Note: You cannot be diagnosed with this disorder, as it's not in any diagnostic manual; you would be diagnosed with Other Specified Personality Disorder instead.
Criteria from the DSM-IV-TR (2000):
A pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
passively resists fulfilling routine social and occupational tasks
complains of being misunderstood and unappreciated by others
is sullen and argumentative
unreasonably criticizes and scorns authority
expresses envy and resentment toward those apparently more fortunate
voices exaggerated and persistent complaints of personal misfortune
alternates between hostile defiance and contrition
Millon's subtypes:
(Millon, ed.).
About PA/NegPD
PA/NegPD is similar to histrionic, dependent, avoidant, depressive, borderline, antisocial, paranoid, masochistic, obsessive-compulsive and narcissistic PDs. It's part of what Millon & Bloom term the "Aggressive Personality Patterns", along with AsPD, NPD, & Sadistic PD.
Renamed Negativistic PD in the DSM-IV; Millon suggested renaming it “oppositional personality disorder” (Lane).
Differential diagnoses include mood disorders, anxiety disorders, somatic disorders, and Oppositional Defiant Disorder. Many children who are diagnosed with ODD will develop PA/NegPD (Millon).
The most common PD comorbidities with PA/NegPD are AvPD (22.78%), AsPD (22.64%), & Sadistic PD (15.36%). The least common was OCPD (0.94%). Less than 1 percent (0.81%) had only ("pure") PA/NEGPD [less than those who had comorbid OCPD] (Millon & Bloom).
Millon defines it on a spectrum from sceptical -> negativistic (Millon Personality Group); or alternatively from discontented [personality type] -> resentful [style] -> negativistic [disorder] (Millon).
In the first DSM, it “... consisted of three subtypes - passive-dependent type who are helpless, overly dependent, and indecisive; passive-aggressive type who express their aggressiveness through passive means like pouting, procrastination, and intentional inefficiency; and the aggressive subtype who react to frustration with irritability, temper tantrums, and overt destructive behaviours” (Coolidge & Segal).
In the DSM-II it was described as being “characterized by passivity and aggression through obstinate behavior, procrastination, stubbornness, and intentional inefficiency” (Coolidge & Segal).
The DSM focuses on its overt/external behaviours and therefore miss its "cardinal qualities"; "underlying the behavior characterizing this personality pattern are profound confusion and ambivalence about self", similar to OCPD but with different coping strategies (Millon & Bloom)
It was a Cluster C PD, but in the DSM-IV & IV-TR it was moved to the Conditions for Further Study section “[d]ue to poor reliability and questionable validity and usefulness” (Coolidge & Segal). It wasn't included in any capacity in later editions.
PA/NegPD has a long history of ‘questionable validity’, as it originated in US military documents about reluctant soldiers during WWII, and continued throughout its history in the various DSMs to have criteria that could theoretically apply to anyone (e.g. dissatisfaction with their job or “personal misfortunes”, feeling misunderstood or unappreciated, complaining too much, etc.) (Lane).
However, Millon says “[s]uch thoughts are normal, but they represent what negativists feel most of the time. To them, every request or expectation feels like a willful imposition. Meeting requests or honoring expectations feels like submission, and meeting demands feels like humiliation” (Millon, ed.).
References
Coolidge, Frederick L., & Segal, Daniel L., ‘Evolution of Personality Disorder Diagnoses in the Diagnostic and Statistical Manual of Mental Disorders’, Clinical Psychology Review, 1998, vol. 18, no. 5, pp. 585-599.
Lane, Christopher, ‘The Surprising History of Passive-Aggressive Personality Disorder’, Theory & Psychology, 2009, vol. 19, no. 1, pp. 55-70.
Millon, Theodore, & Bloom, Caryl, The Millon Inventories, 2008.
Millon, Theodore, Disorders of Personality, 2011.
Millon, Theodore, ed., Personality Disorders in Modern Life, 2004.
I want to talk about the gays. Because, they gays are always claiming stuff for their own, and do you know why that is. It is because straight people started saying, "that's so gay!" to everything they thought was lame or stupid. so, they're essentially saying that they see gay people as lame or stupid. and the gays looked at that and saying, "no, fuck that. I like this, it is ours now." primary example, the rainbow. pretty obvious example, it's on the flag, after all, has been for decades. so anything to with rainbows, gay now.
except, you know who else uses the rainbow? autistics. something about the full spectrum of autism. you know, there are many kinds of autism, and the rainbow represents that. like, I was diagnosed as having Aspbergers as a teen, back when that was listed in the DSM. now, it's just "autism spectrum disorder", because that's "simpler" to understand. when I first heard about that, I was pissed, because I felt it was like amalgamating a rainbow into a single colour. black, I imagined it. not even white, which is all the colours, but black, the absence of colour. I felt all of the distinctions were important to know, because each was a unique autistic identity, not that I ever bothered to learn the other identities, but I felt mine was important, and I felt by striking out all the identities, I could no longer use the specific identity I was diagnosed with anymore. I just had to be "autistic".
but I digress. the point is, the rainbow isn't just important to one group, and to act like it is erases the other group to a certain extent. but I do find it funny when gays claim things for themselves. Sweater Weather, a song which the original artists didn't intend to be gay, is now for gays and bisexuals only. I once saw a tumblr post showing the different colours fire could turn, and because it looked like a rainbow, "fire is gay now." like, sorry to all you straights, but you use fire, you're gay now, I don't make up the rules! the problem is, when gays claim something as solely their property, just to get back at the straights for claiming all the good stuff is theirs, and all the bad stuff is for the gays. like, I understand the anger you could feel about that, I truly do. and some fault lies with the straights, when they think, oh, if this is gay, I can't associate with it, lest I be seen as gay. because gay has always been an insult, a slur, and if it wasn't, there'd be no problem in being seen as gay. but this war over straights and gays isn't helping us, it's only making us defensive and on alert.
and then there's anti-gay violence. when it comes to events like mass shootings, the rhetoric is not to remember the gunmen, but the victims. after the Pulse shooting, a full list of the gays who lost their lives went up on the internet, with instructions to learn their names instead. because learning the gunman's name, above those of his victims, is a little like having a confederate statue: it glorifies the violence, and the men who perpetrated them, rather than mourning and remembering the victims. So the list of the Pulse victims went up, and I tried to remember them. but the thing is, I don't remember their names, not a single one. perhaps it's because learning the victims names are harder, because there's so many more victims than there are perpetrators; perhaps it's because I don't know their stories, they're just names on a list, labeled by their deaths and not their lives; or perhaps, it's because their names weren't repeated, like the name of Trayvon Martin, from the Black Lives Matter movement. or maybe it's all of these things at once.
as a movement, I don't think we can remember everyone. but we can remember the ones that matter the most, and rally around them. because if we try to remember everyone, we'll sink under the weight of all the violence committed against gays. There was a badge I saw once that said, 'Avenge Oscar Wilde'. but if we focused on everyone ever killed by homophobia, we'd never be done avenging. we have to pick a few and fight for them. not to avenge, but to create a world where this can no longer happen.
Hey, I live in the UK and I’m pretty sure I’m autistic, I want to get professionally diagnosed so people will believe me. I fit some of the common autistic traits, and the dsm-v (although mildly) but when I read articles describing autistic people they didn’t really fit me that well. The things that fit me perfectly were descriptions of aspergers. I know that it technically isn’t a thing anymore, but when I’m trying to get diagnosed, should I ask to be tested for it instead of autism? (1/2)
(2/2) I don’t want to risk not being diagnosed if they test me assuming my traits are more severe than they actually are, and on diagnostic tests that I’ve taken, I usually score low on autism ones and high on aspergers ones. I understand that it’s been changed to asd, but I’m worried that they’ll separate the two anyway and I won’t get diagnosed, which would be extremely frustrating. thank you.
You are right that, at least in the DSM-V, Asperger’s is no longer a diagnosis. However, you can still find it in there: the previous diagnosis of Asperger’s corresponds to what would now be called “autism spectrum disorder level 1 without accompanying intellectual or language impairment”.
It sounds like you think ASD corresponds only or mostly to what was previously called autistic disorder (which used to be considered “severe”), and not Asperger’s (which was considered “high-functioning”). That isn’t so. While the current criteria under the DSM-V are tighter than those found in the DSM-IV, this doesn’t speak to the “severity” of symptoms as much as it does on the health care providers’ need to keep the number of diagnoses low in order to minimize costs for them. ASD represents both autistic disorder and Asperger’s.
As such, I believe it may be worth examining your own beliefs regarding what constitutes a “severe” presentation of autism vs. a “mild” one and why you feel that your symptoms are “mild”. I also recommend considering where these beliefs come from, that is, where you got your information. For example, older articles are more likely to push the idea of a “difference” between “autism” / Asperger’s. For “autism”, this often includes an emphasis on the person being nonverbal or unable to live independently. With Asperger’s, there are usually strengths and reassurances included that the person is “still” able to do certain things. Common examples here include living independently, having a career or having special talents. If you haven’t looked into it much, there is a risk of reading those descriptions (that are usually written ffrom an outsider’s POV) and think “But I can do thing! It must be Asperger’s!” - because no one is or likes to be thought of as incompetent (which is how many descriptions of autism unfortunately come across).
Our resources page has a lot of information on this:
What’s Wrong With Functioning Labels?
Functioning Labels Masterpost
Functioning Labels 101
Decoding the High Functioning Label
Functioning Labels Comic
On Functioning and “Functioning”
F*%$ Your Functioning Labels
More Problems With Functioning Labels
Fluctuating Functionality
Asperger’s and Autism
Sabrina and I also talk about the switch from Asperger’s to ASD in this post.
If you have Asperger’s, you are autistic. If you feel more comfortable with that term, ask to be assessed for Asperger’s. If you worry your traits may not come across, discuss this with your doctor.
A psychiatrist who wrote the criteria for narcissistic personality disorder takes issue with a letter from mental health professionals.
To the Editor:
Fevered media speculation about Donald Trump’s psychological motivations and psychiatric diagnosis has recently encouraged mental health professionals to disregard the usual ethical constraints against diagnosing public figures at a distance. They have sponsored several petitions and a Feb. 14 letter to The New York Times suggesting that Mr. Trump is incapable, on psychiatric grounds, of serving as president.
Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder.
Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy. It is a stigmatizing insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Mr. Trump (who is neither).
Bad behavior is rarely a sign of mental illness, and the mentally ill behave badly only rarely. Psychiatric name-calling is a misguided way of countering Mr. Trump’s attack on democracy. He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers.
His psychological motivations are too obvious to be interesting, and analyzing them will not halt his headlong power grab. The antidote to a dystopic Trumpean dark age is political, not psychological.
ALLEN FRANCES
Coronado, Calif.
The writer, professor emeritus of psychiatry and behavioral sciences at Duke University Medical College, was chairman of the task force that wrote the Diagnostic and Statistical Manual of Mental Disorders IV (D.S.M.-IV).
Writing off Trump’s actions as those of a mentally ill person is a disservice to those with mental illnesses. Maybe this letter from the psychiatrist who literally CHAIRED the writing of the DSM will get through to folks.
Note: You cannot be diagnosed with this disorder, as it's not in any diagnostic manual; you would be diagnosed with Other Specified Personality Disorder instead.
Criteria from the DSM-IV-TR (2000):
A pervasive pattern of depressive cognitions and behaviors beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
usual mood is dominated by dejection, gloominess, cheerlessness, joylessness, unhappiness
self-concept centers around beliefs of inadequacy, worthlessness, and low self-esteem
is critical, blaming, and derogatory toward self
is brooding and given to worry
is negativistic, critical, and judgmental toward others
is pessimistic
is prone to feeling guilty or remorseful
Millon's subtypes:
(Millon, ed.).
About De/MePD
De/MePD is similar to avoidant, schizoid, masochistic / self-defeating, negativistic / passive-aggressive and borderline PDs. It's part of what Millon & Bloom term the "Reserved Personality Patterns", along with AvPD & SzPD.
Differential diagnoses include anxiety disorders, mood disorders, and somatic disorders.
The most common PD comorbidities with De/MePD are AvPD (19.53%), AsPD (14.06%), & Negativistic / Passive-Aggressive PD (13.02%). The least common was HPD (1.82%). Less than 6 percent (5.34%) had only ("pure") De/MePD [much higher than people with pure Ne/PAPD or SaPD] (Millon & Bloom).
Millon defines it on a spectrum from pessimistic -> depressive (melancholic) (Millon Personality Group); or alternatively from dejected [personality type] -> forlorn [style] -> depressive [disorder] (Millon).
"The depressive and masochistic are so similar that some authors view them as a single constellation" (Millon, ed.).
In the DSM-IV-TR it was described as being “characterized by a pervasive pattern of depressive cognitions and behaviors, low self-esteem, brooding, and pessimism." (Coolidge & Segal).
"Always in a dejected and gloomy mood, they see themselves as inadequate and worthless. They submerge themselves in criticism for even minor shortcomings and tend to blame themselves when things go wrong. A pervasive pessimism leads them to anticipate the worst - to expect that life will always go wrong and never improve. Their days are spent brooding and worrying, ignoring the good and dwelling on the bad. Saturated with guilt, they wish that life could be different, but instead of taking the initiative, they berate themselves for missed opportunities and feel powerless to change their destiny. Such individuals may indeed be depressed, but their depression emerges from a way of thinking, feeling, and perceiving - a depressive personality" (Millon, ed.).
De/MePD only ever appeared in the appendix of the DSM-IV & IV-TR, and it was dropped because it was "controversial whether the distinction between depressive personality disorder and Dysthymic [Persistent] Disorder [was] useful" (DSM-IV-TR).
However, "many dysthymics did not meet criteria for depressive personality. [...] In fact, the proportion of those with depressive personality disorder who had never met criteria for dysthymia was high", indicating that De/MePD is likely a separate disorder from persistent & major depressive disorders (Millon, ed.).
References
Coolidge, Frederick L., & Segal, Daniel L., ‘Evolution of Personality Disorder Diagnoses in the Diagnostic and Statistical Manual of Mental Disorders’, Clinical Psychology Review, 1998, vol. 18, no. 5, pp. 585-599.
Millon, Theodore, & Bloom, Caryl, The Millon Inventories, 2008.
Millon, Theodore, Disorders of Personality, 2011.
Millon, Theodore, ed., Personality Disorders in Modern Life, 2004.
