Autism Awareness Month, 2019: The Dopamine of Pathological Demand Avoidance

This CNN article, What Biology Tells Us About Presidential Ambition, really struck a nerve: (a) it is about a favorite subject, biopsychology, (b) it is about politics, (c) it is about presidential electoral politics, and (d) April is National Autism Awareness Month. So, win-win-win-win, right?

Every year since the blogs inception, I’ve written about autism in April mostly because my daughter and I both are autistic, albeit high functioning but autistic nonetheless. My sister, one of my nieces, and my mother are all autistic, too. They just don’t know it or won’t accept it. So, it is all very personal to me.

Pathological Demand Avoidance

My daughter and I both have a special type of autism, too, known as Pathological Demand Avoidance (PDA). While PDA isn’t an official diagnosis, it is becoming more widely accepted and will eventually be included in the DSM. I believe, although I may be mistaken, that the DSM-5 has included it in the appendices as a potential addition. [Please note that all of the PDA links go to different websites that have been used to inform this post.]

In addition to all the regular autism stuff of having difficulty with social interactions and communications, obsessive interests, restrictive and repetitive behavior including sensory seeking and sensory avoidance, people with PDA will resist meeting routine expectations, requirements, requests, and orders to an extreme.

PDA List of Traits has a nifty list of qualities, traits, or behaviors common to PDA. Reading through it leaves me a little verklempt because it so accurately describes my daughter and I.

  • hyper-sensitive to rejection
  • extreme shyness- personality based
  • avoids physical contact
  • self-loathing
  • self-critical harsh on themselves
  • mistrust of others
  • distance in intimacy
  • problem in jobs better in jobs with less human interaction
  • resists and avoids the ordinary demands of life
  • appearing sociable, but lacking depth in understanding
  • excessive mood swings and impulsivity
  • comfortable in role play and pretend, sometimes to an extreme extent
  • language delay, often with good degree of catch-up
  • obsessive behavior, often focused on people.

Where I differ from the official line on PDA, and the reason the CNN article is germane, is that PDA is often attributed to anxiety due to a lack of control. Speaking from my experience, the anxiety is not about control, but about uncertainty and being able to predict the future. In fact, there is a 2016 study that supports this view, but even they pay homage to the attempt at control reasoning.

Intolerance of Uncertainty

The 2016 Newcastle study investigated the degree to which intolerance of uncertainty (IU) and anxiety were associated with PDA behaviors. On the basis of surveys and interviews with parents and caregivers, they concluded that typical PDA behaviors were that IU was more strongly associated with PDA behaviors than anxiety. They also found that typical PDA behaviors occurred in a hierarchy: (1) as a response to uncertainty, children engaged in behaviors aimed at regaining control, (2) if that didn’t work, withdrawal into fantasy; and (3) if all else failed meltdowns and even aggression.

Maybe it is just my PDA-based need for control, but my take is slightly different. Anxiety is unfocused fear. It is fear without a definite cause or source. You’re anxious because you are uncertain about what will happen, not because you fear loss of control. And, you act out, not to regain control, but out of fear that some unspecified bad thing is about to happen.

For example, as a young man, the electric would be turned off at my house, sometimes for days at a time, not because I didn’t have the money to pay the bill, but because I couldn’t pay the bill. I couldn’t do it. I couldn’t sit down to write and post the check. This wasn’t because I wasn’t going to let some damn electric company tell me when to pay the bill! But because I was overcome with anxiety when I thought about paying it. And, just like a deer freezing when it senses danger, I froze. There was uncertainty there, but it wasn’t about what would happen if I did or didn’t pay the bill. And, it wasn’t about how much money was in my checking account (although there was plenty of uncertainty there, too). It was more about what did normal people do, how did normal people do it, and would any one think I was being foolish if I did.

The other thing that caused uncertainty was the lack of structure involved with paying a bill. Sure there was a due date, but I could write the check now as soon as I got it. I could write it tomorrow. I could write it on the due date, or even after the due date. It didn’t matter. All that choice, caused me profound uncertainty and, consequently, anxiety. To soothe that anxiety, I would distract myself by reading, walking the dogs, shopping for books, and many other pastimes.

In the list above, you’ll notice that it includes hyper-sensitive to rejection, self-loathing, self-critical harsh on themselves. That’s the root of the problem. Not knowing what other people did and not knowing when to pay the bill, I was left with self-loathing and harsh self-criticism for not knowing.

I could list a myriad of other examples, but that one should suffice. If not, let me know in the comments. Or if you have other examples or if you have an opinion on the role of anxiety and control in PDA or some other comment on autism or anything else. Please feel free to comment.

The Dopamine of Running for President

The CNN article addresses the role of dopamine and the mesolimbic dopamine system. They note that dopamine isn’t the pleasurable reward that we seek in doing something, it is the motivation to seek the reward. They give the example of rats being trained to press a bar ten times for a food pellet when a light flashes (you do realize that the scientists that run these experiments keep those rats on 3/4 of their diet to they’re really wanting that reward, right?).

When you measure the dopamine released in a trained rat, it is released after the light flashes. Not during the bar pressing. Not after the bar pressing. Not before, during, or after the food pellet. It was as soon as the light flashed. It is the motivator for pressing the bar to get the pellet.

If you block the effect of dopamine, the rat doesn’t press the bar to get the pellet when the light flashes. It is the motivator.

One thing that they suppose in the article is that people are able to sustain this dopamine release over long period times to sustain their motivation to achieve long-term difficult goals. In the article, they argue that it is necessary to run for president.

The dopamine goes even further than just motivation, but it is motivation to acquire some pleasure. When applied to presidential candidates, it is the emphasis on the anticipated pleasure of being elected president that drives the candidates. The anticipation of the pleasure that convinces them that they can win. And when they continue after it is clear that they can’t, they convince themselves that there are still worthwhile attainable goals to be had.

The Dopamine of PDA

As I explained in the Dopamine of Social Media, dopamine is the cause of hoping for one more pleasure. One more like. One more purchase. One more thrill. One more pull of the lever of slot machine. It keeps you coming back to drink at the trough. It keeps presidential candidates running. It keeps gamblers gambling. It keeps gamers gaming.

It is about anticipation of the pleasure of doing something. So, to apply it to PDA, which is a disorder fundamentally about anticipation and prediction, you could postulate that the mesolimbic dopamine system is not functioning correctly. Your ability to anticipate the effects of what you’re doing, is not functioning. Instead of anticipating pleasure in doing something — there is a pleasure in paying bills, a certain satisfaction that can be had — you trigger anxiety. And, the more pressure there is to perform some duty, the more you resist because you can’t wrap your head around what is going to happen. Partly because the anxiety is preventing you from thinking clearly. The pressure triggers all of the self-loathing and harsh self-criticism, too. It paralyzes you like a deer freezes when the cougar is near.


  1. Fascinating. When I was in grad school, the “fact” was that dopamine is the reward, but seeing it as the motivator and counteracting the effects of uncertainty and anxiety makes more sense. We could call it the optimism neurotransmitter.

    Liked by 1 person

    1. Howdy Bob!
      When I was in school, low those many years ago, that was the word on dopamine. Even in the first textbook I used to teach AP Psychology, dopamine was said to be involved in pleasure and reward. But, in the last ten years or so, it was realized that it plays a greater role in motivation. Calling it the optimism neurotransmitter sounds good to me.


      Liked by 1 person

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