Understanding, Supporting, and Treating Adults with Pathological Demand Avoidance

Pathological Demand Avoidance (PDA) is a complex condition that affects adults in unique ways. Unlike other mental health conditions, PDA is not recognized by the DSM-5 or ICD-11, which can make it challenging for mental health providers to diagnose and treat. However, research has shown that PDA is characterized by specific characteristics that set it apart from other neurodevelopmental disorders.

One of the key features of PDA is neurological involvement, which can manifest in various ways, including delayed milestones, clumsiness, and seizures. Adults with PDA may also exhibit obsessive behavior, often targeting specific people or their characteristics. This obsession can be motivated by a need for control and may lead to impulsive behaviors.

Social interactions can be challenging for adults with PDA, who may display 'surface sociability' - the ability to manage social interactions superficially but lack a normal sense of social identity. This can result in socially shocking behavior that is viewed as infantile or bothersome by peers. Furthermore, individuals with PDA may resist everyday demands and employ manipulative strategies to avoid compliance, such as distraction, threats, or targeted shocking behavior.

The profile of adults with PDA was first described by Elizabeth Newson and her colleagues over 40 years ago. Since then, researchers have continued to study this condition, shedding light on its unique characteristics and challenges. As a result, mental health providers are beginning to recognize the importance of understanding and addressing PDA in adult populations.

In recent years, I had the opportunity to present at the National Association for Therapeutic Programs annual conference about PDA, highlighting its complexities and implications for treatment. Recognizing the need for more information and support, this article aims to provide an overview of Pathological Demand Avoidance in adults, with the hope of promoting better understanding, supporting, and treating strategies.

By acknowledging the distinct characteristics of PDA and the challenges it poses, mental health providers can work towards developing targeted interventions that cater to the unique needs of individuals affected by this condition. Ultimately, this may involve a combination of behavioral therapy, social skills training, and environmental modifications designed to promote coping mechanisms and improve quality of life for adults with Pathological Demand Avoidance.

Pathological demand avoidance adults