Ownership of the Mind: How Neurodiversity Is Taking Charge of Labels for Deeper Understanding, Part 3
Rejection Sensitivity Dysphoria (RSD) is now considered by many experts to be one of the prominent features of ADHD experience.
During an interview with PBS Frontline in October of 2000, Colorado-based psychiatrist and ADHD expert Dr. William Dodson stated in a discussion of multimodal treatment of ADHD that, “Over the last 20 years, if you read the literature, there are two great trends. One is validating the diagnostic criteria to say that this is a valid, reliable set of criteria if you apply them in order. The other one is saying what works in treatment. ”
Later in the same interview he also said, “Our understanding of the disorder [ADHD] continues to evolve. . . .” which is a very astute observation from a professional who has continued to do the work of validating diagnostic criteria and fine-tuning treatments for ADHD.
While I consider the term “multimodal” valid for treating every single human ailment (even strep throat treatment included antibiotics + drinking plenty of fluids, getting plenty of rest and gargling salt water), this article is focused on one specific challenge of ADHD that in recent years has become yet another named concept and acronym, Rejection Sensitivity Dysphoria (RSD). Even though it is not an official diagnosis and is NOT included in current DSM-5-TR diagnostic criteria, it is a very real experience most familiar to adults with ADHD (for a discussion of the DSM-5-TR criteria here is a critical review).
Fast forward twenty or so years we find that the same Dr. Dodson is placing emphasis on “Rejection Sensitive Dysphoria” as a defining characteristic of ADHD. He describes RSD in a 2021 e-book produced by ADDitude Magazine as, “…an intense vulnerability to the perception — not necessarily the reality — of being rejected, teased, or criticized by important people in your life. RSD causes extreme emotional pain that may also be triggered by a sense of failure, or falling short — failing either to meet your own high standards, or expectations of others.”
I would add “or being too much” right after the mention of “falling short”. In my own experience with adult ADHD, the idea of being sensitive to rejection originally clashed with my desire to be a laid-back and easygoing person. Perhaps I conflated kindness with being laid back and self-reflection with being easygoing. Today I embrace the idea that being sensitive is okay, but being insensitive is not the way to manage sensitivity.
Today I embrace the idea that being sensitive is okay, but being insensitive is not the way to manage sensitivity.
After fMRI technology showed us that social rejection elicits the same brain region activity as the sensation of physical pain, the reality of this struggle fell firmly into place. Everyone will experience rejection and rejection hurts! Does this mean we ADHDers need to just suck it up and get over it?
“Dysphoria” originates from Greek, meaning “pain that is hard to bear, anguish.” Would we tell someone who was stabbed in the chest to suck it up and get over it? Those who experience the pain of RSD will often describe a throbbing hollowness in the chest or gut, it is quite palpable and uncomfortable, and our brains flash the anguish of it all.
As I stated in my introductory article to this series, mental health influencing and coaching via social media brings more awareness to the lived experience of neurodiverse individuals, but also has the risk of concept creep. Sometimes there is an overlap of the two, but at other times one person may be accurately describing RSD in one post and in another reel, is describing what is actually RSD but calling it narcissistic abuse (how dare you criticize me!).
Neither the person experiencing ADHD-related rejection sensitivity nor the secretly self-loathing pathological narcissist is having a very good time. The difference is that the person with RSD may go from zero to “maybe I am unlovable after all” and act in problematic ways while the narcissistic abuser may be punishing loved ones for pushing them anywhere close to self-reflecting on their inner darkness.
Why Is It Such a Big Deal?
RSD is related to negative messaging that begins in childhood for those with ADHD. When the neurodiverse behaviors do not match the neurotypical expectations, frustration emerges from both sides. I remember my older siblings saying things like “Do you ever shut up?”. And once my sister even suggested I desperately needed to change my personality, when I was about nine years old! It is highly likely that whatever I was doing was genuinely annoying to her, but we did not know why back then.
When I was in high school, I wrote in my journal, “Does a personality such as mine smell bad?” The sad part about such a question is that I had friends, I still have some of the same ones! I was not an outcast and was generally a well-loved child growing up no matter what my siblings said. I was not truly rejected over and over, but I was still sensitive.
Originating in childhood, my own version of RSD sometimes stems from my interest-based nervous system and the quantity and divergent quality of new discoveries I have always wanted to share, whether or not others share my enthusiasm. If I read a book about reptiles, I wanted to share immediately all of the cool things I just learned about Gila Monsters. If I saw a cool bird in the yard, I wanted to go ask someone about it. If I was really proud of some new idea I created, it needed to be known and made possible for others. If I could not sleep at night, I may have needed to feel safe and sneak a pallet onto the floor of an older sibling’s bedroom in the middle of the night.
No one is to blame for any of my RSD. Even though hearing “I don’t really care about Gila Monsters” or “I don’t have time to come look at some bird” or “I honestly have no idea what your idea means” or “Sleep in your own room” may have felt like rejection, my family have never once truly rejected me. Still, how many times have I rejected myself over the years because I didn’t fully understand yet?
The Ultimate Task of Managing ADHD-related Rejection Sensitivity
We have to take ownership of our thoughts, feelings, and behaviors. This is always the first necessary step. It puts the focus where we have some control.
After facing reality, what I try to do myself and recommend to clients when dysphoria creeps in is fourfold.
- Ask, “Are they rejecting me or something like an idea, a suggestion, an offer, an interruption, a noise, a momentary interest, et cetera?” This is so important!
- Remind, “I always have the option to accept myself and think of times I was very accepted by others.” This is important to avoid the pre-emptive rejection tendencies. Imagine how this plays out in our most intimate moments of partnership.
- Say, “No matter how intense this feels, it will pass if I allow it to fade without subjecting it to the catastrophic interrogation of my over-active imagination.”
- Do the work of self-soothing. Breathing exercises work and are worth learning in quantity, including making up our own. Exercise helps move the vibrating dysphoria out of the body. Journaling or projecting into one of the many useful models of the self can help externalize and organize in the Narrative Therapy sense of “the person isn’t the problem, the problem is the problem.”
Most importantly, override the negativity bias of the human brain and believe it when positive feedback is shared. Believe it when those who have demonstrated they love us and want us in their lives say it aloud. Never argue against love genuinely offered. Remember to offer that love to the uniquely wonderful neurodiverse Self that we have the honor to wake up and be every day!
The struggle is real even if the rejection may not be, and I like to repeat what a dear friend and colleague said to me years ago, “There is richness in the struggle.”
You can find other articles in this series linked below. Part 4 will dive into PDA which has nothing to do with people saying “get a room” but much to do with Pathological Demand Avoidance.
It will be ready to read ADHD-ASAP.
