Understanding and managing pathological demand avoidance

By Angelika Kubisa - Cognitive Behavioural Hypnotherapist & Coach

BSC, DIP CBH

Published 26th March 2025

Do simple tasks like showering, brushing your teeth, responding to messages, making phone calls, cooking meals, or booking appointments - yet not attending them - often feel impossible? You’re not alone.

These challenges, though sometimes misunderstood, are very real and can be linked to pathological demand avoidance (PDA). This can lead to overwhelming feelings, mood changes, and increased stress and anxiety.

You might hear phrases like “Just go and do it” from family or friends when you’re avoiding tasks, whether it’s about exercising, attending a health appointment, or completing something you’ve been putting off. But PDA isn’t about laziness - it’s about the overwhelming feeling of resistance to demands, even those you place on yourself.

PDA is more common than you may think. It’s particularly present among Neurodivergent individuals, including autistic people, those with ADHD, as well as people who have experienced trauma or anxiety-related conditions like OCD. If this resonates with you, you are not alone.

What is pathological demand avoidance (PDA)?

At its core, PDA is a strong resistance to being asked or told to do something. Even basic tasks - like eating, using the toilet, or getting out of bed - can feel impossible when they come with the pressure of a demand. It’s as if the thought of being asked to do something triggers overwhelming anxiety.

PDA is not about laziness or defiance; it stems from an underlying anxiety response in the brain. The brain perceives demands as threats, activating areas responsible for stress regulation (like the amygdala).

This heightened state of alertness results in anxiety and panic, leading to avoidance of the task altogether.

Why does PDA happen?

PDA is rooted in anxiety. When faced with demands, the nervous system becomes overwhelmed, triggering a fight-or-flight response. For Neurodivergent people, this response can be intensified. Processing social cues, unexpected changes, or environmental stimuli can heighten the sense of being out of control. Additionally, past experiences, including trauma, can further fuel these anxiety-driven reactions, making everyday tasks feel unmanageable.

Common tasks that trigger PDA

Certain demands can trigger resistance, regardless of their size. Here are some examples of common situations that may lead to avoidance:

Direct demands: Simple requests like “Clean your room” or “Go to work” can feel overwhelming.
Internal demands: It’s not just about what others ask, but also what you expect of yourself, such as eating, using the bathroom, or getting out of bed.
Implied demands: Even tasks like answering a question or paying a bill can trigger avoidance, even if they aren’t explicitly stated as demands.

How PDA affects everyday life

For those with PDA, the world often feels like a constant series of demands. Even simple tasks can trigger resistance, which can lead to frustration, guilt, and shame.

Here’s how PDA can impact daily life:

Increased stress and anxiety: The constant pressure to perform tasks heightens stress and anxiety, making it even harder to complete them.
Feelings of laziness or guilt: When others don’t understand, it can lead to feelings of inadequacy and frustration.
Avoidance and withdrawal: Avoiding demands can lead to isolation, withdrawal, and a sense of disconnection.
Meltdowns or panic attacks: Too many demands can overwhelm, leading to emotional overload and panic attacks.

Common ways people with PDA resist demands

People with PDA often employ various strategies to avoid demands. Here are a few common ones:

Making excuses: You might justify avoiding tasks with reasons like “I’m not up for it” or “I’ll do it later.”
Distraction: Changing the subject or creating a new problem to focus on.
Flat refusal: A simple “No” without further explanation.
Withdrawal: Emotional or physical withdrawal, retreating into your own thoughts.
Aggression: Frustration may escalate into aggressive actions as a way to fend off demands.

Coping with PDA: Self-help strategies and tools

If you’re experiencing PDA, here are some self-help tools that may help reduce anxiety and make everyday demands feel more manageable:

Set a routine: A predictable schedule can reduce anxiety. Build in flexibility to prevent rushing from task to task without time to recharge.
Prioritise tasks: Break down your day into must-do tasks and optional ones. Focus on one task at a time and don’t feel pressured to get everything done.
Break tasks into smaller steps: Large tasks can be overwhelming, so break them down. For example, tackle one small task at a time.
Offer yourself choices: Give yourself options rather than seeing tasks as non-negotiable. This can help you feel more in control.
Be flexible: Allow some flexibility in how tasks are completed. Give yourself input into how and when things are done.
Respect your body’s needs: If you’re feeling overwhelmed, allow yourself short breaks to recharge.
Plan for breaks: Schedule regular breaks throughout your day, especially between demanding tasks, to reset your mind.
Reduce triggers: Identify what increases anxiety and try to minimise these triggers, such as loud noises or crowded spaces.
Minimise direct commands: Reframe demands into softer, indirect phrases, like “I wonder if I could...” This reduces the anxiety associated with direct instructions.
Avoid over-scheduling: Don’t overload your day with too many commitments. Leave room for rest and to regroup.
Positive reinforcement: Praise yourself for completing tasks, focusing on effort rather than outcomes.
Limit external pressure: Reduce external pressure from others, and communicate your needs. Ask others to offer choices, rather than making demands.

The importance of self compassion

PDA is not a personal flaw - it’s a natural response to overwhelming anxiety. It’s okay to take things at your own pace and not push yourself beyond what feels manageable. Be kind to yourself and recognise that resisting certain requests or situations is not a sign of weakness.

It’s healthy to challenge yourself occasionally but know your limits. Listening to your body and mind is essential, as is asking for support when needed. It’s also perfectly fine to cancel plans or postpone tasks. Life doesn’t always go as expected, and giving yourself permission to try again when you’re ready is an important part of self-care.

Support for PDA

Working with a therapist who understands PDA can make a big difference. CBT, counselling, mindfulness, and hypnotherapy can reduce anxiety, build self-help strategies, and improve how you cope with stress.

If PDA is impacting your life, support from a therapist can help you develop effective coping strategies and navigate daily demands with greater ease.

Contact:

If you're finding things overwhelming, self-help hasn’t been enough, or if traditional therapies haven't worked for you – and you're curious about how Integrative Hypnotherapy could support you or someone with a PDA profile – feel free to get in touch. You can book a free, informal chat using the form on the website or email me at angelikakubisa@tranquil-minds.co.uk.