Do We Need More Diagnostic Labels?

There appears to be a trend within the world of psychology and the neurodiversity movement to create new labels for traits seen both within and outside recognised diagnostic conditions such as ADHD and autism. At face value, it would seem logical that if you give something a name, you can begin to understand it. But is it also possible that by creating the label, we are in fact distracting our attention from where our focus should be?

Let’s explore two common examples to address this and consider whether there is a better and more effective way of looking at the suffering the individual may be going through, and how they can be best supported.

Rejection Sensitive Dysphoria (RSD)

Rejection Sensitive Dysphoria (RSD) is a condition that causes people to feel intense emotional pain when they are rejected or criticised. Most, if not all, people are rejection sensitive, but where historical difficulties around childhood trauma, executive functioning and/or social interaction exist, this can be amplified. But is RSD a separate condition, or is it an extreme example of a common human experience?

By adopting the label, there’s a risk of attributing low self-esteem to RSD itself, rather than recognising that difficult and/or embarrassing past experiences can lower self-esteem and increase anxiety, leading to heightened rejection sensitivity. Addressing an individual’s anxiety and self-worth would reduce sensitivity to rejection. So by addressing the underlying factors, we can support them in improving their wellbeing and quality of life to the point where their rejection sensitivity is no longer a problem.

The alternative is to maintain the label and insist that rejection must be carefully managed or avoided. But is this realistic? Does it help build resilience?

Ultimately, the RSD label may act as a distraction. It asks no questions and can encourage individuals to focus on external factors outside of their control, which can lead to a heightened feeling of hopelessness. It is known that lack of control over your life contributes to mental health problems.

Pathological Demand Avoidance (PDA)

Pathological Demand Avoidance (PDA) is a profile that describes a person’s extreme resistance to everyday demands. It is often connected to autism but also occurs without autism being present. This label is becoming increasingly common, often applied to children at an early age.

Frankly, the term itself is problematic. Some prefer to call it a “pervasive drive for autonomy,” which sounds less harsh but ultimately carries the same employment and societal implications.

The reasons why PDA may present are varied and complicated, and we have addressed them in this blog: Why Doesn’t My Child Do As They Are Told?. But one of the main factors that can lead to this is exposure anxiety.

Exposure anxiety occurs when revealing something about yourself feels overwhelming. This can include exposing that you are able to do something, telling someone your name, or asking to go to the toilet. It can mean abandoning an activity you are good at because people have noticed you are good at it and are praising you.

The anxiety can make it impossible to tell someone about a problem no matter how much you want to tell them. The more someone wants to know, the more the barrier increases and the harder it becomes to tell them.

Exposure anxiety can range from mild to severe. The mild end includes difficulties telling people your name, talking about yourself, or explaining how you are feeling. This could look like extreme shyness along with difficulty doing the things you enjoy and want to do.

At its most severe, exposure anxiety can create a fierce compulsion to protect yourself against any external control and any perceived ‘invasion’ from others such as an attempt at communication. People must not know that you care about anything because exposing that is way too scary. A person may appear to resist all demands, not because they do not want to comply, but because doing so feels like exposing themselves in a vulnerable way.

People with exposure anxiety may avoid demands made directly to them, because then it looks like they care. They may use strategies of not having responsibility for carrying out the demand. So, if someone assists or makes the person do something, then the responsibility belongs to the person who is helping. The responsibility can also be laid on an object, by acting as if the object has the desire to complete a task and needs to be helped. For example, “the apple really wants to be eaten”.

Strategies to get round this can include responding as someone else (definitely not themselves) or repeating of words and phrases so that the person is responding to themselves, not to the person giving the command. Instead of talking to you, the person with exposure anxiety may simply talk to themselves while seemingly ignoring you.

Is there a better way?

Simply put, yes, there is.

Instead of using labels that are purely descriptive, the key is to focus on the tangible underlying factors, because those are the elements that can be understood, strategised around and managed. Neither RSD, nor PDA are things you just have to live with.

For RSD, Watch Jia Jiang explain how he overcame rejection sensitivity that was holding him back. He also explains how his rejection sensitivity came about. However, before jumping into this technique, we think it better to first work out what is really going on and what is causing or has caused low self-esteem.

For PDA, the key is to explore the reasons behind it, why the individual is not doing what they are asked to do. Putting things in place that take the underlying reasons into account improves the situation dramatically, and reduces anxiety and low self-esteem around the problem.

For both RSD and PDA note that over-accommodating anxieties makes the situation worse because this legitimises the anxiety. Once the reasons have been understood, steps can be taken to (gradually) improve the situation.

Can this approach be applied in a broader context?

RSD and PDA are relatively straightforward compared to conditions like autism, where underlying factors can vary significantly between individuals. However, the approach would be the same. Understand the ‘WHY’ behind the symptoms is the key to alleviate the suffering that comes from it.

This is the approach we at Aspiedent take when supporting individuals, and it allows us to empower them with the understanding and control to improve their lives, rather than simply giving them a label. While providing a label can be helpful, it also runs the risk of preventing you from understanding WHY and finding a way forward.

So do we need more diagnostic labels?

It is difficult to say for certain. But as we continue to learn more about human cognition, it is clear that the number of labels you’d need to describe the diverse ways in which difficulties can manifest would become too confusing. When considering a label, always ask what the benefit to the individual concerned is. If there is no benefit, then best to refuse the label.

What we do need is the ability to better see people as individuals, not just labels, and to take an approach based on understanding rather than categorisation.

If you’d like to learn more about how we approach cognitive diversity and support individuals beyond diagnostic labels, explore our other blogs or get in touch. Understanding the ‘WHY’ behind symptoms can lead to real change.