How Rejection sensitive dysphoria can be the most debilitating trait of ADHD…
When I first read about RSD in relation to ADHD I skimmed over it thinking it wasn't a trait that resonated with my experience, I told myself I was really good at taking feedback, and although I sometimes get upset, I'd take it on board and learn from it. However, when I looked at it again, I realised I had completely misunderstood what it was and how it impacted me. For those who are new to the concept, RSD, Rejection sensitive dysphoria, is a phenomenon where a person has an extreme response to real or perceived rejection or criticism. It is something that is recognised in certain mental health conditions and neurodivergence. Although not a part of the diagnostic criteria, anecdotally it appears to be a universal experience for those who have ADHD.
Once I had re-read and thoroughly understood what RSD is, I realised that it has in fact been a huge part of my experience, and is possibly one of the most debilitating aspects. Looking back over my life I can identify many occasions when it has hit me hard, and although I'm speaking metaphorically, it can actually feel like a physical blow, like you've been winded and are left gasping for air.
If you can relate to this, you'll be familiar with the sensation. It’s as if the world spins out around you and while everyone else carries on as normal, and dramatic as it sounds, you are left feeling as if you are deeply wounded and may never recover. I think part of the reason I initially felt it didn't apply to me is because I had tried my hardest to squash it down, convince myself that I was fine, I could deal with it, I am an adult after all, and adults are supposed to be rational, to not 'overreact' I didn't see any other adults collapsing into a heap at the slightest criticism, so if I did it was another example of how I hadn't ‘grown up'. I now understand that these feelings can't be squashed, that if they aren't acknowledged in the moment or soon after, they will find a way out and not always in a healthy way. Until I realised this, I would frequently re-visit specific incidents from my past that had evoked this response and immediately be transported back to that moment experiencing the intensity of feeling as if it was happening all over again. This had an impact on my friendships, making me guarded around those I felt had, unbeknown to them, caused me to feel this pain.
Aside from the more significant, memorable events that seemed to have a lasting impact, I would also experience mini episodes, often after socialising, feeling that I'd picked up on a 'vibe' from someone that they didn't like or respect me, thought I was too quiet, too boring, too silly, too dumb, too messy, not qualified enough. This all led to huge overcompensation, people pleasing and perfectionism to the extent of never finishing (or sometimes even starting) anything that might be judged by others. As you can imagine, this caused huge issues in both my personal and professional life causing me to over promise, under deliver and feel constantly overwhelmed, prioritising doing things to please others over my family's and my own needs.
This also became a huge part of my personality, I was known for being 'nice' often described as 'too nice', but I didn't know how else to be and still exist in a world that could crush or alienate me at any moment. As with all the traits I am now learning are part of my makeup, awareness has been life changing. I now understand that I react this way, when others don't, that I'm not 'too sensitive' that is just the way I was made, I can't grow a thicker skin and any armour I have tried to build up will have some cracks allowing it to seep in.
I now let it happen, feel it wash over me like a wave and try to observe it objectively while its happening and remind myself, that although it feels like I'll never recover, I will, and that this recovery time is becoming shorter & shorter with each experience.
Personally, I find writing helps me to organise and process my thoughts and emotions, this usually means me writing a letter to the person/people involved, often this is enough to help me get it out of my head and I very rarely send the letter, I always sleep on it and re-evaluate whether I need to send it the following day. If it’s an issue with someone close to me, like a family member then I might share to help them to understand what is going on for me. If it's someone slightly removed I invariably don't send it or bring it up, unless I feel it will impact our relationship going forward & it’s important for me to protect that relationship/friendship.
I realise writing or journaling isn't for everyone, so talking to a safe trusted friend or family member or a professional such as a counsellor or coach, can also be very helpful, even recording your thoughts in a voice memo can be enough to get them out of your head. Sharing with a safe support network can help (like the Umbrella Hub) especially as others there will understand the depth of feeling experienced.
There is anecdotal evidence that ADHD medication can also help with this issue and in particular guanfacine, this is all obviously down to personal choice and whether you have a disgnosis and a sympathetic prescriber. Another option I would like to explore further is EFT (emotional freedom technique) or tapping (see attached blog and information from Hayley Frankland, EFT practitioner)
If you are reading this as a friend or loved one of someone who experiences RSD, there is a risk that you may come away feeling like you have to tread on eggshells around them and not express any discontent or even give constructive feedback. This is obviously unrtealistic and is not my intention, I only wish for you to be able to better understand the people in your life and work on compassionate communication with each other. It will be impossible to avoid RSD completely and there will be times it happens inadvertently when no criticism was intended, hopefully awareness, acceptance and use of strategies will help those important to you to work through it.
My journey with RSD - Hayley Frankland EFT practitioner
Now I have become more comfortable with my AuDHD identity, I can look back and reflect on how RSD has infiltrated its way through every part of my life; showing up in my overly sensitive reactions to anything I perceive as criticism (friends, work, family), my overwhelming emotional responses and mood changeability and a certain guardedness towards any new connections for fear they might lead to me being rejected. Joanne Steer in Understanding ADHD in Girls and Women describes RSD as ‘the exquisite sensitivity to teasing, rejection or criticism, or the individual’s perception that they have fallen short of what was expected, whether this perception is real or imaginary.’ (p.244)
Like many others, I have come to my AuDHD understanding of myself much later in life, having spent decades masking, trying to fit in and always doubting my worth.
I tried standard talk therapy to help me navigate these feelings, and while this therapy works for many, I discovered that for lots of us neurodivergent folk, it often doesn’t suit. I left each session internalising even more of my ‘stuff’ and never feeling like I was growing any sort of acceptance.
And then I found Emotional Freedom Techniques, also known as EFT or Tapping. And I began to discover a greater appreciation and acceptance of what makes me ‘me’.
EFT
Emotional Freedom Techniques, or more commonly known as EFT or Tapping, is a gentle and highly effective practice that allows us to give a voice to our emotions and to process some of the emotions and memories we have been holding on to and which may be keeping us ’stuck’. EFT combines elements of modern western psychological therapy, with a somatic (body-based) approach whilst applying gentle pressure to acupressure points on the body’s energy systems or meridians.
So whether you are just managing a fear of rejection or whether RSD brings up other emotions too, such as frustration and sadness, EFT can gently untangle these emotions and their intensity in you whilst enabling you to process different memories and facilitate cognitive shifts or changes in perspective.
We would start tapping by tuning into our issue, our fear of rejection and rating the intensity of that on a scale of 0-10, 0 being no emotional intensity and 10 being a great deal of distress. From there we create our ‘set-up statement’ with two distinct parts. Here’s an example set-up statement for fear of rejection:
“Even though I am experiencing this fear of rejection because my friend has not replied to my message, I choose to send myself love and compassion.”
Here’s what those parts look like in a therapeutic context:
Even though I am experiencing this fear of rejection because my friend has not replied to my message = exposure to the presenting issue
I choose to send myself love and compassion = a positive affirmation, with elements of CBT
We then add in the ‘tapping’ on the acupressure points. For the most part the tapping points are locate on the head and upper body but a longer sequence of tapping points encompass acupressure points on the wrist and fingers – great for some discreet tapping when in public!
As we tap, we say aloud a shortened version of the set-up statement called a ‘reminder phrase’. Examples could be ‘fear of rejection’ or ‘not replied to my message’. This presents a clear message to our sub-conscious mind which, after some tapping, usually responds with some feedback; a memory, an emotion, a bodily sensation, all of which we can then explore. So in the case of RSD, it wouldn’t be unheard of for someone to start tapping on ‘fear of rejection as my friend has not replied to my message’ but very quickly to be led back to an earlier memory of rejection or maybe even abandonment. If emotions around this earlier time had not been processed and discharged from our body, we will literally have stored them like Polaroid snapshots, meaning that on subsequent occasions we face rejection, we can live through the emotions of that first event over and over again.
How does EFT work?
EFT works in our mind-body on a number of levels. Let’s focus first of all on the amygdala. This is part of the limbic system in our brain and its role is as the fear response centre. Like a meerkat, our amygdala is always on patrol, seeking to detect signals from our body and the environment that a danger or threat is imminent. If a danger is detected, the amygdala is ‘fired up’ our body releases cortisol, the stress hormone and adrenaline that propel is into a fight, flight, freeze or fawn state. For those of us with RSD, our amygdala ‘fires up’ regularly as we have an emotional over-reactivity. This means we can frequently find ourselves in a fight, flight, freeze or fawn state. For me personally, it was the fawn state; always people pleasing, always feeling I had to ‘go the extra mile’ to maintain friendships and make people like me. It was exhausting.
Studies into the effectiveness of EFT have shown that just one hour of tapping can help reduce our stress hormone cortisol by up to 43% and in doing so, calm our amygdala. And so, with cortisol lowered and our amygdala calmed, we can think and respond from a much calmer place.
We also know that in calming our amygdala, we can begin to build new neural pathways in our brain. Our hippocampus, which helps with the forming of new memories and emotions, works alongside our amygdala. Let’s say you once had a ‘close’ friend who all of a sudden stopped replying to your messages, your amygdala can sense the fear (rejection) that this brings and your hippocampus uses the sight of the unread message on your phone with the fear of rejection to be encoded into a memory. This means that the next time you see an unread message, your brain connects to the previous memory of being rejected. That might lead to a heightened emotional state, poor feelings of self-worth, or for others, avoidant behaviours.
As we calm the amygdala, and memories and emotions surface, we can gently, safely and effectively begin to process these, often resulting in cognitive shifts and new perspectives.
And as if that wasn’t enough, research on gene expression has shown EFT has the ability to down regulate some genes associated with inflammatory responses and up regulate some genes responsible for immune functioning, meaning a happier, healthier you!
Website www.embrace-transformation.co.uk
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