Differentiating between pathological demand avoidance and antisocial personality disorder: a case study

Abstract

Purpose The purpose of this paper is to explore the different clinical features of pathological demand avoidance (PDA) and antisocial personality disorder (ASPD) presented in the form of a single case study. The study highlights the potential of misdiagnosis and conceptual confusions to practitioners in forensic settings between the two conditions when working with offenders with personality disorders. Design/methodology/approach A case formulation using the “five Ps” method based on the personal history of an incarcerated male is presented and the clinical similarities and differences between PDA and ASPD are delineated. These differences and similarities are evaluated and applied to offender management including intervention options. Findings There are considerable similarities between ASPD and PDA making the two conditions difficult to separate. Both diagnostic criteria identify childhood behavioural problems, aggression, destructiveness, conduct disorder (CD), manipulation and non-compliance as indications of the disorder. For example, the criteria for later adult ASPD are the presence of childhood antisocial behaviour and CD. However, these behaviours may also be suggestive of the attention deficit hyperactivity disorder and non-compliance that are part of PDA. Violent behaviours and aggression can also be perceived in a similar way. Misdiagnosis of PDA as ASPD reduces the efficiency of treatment programmes. Originality/value The implications of these findings could prove useful in the successful risk management of offenders with PDA. Given the similar behavioural characteristics between PDA and ASPD, the prevalence of PDA among offenders may be higher than observed. The aim of this study is to raise awareness of potential conceptual complications and clinical confusions between the two conditions with a view to aid offender management through case formulation. A large scale study into offenders with PDA would draw attention to the prevalence of the condition as well as its association with offending behaviour.

The Measurement of Adult Pathological Demand Avoidance Traits

“…Forensic psychologists have become interested in the incidence of ASD and the broader autism phenotype in offender populations of the kind considered by Criminal Justice Systems (CJS; Trundle et al 2017 ). While a systematic review of persons with ASD by King and Murphy ( 2014 ) did not find persons with ASD disproportionately over-represented in the CJS, they noted that some persons were more implicated in a variety of crimes, and that individuals with apparent psychiatric comorbidity had more CJS involvement.…”

Pathological demand avoidance in children and adolescents: A systematic review

“…Furthermore, while the development and selection of items for the EDA-Q is fully described by O’Nions, Christie, et al (2014), the pre-identification of groups in that study (again based on parental report) remains a significant methodological limitation. While the current review only included studies on PDA in children and adolescents, studies involving adults (Eaton & Banting, 2012; Egan et al, 2019; Trundle et al, 2017) also rely on the Newson’s criteria. Moreover, the three studies (4, 5, 10) using the DISCO to aid in the identification of PDA used differing sets of DISCO items.…”

Methods of Studying Pathological Demand Avoidance in Children and Adolescents: A Scoping Review Protocol

“…PDA has similarities with other disorders, including oppositional defiance disorder (ODD) (O' Nions et al, 2013), conduct disorder (CD) (O' Nions et al, 2014b), attachment difficulties (Eaton et al, 2018), and antisocial personality disorder (ASPD) (Trundle et al, 2017). Therefore, some researchers question the validity of PDA as a construct within ASD, seeing it as either occurring across disorders (Gilberg et al, 2015) as a set of comorbidities , or as a stand-alone entity (O' Nions et al, 2014).…”