View Full Version : Rejection Sensitive Dysphoria


FroGpants
02-21-14, 02:22 PM
I found this on the Dodson ADHD Center website....

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I have been specializing in adults with ADHD for 22 years. I have found that some parts of the ADHD syndrome could only be talked about after the person had gotten to know me and see me as a person who liked them just as they were and didn’t see them as flawed or defective. After our relationship developed over time and some trust was established, patients were confident enough to reveal a part of their emotional lives that they did their best to keep hidden. This became such a universal experience that it is now the first trait I ask about on the checklist after the traditional 18 childhood criteria from the DSM IV…


• “Question # 19: For your entire life have you always been much more sensitive than other people you know to rejection, teasing, criticism, or your own perception that you have failed or fallen short.”


Over the last 20 years 99.9% of my ADHD patients have not just endorsed this criterion positively; they have underlined it, put stars by it, and added “This is my major problem!!!”


This is the definition taken pretty much verbatim from an old psychiatric textbook of a technical term called Rejection-Sensitive Dysphoria(RSD).


This, in turn, was the hallmark of an unofficial diagnosis called Atypical Depression. In other words, clinicians only saw what they already knew (depression rather than ADHD) and continued to think in terms of mood but just said it was not typical as compared to other mood disorders.


The reason that it was not typical was that it was not a mood disorder, it was ADHD.


The term dysphoria is literally Greek for “difficult to bear” which should give you some idea about how painfully your husband experiences your pointing out his short-comings no matter how helpful you try to be.


People with ADHD nervous systems often state that this RSD is the most disruptive aspect of ADHD in their adult lives.


They have found ways to manage the ADHD impairments in their academic and work lives.


It is the constant vulnerability to being “wounded” by anyone at any moment that continues to throw them into a tailspin without warning and then disrupt their lives for days with obsessive worry about “what did I do to make them hate me so much?”


It does not even have to be real rejection or criticism (although that is common enough in the lives of people with unrecognized and untreated ADHD).


Perceived criticism and withdrawal of love and respect is just as devastating as the real thing.


Rejection-Sensitive Dysphoria is often experienced as if it were a physical wound. Patients will hunch over and clutch their chests as if they have just been stabbed with a spear in the chest as they recount episodes in which they have experienced RSD.


People tend to react in one of two ways:

If they internalize the pain they can instantaneously drop into a full Major Depression-like syndrome complete with suicidal thoughts and impulses.

The difference, of course is that unlike Major Depression which comes on over weeks to months for no identifiable reason the plunge of RSD is instantaneously complete and clearly triggered by some perceived rejection. Because RSD is always triggered by some event and because the mood shift matches the nature of the trigger, the internalized RSD can be considered a normal mood in every way except its intensity.


The RSD can also be externalized. This usually takes the form of a rage at the person or situation that wounded them so severely. Luckily, this period of rage is usually expressed verbally instead of physically and passes relatively quickly (Dr. Tim Wilens refers to these sudden, short outbursts as a “bottle rocket temper”….fzzzt and it’s over for the ADDer although the rest of us are still getting up off the floor).


**It should not be a surprise then that informal surveys of persons who are court-mandated to anger management classes due to “road rage” or domestic violence have found that 50% of both groups have previously undiagnosed ADHD. The combination of neurologically based rejection sensitivity and impulsivity combine to produce a violent response before the ADDer can see it coming and gain control of the outburst.**

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I never thought about my mood going down so quickly but I've always known I was super sensitive. My foo used to get onto me for it. I know I'm always hyper-alert and reactive to other people's opinions (or even a lack of opinion, that means they don't care). And I was never able to shake the whole issue of depression. So maybe this is why.

erratic
02-22-14, 06:11 AM
I have always thought my depression was situational and triggered. I guess many ADHDers would be classified as having Avoidant Personality Disorder?

Fuzzy12
03-02-14, 06:46 AM
Yes that's me :eek:

:(:(:(:(:(

FroGpants
03-05-14, 03:02 PM
I have always thought my depression was situational and triggered. I guess many ADHDers would be classified as having Avoidant Personality Disorder?

Maybe huh? Funny thing though, I also keep getting drawn to Aspergers. I know my mom has it and I'm thinking I might too. The more I learn about it the more it explains the difficulty I've had socially all my life. Which I've had a really hard time understanding because I'm outgoing and all that. But there are a million little social things that I don't get. And Aspergers really explains it.

Which is interesting because Aspergers sounds a lot like Avoidant Personality Disorder and/or APD could be explained by Aspergers.

Anyway, I could be dead wrong. Food for thought.

Daydreamin22
03-05-14, 03:03 PM
Thank you!

FroGpants
03-05-14, 03:41 PM
Yes that's me :eek:

:(:(:(:(:(

Yes! Me too! And for me, it was a HUGE relief to read this. I am SICK of the word depression and being depressed. Gah!!

Reading this made me feel like I could figure out why I was down and take control of my emotions. But then I'm a 'why' person. I feel like I can conquer anything as long as I know 'why' something is a problem to begin with.

I guess some people are able to blow things off or 'just get over it' but that's never been me. But now at least I can look at it, see it for what it is and not let it get to me so deeply.

aeon
03-05-14, 05:37 PM
Sensitive to rejection, fearful of abandonment, easily wounded by teasing.

Yes, that describes me. The “internalizing” part, anyway.

Part of that is the diagnosed ADHD-PI and dysthymia. I suspect part of that is the yet-undiagnosed major depressive disorder, generalized anxiety disorder, and sub-clinical borderline personality disorder.

I can’t afford my meds right now. Life is a different flavor of hell without them. No wonder I used to “self-medicate.”

I didn’t ask to be physically abused when I was a child.
I didn’t ask to be emotionally abused and invalidated when I was a child.
I didn’t ask to be neglected and abandoned when I was a child.
I didn’t ask to be sexually abused when I was a child.
I didn’t ask to be drugged when I was a child.

I didn’t even ask to be here to begin with, but here I am nonetheless.

I know I can’t change the past, and I forgive those who treated me with less than respect for my being. My sense is they had a full plate of their own (untreated) disorders.

But that doesn’t change the day-to-day challenge of being here now.

I don’t mean to be dramatic (or mercurial, or sensitive), but I’ve got this schema that I’m ultimately worthless as a human being. When that’s the foundation I build upon, the architectures of my life aren’t particularly livable or aesthetically pleasing, but they’re all I’ve got, and I do the best I can.

Rejection-sensitive dysphoria...heh. It simply doesn’t feel good to have my deepest fears validated, despite their irrationality.

In fact, sometimes I think I would be better off dead, but I know that doesn’t make sense either, despite my desire to take flight and escape from my wide-eyed self.

daveddd
03-06-14, 12:41 AM
Maybe huh? Funny thing though, I also keep getting drawn to Aspergers. I know my mom has it and I'm thinking I might too. The more I learn about it the more it explains the difficulty I've had socially all my life. Which I've had a really hard time understanding because I'm outgoing and all that. But there are a million little social things that I don't get. And Aspergers really explains it.

Which is interesting because Aspergers sounds a lot like Avoidant Personality Disorder and/or APD could be explained by Aspergers.

Anyway, I could be dead wrong. Food for thought.

your not dead wrong, 35 % of people with adhd meet the criteria for avpd

and higher in autism

emotional dysregulation inhibited , turned in

Sandshrew027
03-08-14, 10:24 AM
Yep, and I think that this could apply as well to most others with ADD/ADHD whom I know.

finallyfound10
04-05-14, 05:56 PM
This is an amazing discovery!! It's what I've dealt with for so long and blamed it totally on my less-than-nurturing-and-sensitive-mother, fairly shame-based Catholic education and alcoholic father. Knowing that this can also play a role and may be managed, to a degree by meds, is amazing.

I have wanted to try Wellbutrin for a very long time but I don't have insurance now and Concerta through Johnson & Johnson Patient Assistance Foundation but hopefully will be getting a job with insurance in the summer.

ana futura
04-05-14, 07:43 PM
Very interesting, this is great to see.

I've been thinking a lot lately about how our lack of impulse control can lead to a lack of agency, autonomy, and self awareness, and this gets as something I hadn't thought of- another reason I lack a sense of agency is that I've spent my whole life trying and failing to please others. I've never sat down and tried to figure out what it is that I WANT to do, because my top priority is avoiding rejection, conflict, and unpleasant situations.

I think this has kept me mentally healthy and safe to a degree, but now it's starting to backfire because I am so stagnant and stuck.

This is so accurate, I'm a mix of both (lately leaning more towards the later)

In the long term, there are two personality outcomes. The person with ADHD becomes a people pleaser, always making sure that friends, acquaintances, and family approve of him. After years of constant vigilance, the ADHD person becomes a chameleon who has lost track of what she wants for her own life.

Others find that the pain of failure is so bad that they refuse to try anything unless they are assured of a quick, easy, and complete success. Taking a chance is too big an emotional risk. Their lives remain stunted and limited.

http://www.additudemag.com/adhd/article/10121.html

USMCcop
04-05-14, 08:27 PM
Dr. Dodson is amazing. I switched to him last month. He read me like a book. My last spell was just as he described as above.

aeon
04-07-14, 11:21 AM
This is so accurate, I'm a mix of both (lately leaning more towards the later)

In the long term, there are two personality outcomes. The person with ADHD becomes a people pleaser, always making sure that friends, acquaintances, and family approve of him. After years of constant vigilance, the ADHD person becomes a chameleon who has lost track of what she wants for her own life.

Others find that the pain of failure is so bad that they refuse to try anything unless they are assured of a quick, easy, and complete success. Taking a chance is too big an emotional risk. Their lives remain stunted and limited.

Ditto. :faint:

mrs. dobbs
04-18-14, 10:49 AM
This helps me immensely. Because I have to sort out ny comorbids with my psychologist to finish my ADHD diagnosis. And over the years, precisely because of exactly what RSD describes, I have been in social anxiety groups, done DBT, told my therapists I had Atypical Depression, read about and diagnosed myself with BPD (esp. physical distress over perceived rejection followed by depression), NPD, AvPD, and have been really ashamed of my interpersonal rejection sensitivity and vigilance. I would get teased for it and so developed alot of management and damage control strategies, the main one being avoidance but others being OCD manifestations and being a pleaser or chameleon. But I have constantly had an opposing force which sought authenticity, truth and justice and I ended up in this horrible situation of being strong enough to go against the norm or speak out but not strong enough to withstand the backlash- or anticipated, perceived or assumed ones. I never had the guts to look back, haha.

botomat
11-01-14, 11:38 AM
Hey so i'm currently undiagnosed as adhd. Always just though i'm a freak of nature until starting to research adhd for my son and im like 'oh right, it all makes sense now'. have my gps appt soon. but one thing i still couldn't place was the emotional pain i feel on a daily basis. iv always known it isn't normal to feel so deeply about everything, to agonise over a harmless comment for weeks and have it take a place in further destroying myself. Like you guys iv always put it down to parents (violence, alcohol, etc... the usual) but not everyone has to avoid work, friends, family everyone after early trauma, and in comparison my experiences werent all that bad really. I've been in therapy since i was 14 (28 now) and have been diagnosed and 'treated' for a range of disorders, ptsd, GAD, Social Anxiety, SAD none of which have worked, have been told i probs have a chemical imbalance and have been on about 5 different anti-depressents. none of which have significantly improved my symptoms.

I have a degree in psychology and post grad in social sciences yet im working from home running an ironing service because i simply cant handle the judgement i feel from other people even though i know logically it is just me being 'over sensitive'. i've been told my entire life to 'stop thinking so much' 'dont' over analyse it' 'your just oversensitive' dont take it to heart' etc etc but i just cant help it. no matter what i do.

Has anyone got any experience with the INTUNIV medication? has it helped. The thought that there may be something out there which could help me achieve at least some of my potential, and help me to stop blaming myself is huge, but i notice it says it could help somewhat.

Thanks for having somewhere where i can have a major rant. its long over due :)

Little Missy
11-01-14, 05:51 PM
Fascinating read. Correct and true, for me anyway.

Except I had a wonderful childhood and really great parents.

Maybe it was all the radiation from WWII.

Pilgrim
11-02-14, 03:43 AM
[QUOTE=botomat;1693953]Hey so i'm currently undiagnosed as adhd. Always just though i'm a freak of nature until starting to research adhd for my son and im like 'oh right, it all makes sense now'. have my gps appt soon. but one thing i still couldn't place was the emotional pain i feel on a daily basis. iv always known it isn't normal to feel so deeply about everything, to agonise over a harmless comment for weeks and have it take a place in further destroying myself. Like you guys iv always put it down to parents (violence, alcohol, etc... the usual) but not everyone has to avoid work, friends, family everyone after early trauma, and in comparison my experiences werent all that bad really. I've been in therapy since i was 14 (28 now) and have been diagnosed and 'treated' for a range of disorders, ptsd, GAD, Social Anxiety, SAD none of which have worked, have been told i probs have a chemical imbalance and have been on about 5 different anti-depressents. none of which have significantly improved my symptoms.

I have always wondered why I thought and think as you do. My home life at times was chaotic and part of me is angry with my care givers.
I must say I do think it is largely genetic. How can genetics be hurtful like this.
I also like you tried heaps of antidepressants. I think these made me worse.
Goodluck

sarahsweets
11-02-14, 08:23 AM
I have experienced these issues and it directly relates to my bipolar.