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Are You Prone to Rejection Sensitivity Dysphoria (RSD)? – 118

depression identity podcast suffering May 11, 2023

Rejection Sensitivity Dysphoria or RSD is a hot topic these days.  It is one manifestation of emotional dysregulation, which is a common but misunderstood and under-researched symptom of ADHD in adults.  Individuals with RSD feel unbearable pain (physical and emotional) as a result of actual or perceived rejection, teasing, or criticism.  And, this symptom is not alleviated with cognitive or dialectical behavior therapy.  I’ve read that this symptom is attributed to a different brain structure, a sensitivity that is different than just being a highly sensitive person, and as with the treatment of ADHD itself, medications such as ADHD medications or antidepressants are often given in the hopes that they will lessen the pain. 

 A significant percentage of adults never find any effective ways to manage or cope with the pain.  So, what do adults do when they are in unbearable pain?  What comes to mind is self-medicate the pain so they can at least do what needs doing in their life.  This could be drink, drug, spend, eat, etc., to escape the pain.

When I read about rejection, it appears to be the intentional act of refusing to accept, approve or support something or someone such as refusal to show someone love or kindness; refusal to accept someone.  Rejection is the act of not giving someone the love and attention they want and/or expect.

In this episode, I talk about:

  • The unbearable physical or emotional pain of rejection
  • The difference between RSD and ADHD
  • What it takes to transform from the inside out
  • And more!

Developing your Executive Function Skills and shifting your limiting beliefs is the fastest and most effective way to overcome ADHD limitations, find focus, gain confidence, and a newfound freedom in your life!

My mission is to put an end to the worldwide needless suffering of adults with ADHD and those with under-developed Executive Function Skills - whether from ADHD, chronic depression or anxiety, trauma, addictions, or chronic illnesses.  And, you don't need a formal diagnosis to know you need help developing these executive function skills in order to greatly reduce your suffering.  


Full Episode Transcript​​Hi Aspiring Achievers,

Rejection Sensitivity Dysphoria or RSD is a hot topic these days. It is one manifestation of emotional dysregulation, which is a common but misunderstood and under-researched symptom of ADHD in adults. Individuals with RSD feel unbearable pain (physical and emotional) as a result of actual or perceived rejection, teasing, or criticism. And, this symptom is not alleviated with cognitive or dialectical behavior therapy. I’ve read that this symptom is attributed to a different brain structure, a sensitivity that is different than just being a highly sensitive person, and as with the treatment of ADHD itself, medications such as ADHD medications or antidepressants are often given in the hopes that they will lessen the pain.

A significant percentage of adults never find any effective ways to manage or cope with the pain. So, what do adults do when they are in unbearable pain? What comes to mind is self-medicate the pain so they can at least do what needs doing in their life. This could be drink, drug, spend, eat, etc., to escape the pain. When I read about rejection, it appears to be the intentional act of refusing to accept, approve or support something or someone such as refusal to show someone love or kindness; refusal to accept someone. Rejection is the act of not giving someone the love and attention they want and/or expect.

Do you relate to being either the Elliot or the Rosemary in the following example? Elliot doesn’t show love, acceptance, approval or support for Rosemary in ways that mean that to her. She experiences unbearable emotional and/or physical pain because she feels rejected and feels she has failed to be a person who can be loved and accepted by a person significant or important to her; in this case, Elliot.

Since Rosemary is the one who has RSD, is it Elliot’s responsibility to show love, acceptance, approval and support for Rosemary no matter what? I’m curious to know what you think.

Due to the unbearable pain that Rosemary experiences, she becomes codependent and turns to people pleasing behaviors to gain the love, acceptance or approval she is seeking from Elliot.

Please note that Rosemary is seeking love, acceptance and approval from outside of herself with Elliot, rather than from within herself because she believes that it should be forthcoming and is separate from self-love and acceptance.

As babies and young children, we need love, approval, acceptance and support from our parents (first of all). We need this to survive. If we don’t get this from them, damage is caused to us emotionally whether we have ADHD or not. We need this in the early years of life so we are nourished by these human needs.

As we get older, and begin to mature, we need to learn to gain this love, acceptance, approval and support from within ourselves, rather than from others. Receiving it from others is a bonus; receiving it from within is essential.

Many of us never learn how to turn this need to something we meet ourselves rather than get met from others. Because of this, and especially what I see in the adults with ADHD I work with, there is a high incidence of codependent behaviors and thinking – all focused on gaining the approval, acceptance, and support of others – at times no matter what that takes.

In our marriages we focus on pleasing our spouse as a means of getting our needs met in the marriage. The faulty belief is that if they are pleased by what we do for them or how we are being for them, then they will meet our needs. It is an unspoken contract that is entered into with the expectation of getting our needs met if we meet the needs of the other person first. This is a faulty arrangement and typically doesn’t work well.

In our friendships we think of the needs of our friends and not our own and say yes when we should be saying no. We don’t because we fear criticism or rejection and feel trapped into saying yes if we are asked to help with something. Friends may not expect a yes every time, but we think they do and so we act accordingly.

In our academic relationships we do more work than is asked for or expected, hoping to be seen as a good student and graded accordingly. We might even volunteer to help the professor in some way to score points in how we are perceived.

In our work relationships we work the crazy schedule and even overtime without pay because our employers wouldn’t give us the amount of work they do every day if it wasn’t reasonable and blame ourselves; we must be slow or less effective than other employees.

What suffers most of all is our relationship with ourselves. We are so focused outside of ourselves on others that we never really get to know who we are. This is typically the quality of life many of my students have been living before we work together.

Since RSD is mood-related, some of you may be wondering how it differs from an actual mood disorder, such as depression. I’ll differentiate for you.

RSD & ADHD o Mood changes always have a clear trigger

o Moods match the perception of the trigger

o Mood shift is instantaneous

o Episodes end quickly in a matter of hours

o Episodes rarely last more than a couple of hours

Mood Disorder (typical symptoms) o Mood changes are untriggered; out of the blue

o Moods are independent of what is going on in the person’s life

o Onset of mood episode is gradual over a period of weeks to months

o Duration of episode must be greater than 2 weeks

Mood Disorder (atypical symptoms)

o Mood changes are triggered

o Moods are dependent of what is going on in the person’s life

o Onset of mood episode is sudden or instantaneous

o Duration of episode can last indefinitely

o Not helped that much by medications; is a therapy and/or skills solution

As you can hear, RSD and atypical depression have similar symptoms.

For those of you who share your current challenges and goals with me, and/or set up a free call to discuss them, as well as what help is available for you, I’d say that emotional regulation is right there at the top. Many of you want to know how to become less sensitive or dysregulated. You tell me that you get triggered by people and situations regularly and it’s exhausting. You want to know how to stay on task and get stuff done when you are constantly getting derailed by how you feel. With regard to RSD, you are deeply dissatisfied with yourself and what you have achieved thus far. You identify with my term “gifted underachiever” because you know that you would be capable of so much more, if you could just resolve what gets in your way. I get it. Knowing that you can’t outperform your beliefs or identity is why I focus on releasing your limiting beliefs and upgrading your outdated identity first thing in my program, so we clear away two areas that are getting in your way and holding you back from achieving more. You may be:

Thinking about bad events repeatedly or excessively, particularly experiences of real or perceived rejection

Experiencing rejection when none is truly present

Viewing minor rejections as disastrous

Living with a persistent fear of rejection

Afraid of constructive criticism, calls for further information, or impartial input because they are all misinterpreted as rejection

Codependent and living with perfectionism or people-pleasing characteristics and behaviors

Many professionals don’t believe RSD is real and won’t treat it. Whether or not it is real according to the DSM or not isn’t the issue. It is real to the people who are suffering with it and needs to be addressed. What I see online for treatments are ADHD and antidepressant medications, therapy to reduce ruminating, improve time management and reduce negative impulses, and accommodations at work and/or school for hypersensitivity. These recommendations don’t seem to get to the underlying issues, especially because medications aren’t for everyone and accommodations still leave you with the issues; just reduces the frequency that they will be triggered, and therapy (CBT and DBT) is said to not be effective in alleviating RSD.

What I didn’t see listed in any of the articles I read was changing your identity (who you believe you are) from the inside out, so you actually shift who you know yourself to be and your behaviors and actions follow. You might be thinking “if it was that easy Dr B, wouldn’t everyone be doing that to eliminate their RSD?” It’s a relatively simple process, and yet takes commitment and guidance to make this shift. If everyone was willing to make the commitment and follow through on it to make this shift, then yes, they could shift their RSD. We spend a full week working on releasing limiting beliefs and upgrading outdated identities and intermittently circle back during our 7-months together in GSD. I felt that more time would be beneficial to work on what limits so many and gets in the way which is why we created that option that’s available now.

The Chinese philosopher Lao Tzu once said, “Give a man a fish and you feed him for a day. Teach him how to fish and you feed him for a lifetime.” My mission is to feed everyone for a lifetime so we create a society of regulated humans rather than people always getting derailed by what they are feeling. I know it takes time and yet the time spent is well-worth the investment because the return is for a lifetime.

As you probably know by now if you are a regular listener to my podcast show, I believe that well-developed executive function skills along with important pre-skills is the answer to the dysregulation that many are experiencing. That said, if you’ve never had your Executive Function Skills assessed, I highly recommend my free PDF, “13 Signs Weak Executive Functioning Is Holding You Back.” This is a good starting point to gain some insights into your level of development or deficit so you can understand what’s been holding you back, and potentially dysregulating you. I use a more comprehensive executive function skill assessment for the students in my GSD-FE program, because I want to know more in-depth information with the students I work with. However, the PDF I created is definitely a good starting place for everyone. You can grab your copy from my website; link is in the show notes. If you’ve been listening to my podcast for any length of time, you know that I differentiate us as “human beings” and “human doings.” Society looks at us through the lens of “human doings” and many of us have been indoctrinated to view ourselves as a “human doing” as well. We value ourselves based on what we can do and when we can’t do many things due to executive function deficits, we don’t feel very good about ourselves and worse yet, may give up hope of life getting any better. Please don't give up hope; rather, borrow mine until you have gained your own hope again. It’s real hope; not cheerleader hope.

You are a precious child of the universe; and are called a “human being” not a “human doing” for good reason. As a “human being”, you don’t have to earn your value; you were born with it. Your value comes from “who” you are “being”; not what you are doing, which means if you focus on “being” the highest expression of what resides within you, you can wake up every day with your value 100%. You may still be developing your “doing” abilities, yet as a “being” you are enough and that’s a great win to celebrate every day of your life. And if you don’t believe me, then please consider coming to work with me in some capacity so I can guide you and celebrate with you all that is amazing about you, the “human being.” – that is, if it’s your time.

Speaking of wins, what’s it going to be for you today? You focused on your self-care this week and are feeling great because of it? That’s great! You set time aside for yourself every day, and even put it on your calendar? That’s fantastic! You have been clearing the clutter from your bedroom so your sleep is more restful? That’s wonderful! Congratulations on each and every one of your wins – big and small. They each deserve your whole-hearted celebrating! YES!! WOW!! THANK YOU!! You are honoring yourself every day and not many people do so. We all have daily wins, if we pay attention and look for them, and I am hopeful that you are celebrating them all. You deserve no less.

How much time do we have? Not much. So, let’s get to it.

Continuing on with RSD, there is something important to note with regard to symptoms noted in the DSM-V for adult ADHD, and that is that they avoid mentioning symptoms associated with emotion, thinking styles, relationships, sleeping, etc. because these symptoms are hard to quantify, yet these are the symptoms most bothersome to adults. The DSM-V criteria is almost useless in that it ignores so much information that is vital to understand about how adults with ADHD experience life. And, my understanding of medications for ADHD, is that they target the 3 core defining areas of ADHD according to the DSM-V which is inattentiveness, hyperactivity and/or impulsivity. As far as I know, RSD is still being mostly ignored here in the US; however, it’s a different story in the European Union, where adult ADHD has been redefined with the addition of emotional regulation as a fundamental part of the criteria for diagnosis. One reason that RSD may not be included in the diagnostic criteria is that it isn’t always present and comes in triggered episodes. Additionally, those with RSD are typically ashamed of their over-reactions and tend to hide this information so as to reduce further shame or embarrassment.

The EU definition of ADHD syndrome includes 6 areas:

o Inattention and hyperfocus

o Impulsivity

o Hyperactivity

o Emotional dysregulation

o Excessive mind wandering

o Behavioral self-regulation (which they equated with EF deficits)

EU intentionally uses emotional dysregulation instead of RSD feeling it is more inclusive of the issues; this comes from a 2013 study: “The type of emotional dysregulation seen in ADHD has been characterized as deficient self-regulation of emotional symptoms such as irritability, frustration and anger and low frustration tolerance, temper outbursts, emotional impulsivity, and mood lability. Emotional dysregulation in ADHD is different from episodic symptoms such as marked sustained irritability occurring within the context of altered mood states, such as an episode of extreme sadness or mania. In ADHD, emotional symptoms tend to reflect short-lived exaggerated changes, often in response to daily events, with rapid return to baseline within a few hours”

RSD is not a new concept. When I was first studying in the 1970s, I found Dr. Paul Wender’s work. He spent four decades conducting the pioneering studies on ADHD beginning in the 1960s, and was the first to recognize emotional dysregulation as a persistent, prevalent, and highly impairing component of what we now call ADHD.

Medications are still being pushed as the answer even though there is no clinical research to support this opinion. Some believe that RSD is neurological and not something that is due to a lack of skills. Skills do not come in pill form. Therefore, it’s another reason to push meds vs. skills. My perspective is obviously different because I have found that developing the right skills, in the right way, solves many of the problems that are deemed unsolvable in the literature. If one needs emotional armor, many can create it without medications once they learn how. And once you learn how to deflect those incoming triggers, you can live without being wounded every single day.

We are the meaning makers in our lives. It’s not hard to imagine that with all of the negative experiences that many of us have had growing up, and the mistakes we’ve made and how people have reacted to us because we think differently about things – that we would be rejected by others. Dismissed as inadequate, inappropriate or not to their liking. To me, to reject is more like the “not to their liking” and means that those doing the rejecting didn’t like my behavior. However, many take it as a rejection of self – they didn’t like me and I am inadequate or inappropriate; not my behavior. How can they reject me if they don’t know me – the person? They can reject me because of behavior which is something they see but me? They can’t see inside of me.

Growing up, we seek approval or acceptance from others; our parents, teachers, peers and such. If we don’t get it and instead, we get rejection or perceived rejection, we start thinking of ways that we might get approval or acceptance from others and this can lead to people pleasing. We focus on others and not on ourselves.

I have lived a life of service for most of my 72 years and it fulfills me. Helping hundreds of adults change themselves from the inside out so they can transform their limiting beliefs and outdated identities to empowering ones, eliminating challenges with regard to how they manage themselves in time and time itself so it becomes a healthy partnership, understanding the causes for procrastination and banishing those causes so things get done, and lighting the way to making decisions more easily that are known to be good decisions before ever acted on absolutely excites me. And that’s only the Fundamentals.

Because I believe in teaching you to fish so you can feed yourself for a lifetime, I have further helped hundreds of adults to integrate the life skills for success so they can live the sustainable, successful life they want and deserve. This is only possible through the elimination of their executive function deficits, which means that they learn to develop those executive functions skills, rather than just being fed some tips or hacks or strategies as workarounds. I view those workarounds as band-aids that fall off in time or we stop using them because we have to consciously remember to use them. Instead, my students learn how to change themselves from the inside out and integrate all they are developing, so they come to know that they can take care of themselves no matter what situation they are in. They have become the person who can do so. If you resonate with my approach and want what others before you have received, I am excited for you, and would welcome the opportunity to speak with you about your current situation and what you are seeking, so we can determine together if what has worked for so many other adults would work for you as well. See the show notes for how to book that free call with me. I want to hear about your current challenges and what you want instead, so we can discuss how that can happen for you.

If you are in our Facebook group, Living Beyond ADHD, you may have noticed that there is no longer any new activity there. Everything is happening outside of that group. The Transformation Club is the closest to what a Facebook training group can be; however, our group was never intended to be a training group. That is why TTC was created so you have privacy, community and quality training and support. You can now book a call to find out if TTC is right for you.

Whatever your needs, we’ve got you covered. Structure. Support. Community.

From my perspective, the most important question to ask yourself is:

What have your deficits cost you up to now and what will the further cost be if you don’t do something about them now?

If you live in the UK, and need what my GSD program offers you but finances are an issue, there is a grant assistance program through Access to Work that just might provide the funding for the GSD program for you; it has for a number of my students. If you live in Australia, or Ireland or other places, there may also be funding to help you access the GSD program. To learn more about what might be available to you if you live in those areas, check the page on my website – link is in the show notes.

And while you are waiting for your grant assistance to come through, if this applies to you, consider coming into The Transformation Club to start your EF skill transformation with other like-minded adults from around the world.

Life is precious, and time even more so. We all get a certain amount of time here. And when that time is up, it’s up. Are you living like you have all the time in the world? You don’t. Time doesn’t wait for us to be ready – it just keeps passing along. I learned a long time ago that my life won’t wait forever for me to be ready to embrace it and live it to the fullest. If I want that life, I have to take action to get ready and live it.

If you want an intentional life, you need to be intentional about what you bring into your life. Be 100% responsible for the life you create for yourself. Even if you have challenges in your life, there are solutions, and you can increase the quality of your life tremendously, especially if you develop your EF skills.

If you resonate with what I share and my approach, and would like to benefit from more than just my podcast show, you have those options now. The decision is yours to make. The years will pass no matter what you decide. It’s really the choice of what you will put into those years rather than them just be passing years filled with frustration and regrets.

You heard me earlier talking about the currency of time as our most precious asset, since it’s not something we can ever get back. No matter how you spend your time, it’s gone. This is a huge price to pay for hesitation or indecision. If you need what I am offering, I urge you to take action today and not do the typical - “that’s nice Dr B and I’ll get around to it at some point but not right now.” You have no time to waste; none of us do. If you aren’t moving forward, you are sliding backwards because time doesn’t stand still.

Review the GSD program roadmap. Watch the free training video. Then book a complimentary call with me to get your questions answered. Or, look at the TTC roadmap if GSD isn’t for you at this time. Watch that free training video. And book a complimentary call to ask questions about TTC, if you have any. Do something to move forward; take some positive action today. The doors to the opportunities in our lifetime don’t stay open forever. I say this because I have waited in the past and doors have closed that I wish could open up again and they can’t. I live a life of service and want to be of service to you in some capacity.

You came to this lifetime with an empowering gift, perhaps many of them, and I would love it if each and every person on this planet were able to express his or her unique, empowering gifts freely, without the threat of being shamed or criticized. Let’s put an end to that stigma once and for all and live full out as Empowered Achievers.

A Favorite Quote: Buckminster Fuller said, “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”

I love this quote and learned this years ago. It’s why I am consistently upgrading myself by building a new model of me, then taking the best from the current version into the new version and building out from there. It’s fun and it works.

Subscribe & Review in Apple Podcasts If you found value in this episode, please leave me a review on Apple Podcasts! Our mission is to help as many people as possible transform their lives, and when you leave a positive review, more people can find this podcast! Just click here to review, select “Ratings and Reviews” and “Write a Review” and tell me what your favorite part of the podcast is. Thank you!

If you’re loving the podcast, and you would like to work with me, you’ll find all the transformative opportunities listed in the show notes. Personal transformation is available to everyone who seeks it. We have made sure that there is an opportunity to fit a variety of needs. There are real solutions to the challenges you are experiencing, so reach out to us. There is a lot of misinformation out and about. Be mindful and intentional with your decisions. Time is your most precious asset, and your life won’t wait forever. I would love to help you realize a new freedom, that is…if that’s of interest to you. Thanks for listening… Until the next time… Bye for now…


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