Pathological demand avoidance or persistent drive for autonomy?

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Pathological Demand Avoidance (PDA) is a neurodivergent profile that is associated with high levels of anxiety, an intense need to avoid everyday demands, and a desire for personal control. The condition is complex, and its expression varies between individuals. However, there are common threads that unite those of us who identify with it.

The term "pathological demand avoidance" (PDA) is not without controversy. The adjective "pathological" is  disliked by many in the PDA, and wider autism communities, because of its negative implications. The word is often associated with disease or dysfunction, which can be stigmatising. As a result, some prefer the alternative phrase “pervasive drive for autonomy”, which was proposed in 2019 by myself, Sally Cat, and fellow PDA individual T. Wilding. The phrase reframes our demand avoidance as a by product of seeking autonomy, and in many ways, it sounds much more positive, almost poetic.

However, my personal view—and that of others in the community—is that we shouldn’t prioritise the desire for a more palatable term in place of an honest reflection of our lived experiences. For some of us, the need for autonomy feels secondary to the overwhelming drive to avoid demands. Our need for autonomy can therefore be seen as a side-effect of our avoidance, rather than the other way round.

If we consider the fact that our hallmark PDA-type of avoidance is essentially irrational, in that it can indiscriminately drive us to avoid things that are beneficial or pleasurable (like drinking when thirsty because our brain has flagged our body's need as a demand), the concept of autonomy-seeking may seem less on point.

There's danger, too, in framing PDA as seeking autonomy, because it can cause people to assume we are never impeded by the condition, so never need help or support.

No Pressure PDA says:

'The word “autonomy” can bring to people’s mind that it’s best to step back and be hands off, but because PDA impacts the things even we want to do I think it’s good to realize that PDA people do rely on safe partnerships to accomplish things.'

I believe it is more important to honour the collective experience of the adult PDA community rather than prioritise a term that may sound more appealing but doesn’t truly reflect the combined reality of the condition.

In this context, I think it's crucial to discuss the term "pathological" and why I believe it should not be discarded. Although the word is often criticised for implying disease, I feel it’s the most accurate term to describe the severity and impact of the demand avoidance we experience. Myself and some fellow PDA advocates, such No Pressure PDA, want to reclaim the word "pathological" in the same way that the disability community has reclaimed the term "disabled". Once seen as a negative label, "disabled" is now embraced as a term of empowerment and identity. Similarly, in the context of PDA, we hope to reclaim the word "pathological" to indicate that our demand avoidance is biologically-rooted, rather than caused by trauma.

Ultimately, I believe that each individual should be free to use the terminology that feels most fitting for their personal experience of PDA. For me, the term "pathological" simply means that my demand avoidance is beyond my conscious control.


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