A few months ago, I became a member of some groups for pathological demand avoidance. Pathological demand avoidance (PDA) is a term coined by Elizabeth Newson from the UK for a set of symptoms that she claims are part of a distinct autism spectrum disorder. These symptoms include:
- Obsessive resistance of everyday demands.
- Appearing sociable on the surface but lacking deeper social understanding.
- Excessive and sudden mood swings.
- Language delay, possibly due to passiveness.
- Obsessisve behavior, often focused on people rather than things.
- Comfort (sometimes excessive) in role-play and pretending.
People with PDA are thought to have high anxiety and a need to be in control. This causes them to actively and/or passively resist demands placed on them by others.
I am not yet sure what I think of the existence of PDA. Is it yet another pathologization of annoying-but-normal behavior, or, worse yet, is it the new drapetomania? You know, the compulsive running-away of slaves? What I mean is, is it a healthy response to excessive authority? I was discussing something like this with my therapist last Thursday. I didn’t mention PDA – we’re treating my symptoms as part of borderline personality disorder -, but now that I think of it, I realize that the idea of PDA fits in neatly here. I have a seemingly compulsive need to resist expectations from others. Until I spoke about this to my therapist, I’ve always said this is a normal part of rebellion against the institutional system I’m in. Or is it? I resist attempts to give me responsibility for my own life, too, and earlier last week, realized I wasn’t sure I wanted to recover, out of fear of losing my support before I was ready.
Now I am not advocating labeling people with more diagnoses than they need. In my own case, it could well be that my problems are due to a combination of autistic overload, BPD-related identity confusion and having lived in situations where others determined my goals for much of my life. I am still unsure as to whether my therapist is not one of these authority figures, who wants independence only insofar as it isn’t defying her idea of who I am.
An important thing which Newson highlights in relation to PDA, is that ABA-style behavior modification does not work with PDA children (or presumabley adults). The therapeutic relationship is much more important than it is presumed to be in behavioral interventions. I like this, although I feel the therapeutic alliance is important for others with autism spectrum disorders too.
One thing I don’t like about Newson’s theory, is that she presumes PDA sufferers to be manipulative. Now I am not one to say that autistics can’t manipulate – they can and do -, but here comes the question again of where manipulativeness comes from: is it an innate PDA characteristic, or is it learned behavior in an attemt to manage a hard-to-cope-with environment? Newson assumes manipulation in PDA is not something the child chooses out of a will to be annoying, but out of a need for control and to avoid anxiety. Overload, of course, is often confused with anxiety, so in this sense I’m not too sure that I think.