Examining Defense Mechanisms Based on Repressed Anger in Patients With Passive-Aggressive Behavior

Abstract

This study aimed to identify and explain defense mechanisms based on repressed anger in patients with passive-aggressive behavior and to analyze their psychological and behavioral consequences. A qualitative design with thematic analysis was employed. Participants consisted of 21 patients with passive-aggressive behavior from Tehran, selected purposively. Semi-structured interviews were conducted until theoretical saturation was reached. Data were transcribed verbatim, analyzed using NVivo software, and coded according to Braun and Clarke’s (2006) thematic analysis steps. Findings revealed three main categories: the lived experience of repressed anger (e.g., feelings of frustration, anxiety, fear of rejection, and guilt), predominant defense mechanisms (e.g., denial, projection, reaction formation, displacement of anger, and rationalization), and psychological and behavioral outcomes (e.g., expression of passive-aggressive behaviors, somatic problems, reduced self-esteem, and interpersonal difficulties). Participants predominantly attributed these mechanisms to family upbringing and cultural norms of emotional suppression. The results indicate that suppression of anger and the use of maladaptive defense mechanisms in patients with passive-aggressive behavior lead to significant psychological and social problems. Identifying these patterns can inform targeted therapeutic interventions and emotional expression skills training.