This is a Global Player original podcast. This episode contains discussions around abusive relationships which some listeners may find distressing. If you or someone you know has been affected by anything mentioned in this episode, support is available. Please see the show description for more details.
Hello and welcome to You're Wrong About ADHD. I'm Katie Rathwick. And I'm Sam Pittis. Coming up, we're going to be talking about rejection-sensitive dysphoria, which is very appropriate today because we didn't win our award on Thursday night, did we, Sam?
No, we didn't. It was a great honour to be nominated for a British Podcast Award. It was. It was a fun night.
Oh, it was. Do you know what? It was a really, really brilliant night, but yeah, not winning an award is rubbish. I have to say, but it was lovely to be there.
Actually, it was really, really lovely to celebrate this. This thing that we're doing with our marvellous producer, Helen, this has become an important part of our lives. And it was a nice celebration about that. That was cool.
It was. And I wasn't massively looking forward to going to an awards ceremony. We know that. Everyone knows that.
However, we had a really good time and I wanted to go because so many people have supported us and so many people sent us lovely messages to say congratulations on the nomination and so many people have got in touch and shared their stories. And actually, all those people that shared their stories have been a real part of this process with us. So for them, I think it's been a shared nomination. Absolutely.
And it was amazing to be nominated. And thank you for listening and thank you for coming on this journey with me and Sam because it's been a flipping privilege to make this podcast and continues to be that. And we're doing a really important subject today, having lost that award. Rejection-sensitive dysphoria.
And it's not part of the diagnostic criteria of ADHD yet. But more and more, the people in the field who know about this stuff are calling for it to be so. And it's definitely something that has impacted my life in the past. Personally, yes.
But also in my relationships with family members who have it. My mum, undiagnosed with ADHD, I'm sure of it, definitely had rejection-sensitive dysphoria. And she lost friends because of it. And relationships with family members broke down because of it.
Have you had any difficulty with it over the years? Well, it's interesting you say that. I mean, I suppose we should say a sort of basic explanation of RSD is an extreme feeling of reaction, an extreme sensitivity to situations where that's being rejected or whether it's disappointment, whether it's embarrassment. And certainly, I would say, I have felt embarrassment and disappointment quite acutely and went to some lengths to avoid them.
And I've talked before about being told I had traits of borderline personality disorder and needing to have treatment to help me not live in extremes. But at the same time, I'm slightly sceptical of RSD. I do think, is this something that needs labelling? Is it not just, honestly, sometimes we get knocked back and sometimes we're feeling low, it makes us really sensitive.
Is it a thing all in itself? I'm never quite sure about it, to be honest. Is it something you've experienced? I definitely have.
I definitely have. I mean, I think everyone, I think you're right to say that everyone experiences it to some degree. You know, FOMO, fear of missing out syndrome, when you log on to Facebook and you see all your friends have got together and you want to fight it. Everyone has had a sense of feeling a little bit hurt by that.
And I think rejection-sensitive dysphoria is where that's a real problem, where you are at home sobbing because you feel that your friends hate you and maybe there was something you did last week and suddenly you were identifying. That's the reason why you've not been invited to this particular event. And I think that is the difference. That's the difference.
It's the key difference between whether or not you just feel a little bit disappointed and let down or whether or not you absolutely hit the roof and you're inconsolable. Because I've definitely been in that situation. So can you give an example where that has been the case for you? Yeah, social media is a really good example, actually.
Because social media is very tricky, isn't it? Because it is used by some people as a way of displaying perfect lives. And which we all know is not true. We all know.
And I've had to limit how much I go on social media for exactly that reason. Because it is essentially a construct. It's a lie. But when I'm unguarded, there have been times in the past where I've logged on and seen that there's been a gathering of friends, people I consider to be really, really good friends.
And I wasn't there. And I didn't even know about it. And I wasn't told. And suddenly I'm thinking, oh, right, okay, I thought they were my good friends.
And it can be then suddenly spiralling thoughts, spiralling sense of confidence. And there are all kinds of reasons why that gathering might have happened. But I'm not having that conversation with myself. And so it's not just being a bit disappointed.
It's actually like a spiral of catastrophes that causes a real sort of emotional problem. It's a massive, massive disappointment and feeling sad and let down and, oh, you know, unpopular. And all these awful things that the lack of confidence is a big one, isn't it? Because, you know, we have ADHD.
And that is something that we struggle with anyway. So, yeah, it can hit you. And it goes back to something you've talked about before. Failing to have a rational conversation with myself.
It's being irrational. It's being irrational and emotional. And having an overwhelmingly ridiculous reaction to something that doesn't require this reaction. Who cares?
Move on. So your friends are not together without you. It doesn't matter. And that's allowed.
But I think, for me, RSD has impacted my life, especially in my relationship with my mum. And I talked about before how I wish my mum had been diagnosed with ADHD because I think it would have made her life so much better. It affected her relationships. So much, this problem.
And my brother and I, she's paranoid. She would jump to conclusions about the things people were saying about her. And they were always negative. She never jumped to conclusions thinking people were thinking positive things about her.
And it would lead to difficulties in friendships with family members. You know, my parents' relationship broke down because she was constantly accusing my dad of thinking things that people weren't thinking. And I think that's why it is so important that we, as people with ADHD, identify this as a massive problem. Because it affects so much more than just our thoughts and feelings and our emotions.
That bit about making assumptions, catastrophizing it. I recognize all that. I know that I have done that. I just think I find it difficult to sort of see how it's broken off into its own individual label.
And that's where I just am a bit sort of, you know, how do you define RSD? And what is it specifically that's different from, you know, being emotionally dysregulated or being depressed or having ADHD? Well, we've got just the right person to talk to about it. Leanne Maskell is joining us.
She's a certified ADHD coach and she's the founder of ADHD Works. And she'll be on to talk to us about rejection-centered history in a moment. Hello, Leanne. Thanks for joining us.
Hi. Thanks for having me. It's great to have you. We've been having a bit of a chat about RSD.
I think it's probably worth starting by just explaining in simple terms what it is. What is RSD? Yeah. So it's rejection-sensitive dysphoria, which was coined by Dr.
William Dodson as essentially extreme emotional pain that is related to real or perceived rejection. Usually that lasts for a very specific period of time. So, like, it might be a few days, it might be a few hours, but it lasts for a limited period of time. And it's triggered by something.
So it's triggered by that rejection or our own thoughts. And it can cause really extreme emotional mood swings, essentially. So it can cause the symptoms of very manic depression and even being suicidal. But the challenging thing is, actually, we might be like a few hours later.
And Dr. Dodson said that this is the only experience that he sounds to be linked specifically with ADHD and not any other condition like bipolar, because it's truly by something it's not a chemical experience. Yeah. You also mentioned in the whole chapter that you dedicate to it in your ADHD-based book, the fact that so many court-mandated anger issues, they think that's all about underlying ADHD as well.
So, I mean, this is huge because this suggests RSD is not just something that we are experiencing in our personal lives as a challenge, but it's actually something that is really societal that we really, really, really need to look at in depth in order to kind of crack open what exactly is going on here. So let's break it down. What happens in RSD? What triggers it in the first place?
Essentially, what happens is there is a up to 30% developmental delay in expected functioning skills of ADHD, and one of those is emotional regulation. So whereas someone that doesn't have ADHD might, for example, they get rejected from a job, and they go, oh, dear, well, I go with my day out of time. There might be a bit, obviously, no next rejection. But for me personally, before I even had ADHD, when I was rejected from a job, I would end up being like, either I need to go into a whole new career, then Googling lots of different things, being like, it's hopeless, I have no future, no prospect, then just ending up, Googling how to kill myself, you know, getting really, really dangerously suicidal, and then waking up fine, and then doing all over again.
And so it's basically that struggle in regulating the emotions, and it can be caused by anything, and it's a really interesting thing to look at, because it's not what you would necessarily imagine, and it's hard to predict it, because it's so influential. So, for example, I was a model since the age of 13, so I've literally been rejected every single day for my entire life and called every kind of horrible thing you can imagine. But it would be certain contexts, like not replying to a friend and then beating myself up about it because I've forgotten to reply to them, and they think I'm a terrible person, and why isn't anyone friends with me, et cetera, et cetera, and then ending up having a fight with them. And so it can come up in lots of different ways, but for me personally, it's what enabled me to accept the whole ADHD diagnosis, because before then, ADHD just didn't resonate with me, but these emotional factors were exactly what I was experiencing, and they were really scary to experience as well, because I just thought I was getting completely crazy.
I had a very similar experience. I was diagnosed with ADHD, and then I was told about traits of borderline personality disorder, and I did a thing called DBT, and the whole point of that was to essentially stop me living in extremes of emotion. And I would do exactly as you described, I would find myself treated by something, and usually it was some form of disappointment or embarrassment, and it was that that feeling was too strong, and I couldn't cope with it, and it would start to spiral to, this is awful, this is the worst thing in the world, everything's awful, everything's pointless. What we're talking about with ADHD is not just being a bit sensitive or feeling a bit rejected, it is actually about an extreme reaction, isn't it?
Yeah, exactly, and I actually think that it's really rooted in shame, and it's because children with ADHD are said to receive 20,000 more negative comments than their peers at the age of 12, which makes a lot of sense, because they're literally going straight into an educational system that says, if your brain doesn't work in this precise way, then you're a failure, and you've got no hope in life, et cetera, if you can't sit still and listen, then you're not listening, even though they're really, really trying. So then as adults, we turn into people that that shame becomes really overwhelming, and we're like, what's the point in even trying anything, and in any way everyone hates them, and it's really difficult to see a way out there. And I think also that relates to a lot of trauma that people might have experienced, so it's those extreme extremities, and also with ADHD in general, it's really dangerous, because there is a much higher suicide risk for people with ADHD, five times higher, and I actually presented to the World Health Organization on this, because I was like, if they actually looked at those emotional symptoms properly during the assessment process, they could help so many people, and I think that's, it's very, very common to hear about people that think that they have borderline personality disorder, or bipolar, and we live in a really unfortunate society that stigmatizes those conditions as well, and they're freaking out, and then they get diagnosed with ADHD, but it doesn't really matter what you call it, it's more about making sure that people have those tools to be able to understand what's happening to them, because I think they really beat themselves up when they feel like that shame is overcoming their ability to regulate their own emotions, and that's what makes it a lot worse, but if you do know, okay, my brain is designed to do this, let's go and watch a TV show, and go to sleep, and wake up, and I'll be alright again, and do the things that you need to look after yourself instead of beating yourself up, but for being upset in the first place, it makes a huge difference. Let's get on to those tools, what do you say to people who really, really struggle with this, and for whom it's massively impacting their lives?
We say, we talk about naming entertainment, and it's something you can't really ever get rid of it, because they're just emotions, and it's actually a really interesting opposite end of the spectrum now, I think it's recognition euphoria, so it's like, as much as it can be painful to have that kind of negative experience, it can also be really amazing when someone says well done, and gives us positive feedback, so it's good and bad, and actually for me personally, I've been able to use that RSV to fuel everything that I do, and it is that really great sense of empathy, because I know if I feel this way, other people are feeling this way, and I can empathise with people when they are kind of mean, okay, there's probably some brute of shame down there, it's not about me, it's not them, so I think what we do on a practical basis is we train ADHD coaches to use this model, which basically involves looking at the thoughts in the first way, so if you can know, first of all, what's happening, so even knowing that rejection-sensitive is a real thing that people experience, then you can realise what's happening, when your life starts to feel out of control, and you want to close down your business and move to Alaska, and you're like, oh, maybe this is an emotional reaction of RSV, maybe I should not break up with a partner right now, and then you can identify the thought of what is actually going on here, because how I see it, it's often this very small trigger, like someone not texting us that, and then because of that, overthinking and hyperactivity, whereas someone else might just get on the other day, we might be recounting every last conversation we've had with these people, did I do something wrong, can I detect if they're annoyed at me, etc, etc, and they're probably fine, they just don't reply, and then if they don't reply, we might message them again, and then it can really escalate into what I call a tornado of rejection-sensitive story, and we don't even know what we're anxious about in the first place, so I think that recognition of it is really important as well, because we basically end up invalidating ourselves, because we know it's Russian, and that's why CBT doesn't always work that well, because it's like, oh, look, these are Russian reports, and I'm like, yeah, that's the problem, is I'm actually saying I know I'm being really ridiculous, I know that they're fine, but I can't stop ruminating on this, but if you can identify what is actually the problem, for example, my real problem here, and someone's not replying to me, is that I think they don't like me, and whatever it is, I think I'm not a good friend, and I'm not aware of being liked, then you can start a questionnaire, like CBT, actually, but it's just doing it through a different lens, being like, okay, does this really make sense, like, what's the proof I've got of this, what's the proof of the opposite, and I often get people, when I'm coaching them, to pretend to be a lawyer from the other side, to help them think of a different perspective, because it can be really hard, because we do get in these really extreme states, and with that emotional regulation difficulty, and a strong sense of social justice, they can be like, no, that person's wrong, within all that time, think about it, but if you can try to figure out a way to think of things from that perspective, and get them out of their own head, it can be really useful. You know, you talked about living in extremes, and then suddenly the next day it was all okay, I think, even though I've been diagnosed with ADHD, which I will accept, even though I've been through DBT therapy, I still have to be honest with you, my initial reaction when people mention RSV is to go, really, isn't that just people getting a bit, it's just all of us, we all feel a bit sensitive sometimes, and we all get a bit upset, and is it really a condition, does it really need a label, is it true, and yet, what you've basically described is me, before I went through my therapy, which I think makes the case that it obviously does exist, and I think what I was taught to do was exactly that, was to say, okay, what's actually going on, take a pause and identify what's going on, maybe that person hasn't responded to your text message, because, honestly, they're busy, and does it mean that they absolutely hate you, and we often talk about awareness, but it's understanding how you're feeling in your body, but also what's going on for you, and quite often I find I'm really tired, or I'm really angry about something else completely, and so that when somebody has said some crossword to me, it's not actually the issue, it's the argument I had that morning, or it's the other massive stress I've got in my life somewhere else, and if you can start to just slow things down and think about what's going on, it does really work, and I think what you've said has really resonated for me, and perhaps it's proved to me that RSD really does exist. Ha ha! We'll have a bit of a discussion about this.
Of course we do. But it's interesting, because you trained as a lawyer, didn't you? You mentioned bringing in, pretending to be a lawyer for the other side. It is, what you're doing, and what you're talking about, is establishing the facts of the case, ultimately.
Isn't it? It's being really honest with yourself about what is true, because we do have this tendency, with the overthinking, to rush the conclusions that aren't, and it's so hard sometimes to pull yourself back to the press space and go, no, no, no, no, that's not the reason why you weren't invited to that party, it's just because you didn't happen to be in the area at the time, and that can be a thing that sort of, you know, it's about taking a breath and remembering to look at it for real, rather than what you think it is. Yeah, it's a challenging balance, because I think the key thing is making sure that you are looking after yourself, and I think that is why traditional therapy might be difficult for people to get to experience, because therapy models are very much like, you know, you're just having human experience, like you really understand the label, and actually, the whole reason I did so much work on rejection-sensitive disorders is because when I wrote ADHD, I said, a very kind of well-established person in the industry said they wouldn't give me any testimonial, because they're like, rejection-sensitive disorders, not like, academically verified, and I said, I know that, but actually, if it was academically verified, I think it would help a lot of people, and every single person I've met, they experience it. and it's so debilitating and so that's what led me to do a lot of work but the difficulty is the balance between because people actually struggle with trusting themselves because we do have that impact of self-awareness then we can be very vulnerable so you know for example actually the whole roots of what i do here it comes from a one called byron katie she's got some really great work of the questions like is it true what is the truth but um the person that first introduced me to that was a really abusive person so um i've kind of brainwashed so like it really depends on who is asking what like whose truth is it because that relationship was really bad and i would be upset for example um but everybody i think valid things like family members think i'm well and they were like you know you need to go do the work and ask yourself it's true so you can really kind of brainwashed yourself into anything but i think that's why it's really important to make sure that when you are doing this you can treat it from a really objective point of view because people in your divergent are really vulnerable to abuse so if you do have a situation where like and often that's i think as a coach people are worried about them the individual being a bad friend for example but actually quite often it's like well whose responsibility is that also and it's all about getting us to take personal responsibility and boundaries all these boring things are not very fun but like the more that we can do that for ourselves the better we can feel in ourselves and build that sense of trust um can we talk about that because it is something that you've written about quite a lot that tendency that adhd is but actually most importantly the rsd in us makes us more vulnerable to these abusive relationships what is going on there why is that well i think it's a huge huge range of factors um i think especially if you have been brought up for your entire life thinking that you are wrong in some way and you know imagine a child that's trying their very best to do something and everyone's saying no you're not trying you're just lazy they have literally been conditioned to not believe themselves and to beat themselves up and to think i just need to try harder everyone else seems to be able to do it and so then you've got these kids at school for example where they are not they're nothing friends they're being bullied because they do things differently to how most people do them um they even found them just like sitting in weird positions like difference as a child is not looked upon very favorably and so they're quite literally like not in the group of being protected and having these kind of like safe happy relationships where they're able to just have fun and that leaves some vulnerable people that want to abuse them or like for me i have been in a variety of insanely abusive situations from my life um to the fact when i was 18 i was literally scouted to do a job off the street by a stranger who said oh you need to lose three inches off your hips to be a model and i don't want to do it i'm like no thanks which is quite impressive that i've managed to say no and then she said i'm going to be fired if you don't do it so i said okay fine i'll try it and then before i knew i was trying to lose weight to do a job i didn't even want to do for some random person so it's like if you don't have that really strong sense of agency and self-awareness of what your needs are and being able to advocate them and trusting yourself as well and trusting and if instead you're trusting the experiences and needs of other people around you if you don't have people around you that genuinely have got your best interests at heart then you're really vulnerable to abuse and um actually if i think about my friendships as well like it would be the friends that were the most kind of toxic that i would be closest to it because they were the ones that were always demanding things from me whereas my friends that were okay if i cancelled were the ones that like kind of slipped because i knew that they would be all right and yeah the ones that were like wanting me to do things i didn't want to do and were kind of more abusive with the ones i ended up saying because it was actually a bit clearer for me of what they wanted from a relationship so i think there's a real real vulnerability of neurodivergent people because we just don't have that same understanding of what is normal um it means that we can be taking a dance job thank you for sharing that it is i think something i've not really considered until katie and i talked about it recently but it makes so much sense and i think that thing you say about not quite trusting yourself is so key because you know i think through periods of my life where you talk about trying to get a balance you're trying to talk about sort of getting life level but i've got no idea what level is i've got no idea which part of me to trust so then you if you bring someone into that situation who's prepared to exploit you actually that's a really dangerous mix isn't it and it's also that people pleasing element of adhd as well isn't it we are so desperate to get someone to like what we are and who we are because you talk about the thousands and thousands of criticisms we've had as children as children and suddenly we meet somebody who maybe does a whole love bombing thing and here we are just wanting to make that keep coming keep coming and that can deteriorate can you tell me leanne what are the things to look out for in an abusive relationship if someone's listening to this and they're just beginning to prickle with the realization that maybe they're in one what are the things that you would tell them to explore write a diary and a diary in a way that feels private for you um like on your phone for example but i think having a diary can be really useful for people with ADHD in general because like when i've been in any situations literally one of my last relationships i kept trying to break up with the person they said oh you're changing mine tomorrow and they were right and i did and then because it was so now or not now i kind of forget all of these things it was only actually when the police asked me a list of questions about commercial and controlling behavior like did they ever try to affect whether you take medication or what you wear or um who you see and i was like yeah yes yes yes yes this is real hard on earth have i been in this situation not realized so keeping a diary is a really amazing thing to be able to look at and realize like actually maybe i am unhappy um because we can convince ourselves so easily every moment that we're the problem keeping a list of the reasons that um you are unhappy again because again i was really fortunate to have couples therapy and i said oh i'm obese and i've returned if you are listening to this and you're worrying that you are the abusive one and actually you're maybe you're a narcissist you're probably not usually the narcissists are the ones that don't think about um but i was like maybe i'm all these things and i said i keep having these emotional reactions at my partner and the couples are so when does that start and it would usually be through things like he would every morning he said you want a drink and say i want coffee and he'd say okay and then you're making a tea so why did you do that to him and he said oh well again gets really aggressive when she has coffee and i was oh my god he's doing it on purpose i think sometimes having another person there can be really useful to realize like actually whether your boundary is being crossed um and talk to someone about it someone that again it's hard for me to give anybody talk to someone objective like a therapist or a coach who can listen because no little doubts it's really really important to listen to them we can be very good at ignoring them and it can feel completely overwhelming to get out of situations like that but i honestly wouldn't be out of this situation the one i'm telling you about right now if it wasn't for coaching and i was really lucky that i got some free coaching from the prince's trust at the time and it was only from talking to them they helped me to like kind of literally plan out how to get out because again i've got nowhere to go i can't figure out like i have no money i've got no life and they were like what can you do right now like just today's solutions i think trying to get some kind of coaching can be really really useful just so you can give yourself that space to get out of a situation where you feel like completely overwhelmed over and over again and talk to people because again the difficulty with talking to people i think is like if i talked to various friends at the time they were just oh you know you're probably overreacting but talk to someone that listens to you and validates your experiences and um know that it's so so so worth getting out like it can feel really overwhelming i'm really like what's the point i don't have any money to live i'm gonna have to go and whatever a date i have no friend i have no relationship but honestly like it's so much better to be alone than to be with someone that makes you feel alone and someone that makes you feel horrible in being yourself and it's quite amazing to see how the reduction sensitive story changes when you take that control over the people that have access to you and when you actually start thinking like who do i want to have in my life not i'm so lucky to have anyone that wants me in their life um and honestly like i can't express how how worth it is and i know it's coming from a very privileged place and i've been able to leave and find a flat but when i have left all of these various situations i've had no money no prospects no jobs nothing and um i just was like well you know i might as well get out now and see what i do by myself so it is so it's not your fault either i think that's the main thing it's not your fault and you have the power to get out of situations anytime yeah and thank you so much for sharing all that um it was i think that's what we all do and actually i think you've really explained honestly and by sharing your own personal experience i think you know talking about the importance of coaching and you know working to try and regulate our emotions so that we can trust ourselves and get out of difficult situations so thank you so much for joining us today thank you yeah it's been really nice to share it and hope it helps that's everything from us for today we'll be back on wednesday with our bonus episode and we'll be talking about everything about how ADHD can be more vulnerable to toxic relationships and don't forget you can listen and subscribe to you're wrong about ADHD on global player or wherever you get your podcasts thanks for listening and see you next time this is a global player original podcast