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The objective of this study was to investigate the familial aggregation of passive aggressive personality disorder (PAPD), and explore issues regarding PAPD raised by the DSM-IV Personality Disorder Work Group. Two thousand seven hundred and ninety-four Norwegian twins from the population-based Norwegian Institute of Public Health Twin Panel were interviewed with the Structured Interview for DSM-IV Personality (SIDP-IV). Because of the rarity of the twins meeting full diagnostic criteria for PAPD a dimensional representation of the disorder was used for the analyses. Overlap with other axis II disorders was assessed by polychoric correlations, while familial aggregation was explored by structural equation twin models. Overlap was highest with paranoid (r = 0.52) and borderline personality disorder (r = 0.53), and lowest with schizoid (r = 0.26). Significant familial aggregation was found for PAPD. The twin correlations and parameter estimates in the full model indicated genetic and shared environmental effects for females, and only shared environmental effects for males, but the prevalence of endorsed PAPD criteria in this community sample was too low to permit us to conclude with confidence regarding the relative influence of genetic and shared environmental factors on the familial aggregation of PAPD.
The essential feature of DSM-IV Passive aggressive (negativistic) personality disorder (PAPD) is: "A pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance" (American Psychiatric Association, 1994). A forerunner of the current diagnostic category was introduced by American psychiatrists in the aftermath of the second World War to characterize soldiers who were reluctant to follow orders, and did so only with concealed hostility and resentment (Millon & Radovanov, 1995). Although modified versions of the disorder have been included in all editions of the DSM classification since 1952, the diagnosis has been controversial in part due to its narrow scope, and was only reluctantly included in DSM-II and DSM-III. Despite having forerunners in the clinical literature for almost a century, there has been very little research effort devoted to PAPD (Blashfield & Intoccia, 2000). It was the DSM-IIIR personality disorder least supported for inclusion in DSM-IV (Millon & Radovanov, 1995). The DSM-IV Personality Disorder work group considered several issues including low prevalence, diagnostic overlap with other personality disorders (PDs), diagnostic reliability, internal consistency and external validity, and concluded...