Can we talk about rejection-sensitive dysphoria (RSD) for ADHD folx?

I was reminded of several things recently. First, that rejection sensitivity within ADHD is a powerful force. Second, it is not often spoken about or understood, even by therapists. And Third, there are plenty of ways we can work with the experience to reduce its impact.

What is rejection sensitivity? ADDitude Magazine sums it up well:

Individuals suffering from rejection sensitive dysphoria may exhibit the following behaviors:

• Sudden emotional outbursts following real or perceived criticism or rejection
• Withdrawal from social situations
• Negative self-talk and thoughts of self-harm
• Avoidance of social settings in which they might fail or be criticized (for this reason, RSD is often hard to distinguish from Social Anxiety Disorder)
• Low self-esteem and poor self-perception
• Constant harsh and negative self-talk that leads them to become “their own worst enemy”
• Rumination and perseveration
• Relationship problems, especially feeling constantly attacked and responding defensively

One way that this shows up for me, and many of my clients, is in the aftermath of time with friends, acquaintances, coworkers, etc.

Let’s say I go and spend time with a close friend. We have a lovely time chatting, laughing, drinking tea. In the moment I feel connected (because I’ve learned how to manage the immediate fears and reactions of RSD), and after a few hours we part ways happily. Zero weirdness.

Then it’ll settle in. Maybe it’ll be the car ride home, maybe as I’m trying to fall asleep that night. It’ll sound a little like this, “Did I screw up that entire conversation? I talked way too much. She probably thinks I’m an idiot. She must hate when she is forced to spend time with me. Did I force my way in? How pathetic must she think me? I can’t believe I’ve screwed up yet another friendship. I probably won’t ever hear from her again. I wouldn’t blame her.”

You get the point.

The physical sensation that accompanies this involuntary tirade is a sinking feeling in my chest, a tight nausea in my stomach, a lump in my throat, a smidge of panic, and the distinct urge to crawl under a rock and rot.

Other times, I won’t have this internal monologue, but I’ll notice a nebulous depression or anxiety that hangs over the next couple of days. Almost an RSD hangover.

Sound familiar?

Here’s the thing, those thoughts are trash. When I check back in with my friend, she’ll be surprised that I felt anything other than warm fuzzies, as she did. She can’t fathom why I would feel that way. And when I search my memory, I can’t really locate the specific moment I acted a fool, but can still palpably feel having done so.

The truth? Most people don’t check back in with that friend. Bathing in a soup of shame, misery, and a fear of over-reacting, they stay quiet. Heaven forbid they acknowledge, out loud and outside of their body, that they’re as mentally unstable as they feel. The embarrassment is paralyzing.

TLDR: You are not mentally unstable. RSD is a normal survival reaction of the brain to get you to preserve relationship and community, because humans can’t survive without it.

Now, this example was based on a close, loving friendship. Imagine this, then, with someone you’re still trying to win over like a new acquaintance or coworker. Imagine if it’s not just one person, but a group of people. Or even worse, imagine that the scenario isn’t all kittens and rainbows, but is in fact is riddled with criticism like in a review at work or when your partner is frustrated with you.

Where is a good rock when you need one?!

Relax. We can cope with this. In an upcoming blog, I’ll teach you the three step process to managing emotions. Yes, it is harder than it sounds.

For starters, remember: Name it to Tame it. “Whoa, my body is tight and I’m having anxiety. That’s probably rejection sensitivity. That happens sometimes after I spend time with others.” Or “of course I feel fear and overwhelm, feedback at work is hard.”

Next, check your mind. If you can’t locate a specific whoops moment, then thank that part of you for trying to protect you from social banishment, and let it fall away. It always helps to return to your body. Notice where the feelings are loud and breathe into them. See if you can focus solely on the physical sensations of this, and whether you can relax even a tiny bit during each slow exhale.

If you can locate a specific whoopsie, then reach out to your friend and apologize. If the relationship is too new or the whoops wasn’t egregious, then apologize to yourself in the mirror (and then forgive yourself). We all make mistakes. You can always phone a friend and replay what happened, or even phone the friend you were with and check out your story with them. It helps to start by saying, “I’m telling myself a story that… did you experience the same story?” It helps if they know, in advance, that you might do this.

But what if you really did screw something up or are getting difficult feedback from work or a partner? Well, for starters, welcome to life. You’re a human. Humans are chronic mistake-makers. We’re all basically bumping around in the dark trying to make our way through this life. Some of us make more mistakes, but that has nothing to do with our value. Some people have more freckles. Does that change their value?

The antidote I’ve found most effective for difficult feedback, is to be gentle with myself and take accountability for it. Someone else: “You didn’t do the thing you said you’d do.” *shame spiral swirls – deep breath* Is it true that I struggle to complete some things? Yes. I can do this. “You’re right, I said I would and I didn’t. I can understand how that’d be frustrating for you. This happens for me sometimes, I’ll go take care of it now.”

Ultimately, we have to be willing to acknowledge and work with our shortcomings – while keeping kindness in our hearts. Am I the very best friend who ever existed? No, probably not. Are any of my friends? Well, they’re pretty great, but they’re all imperfect. Just like me.

(and that’s okay)

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You got this,

D