Pathological Demand Avoidance and Meltdowns: Part One

What does a violent PDA meltdown feel like, and why are families in crisis left to fend for themselves?

CW: This article contains a first-hand account of my internal experience of a PDA meltdown, real accounts of meltdowns in PDA children, and discussion of violence.

What a PDA Meltdown Feels Like

My insides churn like I’ve swallowed a fistful of razor blades.

My heartbeat races. I can hear the blood rushing through my head.

My muscles clench and twist themselves in knots as I double over.

Everything is tangled, buzzing, burning. Every nerve in my body is overvolted and catching on fire.

It’s too much.

It’s like I’m John Hurt in Alien, writhing in pain, fear, and confusion right before the xenomorph bursts through his chest. Every part of my body is screaming at me that if I don’t release the building tension, I am going to die.

I feel like I’ve been possessed. An out-of-body experience, but I haven’t left my body—I’m locked inside it.

A prisoner in my own mind.

It’s terrifying.

The world sharpens and blurs at once. Everything is hyperrealistic, but also dreamlike: a photograph left too long in the developer, dissolving.

I scream. Capillaries burst. Maybe it’s words. Maybe it’s the sound a wild animal makes when it’s cornered. I need the pain and the fear to go somewhere, anywhere, just out of me.

I can’t hear my own thoughts through the buzzing-ringing-wooshing cacophony in my head. Other people try to reason with me. I hear them, but their voices are garbled and far away, like I’m hearing them from underwater.

It’s just more noise, and the louder it gets, the more it hurts.

My rational mind shrinks to a pinprick of light in a long, black tunnel. I try to yell at myself—what is wrong with you, stop, get back in control—but there’s no sound.

My body can’t hear me.

I desperately claw at anything within reach, trying to hold on for dear life.

No one can throw me a lifeline.

No one can reach me.

I can’t even reach myself.

In the aftermath of a meltdown . . .

I’m wrecked, exhausted. Scraped, bruised, hollowed out, like I hit a brick wall doing sixty, and somehow I have to put myself back together.

Sometimes I cry. Sometimes I get defensive, unable to deal with the disconnect between what I did and who I see myself as. Sometimes I can’t remember what happened, or I can only remember bits and pieces.

I’m hurt, lost, and confused, but I’m certain of one thing: no one would behave this way unless there was something rotten inside them. More than rotten—evil.

No one could love me, they’re just stuck with me. They hate being around me. They wish I were someone else.

I wish I were someone else.

I wish I were dead.

.

.

.

Intense, right?

Meltdowns: A Horror Show

PDA (pathological demand avoidance) meltdowns are deeply distressing for bystanders and flat-out terrifying for the person experiencing them. They aren’t just a bad mood, they’re a total mindfuck that leaves behind a lovely parting gift of soul-crushing shame and self-loathing.

Wheeeeeeee.

Unfortunately, there’s not a lot of research on PDA in general, and no research on PDA meltdowns. And even if we operate from the assumption that PDA is a sub-type of autism, we don’t really understand the mechanism behind autistic meltdowns, either.

The gap in information can leave struggling parents of PDA kids feeling lost at sea, floundering. And many of these families are in real crisis.

Symptoms of PDA meltdowns reported in online support groups include:

• Looking panicked or wild-eyed

• Sweating or breathing heavily

• Clenching muscles

• Screaming, growling, or crying uncontrollably

• Lashing out with threats

• Hitting, kicking, biting, or throwing objects

• Self-injury

• Other aggressive or violent behavior

How can you possibly parent when every time your child gets stressed they fit the above description?

We don’t talk about kids who have violent meltdowns.

In 2012, Liza Long wrote a blog post called I Am Adam Lanza’s Mother, (which seems to have been re-titled Thinking the Unthinkable at some point) after Lanza murdered 20 children and six adults at Sandy Hook Elementary School. In the post, she describes being terrified of her own son, Michael, who was 13 at the time:

A few weeks ago, Michael pulled a knife and threatened to kill me and then himself after I asked him to return his overdue library books. His 7 and 9 year old siblings knew the safety plan—they ran to the car and locked the doors before I even asked them to . . . Through it all, he continued to scream insults at me and threaten to kill or hurt me.

. . . We still don’t know what’s wrong with Michael. Autism spectrum, ADHD, Oppositional Defiant or Intermittent Explosive Disorder have all been tossed around at various meetings . . . He’s been on a slew of antipsychotic and mood altering pharmaceuticals, a Russian novel of behavioral plans. Nothing seems to work.

. . . He’s in a good mood most of the time. But when he’s not, watch out. And it’s impossible to predict what will set him off.

I’ve met many, many parents in PDA support groups who would recognize every word of that passage. Here’s how some of them describe their own kids, in their own words:

“He was punching me in the face for setting laptop boundaries or chores and breaking dishes when he was handed food he did not like. We had to hide the knives just in case.”

“Today he landed about 20 hard punches on me. He is only 7 but getting bigger and stronger. His violent outbursts are so frequent and severe.”

“This time he got hands on kitchen knives and a cordless circular saw threatening to kill his self if we didn’t fix his problem. Blades to his neck. Circular saw running within inches of his skin. Begging him to stop from behind a locked door because we also couldn’t let him in the house.”

I think a major reason that parents are drawn to PDA support groups is that it provides a relatively safe space to talk about these frightening experiences of child-to-parent violence (CPV). That’s very hard to find in the rest of society.

When researchers looked at YouTube comments on sympathetic, editorially-controlled news videos about CPV, 90% made harsh, punitive suggestions like corporal punishment, custody/juvenile detention (“bring back Borstal”), or cutting the child off entirely.

The authors argue that the comments reveal a pattern of victim-blaming rooted in ‘just-world’ thinking—the idea that people get what they deserve and could have prevented their own suffering—and suggest that public education is necessary to de-stigmatize CPV.

In a nutshell: if we want people to seek out help, we can’t make them feel like shit about it.

We don’t support them, either.

Of course, even when parents do seek out help for their child’s meltdowns, it doesn’t mean they’ll find any.

When I was a child having frequent violent, destructive meltdowns, my mother was told she could only get support if she relinquished custody to DCFS (Department of Children and Family Services). While my state passed the ‘Custody Relinquishment Prevention Act’ to address this exact issue in 2015, the problem is far from over.

A 2025 brief by the Office of Human Services Policy established that 25,000 cases between 2017 and 2019 resembled custody relinquishment—kids funneled into foster care not because of neglect or abuse, but because their families couldn’t get help any other way.

“Families are basically left to fend for themselves,” Ron Honberg, policy director of the National Alliance on Mental Illness, told NPR in 2013 when discussing the intersection of mental illness and violence in children.

Families being left to fend for themselves is a huge issue when, per the article Families take drastic steps to help children in mental health crises, “[a]bout 7.4 million U.S. children — roughly 1 in 10 — have a serious mental disorder that impacts their ability to function, but most receive no treatment.”

When we parents look for help for their PDA children, they come up against the fact that CPV research has largely ignored neurodivergence, despite evidence that suggests over 50% of CPV cases involve neurodivergent children and that many families seeking a neurodevelopmental diagnosis for their child cite behaviors consistent with CPV as their top concern.

A CPV definition in a 2024 review is “a pattern of behavior that uses verbal, financial, physical or emotional means to practice power and exert control over a parent.” This is very similar to how I see PDA meltdowns described—the PDA Society itself describes PDA as an “anxiety-driven need to feel in control.”

And you might be thinking ‘Great, thanks for nothing. I know my kid has PDA meltdowns, I know what they look like, I very obviously don’t have any support—but why does this happen? What the hell is it?’

I don’t have a clean answer (nobody does, yet) but I’ve got some theories, borrowed from research on stuff adjacent (ish) to PDA and mushed together with my own lived experience via a ton of pattern-matching I have no business doing.

So please take it all with the appropriate grain of salt.

What Happens During a PDA Meltdown?

If you’ve ever seen Being John Malkovich, you remember how it works: Craig climbs into the portal, and for fifteen minutes he’s driving John’s body. John does what Craig wants, says what Craig wants, while John’s own consciousness is just . . . trapped.

Meltdowns: like having your brain hijacked by a deeply unhinged John Cusack. Screenshot from Being John Malkovich (dir. Spike Jonze, 1999)

The idea of being a helpless passenger in my own mind while a puppeteer controls my actions really speaks to my experience of PDA meltdowns. I’m still here, watching, but Craig is in charge now, and I don’t know how to get the controls back.

And the worst part is after. When Craig is dumped out, I’m left to survey all the damage that happened while I was a passenger in my own skin.

Psychiatry has a clinical word for this out-of-body horror: dissociation.

Dissociation, depersonalization, and derealization.

Dissociation is a mental process where a person’s thoughts, memories, feelings, sense of identity, or awareness become disconnected from one another—an umbrella term that encompasses depersonalization and derealization. Dissociation can be normal, like losing track of time while driving, or far more severe.

Depersonalization is that feeling that you’re not fully inside your own body, like you’re watching yourself from a distance, or your thoughts and actions don’t belong to you.

Derealization is a sense that your surroundings aren’t real or are somehow distorted. It’s similar to depersonalization, but the disconnect is pointed outward this time.

In his 2004 review, Dissociation and Violence, forensic psychologist Andrew Moskowitz points out that dissociation is significantly linked to violent behavior, and psychiatric patients who have high scores on the dissociative experiences scale are more likely to be assaultive or aggressive.

Moskowitz is careful to say that his review doesn’t imply that everyone who experiences dissociation has an underlying disorder, but it might be the closest thing we’ve got to actually explaining why a meltdown feels more like existential horror than a temper tantrum.

Just to be clear, Moskowitz is writing about violent adults, not PDA kids. But the descriptions are relatable as hell:

“. . . experiences include reported changes in the apparent size or distance of the perpetrator or victim and feelings of ‘watching oneself.’”

“. . . perceptual distortions (changes in the size of objects, sounds seeming far away), temporal distortion (events speeding up or slowing down), physical or emotional ‘numbing,’ and a ‘sensation of lacking control of one’s actions.’”

“. . . the external world in general, or other persons in particular, seem strange, distant, or unreal.”

And the entire review is threaded with a Jekyll and Hyde metaphor, which is the exact. same. metaphor. that many parents and advocacy groups use to describe PDA-related mood swings.

Two studies cited in the review claim that, even among people with a history of abuse, dissociation—not the abuse history itself—was what predicted who went on to become abusive to family members.

Basically, according to Dissociation and Violence, it’s not the memory of being abused that turns a victim into a perpetrator, but the state of dissociation that leaves the individual without access to their moral identity when they feel triggered.

Many PDA advocates assert that PDA is ‘anxiety-driven,’ and psychiatry acknowledges the overlap between dissociation and panic disorder. The DSM-5 lists depersonalization and derealization as core diagnostic features of panic attacks (as well as a bunch of other symptoms that sound basically identical to a PDA meltdown).

So is a PDA meltdown even its own thing, or is it just a panic attack with terrible PR?

Panic attacks and anger attacks.

I don’t know if meltdowns and panic attacks have the same mechanism, but a meltdown sure as hell feels like a panic attack.

Weirdly, the PDA advocacy community (mostly) embraces the term ‘panic attack,’ even though it tends to dislike (really, really dislike—more on this another time) questions about whether or not PDA could be explained by trauma or another diagnosis that’s already associated with panic attacks.

Credit: the PDA Society training hub

One 2018 clinical review makes me wonder if the ‘panic attack vs. meltdown’ question might be impossible to untangle, given that (per their numbers) something like 40% of autistic people also have a diagnosable anxiety disorder.

But maybe you’re reading this and thinking ‘Panic attacks? My kid’s meltdowns are rageful, not fearful.’

There’s a term for that, too! ‘Anger attacks,’ coined in the ‘90s as a possible variant of panic and major depressive disorders.

Anger attacks sound a lot like panic attacks, with traits like:

• Increased heart rate

• Hot flashes and sweating

• Chest tightness

• Numbness, tingling or burning sensations

• Dizziness

• Shortness of breath

• Trembling

• Panic and feeling out of control

But anger attacks also feature:

• Attacking others physically or verbally (or the impulse to do so)

• Throwing or destroying objects

The symptoms of anger attacks certainly have a lot of overlap with the way many PDA meltdowns are described.

Again, we don’t have a ton of research to draw from here, unfortunately. The studies on panic attacks outnumber the studies on anger attacks by approximately a bajillion to one.

I think there’s a few different factors (and this list is by no means exclusive) that contribute to this research gap:

Ethics

Causing your research subject to lose self-control and fly into an explosive rage is an institutional review board nightmare. How do you trigger an anger attack without risking physical violence, property damage, or psychological trauma?

For the most part, you don’t.

Researchers are stuck in a catch-22: to study a real meltdown, you need to push a subject past their breaking point, but intentionally inducing that level of distress is unethical. So aggression research mostly relies on behavioral proxies rather than anything resembling dissociative rage or a genuine meltdown.

There’s basically two options, and they both kind of suck:

Option one: study explosive anger after the fact via parent interviews, hospital records, self-report surveys, and so on. That gives you a narrative, but not the actual mechanism—nobody’s mid-meltdown when they’re filling out a Likert scale.

Option two: study something safer that might be close enough, like frustration, and hope it generalizes to the real thing.

Terminology

Anger research is fragmented as hell. When scientists do study sudden explosive rage, they publish their findings under a lot of different names—reactive aggression, affective lability, phasic irritability, etc.

Because there isn’t a unified framework for ‘angry meltdowns,’ psychiatrists often reach for whichever diagnostic label best fits their specific field or the patient’s co-morbidities. Different diagnoses can wind up being used almost interchangeably to categorize the same explosive, out-of-control behaviors.

For example:

• Intermittent Explosive Disorder (IED)

• Oppositional Defiant Disorder (ODD)

• Disruptive Mood Dysregulation Disorder (DMDD)

• Conduct Disorder

A clinician working with children might label the behavior ‘ODD’ if it’s directed at authority figures, or ‘DMDD’ if it involves chronic irritability. A different provider, working with adults, might use ‘IED’ if the outbursts seem impulsive and out of character.

And the reliability for some of these diagnoses is very . . . not great.

Then there’s a ton of other conditions that are associated with sudden anger or rage, like:

• Cluster-B personality disorders like BPD (Borderline Personality Disorder)

• Paranoid personality disorder (PPD)

• Attention-deficit/hyperactivity disorder (ADHD)

• Bipolar disorder

• Major depressive disorder (MDD) with ‘irritable features’

• Obsessive compulsive disorder (OCD)

If you’re trying to describe PDA meltdowns to a new clinician, you could plausibly walk away with any number of different diagnoses depending on which intake form they happened to be using that week.

That’s not a knock on clinicians—it’s just what happens when there’s no zone of rarity.

If we look at CPV (child-to-parent violence) again—possibly the closest adjacent field to what happens in a PDA meltdown—we can see the terminology problem unfold:

The definition cited earlier in this article, from researcher Rachel Holt, is “a pattern of behavior that uses verbal, financial, physical or emotional means to practice power and exert control over a parent,” but this isn’t the only definition for CPV.

Here’s another one, this one from the Spanish Society for the Study of Child-to-Parent Violence (emphasis mine):

Repeated acts of physical, psychological (verbal or nonverbal) or economic violence by children against their parents or parental figures. The following behaviors are not considered child-to-parent violence: one-off acts of aggression... [or] those caused by (transitory or permanent) psychological disorders (autism or severe mental disability).

Autism and psychological disorders get an explicit exemption. By this definition, PDA kids may never show up in the data.

Nikki Rutter, deputy director of the Centre for Research into Violence and Abuse, notes in her 2023 review “My [Search Strategies] Keep Missing You”: A Scoping Review to Map Child-to-Parent Violence in Childhood Aggression Literature, that 135 different terms were used across just 55 papers to describe the same phenomenon—a child harming a parent, and more than half the relevant research doesn’t even self-identify as being about this topic.

It’s hiding in plain sight under labels like:

• challenging behavior

• tantrum-hit sequences

• emotional and behavioral difficulties

• coping or survival behaviors

• explosive, oppositional, and aggressive behavior

The title, “My [Search Strategies] Keep Missing You” is a big flashing arrow pointing to the problem: the research literally can’t find itself. Studies about the same phenomenon are scattered across psychiatry, education, social work, criminology, occupational therapy, law, etc.

And each field uses its own vocabulary, so digging into this topic is fucking exhausting—from experience!

Moralization

While kids with neurodevelopmental disabilities like autism and ADHD are more likely to show recurring patterns of aggressive, violent, and destructive behavior, research often doesn’t use those terms. It uses terms like ‘challenging behavior’ instead.

The language swap isn’t an accident, and it’s not really about any differences between the kids—it’s about the moral weight of the words. Terms like ‘violence’ and ‘abuse’ are so loaded that using them to describe a neurodivergent kid feels like a category error.

But even researchers who study people who intentionally engage in violent acts (gang leaders, soldiers, police officers) argue that the word ‘violence’ doesn’t require evil intent. Alan Page Fiske, an anthropologist who spent his career studying why humans hurt each other, points to a concept the legal system has accepted for a long time: mens rea—you can do something violent without being fully culpable for it if you didn’t intend to do something wrong.

Society seems less willing to accept that kind of nuance outside of the courtroom, and that black-or-white thinking muddles research and isolates families living with the reality of violent meltdowns. We’ve collectively decided ‘violence’ and ‘abuse’ imply moral degeneracy, so anyone whose situation doesn’t fit a clean villain arc needs something softer.

But in practice, terms like ‘behavioral difficulties’ are just erasure. The behavior doesn’t get gentler just because the language does. It costs the kid, because vague euphemisms lead to a hundred tiny, underpowered datasets, and it costs the parent, because there’s no way to ask for help with something you’re not allowed to talk about. The taboo isn’t protecting people, just our delicate sensibilities.

The problem is that anger, in general, is viewed as a failure of character rather than a biological glitch. Unlike panic attacks, anger attacks violate the social contract by threatening other people, property, or public order, so panic attacks get medicalized where anger attacks are criminalized.

And society seems pretty comfy with that framing. If explosive anger is a character defect, the rest of us get to reassure ourselves that we’re different. Not just different—better. Good people stay in control. Bad people don’t.

Parents, desperate to see both themselves and their children as good, redefine their own experiences. One small study on mothers absorbing violence from their neurodivergent children found that they made sense of being targeted by describing themselves as their child’s ‘safe space.’ I see this same language used in PDA support groups constantly, and I think it’s dangerous as hell.

One mom in the study said (emphasis mine):

“The fact that he doesn’t manage [the impulse to hit] with me in the same way, I’ve always felt quite proud of that fact. It’s almost like Well I’m his safe space … and he’s about to be exactly who he needs to be at that moment, and that’s fine.”

Let me be really clear: as someone who was once a violent child, and who does not judge violent children, this scares the living daylights out of me. We cannot reduce a child in a violent crisis to a journey of self-discovery.

This kind of ‘finding yourself’ isn’t what we should be aiming for. Screenshot from Joker (dir. Todd Phillips, 2019)

The ‘challenging behavior’ euphemism, the ‘rotten kid’ judgment, the ‘safe space’ martyrdom, they all do the exact same job—reducing an incredibly complex issue down to a simple moral judgment.

And yes, society has a legitimate interest in protecting others from harm, but public safety and medical inquiry are not mutually exclusive, and understanding the root causes of explosive anger may give us better tools to prevent harm before it occurs.

So I guess that’s what we’ll dig into next time on Meltdowns: an essay that was supposed to be 2,000 words and is now an unwieldy multi-part monster.