My ADHD: Rejection Sensitivity Dysphoria

Hello my Zebras and Spoonies! Thanks for coming and visiting with me today. I’m glad that you are here. Today is my second installment for the “My Diagnosis” series and the second part that is talking about My ADHD.

I want to start by talking about the fact that Rejection Sensitivity Dysphoria (RSD) is not a symptom listed in the DSM5. This has caused many people to tell me that it isn’t really a part of ADHD. The thing to keep in mind is the actual role and purpose of the DSM5. It is a diagnostic manual. This means that the purpose of the book is not to cover each diagnosis in it’s fullness. The purpose of the book is to cover the criteria that are needed to be diagnosed with the diagnosis. This means that every diagnosis in the DSM5 is not represented in it’s full capacity. It is only presented in the manner that will allow a provider to know if someone has met (or not met) the diagnostic criteria for a disorder. There are many aspects to all of these diagnoses that are not talked about in the DSM5 because they are not diagnostic features of the diagnosis.

There is a ton of research out there that clearly demonstrates that RSD is a thing and that it is a thing that is strongly linked with ADHD. I’ve added some articles at the bottom of this post if you want to read more about that connection. It is a small selection, but is something to get you started. Additionally, RSD is also strongly linked with Autism. I personally feel that both diagnoses have contributed to my RSD in their own ways. Since this is a post about My ADHD, I am going to focus on the ways that ADHD has caused me to experience RSD. I’ll talk about my experience with Autism and RSD in another post.

The other thing to keep in mind it that RSD is a recently coined term. Prior to the term being coined it was recognized that rejection caused trauma and was primarily talked about in the PTSD context. The term “Rejection Sensitive Dysphoria” was coined by Dr. William W. Dodson of the Milton E. Hershey Medical Center to describe the extreme mental and emotional pain that even the mere perception of rejection can trigger in some people. He coined this term in 2016. So, if you are looking for research on this topic before 2016 you’ll need to look for it under the PTSD heading rather than the newer RSD term. It is also important to note that RSD is not a generally accepted psychiatric term and many are still using PTSD to describe this phenomenon. But regardless on the language being used, the reality and connection is well established.

I think my RSD as being the scars from a thousand small paper cuts. Each individual cut is of little consequence and the individual scar has little impact on my functioning. But it is the combined weight of these scars that carries the true impact. Being told once that you are not good enough doesn’t carry much clout. Being told that you aren’t good enough frequently by a single person carries more. But what carries the most power is when every adult you ever knew as a child told you (in some way or another) that you were not good enough. That all adds up to a really heavy burden of self doubt and self rejection. It leads to the expectation that everyone I meet will reject me.

I have been married for 22 years now. Our relationship has been good and has been stable. Yet, I spend every day waiting for the inevitable day that he will reject me. That’s what the RSD gremlin keeps telling me: that him leaving him is inevitable because I am not good enough. If there is ever a time that I cannot read his body language, and because of my Autism this is fairly often, the RSD fills that unknown with a negative assumption like: “He’s mad at you.” This leads me to anxiously checking in with him by asking “are you mad?” on a fairly regular basis. I am very lucky and my partner is endlessly patient with this forever need for reassurance. Because the truth is that the need for reassurance will never stop. There will never be a point in our relationship that I begin to feel secure.

When I meet new people, I start that relationship with the assumption that they are not going to like me. This makes me very slow to invest in making new friends. Why put in the effort for a new friendship when they are only going to reject you in the end? And why do I assume this will be the result? Because I was always rejected when I was a child. I didn’t build any meaningful or real friendships until I was in my twenties. I was only able to do it then because I had therapy and had learned about the RSD gremlin and the lies that it was telling me.

This even effects my work. I am so used to being rejected that I assume that I am going to be fired. Doesn’t matter that over the majority of my working career I have received perfect work evaluations. My brain still tells me that I am an imposter and that I cannot possibly be good at anything. After all, how could all those adults I grew up with ALL have been wrong about me? If everyone tells you a thing, it must be true. Right? Well, that’s what the child’s brain believes.

There is no good way to explain all the ways that this impacts my life. But let me describe to you what it was like starting the most recent nursing contract I have as a travel nurse. Let me start by saying that I have about 20 years of diverse nursing experience. I have an excellent work record and excellent references. I hold 2 nursing specialty certifications. Yet, everyday for the first 6 weeks or so, I was filled with a sense of dread and anxiety as I drove to work because I was filled with a certainty that that was going to be the day that I was discovered for the imposter that I am and I would be rightfully rejected. When new nurses come to me with questions about how to perform a task, my knee jerk response is to tell them that they need to go find someone that is qualified.

So, What is it about my ADHD that caused me to have RSD? Well, I was always told that I was really bright. I was put into the Gifted and Talented program because I had so much potential. I was never sure what that potential was for or what it meant to have it, but I knew that potential was a really good thing. But then I reached the point that I just couldn’t keep up any more. I started hearing things like “Why are you throwing away all your potential?” and “If you just worked harder you could do really amazing things.” It didn’t matter that I was trying harder than I ever had before. That still wasn’t enough. Even though I didn’t know what that potential was, I understood that not keeping it was really bad. It was clear to me, from all the adults around me, that I was failing at everything.

There was also this strange paradox that I felt like no one noticed I existed until I was messing things up. When the adults felt like I was doing things well, they just ignored me and I felt like I stopped existing. There were times that I intentionally messed up to just check that I was still in the same reality as other people and that they could see me. Because when I messed up, everyone took notice. My mistakes were the only thing that ever attracted anyone’s attention. If I was doing well, it wasn’t remarkable enough to merit notice. So, in that sense I failed. And when I was failing and getting the attention that every child needs and deserves, I was getting in with a strong message of “You’re not good enough.”

This has lead to this ever present need for validation that I do exist and the things that I am doing are worthy and notable. Because if there is nothing but silence, my brain will interpret that as a kind of rejection. After all, people that are worthy get attention. They get chosen for the team. The get picked for the social events. They are invited to do the things. I was never getting those things. That silence was just another form of rejection.

There is a ton of internalization to all these little messages that on the surface seem completely harmless. But every time I was asked “Why can’t you just sit still?” I asked myself why I couldn’t do it when it seemed such an easy thing for the other children around me. When I was told that I needed to try harder, I believed them. I believed that I was not putting in the effort and that the reason I was failing was because I was lazy. The end result was that I believed that I wasn’t good enough and that I had failed everything at a personal level. I even believed that it was a choice that I was making and that I was such a bad person that I kept repeating that same choice to continue to fail. And what kind of person does that? Well, only the worst of the worst or the lowest of the low would make that kind of choice every day. And I believed that I was that kind of person.

I believed the RSD imp, because it was what I had always been told.

Because I have had really good therapy, I can take on the RSD imp and properly tell it to bugger off. That means that despite all these feelings, I can still drive to work and still teach the new nurses how to perform that nursing task. But the truth of it is, that there is no amount of therapy and there is no drug that will ever make the RSD imp fall silent. I will spend my entire life listening to my inner voice repeating the messages of not being good enough that I repeatedly heard as a child. I will have to choose, every day, not to listen to the RSD imp.

And what it means that the people around me will see a well polished mask that projects confidence and self assurance while I am really a small child trembling before them filled with fear and anxiety about being rejected while hoping that this time someone will pick me first to be on their team. That is a wound that cuts deep. Because I have never in my life been someone’s first pick for the team. Despite all the good that I have done in this world, there is always that imp that tells me that this means that I am worth nothing and that I mean nothing. It doesn’t matter that I know that this is a lie. It still hurts and I still have to live with it every day.

Articles on RSD and ADHD

  1. Understand and address complexities of rejection sensitive dysphoria in students with ADHD
  2. Justice and rejection sensitivity in children and adolescents with ADHD symptoms
  3. Long-Term Associations of Justice Sensitivity, Rejection Sensitivity, and Depressive Symptoms in Children and Adolescents
  4. New Insights Into Rejection Sensitive Dysphoria
  5. Rejection: What Is It & How to Deal With Being Rejected
  6. Understand and address complexities of rejection sensitive dysphoria in students with ADHD
  7. Justice and rejection sensitivity in children and adolescents with ADHD symptoms
  8. Long-Term Associations of Justice Sensitivity, Rejection Sensitivity, and Depressive Symptoms in Children and Adolescents
  9. New Insights Into Rejection Sensitive Dysphoria
  10. Rejection: What Is It & How to Deal With Being Rejected
  11. Differential diagnosis and comorbidity of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults
  12. The Oxford Handbook of Social Exclusion
  13. Understanding ADHD in Girls and Women

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