Rejection Sensative Dysphoria

[Targhee]

What can you tell me?

Have you discussed this with your provider? Have you tried medication? Has CBT or DBT worked (I hear it doesn’t for RSD)? How to you handle interactions with someone with RSD (related to ADHD)? How do enforce rules and keep expectations without crushing them in the perception of being highly criticized or rejected? 

[Targhee]

Here’s a little info

https://www.dodsonadhdcenter.com/rejection-sensitive-dysphoria/

[maize]

I think DBT could be helpful.

[Targhee]

23 hours ago, maize said:

I think DBT could be helpful.

I had thought so too, but several professional sources said no. I’m hoping someone out there might be able to give some personal experience.  I have known this about my child since age 2 but could never put a name or cause to it.  This symptom of ADHD (not an official DSM symptom but anecdotally present to one degree or another in a high majority of those with ADHD) is the most debilitating for my dc right now, and the dysphoria so severe that it is in that moment causing extreme depression and anxiety.

[J-rap]

Interesting.  Is it always found along with ADHD, or can it exist without ADHD?  It also sounds like a mild borderline personality disorder trait, or even just being a highly sensitive person.  In any event, it's super interesting to me, and I can definitely see one (or more!) of my own family members having something similar to this.  Brain condition categories are so complex and vague.  

I'm sorry your dc is struggling with this.  I was going to suggest DBT too, 

Thinking about this more, my dh has a relative who has something similar to this, but it was never really given a name.  He finally found a prescription drug, after a number of years, that has stabilized his perceptions of events and criticism, and says that it has absolutely changed his life.

[maize]

9 hours ago, Targhee said:

I had thought so too, but several professional sources said no. I’m hoping someone out there might be able to give some personal experience.  I have known this about my child since age 2 but could never put a name or cause to it.  This symptom of ADHD (not an official DSM symptom but anecdotally present to one degree or another in a high majority of those with ADHD) is the most debilitating for my dc right now, and the dysphoria so severe that it is in that moment causing extreme depression and anxiety.

The use of DBT for conditions other than Borderline Personality Disorder is new and expanding, a body of research sufficient to illuminate best practices hasn't developed yet--I see no way for professional sources to be definitive that it won't help.

I haven't heard the term rejection sensitive dysphoria before but based on the description it is not unique to ADHD and in fact fits well with BPD symptoms--which DBT is the best research backed treatment for. Accepting emotions and learning to apply coping skills is part of DBT and seems relevant here.

I'm glad to have a term for this--a couple of my kids definitely experience it. I'd love to see more research on it.

[Targhee]

6 hours ago, J-rap said:

Interesting.  Is it always found along with ADHD, or can it exist without ADHD?  It also sounds like a mild borderline personality disorder trait, or even just being a highly sensitive person.  In any event, it's super interesting to me, and I can definitely see one (or more!) of my own family members having something similar to this.  Brain condition categories are so complex and vague.  

I'm sorry your dc is struggling with this.  I was going to suggest DBT too, 

Thinking about this more, my dh has a relative who has something similar to this, but it was never really given a name.  He finally found a prescription drug, after a number of years, that has stabilized his perceptions of events and criticism, and says that it has absolutely changed his life.

Dc is in therapy with a counselor using DBT in particular. However this and other articles suggest no therapies are particularly helpful. https://www.additudemag.com/rejection-sensitive-dysphoria-how-to-treat-it-alongside-adhd/

From it:

“Psychotherapy does not particularly help patients with RSD because the emotions hit suddenly and completely overwhelm the mind and senses. It takes a while for someone with RSD to get back on his feet after an episode.”

My dc becomes so instantly in a state of panic, fear, hurt that dc seems incapable of executing anything learned from DBT or any other coping mechanisms. Dc often appears as having been punched in the chest, physically retreating and clutching chest in pain. But once subsided, function is fairly normal.

Also, @maize though it is similar to BPD in this single trait:

“When this emotional response is internalized, it can imitate a full, major mood disorder complete with suicidal ideation. The sudden change from feeling perfectly fine to feeling intensely sad that results from RSD is often misdiagnosed as rapid cycling BPD.

It can take a long time for physicians to recognize that these symptoms are caused by the sudden emotional changes associated with ADHD and rejection sensitivity, while all other object relations are totally normal”

Also in the article with regards to prevalence:

“Rejection sensitivity is part of ADHD. It’s neurologic and genetic. Early childhood trauma makes anything worse, but it does not cause RSD. Often, patients are comforted just to know there is a name for this feeling. It makes a difference knowing what it is, that they are not alone, and that almost 100% of people with ADHD experience rejection sensitivity. After hearing this diagnosis, they know it’s not their fault, that they are not damaged.”

I had heard about this about a year ago, along with emotional sensitivity and emotional flooding, as even more universal to ADHD (all Typs) than any other symptoms, though it was after DSM V. Right now I am hoping to learn and understand more. Dc does not have other symptoms of BPD, but definitely has this RSD more intensely than the other ADHDers in our home.

[maize]

This could explain some stuff in my family...

ADHD households are complicated.

[maize]

Sudden intense emotions are a hallmark of BPD, so I would think techniques for dealing with them in BPD individuals would be generalizable to some degree at least for anyone who experiences sudden intense emotion.

[sbgrace]

I wonder about my son when I read about this. It makes it hard to discuss/address areas of weakness, because he just can't bear to think about or allow anyone to talk about x or y. He wounds easily, and I am discouraged to think there isn't a cognitive treatment. 

[maize]

15 minutes ago, sbgrace said:

I wonder about my son when I read about this. It makes it hard to discuss/address areas of weakness, because he just can't bear to think about or allow anyone to talk about x or y. He wounds easily, and I am discouraged to think there isn't a cognitive treatment. 

I've been researching on and off all morning, I've found no studies at all specific to this (probably because it is not an official diagnosis) and there for no evidence that therapy could not be helpful. The author of the article does not support his claim.

 

 

[maize]

Just to clarify, when I use BPD I am referring to Bordeline Personality Disorder not Bipolar Disorder (which I think the rapid cycling reference was to).

[Guest]

This is a diagnosis I have never heard of before and haven't come across it so far with my two. I did look it up and found what Targhee is saying. I'm quoting another article on it from WebMD, hopefully it might be useful to you Targhee, if you have not seen it already.

https://www.webmd.com/add-adhd/rejection-sensitive-dysphoria#1

Here's a quote:

Quote

Therapy can help with other symptoms of ADHD, but it doesn't do much for RSD. This is because RSD episodes happen suddenly and without warning. But a therapist can help you learn how to get a handle on your emotions and deal with rejection in a more positive way.

Another way to deal with RSD is to manage the stress in your life. You're more likely to have an emotional breakdown when you're stressed out. Eat right, sleep well, and do things like yoga or meditation to keep your mind calm.

 

[maize]

48 minutes ago, Moved On said:

This is a diagnosis I have never heard of before and haven't come across it so far with my two. I did look it up and found what Targhee is saying. I'm quoting another article on it from WebMD, hopefully it might be useful to you Targhee, if you have not seen it already.

https://www.webmd.com/add-adhd/rejection-sensitive-dysphoria#1

Here's a quote:

 

The WebMD articles and others all reference William Dodson's articles, which as best I can tell are the source of the assertion that therapy won't help. Dodson himself offers no studies or data to back up such an assertion.

 

This quote "Therapy can help with other symptoms of ADHD, but it doesn't do much for RSD. This is because RSD episodes happen suddenly and without warning." makes no sense; panic attacks also happen suddenly and without warning but therapy is a standard treatment.

[sbgrace]

I'm wondering about distress tolerance type work. Something along these lines? 

 

[Guest]

23 minutes ago, maize said:

The WebMD articles and others all reference William Dodson's article, which as best I can tell are the source of the assertion that therapy won't help. Dodson himself offers no studies or data to back up such an assertion.

 

This quote "Therapy can help with other symptoms of ADHD, but it doesn't do much for RSD. This is because RSD episodes happen suddenly and without warning." makes no sense; panic attacks also happen suddenly and without warning but therapy is a standard treatment.

 

Maize, I did not look into it too deeply, but honestly, I am with you on using therapy. I'll try to find some time to look into it further. DBT falls under the CBT umbrella and you can find mention of it in Aaron Beck's (founder of CBT) website along with mindfulness, and I am all for it at a personal level. I am all for therapies that stem from the cognitive and socia-cognitive theories. We don't all make the same choices though ?

[Targhee]

3 hours ago, sbgrace said:

I wonder about my son when I read about this. It makes it hard to discuss/address areas of weakness, because he just can't bear to think about or allow anyone to talk about x or y. He wounds easily, and I am discouraged to think there isn't a cognitive treatment. 

YES which makes even the idea of therapy a criticism ? 

[Targhee]

Dc is in DBT and we will persist with it. Other dc is in therapy with CBT as primary method. I am hoping as they have more practice with these things they will have greater success. I am wondering about medication now though - guanfacine was one I saw recommended. The other was an MAOI, which is a much bigger commitment and one you have to vigilant about contraindications.

[Targhee]

3 hours ago, maize said:

Just to clarify, when I use BPD I am referring to Bordeline Personality Disorder not Bipolar Disorder (which I think the rapid cycling reference was to).

I was using BPD as borderline personality disorder as well. I am not sure but I think you are right he was talking about bipolar here, but in another article I read the same thing about borderline personality disorder. I will see if I can find it.

[Guest]

34 minutes ago, Targhee said:

Dc is in DBT and we will persist with it. Other dc is in therapy with CBT as primary method. I am hoping as they have more practice with these things they will have greater success. I am wondering about medication now though - guanfacine was one I saw recommended. The other was an MAOI, which is a much bigger commitment and one you have to vigilant about contraindications.

I was reading that a combination of two meds is more successful. I can't remember if it was the WebMD article. Guanfacine was one but I can't remember the other off the top of my head. Please don't feel it as a criticism in any way on my part. If a child needs meds then they need meds. You need to do what you feel is best for your child.

[Targhee]

22 minutes ago, Moved On said:

I was reading that a combination of two meds is more successful. I can't remember if it was the WebMD article. Guanfacine was one but I can't remember the other off the top of my head. Please don't feel it as a criticism in any way on my part. If a child needs meds then they need meds. You need to do what you feel is best for your child.

It isn’t a criticism. My kids have been on meds for ADHD for 6+ years. I just didn’t realize there was a term for what I observed, let alone treatment.  I did read tgat guanfacine was only effective for about 50% of people.

[Guest]

39 minutes ago, Targhee said:

It isn’t a criticism. My kids have been on meds for ADHD for 6+ years. I just didn’t realize there was a term for what I observed, let alone treatment.  I did read tgat guanfacine was only effective for about 50% of people.

It was in this, also from ADDitude but not the one you linked above, that I saw it in:

https://www.additudemag.com/download/rejection-sensitive-dysphoria-treatment-symptoms/

I am agreeing with Maize that all the information currently out there appears to be from William Dobson.

I am just providing the information to you, in case you haven't seen it. I believe that we all make choices based on our own unique situation and child, which is why, as I explained above, I don't pass judgment. We all want what is best for our kids! Personally, I don't medicate ADHD and that is my decision for my own unique situation and child ?

I hope you find what works best for your child,

M

[Guest]

3 hours ago, maize said:

The WebMD articles and others all reference William Dodson's articles, which as best I can tell are the source of the assertion that therapy won't help. Dodson himself offers no studies or data to back up such an assertion.

Sadly I am not finding studies of any kind that might be helpful to any of you. I guess the diagnosis is just too new. I checked a couple of my CBT books and didn't find anything. I'll check again when I have a bit more time. I have quite the collection of psych and CBT resources as I have a personal interest in psychology.

Anyway, I'll be back if I find something useful to contribute.

[maize]

If this helps:

Based on the description, the person close to me who was diagnosed with BPD very much had this symptom.

Intensive DBT (inpatient setting) was life changing for them. 

Which makes me think that yes DBT can be helpful.

Of course not all DBT providers are equal, and more importantly not all people are the same or respond the same. I do hope your child finds some relief.

And I find this helpful in evaluating some of my own kids so I'm glad it was posted.

[geodob]

The instant state of panic and fear, is a 'Fight or Flight Response' to Rejection. 

This causes a sudden surge of Cortisol and then Adrenaline, which is an automatic response to Danger.  Where Rejection has become a trigger for this Fight or Flight Response. 

The Cortisol is produced by an area of the brain called HPA axis (Hypothalmic Pituitary Adrenal Axis).   Which is recieved by a certain type Receptor ( A2a Receptor).   Which regulates the response to the Cortisol / Adrenaline.  With Guanfacine, it will stimulate the A2a Receptor,  which can prevent the Panic Response from occurring.  Another medication that also does this, is Clonidine. 

If you try either of these med's and find that they do help?  Then this will confirm that his A2a Receptors are a major factor.  If the meds inhibit his response to Rejection?  Then while he is on the meds, he could then be exposed to 'levels' of Rejection.   Where the meds may provide him with 'more normal' responses to rejection.  Without it triggering the Fight or Flight Response.  So that the meds could be used, to help him develop a new response to Rejection. 

Where this could be looked at as similar to a 'Phobia'?  So that he is helped to overcome this Phobia.

[Guest]

Deleted post. I looked up certain things and got some answers to some of my thoughts/ speculations. I will not be adding links as it is not something that would add anything useful for the OP or her child.

[Guest]

The emotions articulated by an adult/ female/ mom with ADHD, RSD, and Emotional Hyperarousal:

https://www.additudemag.com/slideshows/emotional-sensitivity-adhd-rejection-dysphoria/

[Guest]

12 minutes ago, Moved On said:

The emotions articulated by an adult/ female/ mom with ADHD, RSD, and Emotional Hyperarousal:

https://www.additudemag.com/slideshows/emotional-sensitivity-adhd-rejection-dysphoria/

Maize, did you see page 9, step-four? She talks about CBT/ DBT ?

[Guest]

Also from ADDitude:

Quote

What Does Rejection Sensitive Dysphoria Look Like in People with ADHD?

Rejection sensitive dysphoria (RSD) is an intense emotional response caused by the perception that you have disappointed others in your life and that, because of that disappointment, they have withdrawn their love, approval, or respect. The same painful reaction can occur when you fail or fall short of your rather high goals and expectations. RSD commonly occurs with ADHD, and causes extreme emotional pain that plagues both children and adults — even when no actual rejection has taken place.

RSD is difficult for people with ADHD to describe, but all who have it agree that it feels awful. Indeed, the term dysphoria is literally Greek for “unbearable.” Often those with RSD hide these 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.

 

Here's the link:

https://www.additudemag.com/rejection-sensitive-dysphoria-adhd-symptom-test/

The link includes a self-test.

ETA: Again, it has been contributed by Dobson.

[Pen]

On 7/24/2018 at 11:25 AM, sbgrace said:

wondering about distress tolerance type work. Something along these lines? 

 

Whether or not it works for rsd I greatly appreciate you having shared that video!

[Targhee]

Thank you to all who are responding. I’m still reading and thinking, and wondering, about it all.

[Targhee]

15 hours ago, nwahomeschoolmom said:

Wow this is really interesting...I have never heard of this before, but am pretty sure I have experienced this in someone I know with ADHD. So how would a RSD intense reaction be different from a "meltdown"? 

I think meltdown is usually about either unmet expectation, task switching when hyper focused, or sensory issues. Not always, but I would guess usually.  The RSD is about perceived criticism or rejection.  I do have one cryer (imploding) and one fighter (exploding) when meltdowns happen.  What I see that I believe is RSD is more like wounding - pain, hurt, hiding or shielding themselves as if they perceive a major threat against their safety/well being.

[Targhee]

On 7/24/2018 at 1:55 PM, Targhee said:

I was using BPD as borderline personality disorder as well. I am not sure but I think you are right he was talking about bipolar here, but in another article I read the same thing about borderline personality disorder. I will see if I can find it.

https://www.webmd.com/add-adhd/rejection-sensitive-dysphoria

It mentions BPD, as well as Bipolar and other mental health conditions, that would be on a differential.

 

Reading this again, and the part about therapies in particular, I think it suggests not the CBT or DBT wouldn’t be helpful, but that they cannot prevent an episode of dysphoria or “cure” RSD symptoms.  They can be useful for managing the effects of the intense emotional state after it happens.  It seems to suggest that the severity of dysphoria can be significantly diminished for some with medication.

[Guest]

1 hour ago, Targhee said:

 The RSD is about perceived criticism or rejection.  I do have one cryer (imploding) and one fighter (exploding) when meltdowns happen.  What I see that I believe is RSD is more like wounding - pain, hurt, hiding or shielding themselves as if they perceive a major threat against their safety/well being.

 

Yes, this is what I was beginning to see from what I have been reading. I deleted my comments in one of my previous posts as I can sense you are trying to be careful about how much you share and I don't want to add to your concerns while you are trying to figure things out. 

If you want to delete anything at any point just post here and I will remove the quote. 

[Guest]

1 hour ago, Targhee said:

https://www.webmd.com/add-adhd/rejection-sensitive-dysphoria

It mentions BPD, as well as Bipolar and other mental health conditions, that would be on a differential.

 

Reading this again, and the part about therapies in particular, I think it suggests not the CBT or DBT wouldn’t be helpful, but that they cannot prevent an episode of dysphoria or “cure” RSD symptoms.  They can be useful for managing the effects of the intense emotional state after it happens.  It seems to suggest that the severity of dysphoria can be significantly diminished for some with medication.

 

Targhee, for some people therapy without meds for anxiety or depression is just not enough. Anxiety is also unpredictable and left untreated can lead to depression. SPD induced anxiety is another one that is challenging to cope with. Some people cannot cross over that barrier of being able to use the strategies before things escalate. It is why for some, a combination of meds and coping strategies works best. I am not encouraging you towards meds or telling you you shouldn't use them. You need to see which category your own unique child fits into in this case. The lady in the story I linked does not say she is on meds but she doesn't say that she is not either. There is very little on RSD to begin with but one thing to keep in mind is that CBT type approaches focus on reframing negative thoughts or faulty perceptions about situations/ experiences. Sometimes a person may start with a combo of meds and strategies and then maybe be able to come off the meds once they are able to use the strategies effectively to control the situation, and especially their emiotions, before things escalate.

[Targhee]

2 hours ago, nwahomeschoolmom said:

I am glad this topic came up (though sorry you are dealing with it).  Having read about this is helping me with my 6 year old son.  My husband had put him on timeout for not calming down (long story) and instead I went to his room and gave him a "time in" and that was what he needed.  

Also, this might not relate or might sound weird....but...I'm wondering if studying the virtue of humility as monks practice it (Orthodox monks in particular) could help RSD.  To be excellent at humility, you have to be willing to hear criticism.  The more criticism you receive, the more your virtue is being tested and the more you are practicing humility. (Therefore, maybe tricking yourself into hearing criticism etc because you primarily want to be excellent at virtue...until eventually (after years perhaps) you realize the criticism is not quite as bad.  It will not cure it...but it could possibly help.  From much personal experience, I know that many issues are physical and biological, but the spiritual side can often ameliorate it even if you still struggle.

Perhaps this in a way would work. It’s a bit like exposure therapy. Thank you for the thought.

[Guest]

Targhee, exposure therapy is one of my favorite strategies of CBT. I have used it with both my two, primarily for sensory issues. Here's an article from the Beck Institute I found for you. It's for PTSD but you can find some useful info that can tie in with RSD.

https://beckinstitute.org/exposure-strategies-ptsd-treatment/

[exercise_guru]

I first learned about this RSD from the Additude magazine site here.  I have a child who is incredibly bright but has RSD intensely. I have talked to her counselor about it I have tried to find a counselor who handles social thinking hoping that might help increase her awareness and allow me to better parent her. I continue to strike out. Please if you find anything useful do update.