When your brain treats everyday expectations as existential threats, “trying harder” isn’t the answer. Understanding the anxiety-autonomy paradox is the first step toward genuine freedom.

Imagine knowing exactly what you need to do to improve your life – apply for that dream job, schedule an overdue doctor’s appointment, or even just reply to a text – but feeling physically paralysed by the mere expectation of doing it.

This is the story for many high functioning autistic adults with Pathological Demand Avoidance (PDA), trying to marry their intentions with their choices but coming up short each time.

And to add some further clarity here, this isn’t laziness or outright defiance.

PDA is actually an anxiety-driven survival mechanism.

It’s a behavioural profile which manifests as a need for autonomy that defies any rational thought processes.

What this means in practical terms, is that the tasks someone wants to complete or the activities they want to engage in, become impossible due to the weight of perceived pressure.

This results in talented professionals ghosting jobs they excel at, loving parents missing school meetings, and a pervasive sense of being “broken.”

But with increased awareness, the will and drive to do the seemingly impossible can be found.

The advice, “just do it,” is so far from what’s actually needed, there needs to be a complete revision around how we approach this profile of neurodivergence.

When intentionality and action can be married, anything is possible.

And so, the question is, “how do we do that in the most compassionate way?”

What is Pathological Demand Avoidance in Adults?

Pathological Demand Avoidance (PDA) in adults is an anxiety-driven profile within the autism spectrum characterised by an overwhelming neurological resistance to everyday demands and expectations.

And this resistance occurs regardless of whether or not the person wants to engage with the task, or even enjoys the activity in question.

At its core, PDA represents an extreme need for autonomy where the brain’s threat-response system activates against perceived control from external sources.

As a result, adults with PDA typically develop sophisticated strategies to avoid external demands, which can include things such as negotiation, distraction, or procrastination.

Although these avoidance mechanisms can appear manipulative, they are actually the manifestation of a desperate attempt to manage overwhelming anxiety triggered by perceived loss of autonomy.

The knock on effect of this is experiencing continual employment difficulties, relationship strain, and isolation frequently result from misunderstood PDA behaviours.

Over time, many adults with undiagnosed PDA internalise messages that they’re lazy or defective, leading to depression, chronic shame, and identity fragmentation after years of masking.

The Autism-PDA Connection in Adults

Fortunately, Pathological Demand Avoidance is beginning to receive increased recognition as a significant aspect of the profile with the autistic spectrum.

Unlike more traditional autism presentations, adults with PDA often display better surface-level sociability and linguistic skills, which can often mask their underlying difficulties.

The PDA subprofile of autism is particularly unique as it represents a specific intersection between social communication challenges and an extreme demand sensitivity, which creates a unique set of support needs.

And although the research is still in its infancy, emerging findings suggest there is a significant overlap between PDA and autistic sensory processing differences.

The same neural pathways that process sensory information may also become overwhelmed by perceived demands, triggering similar fight-flight-freeze responses.

This explains why many adults with PDA report physical symptoms like nausea, dizziness, or “brain fog” when faced with expectations.

Gender Differences in PDA Presentation

• Women with PDA: Develop advanced masking strategies, appearing compliant while experiencing intense internal distress
• Diagnostic Timeline: Women often receive their first accurate assessment well into adulthood, while males are typically identified earlier

The Misdiagnosis Pipeline

Common Misdiagnoses	Impact on Treatment
Anxiety disorders	Interventions may increase pressure and demands
Depression	Fails to address underlying demand avoidance
Personality disorders	Creates inappropriate treatment approaches

Co-occurring Conditions

PDA frequently coexists with other neurodevelopmental conditions, creating layered challenges that can be misinterpreted:

• ADHD: Compounds difficulties with task initiation and completion
• Dyspraxia: Adds motor planning challenges to demand avoidance

These combinations can be mistaken for high-functioning autism without the demand avoidance component. Understanding this complex intersection is crucial for appropriate support.

PDA vs Typical Demand Avoidance: What’s the Difference?

• Neurological Basis: PDA operates on a fundamentally different neurological level. The avoidance is involuntary and brainstem-driven, not a conscious choice. Adults with PDA experience a genuine neurological inability to comply despite often wanting to engage with the task.
• Physiological Response: When faced with demands, PDA triggers full fight-flight-freeze reactions with elevated cortisol and adrenaline—identical to responses to physical danger. This explains why willpower alone cannot overcome PDA and traditional motivation techniques often backfire.
• Functional Impact: PDA severely disrupts daily living even with enjoyable activities. An adult might be unable to attend a concert they’ve been eagerly anticipating simply because leaving the house at a specific time becomes an insurmountable demand, distinguishing PDA from ordinary procrastination.
• Complex Avoidance Strategies: Rather than simple refusal, adults with PDA employ sophisticated avoidance mechanisms including distraction, excuses, or even physical illness. These can appear manipulative but represent desperate attempts to manage overwhelming anxiety—part of the neurodivergent symptoms
• Demand Type Neutrality: Unlike typical avoidance which focuses on unpleasant tasks, PDA reactions occur regardless of whether the activity is desirable. External expectations transform even beloved activities into sources of unbearable pressure, explaining why adults with PDA might avoid activities they genuinely enjoy.

What Does PDA Look Like in an Adult? Recognising Symptoms

In order to properly identify Pathological Demand Avoidance in adults, it’s going to require looking beyond surface level behaviours and asking, “what is the underlying anxiety driving them?”

And this is because the condition frequently masquerades as anxiety disorders, depression, personality disorders, or simply as “difficult personality traits.”

This creates what is known as a diagnostic overshadowing, leading some clinicians to observe only the secondary effects of PDA—the anxiety, low mood, and relationship difficulties—rather than recognising the specific demand avoidances driving these symptoms.

And then, the diagnostic picture is further complicated due to the various contexts in which PDA can present.

An adult might function well in certain environments such as relationships, which might not activate the fight or flight mechanism. But then they might completely shut down in other circumstances relating to work for example.

The result is an inconsistent clinical picture that doesn’t fit into any existing diagnostic categories.

This can then be viewed by some clinicians unfamiliar with PDA as evidence against neurodevelopmental conditions, reasoning that “real” autism would affect all situations equally.

The Hidden Face of Undiagnosed PDA in Adults

Beyond the more obvious symptoms, the sophisticated coping mechanisms that many adults with PDA use to mask the condition can contribute significantly to misdiagnosis or their struggles being interpreted.

And these hidden manifestations often go unrecognised even by mental health professionals unfamiliar with PDA.

One of the most common hidden signs is internalised shutdowns.

Rather than openly refusing demands, many adults with PDA appear to agree but then “forget” commitments, become “sick” before important events, or find other ways to withdraw without direct confrontation.

These behavioural patterns can be misinterpreted as flakiness or lack of commitment rather than the demand-related anxiety of PDA.

Then there is also perfectionist paralysis, another hallmark of the condition, which can see individuals avoiding tasks entirely due to fear of imperfect outcomes.

However, unlike general manifestations of perfectionism, this form of paralysis can actually present quite inconsistently, affecting areas where external expectations exist while allowing free engagement with self-directed activities.

This can often create confusion within friends and family, who see someone that is absolutely capable of applying themselves in complex tasks, but seemingly unable to complete simple ones in others.

Hidden PDA Manifestations: The Social Mask

• Social Chameleon Behaviour: Adults with PDA often mimic others’ mannerisms and interests to navigate social situations while masking their difficulties. This high masking in autism creates a convincing façade of neurotypical functioning that can delay diagnosis for decades.
• Sensory-Driven Avoidance: Many subtly leave environments with fluorescent lighting or background noise without explaining the real reason, leading to misinterpretations of rudeness or disinterest.

The Psychological Impact of Undiagnosed PDA

Impact	Manifestation	Consequence
Self-Punishment	Internalising messages of being “lazy” or “defective”	Depression, anxiety, chronic shame
Treatment Misdirection	Secondary mental health conditions become the focus	Underlying PDA remains unaddressed
Recovery Complications	Severe autistic shutdowns	Extended recovery periods needed

Without proper identification, these adults struggle through cycles of demand avoidance, shutdown and recovery, further complicating their ability to meet life’s expectations

Spotting Obvious PDA Symptoms in Adults

• Immediate Refusal: Adults with PDA often instinctively reject demands even for activities they genuinely enjoy. Someone might enthusiastically discuss attending a concert but become overwhelmed once tickets are purchased, as the enjoyable activity transforms into an obligation with expectations attached.
• Strategic Negotiation: Rather than directly refusing tasks, PDA adults frequently engage in extended debates about why something “shouldn’t” be done. This manifests as excessive questioning, finding logical-sounding reasons to postpone action, or identifying “loopholes” in expectations.
• Physical Anxiety Responses: When confronted with deadlines, appointments, or social obligations, adults with PDA experience intense physiological reactions. These include panic attacks, nausea, headaches, or complete shutdown—even for minor demands others would handle routinely.
• Social Camouflage Skills: Many develop sophisticated role-playing abilities, using charm, humor, or intellectual prowess to deflect attention from unmet responsibilities. This masking can be so convincing that others are shocked when the person’s life eventually unravels from accumulated avoidance.
• Burnout Cycles: These avoidance patterns typically create exhaustion, withdrawal, and physical symptoms over time. This overlaps with executive dysfunction in autism, but differs crucially—executive dysfunction involves difficulty organizing tasks, while PDA adds anxiety-driven resistance to the very concept of demands.

How Different Groups Experience PDA Autism in Adults

Pathological Demand Avoidance manifests uniquely across different populations, influenced by factors including gender, cultural background, and life stage.

While the core experience of demand-related anxiety remains consistent, how it presents—and how others respond to it—varies significantly.

PDA within adults manifests through neurobiological mechanisms, varying across populations:

1. Neurological Drivers:

   a) Heightened amygdala reactivity to perceived demands

   b) Reduced prefrontal cortex regulation of emotional responses

   c) Altered dopamine signalling affecting motivation and reward processing

2. Systemic Interactions:

• Sensory processing differences amplify demand perception
• Executive function challenges compound avoidance behaviours
• Social cognition variations influence masking strategies

1. Adaptive Response Spectrum:

Low Masking	High Masking
Overt avoidance	Sophisticated camouflage
Frequent meltdowns	Internalised shutdowns
Social withdrawal	Apparent social adeptness

Late-Diagnosed Adults with PDA: The Masking Crisis

Adults who were born before the 1990s often receive their PDA diagnosis after years of unexplained difficulties.

The delayed diagnosis leads to unique set challenges which stem from identity-fragmentation.

After spending so much of their life maintaining a socially acceptable persona while suppressing their authentic needs, many describe themselves as “actors” who appear normal in public but remain an unknown quantity to themselves.

This chronic dissociation becomes so normalised that reconnecting with genuine preferences and needs can feel like a huge leap of faith and more frightening than liberating.

Another factor to reaffirm is the diagnostic overshadowing that can frequently contribute to these delayed diagnoses.

Co-occurring conditions such as anxiety disorders, depression, or eating disorders often become the focus of treatment, while the underlying PDA traits remain unaddressed.

This pattern of misdiagnosis is especially prevalent in high-masking autistic women, due to the highly refined social camouflaging skills that can conceal their difficulties from even experienced clinicians in some instances.

Added to that, there is also a huge amount of societal gaslighting that can compound these difficulties even further.

Adults with undiagnosed PDA typically endure countless variations of “you’re too sensitive” or “you’re just not trying hard enough,” gradually eroding their self-trust.

And so, by the time diagnosis becomes possible, many have internalised these messages so deeply that self-advocacy feels dangerous—who are they to challenge decades of feedback from authority figures?

The Compensation Paradox

• Achievement Masking: Many develop compensatory hyper-competence in specific domains, overachieving professionally while struggling with basic self-care
• Public/Private Divide: The stark contrast between external success and private dysfunction deepens feelings of shame and isolation

Burnout Timeline in Late-Diagnosed PDA

Stage	Manifestation	Impact
Early Adulthood	Successful masking	Appears functional but accumulates internal strain
Mid-life	System overwhelm	Catastrophic collapse that seems “sudden” to outsiders
Post-collapse	Recovery period	Recognition of long-ignored warning signs

This delayed burnout pattern represents perhaps the most concerning aspect of undiagnosed PDA. The façade maintained through early adulthood eventually crumbles when accumulated stress overwhelms coping mechanisms, following years of increasing strain that went unrecognised or unaddressed.