Pathological Demand Avoidance or Persistent Drive for Autonomy: Language Matters

While not a recognized “diagnosis” in the DSM, there has been more research and talk around Pathological Demand Avoidance (PDA), a behavior profile characterized by avoiding, resisting, or otherwise not complying with expectations or commands. Many autistic people identify with the PDA profile, though some research suggests that non-autistic people can display PDA traits as well (although with what I know of the rampant misdiagnosis around autism, I have questions about those studies).

Since it is important to be mindful of the language we use and how that language affects the communities we discuss, it is essential that we note how the name “Pathological Demand Avoidance” is inherently, well, pathologizing of the individuals who display these behaviors. It assumes that the demand avoidance is bad or wrong, and the individual should be complying or meeting these demands.

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This is an issue in particular for the autistic community, many of whom are taught from an early age that their behavior is wrong and needs to be corrected, even though the behavior is meeting a need. Those pushing for affirming approaches to understanding the autistic (and other neurodivergent) experiences have called to change the name to Persistent Drive for Autonomy. Basically, instead of thinking of PDA as resistance or noncompliance, we see it as a desire to control our bodies and our experiences, a natural part of human experience.

As a side note, I also find “drive for autonomy” to be more accurate than “demand avoidance.” While I do not fit a full PDA profile, I have some of the traits. In high school, my math teacher told me she would not recommend me for AP Statistics because she felt I was not smart enough for the class. I went over her head, enrolled anyway, and got straight As purely out of spite. I would hardly call that “demand avoidance.”

Conceptualizing individuals as “avoiding” demands inherently strips away autonomy. It prioritizes getting someone to comply over identifying and meeting their needs, and it blames them for struggling when those needs are not met. We need to foster autonomy, not strip it away from those most victimized by the system.

Are there demands we need to meet? Of course! But when someone is unable to function, or is otherwise struggling, it is unhelpful to shame them and insist that they just do it anyway. Let’s shift the focus over to fostering healthy autonomy and connecting people to the supports they need.

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Published by Dr Marschall

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. She completed her internship at the National Psychology Training Consortium with specializations in assessment and rural mental health. Currently, she specializes in trauma-informed and neurodiversity-affirming care, and she is certified in telemental health. Dr. Marschall runs a private practice, RMH Therapy, where she provides individual and family therapy as well as psychological assessments across the lifespan. Dr. Amy Marschall is an author and professional speaker.

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