Rejection Sensitive Dysphoria and ADHD | ADHD | Episode 20
ฝัง
- เผยแพร่เมื่อ 22 ส.ค. 2024
- Is RSD the same as emotional dysregulation in ADHD? I'll share my thoughts about what is useful (and what is not) about the concept of Rejection Sensitive Dysphoria.
Join the conversation on Facebook: / drjohnkruse
🎯 Key Takeaways for quick navigation:
00:00 🧠 *Introduction to Rejection Sensitive Dysphoria and ADHD*
- Rejection sensitive dysphoria (RSD) is a concept strongly associated with ADHD, particularly in adults.
- RSD involves intense negative emotional reactions, often triggered by criticism, rejection, or negative feedback.
02:21 📖 *Understanding Rejection Sensitive Dysphoria*
- RSD is characterized by intense disappointment, shame, and negative emotions when individuals with ADHD experience criticism or rejection.
- Dr. William Dodson, a psychiatrist, has played a significant role in popularizing the concept of RSD in the ADHD community.
- It was initially linked to societal disapproval of ADHD behavior, especially in children.
05:12 🤔 *RSD vs. Other Mental Health Conditions*
- RSD can be confused with depression, but it is distinct in that it is always a reaction to a specific stimulus, not a pervasive mood disorder.
- It differs from bipolar disorder and borderline personality disorder, although misdiagnosis can occur.
08:10 💢 *Impact and Misdiagnosis of RSD*
- RSD can lead to anger management issues, and up to 50% of individuals mandated for anger management have undiagnosed ADHD.
- Misdiagnosis is common, with some individuals being labeled as having depression or other conditions when they have RSD.
11:02 💊 *Treatment Approaches for RSD*
- Dr. Dodson recommends medications like alpha agonists (e.g., clonidine and guanfacine) and monoamine oxidase inhibitors for managing RSD.
- Psychotherapy is not considered an effective treatment by Dodson, as he views RSD as a primarily biological issue.
14:38 🧐 *Critiques and Concerns about RSD Concept*
- RSD may not be universal among individuals with ADHD, as some may not experience it.
- Emotional dysregulation in ADHD encompasses a broader range of emotions, including positive ones.
- The biological-only explanation for RSD may oversimplify its origins, as environmental factors can play a significant role.
- Psychotherapy, despite being dismissed, may still have a role in managing RSD, as seen in the treatment of panic attacks.
26:40 🧠 *The use of MAOIs for RSD and ADHD*
- MAOIs (Monoamine Oxidase Inhibitors) have been suggested as a treatment for Rejection Sensitive Dysphoria (RSD) in the context of ADHD.
- There is no specific data supporting MAOIs as the superior treatment for RSD in ADHD when compared to stimulants or non-stimulants.
- Stimulants and non-stimulants like bupropion or atomoxetine have also shown efficacy in addressing the emotional component of ADHD, including emotional dysregulation.
27:48 📚 *Questions from the audience and potential treatments*
- Discussion of audience questions, including the use of Dialectical Behavioral Therapy (DBT) for emotional regulation.
- DBT, originally designed for borderline personality disorder, has been found helpful for emotional regulation in various situations, but there are no specific studies on DBT for RSD in ADHD.
- Addressing fear of rejection or neglect, suggesting that medications and cognitive-behavioral strategies can be helpful.
- Cognitive strategies involve reframing emotional volatility as a component of ADHD and redirecting attention from self-evaluation to the task at hand.
- Clonidine, an alpha agonist, is mentioned as a medication option, but its efficacy for RSD is not conclusively proven.
31:16 🤝 *Combining therapies and tactics for emotional regulation*
- Discussing the use of internal family systems therapy and clonidine as treatment approaches.
- Suggesting the combination of therapy approaches like DBT, awareness of ADHD, and cognitive strategies for emotional regulation.
- Emphasizing the importance of knowing that while RSD can be challenging, it is not a sign of weakness, and individuals can learn to manage it effectively.
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"Intense" is an understatement, felt like torture, like my brains are trying to scrape their way out of my skull.
I got inattentive ADHD, and only had two strongly expressed RSD episodes 1,5 years ago (besides crying my eyes out for almost two years after parting from my first GF, as our feelings were not mutual).
P.S. I'm not a mental health specialist, but I guess it's different from depression, because it did not incapacitate me, it did not take away will to live, just made me feel like a miserable failure. I've never had a clinical depression anyway, just temporary reactive one - caused by some events in my life.
In a way, | suppose it's how my midlife crisis manifested itself ("you were a gifted kid, and what have you achieved?!") + grief for my first girlfriend (or rather not for her as a person, but that feeling of love and being accepted, I love my wife, but nothing compares to the first time) from over twenty years ago + depressive mood caused by my disability, which makes me unable to go to romantic walks with my wife, perhaps, I should get a wheelchair, so I could at least roll along with her, as for now I still can walk, but only mere 500-700 metres.
Same here. Inattentive ADHD diagnosed as adult. Took my divorce so hard it threw me into to what was seen as a major depressive disorder. I think that’s normal but in therapy now for different issues and the first thing I told my therapist was “I think I am too sensitive”. This is before I knew I had ADHD. My daughter has it but I thought she got it from her Dad. Nope, looks a lot like I was only worse. Just talking to her in a certain tone throws her into emotional dysregulation. She is doing the avoiding thing too and I think now what I thought was social anxiety is actually RSD. @@TotalRookie_LV
wow and what? and, then, back to wow. the shame...the anger...especially when you try so hard..i hate feeling like i always get it wrong..this kind of explains it...going to listen again. thank you.
My video on shame and ADHD may be particularly helpful.
Good review of rsd.
Small technical suggestion: put the microphone closer. It's hard to hear with the volume up all the way.
“Psychotherapy can't help Rejection Sensitive Dysphoria because it is biological issue. It happens so quickly, powerfully there is no chance for cognitive or emotional strategies to deal with it.”
I think this is correct.
Think of it children in various tribes who were molded to have distorted body parts - like forehead, ear lobes or lower lips - they grow up with deformities - but they are functional. These are not their fault, these are not making body dysfunctional - and if we label these adults as abnormal - we will create toxic shame inside them. It was not their choice - the deformities happened in childhood, by superstitious adults, it was not child's laziness or lack of courage or lack of strength - and psychotherapy suggests that abnormalities are not allowed in society - when abnormalities are decided by supermodels and narcissists and anyone with lack of empathy.
Psychotherapy cannot change someone's body being distorted and RSD is form of permanent distortion - but it can help to validate and accept the deformity, change the lookout at it as disorder and learn how to live with the permanent consequences - not as a tool to blame or criticize someone who was criticized to the point of distortion.
CBT is therapy of ableism where trauma is ignored, complex trauma is banned and instead there are labels and stigma to label anything neurodiverse as disorder.
The only disorder is being serial killer, being Trump, being without empathy, and instead to be with hidden agenda to harm and hurt others without ability to know the consequences of aggression and violence on others. That is disorder. Being abused and traumatized is not disorder - it is unfair to label and stigmatize targets of abuse and abnormal, sick and distorted. In the end it does not help - abused targets will feel guilt and shame and abnormal, that is the only thing which CBT is doing to anyone who genuinely seeks help with aftermaths of being abused.
Instead of CBT there is Humanistic psychology which is based on acceptance and validation.
One might say that panic attacks are a biological issue that happen quickly and powerfully, but we have robust evidence that CBT is helpful for addressing individual panic attacks and making someone less likely to have future panic attacks, and we can see changes in patterns of a brain activation in response to such CBT.
While some CBT therapists may not do a good job of dealing with trauma, I'm not aware of any aspect of CBT itself that would prevent it from being empathetically and supportively used to address someone's experience of trauma.
@@DrJohnKruse From my experience in social anxiety- CBT did help me with panic attacks at certain level - but it failed to address toxic shame, trauma, pureOCD worries intrusive thoughts, masking, hypervigilance and mostly people pleasing and handling toxic and intrusive people and situations such as low Maslow Needs - having no shelter, and depending on corrupt system - where oppression and pathocracy are unknown in CBT. CBT instead focused on person who is abused, as if experiencing abuse is abnormal and personal choice.
What I hate the most about CBT is that it is patronizing, it gives message that feeling fear and panic is abnormal, that other people who appear without fear are all normal and sane and that we are not allowed to feel emotions, that we must stifle them down, we must label them quickly by using limited vocabulary in DSM - which leads to hyper-cognition and misdiagnosis - and it is NT approach where a certain norm is presented as valid and anything that does not comply with someone's ideology is insane and abnormal.
I see it simply like this: the only pathology is being violent and aggressive. That is disorder.
Feeling anxiety, feeling fears, feeling panic - it is not disorder, it is not something to destroy, stifle down or label and stigmatize. By doing so - we will develop personality disorder - because we won't be able to trust our own brain, our own emotions, our own thinking patterns - and then we will try to be like everyone else - when they are happy, we must be happy. When they are sad - we must fix them. When we are sad -they must fix us. This leads to codependency, it is not healthy to destroy emotions.
I am strong supporter of Anti-psychiatry movement from 1960s. It is not about declaring psychology is bad - but that we must be careful how we handle ourselves and other people, that we do not use psychology to control or manipulate - as CBT is doing. Instead the point of psychology is to give us tools - and it is on our own common sense and free will to use them in accordance to what we know is the best and the most healthy thing to do. That we become the initiators - not mere sheep with herd mentality and groupthink, mimicking others.
I like this quote:
Dr James Davies (PhD), TWITTER:
DSM defined 'mental disorder' as a 'dysfunction in the person' - as if suffering stems from a faulty self. This of course is pure ideology, with no objective evidence to support it - an ideology erasing any notion that our suffering may have meaning or something vital to teach.
"I thought I was just an asshole." This made me laugh, but it's real. I've said it myself.
I can understand that the rejection response is so powerful that it can feel like agony and can be so intense and excruciating that the person w ADHD cannot slow down their thoughts to objectively analyse if the rejection is is real or perceived or rational. I get that.
What I have been struggling with is if these intense feelings justify verbal aggression. I left my ex spouse of almost ten years because the RSD was destroying me. I've been told by him and his therapist that I am prejudiced and ableist because leaving him over his RSD is me hating people w ADHD. but I could sigh because work emailed me at 10pm on my day off to ask me to come in at 5am, and he would act as if I called him a monster. He took things that weren't even remotely related to him as an insult, and when that happened, he launched metaphorical nukes at whoever he deemed as rejecting him. If I wasn't smiling and happy and chipper at all hours, he took it as rejection. And his anger when his RSD was so bad that more than once the cops showed up and more than once he got sent to court mandated anger management programs. What made me leave was when he physically harmed me.
But in trying to work it out on counseling, I was told he hit me because of this RSD, therefore it was not abuse. It was my fault for triggering his RSD. In that specific instance, whst triggered his RSD was me deciding to spend a weekend w my family after we got bad news about a family member I am very close with getting a terminal cancer diagnosis. My ex told me I was betraying him, and never cared about him, and how come I was willing to spend a few hours w my brother (who has been my best friend my whole life!) when I never spent time with him (a gross distortion, I had slowly given up every hobby and interest of mine and now when I wasn't working of cleaning, I was a captive audience for his ADHD special interest rants and I didn't have any friends at all anymore because any free second not in his presence could set off his RSD). But yeah, telling him I would be going to dinner w my brother and my mom (half brother technically, very complicated FoO, but his mom/my step mom is amazing) resulted in me needing stitches and a cast. But his therapist told me it's not abuse, it's rsd, so I was wrong to get treatment for my black eye and broken wrist because it jeopardized my exes criminal background report and future job opportunities.
Since we've split, I've lost a lot of friends because they think what happened to me wasn't abuse, and I'm being unfair to my ex because "RSD is hell" and I don't have enough empathy for that and I should have tried harder to be more accommodating of his RSD than throwing in the towel after only 10 years of trying.
Sorry for commenting on such an old video, I've just been trying so hard to figure out where I went wrong and I still don't understand how it's my fault since he has adhd, but if he didn't have adhd, everyone would be saying it's abuse and I was right to leave. All I'm getting is shamed by adhd experts I try to talk to for not understanding how bad rsd is.
Should I have stayed and tried to be more accommodating? His rage was just so bad, I sobbed because of the horrific things he would say to me. I feel like some part of me died and everyone is telling me that is what I deserve for being a terrible neurotypical. Is the rage and anger justified? Is it excusable? I'm lost about how to deal w RSD as the person on the other end, and everything I see just says "endure it and deal with being called names and yelled at."
That doesn't sound like RSD...more likely borderline personality disorder
Also another something....since he is violent and uses damaging words that doesn't necessarily sound like it's coming from ADHD.
Hi Dr.John thanks for Cruzin'.......🥥🥥🥥🥥🥥🥥🍍🍌
SO much for the medical standard of not diagnosing people that you have not personally examined.
When a diagnosis is based ENTIRELY on observable phenomenon, and we have hundreds of hours of video evidence that the individual displays these objective behaviors, in a variety of settings, across time, there is neither a rational nor an ethical basis for your statement. Or, in a different framing, is that in the modern world, many individuals are being diagnosed via video evaluations, whether or not one considers that a personal examination.
@@DrJohnKruse Pure unethical quackery.
@@michaelderobio5256 please first pay attention to what has been said, and then think about it, before offering your opinions. Your name calling doesn't alter the substance of what I wrote.
I have to agree with you. One could say Trump is a narcissist and most celebrities and politicians are just that. I don’t see ADHD in him. I see it in Biden though. That’s just my opinion though. Everybody is entitled to one.
He needs to speak louder
You can always turn on You tube automatic Subtitles by pressing letter C or icon at the bottom of the video.
Are you think that metylophenidate can help with RSD? I take this medication for my ADHD and it really help me for getting emotional stability, I also observe such improvement in social situations but I don't know if it is responsible for it or another factor.
Methylphenidate
@@buddysmilespopcornthesnake8611 yes, I'm not from anglosphere so I can make mistake ;) In Poland it's named _metylofenidat._
Yes, there are studies showing that amphetamine or methylphenidate can help with emotional stability in people with ADHD.
Dodson does not recommend MAOIs for Rejection Sensitivity. He recommends Alpha Agonists, Guanfacine and Clonidine. Dr. Kruse himself brings up MAOIs as being reputedly better for atypical depression, a term I do not think Dr. Dobson would equate with RSD. And then Dr. Kruse refutes MAOIs, saying they are not clearly better than other antidepressants for atypical depression, when Dobson never recommended them or even spoke of them in treating RSD.