Understanding Pathological Demand Avoidance

Pathological Demand Avoidance (PDA) involves avoiding everyday demands or tasks typically due to feeling anxious about them. It is a natural human trait to want to avoid certain things that feel unpleasant and people practice different degrees of avoidance for varying reasons.

Avoidance may vary based on what, specifically, is being circumvented or how someone feels in the moment. For example, you may avoid working on a big project more than you might avoid taking a shower. Similarly, avoidance may be stronger when your stress levels are higher.  

Direct demands include requests or questions such as, “Can you please pay that bill?” or “Can you go to the grocery store on your way home?” Indirect demands include having a deadline, needing to make a decision, planning an event, coping with a life transition, being in an environment with a lot of sensory stimulation, or a person’s internal expectations such as perfectionism, etc. Demands can also include routine tasks such as cleaning, cooking, going to school or work, getting up at a certain time, etc.

PDA Links to Autism and ADHD

PDA has been associated with autism and is considered a subtype of autism. For some people, PDA may develop due to not understanding accepted social norms around task completion or feeling forced to comply with unclear rules and expectations. Demand avoidance can be a rational way to try to manage one’s surroundings when one’s needs are not recognized or met. Furthermore, avoidance behaviors are natural responses to stressful circumstances.

Many people with ADHD also identify with PDA. ADHD can make it difficult initiating and completing tasks. And, task initiation may be more difficult if it is too easy, too difficult, or boring which can be similar to PDA. However, those with ADHD may not be trying to actively avoid a task. The heightened emotion can that can accompany ADHD can become an added barrier to task completion which is also similar to PDA.

When Avoidance Behavior Becomes Problematic

Pathological demand avoidance refers to an extreme or all-encompassing amount of avoidance that creates problems in a person’s life. It is important to note that labeling demand avoidance as pathological may unintentionally be judgmental toward neurodivergent people. However, some aspects that make demand avoidance “pathological” include:

• Avoiding a demand simply because it is a demand. This may be related to anxiety about the expectations the demand might imply, which can create a sense of loss of control.

• There is an excessive or irrational quality to the avoidance. For example, someone has a strong emotional reaction to an objectively minor request.

• The avoidance creates significant difficulties in one’s life.

For some people demand avoidance may be overt, noticeable, or of a reactive quality. For others, it may be internalized and more passive, and they may try to hide difficulties and avoidance.

In addition to triggering anxiety, certain demands or situations can cause sensory overload and disrupt a person’s usual routine, causing a feeling of being overwhelmed. This PsychCentral article provides an overview of PDA.

Coping with Pathological Demand Avoidance

Continuously avoiding situations that are uncomfortable or cause us anxiety to a degree in which it effects our day-to-day life, may be a sign of PDA. There are different coping strategies that can set you off on a path towards positive change. Take a look at our list below:

• Recognize and name demands to build self-awareness. Demands are a part of our daily life and it is helpful to name what feels demanding to you. Some may be subtle such as needing to pick up dry cleaning or the expectation to say hello to someone as you pass them in a hallway.

• Recognize avoidance and the many forms it can take. Examples include distraction, procrastination, excusing yourself, trying to control a situation, masking/trying to hide avoidance, etc. 

• Cultivate self-acceptance and self-compassion. It is natural to be self-critical about experiencing challenges and difficulties. However, self-criticism can increase anxiety. Once, you recognize demand avoidance, ensure your inner dialogue is kind and compassionate. Remember that challenges are normal and you are doing what you can to get through the day.

• Adjust self-expectations. Check in with yourself about your expectations for meeting demands. Are your expectations realistic and doable? If not, see if you can set small and doable goals for yourself.

• Make demands less demanding. Are there ways in which you can make demands feel less anxiety-provoking? For example, can you chip away at demands over a longer period, take unnecessary demands off of your plate, or set a realistic maximum number of demands to complete in a day?

• Manage anxiety and/or sensory overload. It is important to take doable actions to manage anxiety and/or sensory overload to lessen demand avoidance. For example, take short breaks throughout the day, take time away from sensory stimulation, practice relaxation exercises, etc.

Ask for a Little Extra Help

The same way in which you might focus on managing daily demands and lessening them so as to not switch into overload mode and engage in demand avoidance as a consequence, you might want to ask for a little extra help in managing your PDA.  To learn more about coping with demand avoidance and the therapy options available to you, please contact us at CBT Denver.