Rejection Sensitive Dysphoria Is Common with ADHD

Rejection Sensitive Dysphoria Is Common with ADHD

Rejection Sensitive Dysphoria is common in those with ADHD. And the pain that people experience is very real as Dr. H describes in this mini episode.

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A transcript of this episode is below.


Dr. Ned Hallowell:
This episode is sponsored by OmegaBrite Wellness. Get a free bottle of OmegaBrite CBD full spectrum soft gels with free shipping when you buy one bottle of their 7010 MD Omega-3. Use offer code Ned, that’s my name, Ned, at omegabritewellness.com. Distraction is also sponsored by Landmark College in Putney, Vermont, the college of choice for students who learn differently. Learn more at lcdistraction.org.

Dr. Ned Hallowell:
Hello, this is Dr. Ned Hallowell with a mini episode of Distraction. Today I want to respond to a couple of questions that have come from my recent debut on Tik Tok #nedtalks on Tik Tok. If you go there, you’ll see a bunch of 60 second video clips that I’ve made. A couple of questions that have come up… On Tik Tok you don’t have a lot of time to answer a question. So a couple of questions that would take a little bit more than the brief space we have on Tik Tik to answer questions I thought I’d deal with here.

Dr. Ned Hallowell:
The first one regards rejection sensitive dysphoria, RSD, condition that William Dodson, one of the great clinicians in our field has really taken to the general public. It’s received widespread attention because it’s so common. Now rejection sensitive dysphoria is a bunch of syllables that simply refers to a person’s tendency to be more than average sensitive to rejection. None of us likes rejection. If someone comes up to you and says, “You’re ugly,” you’re not going to like that. Or if someone comes up to you and says, “You’re stupid,” you’re not going to like that. Or if you apply for a job and don’t get it, you’re not going to like that. Or if you ask someone out and they say, “You must be joking,” you’re not going to like that. So, it is a baseline fact of human existence that rejection is not pleasant.

Dr. Ned Hallowell:
However, there’s tremendous variability in how people respond to rejection. Those of us who have what’s called rejection sensitive dysphoria, we have an exaggerated response to rejection. Oftentimes we imagine rejection when it really isn’t there. Someone can say, “Oh, I really like your tie.” And you think, well, does that mean you don’t like my shirt? So we can imagine rejection where none as intended. That’s the dilemma of the person who has RSD, rejection sensitive dysphoria.

Dr. Ned Hallowell:
It happens to be very common in people who have ADHD. People don’t have ADHD can have it as well. People with anxiety disorders, people with post traumatic stress disorder, people who have a very insecure childhood, never got the kind of grounding and reassurance they needed and never developed what I call the emotional shock absorbers to allow you to deal with and rebound from rejection or disappointment. So there are many ways you can acquire rejection sensitive dysphoria, but it happens for whatever reason to be common in the ADHD population. We are inclined to overreact to rejection and to imagine rejection where none is intended.

Dr. Ned Hallowell:
What do you do about that? Well, you begin by simply knowing that it exists, that you have an exaggerated response to rejection, and sometimes you perceive it when it’s not even there. Now that can help you put it into perspective, you see, because by definition, the rejection sensitive dysphoria is a loss of perspective. You are magnifying the importance of the disappointment. You are magnifying the damage to your self-esteem that the rejection has done. You are turning a molehill into a mountain. So you want to learn how to bring that mountain back down to the molehill it ought to be.

Dr. Ned Hallowell:
That’s a skill that you can cultivate. One good way is to go to my favorite rule which is never worry alone. Talk to someone about it. Do you think that person really hates me? Do you think my not getting the job means I’m a total loser? Do you think my not getting a good grade in the course means I have no future in this field? You want to reality test, as the jargon puts it, your reaction, because your reaction is exaggerated. One way to bring that mountain back down to a molehill is to test your reaction out with a friend and say, “This is how I reacted to that. What do you think?” And the friend will say, “You’re exaggerating.”

Dr. Ned Hallowell:
Well, in order to do that, you have to be willing to make yourself vulnerable. You have to be willing to say, “I had this extreme reaction.” Then let your friends say, “Gee, it doesn’t sound like that person really was putting you down all that much.” Or the job you didn’t get it, well, there’s plenty of other jobs out there, and it doesn’t mean you’re a loser at all. There’s nobody in this world who hasn’t applied for something and not gotten it, whether it’s a team, a job, a date, or whatever it might happen to be.

Dr. Ned Hallowell:
So, start building your emotional shock absorbers as I call them. You do that with friends, with belief systems, with faith, with aphorisms, slogans. Epictetus, the great stoic philosopher, really the father of cognitive therapy, was a slave, and he discovered that the one thing he could control was his thoughts. So even as a slave, he was happy. His master freed him because he said, “Epictetus, if you can explain to me your secret, I’ll set you free.” Epictetus did, and it worked. The master set him free, and now Epictetus is revered as one of the fathers of a whole school of philosophy called stoicism. So, it’s about learning how to take control of your emotions and your thoughts instead of being at the whim, the horrible often devastating whim of your perceived rejections. You want to learn how, and seeing a therapist can help a great deal, learn how to build up your emotional shock absorbers, your reality testers, your capacity to reassure yourself, to give yourself self-talk without necessarily having to find another person.

Dr. Ned Hallowell:
Dr. Dodson also recommends a couple of medications that oddly enough can be helpful for this. They’re not antidepressants. They’re what are called the alpha agonists. Clonidine is one, and Guanfacine is another, that in low doses have been found to be effective in dealing with RSD. Now, why that is, we don’t know. But it is very interesting that a medication can help improve a person’s capacity to tolerate rejection. It just shows there’s this tremendous interface between the mind and the body, between what we think of as femoral and psychological, as opposed to what we think of neuro-transmitter driven biology. They overlap. They’re, in a sense, one and the same, that you can use a medication to treat what seems like such a purely psychological experiential phenomenon. So rejection sensitive dysphoria.

Dr. Ned Hallowell:
The other part of the question the person asked was, “Well, what if the rejection is real?” What if you have been dropped by the person of your dreams? What if you did make it up to the final cut and didn’t make the team, or didn’t get the job, or didn’t get the promotion? There’s no doubt that’s a rejection. What if it’s real? Well, you deal with it in exactly the same way. You rely on your emotional shock absorbers. You rely on your support system. That’s why it’s so important to have a support system, what I call your network of positive connection, connection to friend, connection to family, connection to a dog, one of the ones that I champion all the time. Connection to ways of self-soothing be it music, be it beauty, be it a walk in nature, ways of self-soothing, reliable ways of self-soothing, and avoiding the dangerous ways of self-soothing, which is excessive alcohol, drugs, dangerous seeking behavior, impulsive acting out. So you want to try to cultivate the adaptive forms of self-soothing and steer clear of the maladaptive.

Dr. Ned Hallowell:
But that’s why it’s important to have a philosophy, or a belief system that you can reliably turn to, a passage from literature, a letter from a friend, something that you remember that stuck with you that helps to bring it out when times are tough. My father-in-law who’s since passed away, loved the poem “If”. I’ll send you to that poem. It’s a great one if you want to have something that you can turn to for some degree of stabilization. We all need that. People who have this predilection toward overreacting to disappointment and rejection particularly need to develop those emotional shock absorbers that you can bring out so that you don’t suffer the terrible pain that RSD can create if you don’t know what you’re dealing with.

Dr. Ned Hallowell:
I hope that makes sense because it’s a common phenomenon, not just in the world of ADHD, but in life in general. Life has enough pain in it, but you don’t want to… I call there’s necessary pain and then there’s unnecessary pain, and the pain of RSD is unnecessary pain, so take it upon yourself to learn how to master it. Work with a professional. You’ll discover that these episodes, while no fun, do not have to be devastating, and indeed can turn into growth. That is a fact, that the painful experiences, the old saying what doesn’t kill you makes you stronger, it’s true. It’s true. But we don’t want you to get killed in the process.

Dr. Ned Hallowell:
Okay. Before I go, I’d like to thank our sponsor OmegaBrite Wellness. Get a free bottle of OmegaBrite CBD full spectrum soft gels with free shipping when you buy one bottle of their 7010 MD Omega-3. Use offer code Ned, that’s my name, at omegabritewellness.com. Please reach out to us with your questions and comments by emailing [email protected] That’s [email protected] And if you happen to be on Tik Tok, my new favorite platform, you can find me there with the username @drhallowell. I’ve posted a whole bunch of videos about common ADHD issues, and they’re only 60 seconds apiece. Take a look and let me know what you think. Distraction is created by Sounds Great Media. Our recording engineer and editor is the estimable Scott Persson. Our producer is the very talented Sarah Guertin. I’m Dr. Ned Hallowell, until next time.

Dr. Ned Hallowell:
The episode you just heard, just now heard, was made possible by my good friends at OmegaBrite Wellness. Get a free bottle of OmegaBrite CBD full spectrum soft gels with free shipping when you buy one bottle of their 7010 MD Omega-3. Use offer code Ned, that’s my name, at omegabritewellness.com.

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