doi.org/10.1080/00223891.2020.1818572 Published online: 02 Oct 2020. Submit your article to this journal View related articles View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=hjpa20 JOURNAL OF PERSONALITY ASSESSMENT https://doi.org/10.1080/00223891.2020.1818572 CLINICAL APPLICATIONS AND CASE STUDIES Evaluating Stable and Situational Expressions of Passive-Aggressive Personality Disorder: A Multimethod Experience Sampling Case Study Katie C. Lewis1 , Jeremy M. Ridenour1, Seth Pitman1, and Michael Roche2 1Austen Riggs Center, Erikson Institute for Education and Research, Stockbridge, Massachusetts; 2West Chester University, West Chester, Pennsylvania ABSTRACT ARTICLE HISTORY Passive-aggressive (PA) personality traits have received increasing attention in the research litera- Received 25 June 2020 ture and are known to interfere with treatment engagement and recovery. Theoretical disagree- Accepted 18 August 2020 ments about PA, combined with its omission from the DSM-5, have left open many questions KEYWORDS regarding its dynamic structure and temporal stability. Our goal in the present case study was to Personality; personality use a multimethod, experience sampling assessment framework for a single research subject assessment; passive- enrolled in long-term residential treatment who exhibited significant PA traits to provide a com- aggression; personality plex portrait of daily interpersonal behaviors and experiences across a range of contexts. We disorders; multimethod review data gathered over a year of residential treatment to identify changes in self and interper- assessment; ecological sonal functioning and to deepen our understanding of the dynamic motivational structure of PA momentary assessment over time. Our findings expand understanding of both PA dynamics and provide support for inte- grating multimethod assessment into routine clinical practice. After participating in a two week-long experience sampling in indirect and unexpected ways. Dale displayed frequent study on daily interpersonal interactions, Dale, a middle- anger toward staff, felt unappreciated and ignored by others, aged patient in residential treatment, sits with the researcher struggled with communicating feelings of frustration, and for a feedback session to review his results. On first glance, (perhaps consequentially) often defied responsibilities, con- it appears that Dale spent much of the last two weeks feeling veying a picture of an individual struggling with anger but quite angry – his responses reference feelings of being only able to express these feelings in passive-aggres- enraged, pissed off, and furious – and the researcher antici- sive ways. pates that Dale will spend the feedback session venting Passive-aggression (PA) has alternately been conceptual- about his frustrating past two weeks. Instead, Dale expresses ized as a trait, a dynamic pattern of behavior, and a person- bafflement –“But, I’m not an angry guy!” he insists, strug- ality syndrome or disorder (Hopwood & Wright, 2012). gling to reconcile the descriptions of his experiences that he While PA personality disorder is not currently listed as a “knows” he provided, with what he “knows” about himself. personality disorder in the DSM-5 (APA, 2013), over the How can the discrepancy between Dale’s conscious past decade there has been a revival of interest in under- reporting of daily experiences and his more general internal- standing PA dynamics (Bradley et al., 2006; Hopwood, 2018; ized self-concept be understood? It is known that people are Hopwood et al., 2009; Hopwood & Bornstein, 2019; typically only partially accurate in their self-perceptions Hopwood & Wright, 2012; Joiner Jr & Rudd, 2002; Masiak (Vazire, 2010); a variety of factors may interfere with an & Eugene, 2011; Rotenstein et al., 2007). Hopwood and individual’s capacity for accurate self-appraisal, including Wright (2012) outlined three defining features of PA per- severity of personality psychopathology (Carnovale et al., sonality disorder: 1) engagement in irresponsible behaviors 2019), specific personality traits such as narcissism (Robins at work to express grievances or negative emotions, 2) feel- & John, 1997), and elevations in negative affect (Paulhus & ings of inadequacy, especially in relation to perceived power- Levitt, 1987). Feelings of anger, the primary experience of ful authority figures, and 3) harboring unexpressed concern and conflict for Dale, are particularly difficult for contempt and resentment about perceptions of mistreatment people to recognize and own (Vigil-Colet et al., 2012). For by others. Developmentally, PA is believed to be caused by patients diagnosed with personality disorders, a lack of impairments in assertiveness, emerging from disruptions in insight into these emotional patterns tends to be the rule, the child’s relationship to authority figures (Hopwood et al., rather than the exception (Bradley et al., 2006; Westen, 2009; Kernberg, 1976) and particularly to caregivers who 1997). Members of Dale’s treatment team were well-aware punish expressions of anger, refusal to submit, and autono- of his capacity for hostility – though it was often expressed mous strivings (Benjamin, 1996). A recent study of CONTACT Katie C. Lewis [email protected] Austen Riggs Center, Erikson Institute for Education and Research, 25 Main Street, Stockbridge, MA 01262. ß 2020 Taylor & Francis Group, LLC 2 K. C. LEWIS ET AL. psychiatric patients enrolled in day treatment found that Although the study was exploratory in nature, we devel- severity of PA traits was associated with greater impairments oped general hypotheses regarding the kinds of interpersonal in interpersonal functioning, particularly with regards to the patterns that would be likely to emerge, and what changes enactment of cold and vindictive behaviors (Laverdiere would be observed over the course of treatment. Given et al., 2019). Regardless of whether PA is conceptualized as Dale’s reactions during the research feedback session and in a trait, dynamic pattern, or formal personality disorder, it is light of existing literature on limitations in insight in indi- known to interfere with treatment engagement and recovery viduals diagnosed with personality disorders, we anticipated (Masiak & Eugene, 2011) and to be related to anxiety, that at baseline there would be marked discrepancy between depression, hopelessness and suicidality, and substance use Dale’s self-reported general personality traits and behaviors, (Joiner Jr & Rudd, 2002). his characterizations of interactions during daily life, and his As with other personality disorders, for case conceptual- underlying relational schemas, emotional awareness, and ization and treatment it is essential to understand both implicit self-concept as assessed through performance-based implicit motivational factors as well as conscious awareness measures (Carnovale et al., 2019; Vazire, 2010). In keeping of relational difficulties and sense of self. Hopwood (2018) with Hopwood and Wright (2012), we anticipated that has argued for the importance of understanding the Dale’s data would reveal three pervasive themes representa- expression of personality traits both in terms of longitu- tive of his underlying PA dynamics: 1) experiences of self as dinal dynamics (fluctuation versus stability over long peri- powerless and submissive, 2) perceptions of authority figures ods of time), between-situation dynamics (the context- as domineering and hostile, and 3) patterns of unexpressed specific details of when and how personality traits are hostility resulting in uncooperative behaviors aimed at expressed), within-situation dynamics (the real-time unfold- reducing the perceived power of authority figures ing and sequencing of interpersonal perceptions, affects, (Hopwood, 2018). Over the course of treatment, we antici- ’ and behaviors), and how levels of awareness across these pated that Dale s data would show movement toward greater different temporal contexts may vary. Tying stability, convergence in findings across measures and domains, awareness, and motivation together, he argues that “…a enhanced self-efficacy with improved capacity to express satisfying model about how personality manifests in situa- anger and engage conflict directly, and the development of tions must make distinctions between the situation the per- more benign attitudes and expectations for interpersonal son is in, how the person feels on the inside as opposed to relationships, especially toward authority figures. We sought how they are perceived on the outside, and what they are to integrate our interpretations of findings across these ele- trying to do in contrast to an abstract description of their ments under the general domains of dynamics of self and behavior” (Hopwood, 2018,