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Old 04-05-14, 06:10 PM
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Rejection-Sensitive Dysphoria (RSD)

This entire "quote" was posted by FroGpants in the Depression thread on 2/21/14. I though that it was so important for as many to see it as possible since so many of us seem to deal with this issue and it causes the domino effect in our lives. This post may change my life!!!

Quote:
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.
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  #2  
Old 04-05-14, 10:50 PM
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Re: Rejection-Sensitive Dysphoria (RSD)

He's my doctor and was amazed at this. I fell into instantaneous and horrid depression due to this a couple months Ago. I described this to him to the T and had no idea what it was until he mentioned this.

Dr. Dodson does have critics. He also allows prescribing appropriate doses, not the arbitrary and baseless guidelines of the FDA. He wants you to receive the correct and therapeutic dose.
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Old 04-06-14, 12:37 AM
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Re: Rejection-Sensitive Dysphoria (RSD)

I was told about RSD not long ago and I think for me my RSD if I have any is because of autism, mood disorders and a few suspected personality disorders. It's seems a blow up about the same things in a cycle of behaviour, i.e going from normal, to happy, to above happy, to going down in mood to even lower - plus the two moods mixed together.

A lot of it does relate directly to my more anti-social PD's like Pathological Demand Avoidance and even my anti-social PD's triggered from extreme anxiety.

Have a read for yourself and see what you think:

http://www.additudemag.com/slideshow/40/slide-1.html
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Old 04-06-14, 04:23 AM
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Re: Rejection-Sensitive Dysphoria (RSD)

Its so dreadful that you've done your utmost, worked your butt off, pulled out all the stops and still get attacked in your character the moment you inevitably slip up. Those can be the times when you can just want to give up and say to hell with it all. But of course, picking up again is also what we do. Until the next blow falls.
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Old 04-06-14, 04:48 AM
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Re: Rejection-Sensitive Dysphoria (RSD)

thank you for posting this!
i stll have this problem in spite of massive improvements.

my boss has the " externalized version". when i say i've had a bad day at work, I'm not kidding...
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Old 04-06-14, 08:17 AM
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Re: Rejection-Sensitive Dysphoria (RSD)

wow... probably my most defining trait... thanks and thanks frogo...
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Old 04-06-14, 10:17 AM
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Re: Rejection-Sensitive Dysphoria (RSD)

So what's the solution? Make sure you never put yourself into a situation where you could get rejected? Therapy of some sort? Meds? I'm a lot less sensitive and a lot less emotional on stimulants. And anti depressants make me obsess less so I don't dwell so much on rejection.
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Old 04-06-14, 01:43 PM
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Re: Rejection-Sensitive Dysphoria (RSD)

Therapy. And meditation has helped me with this hugely. I'm still reactive, but i'm much better at being able to accept my mistakes, and i don't do as much blaming of myself and others.

I just applied for a job, which i've been needing to do for months but have been avoiding, for fear of failing.

Through the entire process i've been using self soothing techniques i learned in therapy and meditation. Without them i'd be a basket case i think.
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Old 04-06-14, 02:28 PM
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Re: Rejection-Sensitive Dysphoria (RSD)

Hola Finallyfound:

I am a senior now, so my earlier memories are vague or lost but I remember I would be so sensitive around other people it hurt physically.

I remember one party I attended. I knew most of the people. I liked them. I thought I would be ok.

Yet, standing in the parlor, drink in hand, while everyone made small talk, I felt I was drowning in emotions, not mine, theirs.

I could sense who was having a affair, who was angry, who was attracted to whom and more. (I was able to verify much of this later.) It was like I was standing in a river of emotions that were flowing downstream, around me and through me.

When someone complimented me about my dress, I went into shock and had to leave the room. I hid in the back room pretending to try and fiddle with the desktop computer (with permission).

Being the intellectually curious person that I am, I tried to understand why this happens to me. My conclusion was I was born with less myelin sheathing around my neurons. Made sense to me.

In the end, CBT, professional and self-help, late maturation, journaling and coping skills helped ameliorate the condition. The condition has reduced due to an aging brain. In fact, I had come to rely on this "skill" because I could read people well. So, now I miss it.
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Old 04-06-14, 02:56 PM
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Re: Rejection-Sensitive Dysphoria (RSD)

I read about this in another forum, one that is mostly professionals treating ADHD. A research oriented person was skeptical, since dysphoria is related to low serotonin activity, not low dopamine or norepinephrine activity. He also pointed out that this is a term created by Dr Dobson, not one in the generally accepted psychiatric lexicon, or the DSM.

The clinical people and the patients, however, were unanimous, if not in the technical terminology, then in their agreement that yep, this is a significant difficulty for people w ADHD.

Not too long ago, when I thought I was providing a context or explanation for something, my talk therapist wrote and said, "Sensitivity to criticism." While I freely admit that I am, in this case, I didn't think that my explanation was in response to perceived criticism. But somehow, testily replying that "I was NOT being SENSITIVE TO CRITICISM!!!" didn't seem to be the way to handle this one.

In fact, I get all tongue-tied and discombobulated when I get hit with criticism. Part of the "hit by an arrow" reaction, I guess, but impulsive responses in that situation is not one of my ADHD problems.
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Old 04-06-14, 04:23 PM
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Re: Rejection-Sensitive Dysphoria (RSD)

Quote:
Originally Posted by Fuzzy12 View Post
So what's the solution? Make sure you never put yourself into a situation where you could get rejected? Therapy of some sort? Meds? I'm a lot less sensitive and a lot less emotional on stimulants. And anti depressants make me obsess less so I don't dwell so much on rejection.
He told me that he found Tenex (Intuniv) assisted many of his patients, but there needs to be more research. Other doctors have criticized his assumption on RSD. Regardless, I believe it's biological.

From what I understand, Dr. Dodson believes ADHD causes it's patients to be overly sensitive, susceptible to self judgement, etc. I can tell you that I was amazed how much he knew about me, without even knowing my whole story. He seemed to be able to read my mind.

The reality is, no one really knows much about the brain or how medications work in the brain.
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Old 04-06-14, 04:51 PM
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Re: Rejection-Sensitive Dysphoria (RSD)

Quote:
Originally Posted by ADD me View Post
I read about this in another forum, one that is mostly professionals treating ADHD. A research oriented person was skeptical, since dysphoria is related to low serotonin activity, not low dopamine or norepinephrine activity. He also pointed out that this is a term created by Dr Dobson, not one in the generally accepted psychiatric lexicon, or the DSM.

The clinical people and the patients, however, were unanimous, if not in the technical terminology, then in their agreement that yep, this is a significant difficulty for people w ADHD.

Not too long ago, when I thought I was providing a context or explanation for something, my talk therapist wrote and said, "Sensitivity to criticism." While I freely admit that I am, in this case, I didn't think that my explanation was in response to perceived criticism. But somehow, testily replying that "I was NOT being SENSITIVE TO CRITICISM!!!" didn't seem to be the way to handle this one.

In fact, I get all tongue-tied and discombobulated when I get hit with criticism. Part of the "hit by an arrow" reaction, I guess, but impulsive responses in that situation is not one of my ADHD problems.
You have a point, but recall he states the depression caused by RDS is instantaneous caused by the rejection or perception of such. I think that's the point people and professionals are missing. This may debunk that RDS is caused by improper balance of serotonin.
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Old 04-06-14, 06:50 PM
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Re: Rejection-Sensitive Dysphoria (RSD)

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Originally Posted by Fuzzy12 View Post
So what's the solution? Make sure you never put yourself into a situation where you could get rejected? Therapy of some sort? Meds? I'm a lot less sensitive and a lot less emotional on stimulants. And anti depressants make me obsess less so I don't dwell so much on rejection.
And if you're not on meds: constant self-talk to rationalize the situation and keep yourself from overreacting.

OK. I may have some RSD grouped with all the other disorders. I actually have a dysphoric disorder and I'm sure people here have witnessed what happens. RSD symptoms aside, it's also harder to control symptoms of ADHD and mood disorder symptoms.
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Old 04-08-14, 02:30 PM
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Re: Rejection-Sensitive Dysphoria (RSD)

Wow, I'm so glad this helped someone else!! I was nervous about posting it, I know how stuff can get nitpicked around here and I'm, well, sensitive to criticism

I don't know a thing about Dodson or his center or whatever all that is, I included that just to say, this is where I found this.

This was huge for me because I've done years of therapies and meds and was still having the same issues I've had all my life. And all those issues kept swirling around in my head and refused to let go and current stuff was just getting piled on top.

I remember in high school a volunteer had come in to help tutor us... I was at an alternative high school... and I just wasn't getting WWII. The tutor got frustrated with me, made some mild criticizing statement and when I got upset he said I needed to learn to take criticism. That might not have stuck with me but it wasn't long before someone else came along and said the same thing.

Why does everyone else seem to be able to shrug stuff off?

WHY do people keep saying I'm too sensitive?? And WHY don't people get as worked up as I do??

I had a solid decade of trying desperately to overcome my issues and it just wasn't happening. I was still hurt about things that had happened a million years and my entire foo (and friends) finally got tired of it.

I stumbled onto this and it completely changed my outlook. I've been saying for awhile now that perception can change everything. And my perception had been stuck my entire life. I didn't know any better. I assumed that when I was depressed it was for the same reason(s) as anyone else and that mainstream treatment would help me out of it. But it didn't.

Instead, there I was, 10 years later, still replaying that old tape in my head.

So when I found this, everything fell into place. All those situations, all those things said to me or about me or all those times I felt emotionally battered by others, I was magnifying it hugely. Not intentionally of course. I would look at others and how they reacted to situations and marvel at how they were able to blow things off. I couldn't do that. No matter how hard I tried. I didn't understand why and I hated that I couldn't and all that ever did was make me feel even worse.

Anyway in my usual adhd way I glossed over the whole 'Dodson' thing and even the 'rejection-sensitive dysphoria' label. I just zeroed in on the meat of it. The description. I don't care what it's called or who said it.

It's been a few months since I first found all that and the change in me has been extraordinary. Now that I understand my (over)reactions to others. I'm no longer at odds with my foo and when things are said or done that I might have ordinarily had a strong reaction to, now I know to take a step back and take a deep breath and try to turn my attention elsewhere. Don't let it create a loop.

I also know now to let those old brain loops go. I'm even working to replace them with good loops... all the times people have said nice things to me and about me. All the compliments I've gotten over the years.

The amazing thing is that the more I've learned about adhd and this issue and putting all those years of what I thought was typical depression behind me, the more I'm really starting to like myself.

Obviously, my experience isn't going to be the case for everyone so this may or may not apply and it may not even make sense to some but if it was this huge for me then there's probably someone else out there it will help. I am just so incredibly thankful to finally have answers and be aware of how my own emotions work and that I don't have to be at their mercy anymore.
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Old 04-08-14, 02:40 PM
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Re: Rejection-Sensitive Dysphoria (RSD)

I think the most important thing, in his claim of RSD, is the depression caused by it is instantaneous. You immediately fall into depression, and that's what he told me.
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