Pathological Demand Avoidance (PDA) in Neurodiverse Relationships
Tuesday, January 7, 2025. This is a complete rewrite of a blog post I first wrote on 6/13/23. I spoke at the American Family Therapy Academy in Baltimore a week later to an audience of colleagues on understanding Demand Avoidance.
In my work with neurodiverse couples, I often encourage partners to dive deeply into understanding neurodiversity and relationships. It’s not just about learning diagnostic terms or theories but fostering a shared understanding that creates space for empathy, growth, and collaboration.
One term that has surfaced repeatedly in sessions with my neurotypical clients is Pathological Demand Avoidance (PDA). For some, stumbling across the term has brought clarity, while for others, it’s raised even more questions.
Take one client, for instance, who shared this insight: “I read an article about PDA and started seeing some of my husband’s quirks in the description. It’s not the little things—like asking him to pick up milk—but the bigger issues, like communication and cooperation, where I feel this resistance.” This reaction is a common starting point for conversations about PDA in couples therapy.
What Is Pathological Demand Avoidance?
Pathological Demand Avoidance, sometimes referred to as Extreme Demand Avoidance, is not about laziness or a simple reluctance to tackle tasks. For some neurodiverse individuals, requests—even routine ones—can feel overwhelming, triggering anxiety and resistance.
The term was first coined by Elizabeth Newson over two decades ago when she observed children exhibiting what she described as “demand-avoidant behavior.”
Since then, PDA has been discussed as part of the autism spectrum, though some researchers argue it may manifest outside of autism as well, perhaps tied to personality traits or other conditions. However, PDA remains controversial—it’s not included in the DSM, and the research around it is still in its infancy.
As a therapist specializing in neurodiverse couples, I approach PDA cautiously.
It’s both a useful concept and a potential minefield. Mislabeling or misunderstanding PDA can lead to significant harm, especially when it’s confused with personality disorders or viewed through a neurotypical lens that lacks context.
Traits Often Associated with PDA
PDA is often described as a behavioral profile rather than a clear-cut diagnosis. Traits linked to PDA include:
Negative Affect: Mood swings, heightened emotional reactivity, and fluctuating emotional states. For example, Trull et al. (2008) describe this as “extreme shifts in mood” and “exaggerated reactivity to environmental stimuli.”
Antagonism: Low agreeableness, including traits like combativeness, grandiosity, and distrustfulness, often correlating with externalizing behaviors.
Disinhibition: Acting impulsively, prioritizing immediate gratification without regard for consequences (APA, 2013).
Psychoticism: Aggression, impulsivity, and aloofness, which can resemble traits seen in personality disorders (Eysenck’s dimensions).
While these traits paint a picture of PDA as a challenge, they’re often too broad and can easily be misapplied. For neurodiverse individuals, what looks like “exaggeration” or “impulsivity” may be a genuine response to overwhelming stimuli. Context is everything.
The Challenges of Defining “Demand”
In the context of PDA, a “demand” can be any request, expectation, or obligation—even something as simple as initiating a conversation. Demands may be explicit or implied, and what feels routine to one partner may feel insurmountable to the other.
For neurotypical spouses, this can be incredibly frustrating.
They may feel their requests are reasonable and see their partner’s resistance as deliberate or even manipulative.
Meanwhile, the neurodiverse partner may experience these demands as a threat, triggering a fight-or-flight response.
It’s a recipe for gridlock unless both partners learn to approach the issue with mutual understanding and flexibility.
PDA in Relationships: A Complex Dance
Pathological Demand Avoidance can manifest in varying degrees.
Some folks may manage workplace demands effectively but struggle at home, where emotional expectations and intimacy require ongoing engagement. The very fabric of a committed relationship—cooperation, interdependence, and emotional reciprocity—can feel overwhelming.
A spouse with PDA traits might resist in ways that appear passive-aggressive or oppositional. They may:
Refuse to engage with requests, either directly or subtly.
Express frustration or anxiety when faced with expectations.
Withdraw emotionally or physically from situations that feel demanding.
Perceive their partner’s requests as controlling, even when that’s not the intent.
This dynamic often leads to resentment and hurt feelings. The neurotypical partner may feel unsupported, while the neurodiverse partner may feel unfairly pressured.
Reframing the Narrative
One of the biggest challenges in couples therapy for neurodiverse relationships is dismantling the stories each partner has built about the other. For example:
The neurotypical partner may tell themselves, “My spouse is selfish or lazy because they refuse to help.”
The neurodiverse partner may think, “My spouse is constantly trying to control me.”
Both narratives are reductive and miss the nuance of what’s really happening. Therapy helps couples move beyond these “stories” to uncover the underlying needs and fears driving their behaviors.
Moving Toward Collaboration
For neurodiverse spouses with PDA traits, the work often involves finding ways to confront the discomfort triggered by demands. This doesn’t mean forcing compliance but developing strategies to manage the anxiety and resistance that arise.
For neurotypical partners, the focus may be on reframing how they approach requests. Instead of framing a need as a demand, they can experiment with:
Collaborative Problem-Solving: Framing requests as opportunities to work together.
Flexibility: Being willing to adjust expectations and find compromises.
Empathy: Recognizing that resistance is not a personal rejection but a response to internal overwhelm.
A Shared Path Forward
Marriage, particularly in neurodiverse relationships, requires constant negotiation of expectations. While PDA adds an extra layer of complexity, it’s not insurmountable. By approaching each other with curiosity, compassion, and a willingness to adapt, couples can transform what feels like an impasse into an opportunity for growth.
To my neurodiverse clients, I say: Yes, “demands” can be overwhelming.
But if your goal is to build a fulfilling partnership, it’s worth exploring how to meet your partner halfway. I can help with that.
And to my neurotypical clients: Your frustration is valid, but understanding and flexibility can go a long way in bridging the gap.
Together, we can move beyond the labels and stories to build relationships rooted in mutual respect and connection.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
Butler, Emily. (2021). Reframing PDA: The Power of an Autistic Perspective.
Moore, A. (2020). Pathological demand avoidance: What and who are being pathologized and in whose interests? Global Studies of Childhood, 10(1), 39–52. https://doi.org/10.1177/2043610619890070
National Autistic Society. (n.d.). PDA - A Guide for Autistic Adults.
O’Nions, E., Christie, P., Gould, J., Viding, E., & Happé, F. (2014). Development of the ‘extreme demand avoidance questionnaire’ (EDA-Q): Preliminary observations on a trait measure for pathological demand avoidance. Journal of Child Psychology and Psychiatry, 55(7), 758–768. https://doi.org/10.1111/jcpp.12149
O'Nions, E., Viding, E., Greven, C. U., Ronald, A., & Happé, F. (2014). Pathological demand avoidance: Exploring the behavioural profile. Autism, 18(5), 538–544. https://doi.org/10.1177/1362361313481861
White, R., Livingston, L. A., Taylor, E. C., Close, S. A. D., Shah, P., & Callan, M. J. (2022). Understanding the contributions of trait autism and anxiety to extreme demand avoidance in the adult general population. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-022-05469-3