Conceptualising Pathological Demand Avoidance in Adulthood: A mixed methods investigation

: (Alternative Format Thesis)

Abstract

Pathological demand avoidance (PDA) is generally defined as a condition characterised by avoidance of everyday tasks using social strategies, as well as emotional lability, and often behaviour that challenges. PDA is often described as a profile of autism. Despite not being recognised by the DSM-5 or ICD-11, increasing numbers of adults identify as having PDA. Research into PDA is lacking, particularly with adults with PDA. It is debatable how PDA should be best categorized, whether as a neurodevelopmental or psychiatric label, or indeed whether it should be a label at all. This thesis investigates conceptualisations of PDA using quantitative and qualitative methods. Chapter One discusses the background literature of PDA. Chapter Two reports two quantitative studies testing relationships between PDA and established conditions such as autism, anxiety, and ADHD. Chapter Three develops a new measure of demand avoidance traits in order to further investigate the relationships between PDA and types of anxiety. Chapters Four and Five are qualitative studies using interview data. Chapter Four explores the lived experiences of adults with PDA, looking at the impact of being labelled as PDA. Chapter Five investigates how clinicians working with PDA define and understand PDA. Chapter Six is a general discussion of the thesis findings. Overall, results suggest that PDA is best described as a behaviour cluster and contributes little to understanding the underlying reasons for PDA behaviours beyond those supplied by existing diagnostic labels. However, PDA is an attractive label, and both adults and clinicians favour its continued use.

Date of Award	25 Mar 2026
Original language	English
Awarding Institution	University of Bath
Supervisor	Ailsa Russell (Supervisor), Anthony Little (Supervisor) & Kate Cooper (Supervisor)