Transcription
About two years ago, I created a video titled "Three Ways to Manage Rejection Sensitive Dysphoria." 31,000 views and many comments and emails from you, my viewers and supporters, thanking me for helping people identify and cope with their RSD has certainly motivated me to continue helping people on their path to healing. So, I'm excited to share with you my new video, "Five New Ways to Manage Rejection Sensitive Dysphoria."
In the two years since I've created that first video, that I had no idea would take off in popularity like it did, I have gained a much deeper understanding of RSD while continuing to work with clients who have suffered from it. The five strategies I discuss today have been the most successful strategies with the best outcomes for my clients with RSD, so I'm really excited to share them with you today.
Rejection Sensitive Dysphoria (RSD) is an extreme emotional sensitivity and emotional pain triggered by the perception, not necessarily the reality, that you have disappointed others and therefore they have withdrawn their approval, friendship, or love. It also can be described as being a person that has been rejected, teased, or criticized by important people in their life. The same painful reaction can occur when you fail or fall short of your high goals and expectations. Part of RSD contains a strong element of perfectionism. RSD commonly occurs with ADHD and causes extreme emotional pain that plagues both children and adults, even when no actual rejection has taken place. The term dysphoria is literally Greek for unbearable. Often, those with RSD hide their intense emotional reactions from other people and feel ashamed of their vulnerability. The condition often triggers a profound and wide-reaching sense of failure, as though the person with RSD hasn't measured up to personal or external expectations.
Strategy number one: In childhood, the best friend you thought was your best friend was not actually your best friend anymore. The day you realized they wanted to hang out more with someone else, their eyes lit up when the other person entered the room. You didn't get invited to the three-person sleepover. The boy or girl you had a crush on didn't like you the same way. In your mind, you believed this best friend was it for you. You were good. You felt nice and comfortable. In your mind, you believed you were an integral part of the group and would never be excluded. In your mind, mind you were convinced your crush would reciprocate the exact same feelings back to you and you would live happily ever after. After all, doesn't everyone deserve to find their person? And then the first stage of grief and loss happened, which was shock and disbelief. It's where one of our first major impactful mental mismatches occur in childhood. Prior to any social rejections or disappointments, we could have a very healthy self-level of self-esteem and healthy self-talk that actually exists every day. But then the world shows us something different from what we believe about ourselves through its social rejections and disappointments. Initially, in our lives, we think we are a good person with good personality characteristics and then are told from the social world that we ain't as hot as we thought we were. Now, keep in mind, it may be only one or two experiences, but it shows you how impactful those experiences can be. It shocks us, saddens us, and angers us.
Now, here's a visual of the five stages of grief. So, we've got shock and disbelief, anger, bargaining, sadness, depression, and acceptance. Now, nobody teaches us that typically the first grief and loss we experience is social loss in childhood. Nobody really teaches us those words because often times the adults in our lives don't even have the knowledge as well, let alone teach us about it. An adult's empathy for us as a child experiencing loss doesn't prevent the inevitable pain, but it does go a long way in helping us recognize that our feelings are important and we're not crazy. Grief and loss is not just about death and dying. Grief and loss is an experience we have when we value ourselves, others, and possessions, and something fundamentally changes for us while being perfectly content, satisfied, or happy with it previously. It's typically unpredictable and catches us completely off guard. Grief gives us new, unfamiliar, and intense thoughts, feelings, and body sensations. You should go through this exercise in therapy. Pull out the stages of grief and walk through the experience in a healing way. You've been wondering all these years why you're still stuck on some of these issues. You can't seem to move on. It's partly because you didn't know you were actually grieving and nobody was able to process it with you like it needed to be processed at the time. But even if you did process it at the time, you would still need process maintenance over time. So now you can do something about it and walk work through your old grief.
Strategy number two: Shame and guilt are common emotions that we experience. If I'll give a short example to give you the difference between them. On the playground, Little Johnny gets a little overzealous, steals the basketball from another kid during a school pickup game, and while doing so, gets too much of the other kid's hand and breaks one of his fingers. If he is experiencing mostly shame, he will probably try to get as far away from the situation as possible, bury his head in the sand, and think to himself that he is the absolute worst, biggest POS on the planet. If he experiences is mostly guilt, he'll probably apologize right away and feel so bad about what happened. He'll have some sort of accountability. And of course, he can experience both. Shame is about the whole self being bad, and guilt is having a personal responsibility for a behavior. Having ADHD, just by the nature of the condition, poses challenges with socially acceptable expressions of emotion. It's challenging for some with ADHD to identify their emotions and then express what they're going through in an organized and understandable way. The neurotypical brain may have a better chance to delay or suppress the negative expression of emotion in front of others than the neurodiverse brain that may be more impulsive, reactive, and intense, and essentially organic in their response. You might think an organic response is the more honest and truthful expression, but because that response's intensity can shock or frighten some, we tend to prefer a more socially subdued emotional response. We respond better socially to a more relaxed, logical response, despite us being emotional human beings.
So here's what you can do to manage your shame and guilt. First, get educated. Learn the definitions of shame and guilt. We can't fix something if we don't know what it is. Second, talk to someone about it right away. Shame is an emotion that feeds off of secrecy, so once you put it out to the world, it no longer has power to it. From a secrecy standpoint, people hide shame and allow it to spread like poison, and it can be an emotional death blow. Stop shame in its tracks by telling someone what you're ashamed of. Third, when you're talking to someone about your shame, ask them if there's something they are ashamed of. This accomplishes a couple of things. One, by you both sharing your experiences, you're normalizing the emotion of shame, which reduces its power right away because now two people are no longer in secrecy. And two, you we're now more emotionally and mentally intimate with another human being, which helps us feel more connected to others in the world. This world can be a very lonely and isolating place, so connect with others when you can.
Strategy number three: Take anxiety medication for your RSD. An RSD episode is often a precursor to generalized anxiety and, more terrifying, the precursor to a panic attack. This may not be applicable to everyone with RSD, but the individuals I've worked with in my practice over the years respond very well to anxiety and depression meds, specifically Lexapro, Prozac, and Zoloft. Anecdotally, I have seen women have more success on Zoloft, and men have more success on Lexapro or Prozac, but probably Lexapro more than Prozac. In addition, the American Journal of Psychiatry put out a study that revealed that women had better outcomes on Zoloft, and men had better outcomes on tricyclics such as Tofranil. I don't have enough experience working with men on tricyclics, so I can't anecdotal speak on the matter. Overall, these anxiety meds take a little off the edge for you and make you less hypervigilant and stressed. They also help you when you get mentally stuck on something and normally can't let it go, but this medication usually allows you to let things go. The medication doesn't completely stop thoughts, but it provides you the ability to let go of some of the stressful thoughts and dulls your emotional intensity.
A 2023 study showed that 94% of the study participants taking Prozac had experienced an improvement in their psychological distress after one year on the medication, followed by Zoloft at 91% and Lexapro also at 91%. The overall improvement rate of 92% among the study sample indicates only that selective serotonin reuptake inhibitor medication effectively improves patient-reported outcomes, specifically psychological distress, over one year of taking the medication. The study was on depression, but anxiety and depression can often go hand in hand, and these meds are prescribed for both anxiety and depression.
I'm going to now talk a little bit about the RSD mindset. When you have ADHD and RSD, you recognize that many of your behaviors push people away, but not necessarily know why. You tend to have a concrete justification in your head as to why you did what you did or said what you said, and you often can't understand for the life of you why someone is responding poorly to what you said or did. You can't see it any other way than what made sense to you in your head. In other words, if I asked you if the same situation was to arise again, would you do anything different? You would probably say no. That's going to naturally make you anxious about everything you do when it comes to people. You worry about what you say, how you said something, did it offend them? Do they like you? Do they hate you? Am I weird? The list goes on and on. Please watch my other video on RSD and rumination and relationships, where I go into great detail about anticipatory anxiety. This is where you mentally spiral and start imagining the most awful social encounter with the people you're supposedly going to be spending time with.
Strategy number four: Get your OCD under better control. OCD stands for obsessive-compulsive disorder. An RSD episode can merge into an OCD cycle where, after a social interaction, you ruminate on something going wrong. In your mind, you experience anxiety, then you use some mental or physical compulsions to provide some temporary relief. That's you trying to fix the wrong, and then it boomerangs back to your original rumination, and the cycle starts all over again. You really can't escape it until your brain finally lets it go, but usually hours later. Obsessive-compulsive disorders are typically characterized by the presence of recurrent, intrusive, and disturbing thoughts, which are known as obsessions, which often elicit anxiety or emotional stress, followed by repetitive, stereotypic behavior or thoughts, which would be compulsions, in order to neutralize the negative effects. OCD can be divided into predominantly obsessional thoughts, predominantly compulsive acts, or in a subtype of combination of both obsessions and compulsions. Fear of contamination, sexual hypochondriasis, and excessive thoughts, including scruples and guilt, are the most commonly reported obsessions, and washing, repeating, checking, and ordering are the most commonly reported compulsions.
From a mindset standpoint, to manage your OCD better, you have to stop assigning such intense power and value to your thoughts. Your thoughts are not that important, and OCD tries to convince you that what you just thought must be true.
Strategy number five: Radical accountability is when we take everything we go through in life, including our thoughts, feelings, and actions, and no matter how the outcome turns out, we look inward to find something useful and productive that stimulates us to keep for moving forward and accomplishing our goals. It's about what you can do, what you can control. Radical accountability for someone with RSD looks like taking a responsibility for developing better strategies to improve your emotional intensity, just to the point that it doesn't have a detrimental effect on your social relationships. We can somewhat measure this based on whether people stop becoming your friend, stop spending time with you, or even just flat out tell you that what you're doing is really affecting them. That can include accepting influence from others and putting their advice into action. If five people are telling you basically the same thing, you're probably the common denominator, and you should probably take what they're saying to heart and change some things. So, if they are suggesting you rethink something you're overly emotional about, maybe there's some merit to it. Take into consideration what feedback they are given you. It could also include you wearing one of those watches that tracks your blood pressure and notifies you when your heart is beating too fast.
RSD is a chronic and debilitating condition if not properly treated. It's a lifelong process to identify, cope, and heal from its negative impacts, but the rewards are tremendous when you work the program every day. You have more inner peace, better productivity, and stronger relationships. Some say, "How can you take responsibility for RSD if you can't control the emotional reactions?" I say, you may not be able to control what just happened to you during this event, but what about next time? What about learning, growing, evolving, and changing? RSD is not paralysis. We wouldn't ask a person who's physically paralyzed to get up and go for a brisk jog. RSD is mostly an emotional response, and humans can get better at their emotional expressions over time and practice. This is a philosophy I suggest you adopt and put it into practice every day of your life.
Get evaluated for autism as well, because autism is a developmental disability caused by differences in the brain. Who who have problems with social communication, emotional expression, and interactions with others. 50 to 70% of individuals diagnosed with autism have ADHD, and about 40% of individuals with ADHD have autism.
Now, a little perspective on ADHD and perception. Literature on ADHD and perception has revealed that individuals with attention deficit hyperactivity disorder suffer from various neuroschistosomiasis by deficits in their senses and speech articulation. People often with RSD know what they are thinking, but can't quite articulate it as it appears in their head. They can get stuck in their head. They use metaphors a lot or analogies, and that's how they talk. So sometimes when you hear them talk a lot in analogy, pay attention. They're trying to communicate what's going on in their head to you. I liken it to trying to bring the spoon to your mouth, but you keep hitting your nose. The words get lost in translation. So, I'm going to repeat this again: People often with RSD know what they're thinking, but can't quite articulate it as it appears in their head. They can get stuck in their head. I liken it to trying to bring the spoon to your mouth, but you keep hitting your nose. The words get lost in translation.
Okay, so what can we do about the perception deficits to improve our perception? We must understand that perception is not permanent and can can be improved by expanding one's views, beliefs, and knowledge. One strategy I like to use with my clients is to show them three pictures of a house. One shot is the front door view, another shot is inside the house, specifically the living room, and the third shot is a bird's eye view of the house. The view from inside the house is the person with the RSD. The shot from the door is the view from someone else, and the bird's eye shot as if the event was caught on camera. Because all the photos are of the house, which represents the event that the person with RSD experienced, I am now able to provide a visual that encapsulates that there can be alternative possibilities. Expanding that altern those alternatives exist in addition to their experience. It's not at all to suggest that they were wrong, but to be open to the possibility that their experience is one piece of the puzzle. We still need to fill in the rest of the puzzle with other people's experience and give it equal consideration.
I have a whole host of videos on RSD, so take a look at them as soon as you can. I really admire all my clients who come to me and talk to me about these very intimate and vulnerable situations they go through. There's such a connection that I have with my clients that sit across from me and within five minutes open up about the very things that stress them out, that they are super scared about, and it's just I just admire it. I really do. I want to give more people an opportunity to, I know mental health to get more treatment. So, it's it's impossible to treat everybody. Sometimes I have a waitlist. Sometimes because of various reasons, I can't get you in. So I want to do more of some lives, some YouTube live and and interact with you and see what's going on and talk with you a little bit and even have some laughs. There's a there's a ton of laughing that goes on in this office. It's sometimes what keeps me going, just just to simply have a laugh or two with each client, and to to just feel the joy that happens when you're connecting with somebody. It it brings me a lot of joy. I really do. I really do love the interaction with with everybody. Well, I can't. Well, okay, let me back up a little bit. There have been times that I that I've had some pretty bad experiences with people, but that's happening less and less over time. Who knows why? But there have been some some tough moments in here, but overall, you know, it's it's great to be in this position and and to work with people, and I love learning new things too. So that is all I got. If you like the video, pass it along to somebody and subscribe if you'd like. Thank you.