Oxford Psychiatrist: The Fastest Way To Cure RSD! (New Research)

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0:30Dr. Jessica Eccles:In ADHD, emotion dysregulation is a really massive feature, but it's just not in the diagnostic criteria. They are impulsivity, hyperactivity, inattention. But the things that adults complain about or say, I really wish could be changed, is the emotion regulation. Dr. Jessica Eccles, PhD, is an ADHD expert specializing in RSD. Oxford and Cambridge graduate in medicine. She's here to share groundbreaking research shedding light on RSD. A lot of neurodivergent people find tolerating uncertainty absolutely painful, possibly being threatened or judged. They are often more likely to use substances or be addicted.

1:10Could someone disassociate with themselves because who they are has been criticised so many more times than a neurotypical person?

1:19Dr. Jessica Eccles:I think that is... Huge announcement just before we start. Tickets to the ADHD Chatter podcast live theatre show are selling fast. I'll be joined on stage by three leading psychiatrists, and we'll be unpacking all things ADHD, how to process a late diagnosis, or ADHD, and of course the dreaded rejection sensitivity dysphoria. I really hope you can join me for a night full of validation, laughs and insights, and one that will remind you that you're not broken, just different, and that you have always been enough. It's on the 19th of May in London. You can find a link to the tickets in the description.

1:54I can't wait to meet you in person.

1:59Jessica Eccles, welcome.

2:01Dr. Jessica Eccles:Hello, Alex. It's lovely to be back. You are at the cutting edge of RSD research. Is there anything about RSD that you've learnt that we don't already know? well um alex there's quite a few things one is actually that we really don't know a lot about rsd i mean it's you would think that we we do because people talk about it and it's obviously something that um patients and um neurodivergent people really identify with but the actual amount of research on it is really really small so um we just published this year um a paper on the experience of rejection sensitivity and that was really interesting in that we showed three things that rejection sensitivity was associated with withdrawal that it was associated with masking but that it was an embodied feeling so my whole sort of work ethos is about how neurodivergence is an embodied phenomena it's a whole body thing rejection sensitivity the research that we did suggests that it is a whole body thing so the the people in the research described the threat of rejection or actual rejection as feeling like a punch in the chest as though I can't remember the exact words but something like the rug being pulled out from underneath them or the ground falling out from beneath their feet that this experience of rejection or perceived or the threat of rejection kind of changed their actual body temperature so what we know is that there is actually very little research on on rejection sensitivity That research that we just did shows that it is an embodied phenomena.

4:26Dr. Jessica Eccles:But the other important thing I think to bear in mind is that the research about RSD shows it's not necessarily particular to ADHD. So there are some papers, very interesting papers about social pain and vicarious social pain in autism and rejection sensitivity. And it's also in the trauma literature and in the esteem literature. I think it comes back to the idea of possible rejection as a fundamentally painful experience. And I do research about neurodivergence and physical pain. so we've shown that you know neurodivergent people as your paper just published last month more likely to experience chronic pain and fatigue because of having flexible joints what we know is that if you experience so if you experience physical pain that lights up bits of your brain and bits of the brain involved in fear and emotion if you experience social pain that lights up the same parts of the brain as physical pain and even more interestingly if you observe someone in pain you that may light up the same parts of your brain in pain so there is this really kind of fundamental thing about the experience of pain and I think rejection sensitivity is a good example of the brain body nature of pain i interviewed a number of women when i was researching my book my rejection sensitivity dysphoria book and i spoke to one lady she's 45 years old just following on from the physical pain and she explained that she was getting ready to go out for dinner with a friend and about an hour before she was due to meet her friend her friend text her and said i'm really really sorry something's come up can we reschedule yes and she instantly she said it felt like someone had slid something sharp into her ribs yes and she was catastrophizing in her head she thinks that her friend doesn't want to reschedule she hates her she finds her annoying she's always only tolerated her and she almost started she started trembling and she replied back with a shaking hand saying no problem okay yes but she's masking that she masked the response so and then her knees curled up and she collapsed onto the sofa and she put her arms over her knees and almost like curled up into a ball on the sofa and the pain she described was was gut-wrenching is that a typical response to yes to rejection Well, I think different people experience it in different ways.

7:47Dr. Jessica Eccles:And in the research that we did that was led by Annabelle Rowney-Smith and Beth Sutton and Lisa Quart and myself, the physical things came up as almost universal in the participants who were interviewed about their experiences of RSD. And the most common physical experience was gut-wrenching. something to do with this sort of very visceral sense of um of the body but i think it manifests itself in different ways for different people so some of my um patients and you know people i know they might not catch that sort of complete physical feeling I think it might translate in slightly different ways so the woman you describe interviewing you know she she felt dreadful she um sort of curled up and sounds as though that was quite um paralyzing I think for some people, and that that was a very inward experience, that for some people it turns outwards and that this emotion regulation issue can probably lead to flashes of anger.

9:13Dr. Jessica Eccles:Anger. You know, I think sometimes when I talk to patients who have emotion regulation difficulties, and we know that, you know, emotion regulation difficulties are massive in neurodivergence, even if they are not in the diagnostic criteria, it's like this idea of going from 0 to 60, the sort of red mist descending, and that for some people, that feeling of being possibly rejected or slighted or judged can actually translate into anger. And that anger, can that turn into, at best, verbal abuse, or can it transition into something worse, i.e. violence? I think it could. I think it can transform into several different things, actually.

10:08Dr. Jessica Eccles:So I think it could, especially when you think about neurodivergent people having issues with impulsivity. So, you know, your filter is sort of come off slightly that you may in conjunction with this feeling of emotion dysregulation, the perceived rejection or slight or judgment that this may lead to impulsively shouting or, you know, making comments. but it could lead to I think it could absolutely lead to physical violence or at least the the fear of violence in and of yourself and it might be that if you are the sort of person who thinks I am on a hair trigger and if I if I am activated I'm going to react and I am terrified of my reaction that means you're probably walking through the world quite you know um scared of your own self but I also think that that sense of rage for want of a better word uh might be translated differently so not into anger um so i have a thing whereby myself i'm audi hd um have um i wouldn't say i experience typical rsd very um often there are a couple of circumstances and people who can bring it out but I wouldn't say it was a very common experience but what I do get is quite activated on behalf of feeling that my patients have been rejected or misunderstood and that that leads in some ways to a feeling of anger but not that I was gonna you know hit the patient but a feeling a desire like an actual desire for change a desire for for making a difference a desire to validate people's experiences so for me that that flare of anger is actually very much associated with a desire for change and a little while back I was involved I mean I'm sure you're aware Alex of you know there's all these discussions is ADHD being overdiagnosed and I was invited to a prestigious debate about it and I had a sense of what I wanted to say but I hadn't particularly scripted it and I in the moment when I was in the room and there were people in the room who were you know there because they were neurodivergent And I could see their reactions on their faces to what the counter argument was that, you know, that was sort of dismissing or invalidating their experiences.

13:40Dr. Jessica Eccles:seeing their faces and that feeling of um invalidation and rejection sort of fired up something in me that i was probably even more um fiery uh verbally than i would have been normally because it felt so much more important because i could see how it was hurting people in the moment just rowing back a second yes you mentioned that there were two things that could trigger rsd and you what would those be in me um well i think i mean it's sort of ironic because i am a associate professor of brain body medicine that i am uh naturally uh quite uh i'm quite unknown to myself and i think that this is quite true in some ways of a lot of um medical professionals.

14:39Dr. Jessica Eccles:So when I was my first year of medicine, like a lot of medical students, I spent three days a week in the dissection room. Did I learn really? Do I remember any anatomy from my dissection days not really I think that was fundamentally an exercise in dissociating and disconnecting it was a way of teaching you distance and also as a doctor you are often medical doctor often dealing with quite difficult situations on the end of the telephone or in the hospital in the middle of the night and you there is a degree to which one has to distance yourself from your emotions so I think in general I am probably like a lot of neurodivergent people quite disconnected from my feelings so I am probably less I mean it's a bit of a paradox because obviously we're saying neurodivergent people are more prone to RSD I'm saying that in myself I think I am quite masked from it but when I do experience it it It feels very, very significant.

16:07Dr. Jessica Eccles:But it would be in the context of, yeah, something pretty that felt fundamental, you know, to my identity, I think. With RSD being a very emotional experience, as well as a physical one, but we'll talk about it being a very emotional one for now. and surely therefore if you have an ability to disassociate from your emotions that's almost a shield from rsd i think it's a double-edged sword uh so i think yes in so there is a degree to which masking or disconnection is adaptive and it must be from an evolutionary perspective you know you're running away from bears and things or bears are making you run um uh you don't want you know prey smelling fear and all of that sort of thing so there is a degree um to which we all have to mask in order to get through the world um and to do the things um that you know you're expected to do but at the same time um i think that although masking can possibly protect you from RSD, we have done some quantitative research.

17:35Dr. Jessica Eccles:So looking at numbers, we haven't published it yet, but this is with our student, Rebecca Gazet, that we have shown that rejection sensitivity leads to dissociative experiences, so disconnecting in neurodivergent people, and that that is altered by the presence of masking. So I think if you mask, you might be protected a little from experiences of rejection or if you can reframe them, you know, kind of cognitively appraise them. But at the same time, this could lead to dissociation, which could potentially be implicated in severe mental illness. We talk in the RSD paper about the overlaps with the fact that this phenomenon led to people feeling disconnected and how feelings of disconnection and dissociation may be driving experiences in things like bipolar disorder or what some people describe as borderline personality disorder and also in complex PTSD.

19:05Could someone disassociate with themselves who they really are because who they are has been criticised so many more times than a neurotypical person?

19:16Dr. Jessica Eccles:I think that that is absolutely true. So, you know, I talked to some patients and I have some friends who say, you know, when I was at school, I was the class joker. I was the life and soul of the party. but that wasn't me at all that's what people have said to me that you know they basically put on a mask in order to survive and if you do that for so long how do you know who you are it's a really it's a really difficult question and I think you know some people do that professionally I mean, if you choose to be an actor or comedian, possibly even a politician, you are putting on, you are inhabiting that mask perhaps because it is safer to do it in that kind of dosed way.

20:31Dr. Jessica Eccles:I will for that moment be masking someone else's emotion and that is my way of feeling it but keeping it at a distance and there is I remember when I was um um I mean I'm a you know um I'm a neuroscientist I'm I'm very much a firm believer in the sort of biological elements of um neuroscience and human experience but I remember being struck when I was revising for my membership exams about a psychological defense so you know people talk about you know psychological defenses you know minimization or catastrophization or projection you know all of those sort of things one of them was called incorporation which is where you have for want of a better word a slight an unstable sense of self and you take on the identity of other people so a bit like being a chameleon and I found that I found that fascinating because it's not something that we think about or talk about a lot but that your own sense of identity is so fragile or distant from yourself that you um kind of have to become someone else but I suppose we are all you know we've all been different people and you know we're never the same person are we I'm sure um although part of me thinks I'm exactly the same person as I was when I was six as I was when I was 13 but all of our cells and everything they're all changing all the time sometimes i come out of the cinema and i adopt the personality of the lead actor in the film well this is interesting what about the accent do you adopt the accent sometimes yes yeah from a social event and i will lie sometimes in order to fit in like football for example i hate football if someone starts talking about football i will say i support whatever team oh do you have a reserved one in your head ready yeah but then i always get stuck because they ask follow-up questions like who's your favorite player and then i have to go i don't know well i think what you're talking about is absolutely fascinating so um uh what i find fascinating is what you're talking about in terms of the accents um in that uh we we think about ADHD and we think about autism but we often forget about tics and Tourette's and tics and Tourette's are very important part of neurodivergence and you know as we were talking about the anger that sort of impulsivity in Tourette's you have or you have this combination of impulsivity and compulsivity.

23:30Dr. Jessica Eccles:So this idea of being compelled, you know, it's almost as though you don't have a choice and it's also impulsive in the moment. And one of the features, so people think Tourette's is swearing. I mean, that is actually the vast majority of people who have Tourette's do not swear at all. But what they may have is stuff called, I think it's a great word, echo phenomenon. So this is where you might start mirroring someone's body language completely subconsciously. might start mirroring you might start doing the same you might start mirroring accents so if you're in a conversation with someone and I have this this sort of issue sometimes if I'm talking to maybe someone from Australia suddenly developing an Australian intonation and it's really embarrassing um but uh that that kind of contagious element is really interesting and i um that echo phenomena so body language accents it can also i think apply to uh people's moods so you can kind of have this feeling and this happens sometimes on psychiatric wards or in schools you know that there is almost like people mirroring other people's moods which as I was talking about you know you could see the bits of the brain when you're mirroring so that is that is a very a thing that we just don't talk about a lot though it does crop up on social media sometimes mimicking and I think mimicking is a form of echo phenomena but what was really interesting is we we have a clinic in our NHS service the neurodivergent brain body clinic and most of the people in that clinic have an autism or an ADHD diagnosis or both but we looked at the data and we found that almost all of those patients they actually had significant features of tics and Tourette's and that the features of tics and Tourette's predicted emotional regulation problems more than the ADHD or autism features but yes the other interesting thing about Tourette's is that there is this people often you know they think about it as swearing but there's this a really interesting phenomenon i used to experience it i actually have a tourette's diagnosis um i used to experience it in chemistry lessons where you would see a beaker of acid i would see a beaker of acid and i knew i didn't want to die i absolutely didn't want to die but i would become overwhelmed by the feeling of i should drink that clear acid does that make sense Alex in terms of it feels compulsive and you get that too people might look out of windows and think I should jump from it they don't really want to jump but just looking out the window makes you think you should same with train tracks cliffs and when you combine that with emotion regulation difficulties trauma it is a recipe for making it difficult to make predictions about risk.

27:25What would have to happen for somebody who experiences that compulsion to jump but they don't want to? What would have to happen for them to actually take that leap or for you to drink that acid?

27:36Dr. Jessica Eccles:Well, that's the interesting thing for a neurodivergent person is to what degree can you be filtered and to what degree can you put your own brakes on and that as we all know in um for neurodivergent people can be incredibly context dependent so one day you might be that might be absolutely um manageable but say you had a number of stressors including i don't know mixed social messages feeling rejected or loss of routine or predictability that could make that experience much more compelling. I know a woman who told me her heartbreaking RSD story and she had been sober for seven years and she explained how last weekend she relapsed and she told me she was sat in the office it was Friday afternoon five o 'clock ready to clock off for the weekend and then her email pinged and it was from her boss.

28:36And it said, Bethany, that was her name, have a lovely weekend. Can we have a chat Monday morning? That's all it said. And she instantly catastrophized with thoughts such as everyone in the office has finally figured out that I'm useless. They all hate me. I'm definitely going to get fired. And on the way home, she picked up two bottles of wine and got absolutely drunk Friday night. She drank again Saturday. She went into work Monday morning trembling, shaking, and she sat down in her boss's office and her boss said, Bethany, I would like to offer you a promotion.

29:12Dr. Jessica Eccles:Wow. It sort of has a happy ending, that story. But is a reaction that big, relatively common with ADHD women? I think, I'm not sure it's just women. I think that what that story does is illustrate a sort of the kryptonite nature of tolerating uncertainty and potentially perceived rejection in a neurodivergent brain that for a number of brain body reasons is more likely to potentially be addicted to substances so I can I wouldn't necessarily say it was incredibly typical but it's totally understandable in terms of how neurodivergent people can be in the world so we know that a lot of neurodivergent people find tolerating uncertainty absolutely painful you're just in the same way as we've been talking about rsd is being painful that um things not being predictable are painful um that this sense of um possibly being threatened or judged is painful and we also know that neurodivergent people you know maybe for various reasons to do with impulsivity and compulsivity they are often trying to take the edges off a brain that is whirring and probably poised to spot danger and pattern seek and for those reasons and also you know lots of bodily things that we study to do with inflammation and the autonomic nervous system that substances are a means of trying to cool that down so I can I think it's a really underexplored area and we need to do some proper research into it why is it that um neurodivergent people are more likely to um use substances or be um addicted because you can be addicted to lots of things that aren't even necessarily substances but i also wonder alex if um you know what you describe you know this sort of feeling of imposter syndrome the unpredictability i called it kryptonite um that actually that led you know that feeling of things being out of control that sense of unpredictability meant that the person you described actually reached for something very predictable even though it sounds um uh dangerous and self-destructive um it's actually a sense of certainty she knew what the outcome would be if um she started drinking and was that a self-sabotage or what you think of a self-sabotage actually a form of trying to have control well i guess it was the antidote at least in her mind to the deep emotional pain the pain it is it's pain yes that came with the thought of that monday morning meeting which was the ultimate rejection going to get fired yes when in fact she was going to get promoted and and it shows how we can be exquisitely sensitive to something and we think it's danger but actually it could be reward that you've made this sort of sense that there's something in the water and you think the worst but actually it could be it could be really good but I think there's a protective factor because if you think if you're always thinking the worst then you're never disappointed.

33:37Does that also mean though that you won't reach your potential you won't apply for that promotion you won't stand up to your friend who is walking over you maybe you'll stick in that abusive relationship like can it make you vulnerable i i actually think it probably can make you vulnerable because it um uh it means that you're probably less likely to break outside of your patterns um because um it seems more terrifying to do something different um

34:12Dr. Jessica Eccles:And I think that feeling probably does hold people back. But I think also for some people, it may do the opposite. That feeling, they might be like, I'll do it anyway. But I think in the workplace, it is important for managers to realise um it's perhaps not best practice to send such emails at five o 'clock and often uh if possible to include an agenda so that there is a sense of context because i think a lot of people but particularly neurodivergent people do struggle with that idea of the unexpected meeting if you are someone like bethany and many of the people who listen and watch this podcast you're sort of living your whole life constantly feeling like you're about to get told off like you're about to disappoint someone you're about to do something that's going to annoy someone and that's a constant fear what coping strategies do you put around yourself to protect you from the extreme emotional pain of criticism do people please i think some people do i think and this um this this came up in the research the rsd qualitative research that we did is that people um people withdraw so they might avoid situations and i think in that in that work some of the people that we interviewed said that they even you know missed out on career opportunities because they were afraid of or they feared rejection or that they would sort of hobble themselves, so like hand in essays late, knowing that they'd get a lower mark in order to make that feeling of possible rejection less.

36:16Dr. Jessica Eccles:But in terms of people-pleasing, I think that that is also another mechanism is to put your own needs aside in order to make sure that other people... to try and control the situation by people-pleasing. But you get into a vicious circle, don't you? Which is not very helpful. So sorry to interrupt your hyperfocus, but I finally found an app that actually works. I've been using Teemo way before they became a sponsor, and it's changed me as a person. I've got organizational skills that even make neurotypical people jealous. Let me explain. Teemo wasn't named App of the Year in 2025 for no reason.

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38:14Dr. Jessica Eccles:Yes. And this is the trigger that is so painful and therefore you people please, you're a perfectionist or you avoid conversations. But what is actually being triggered? Is it, as William Dodson theorises, that it's the 20 ,000 extra micro rejections we received in our formative years and that cumulatively is a trauma? What is being triggered? What is causing the pain? Well, I don't think we completely know. And we could hypothesize and we do. It does seem that neurodivergent people are more likely to experience trauma. And the work that we are doing, particularly at Brighton Sussex Medical School, about the sort of neurodivergent brain body type suggests that maybe perhaps because of these flexible hypermobile joints.

39:08Dr. Jessica Eccles:that neurodivergent people experience trauma differently because they have a, and we talk about this in the earlier ADHD chatter episode, they have this trigger happy autonomic nervous system. So you're constantly, your propensity to go into flight or fright, I always say that wrong, sorry, is so much um is um is that's on a hair trigger so if you combine that with having loads of triggering experiences or you know um micro traumas and the propensity to um feel physiologically um in flight or fright and then you maybe combine that with um what we talk about on I have the Bendy Brain YouTube channel on the Bendy Brain episode four.

40:08Dr. Jessica Eccles:I think we talk about unusual sensory experiences and people having this very vivid mental imagery. So if you combine trauma, neurodivergence, the brain body type that is, you know, hair trigger in terms of flight or fright and a very vivid mental imagery, that is going to be feel traumatic and you're going to feel that in the in the body also the other thing that i think is that a lot of neurodivergent people and we've done research into this um or we're doing research at the moment um uh you know this idea of alexithymia this difficulty understanding describing or recognizing emotions so we also know that neurodivergent people are have differences in something called interception which is the inner sense of what's happening in the body so if you combine difficulties working out what's going on inside the body and difficulties recognizing or describing or distinguishing emotions in a body type that maybe because of hypermobility and variant connective tissue is primed for fear and you know we did these brain imaging studies you know showing differences in parts of the brain that are involved in fear processing and because you're neurodivergent and maybe adhd you're not able to put the brakes on in the same way.

41:49Dr. Jessica Eccles:This is a recipe, potentially, for feeling awful. And if you've got that cookbook with that recipe in it, and that's you, and you are living in fear all of the time, and you anticipate rejection and criticism around every corner, or if someone benignly responds to a text message with a thumbs up emoji and you instantly recoil, if that's you can you retreat socially and can that create loneliness oh yeah i am sure and that's what in the in the in the paper with the um with the interviews of people talking about their rejection sensitivity that is precisely what they said is that it can lead to social withdrawal or only socializing with other people who understand the phenomenon um uh yes and that can lead to loneliness and a sense, a lack of connection.

42:44Dr. Jessica Eccles:My colleague at Brighton Sussex Medical School, Lisa Quatt, who is also on the rejection sensitivity paper and she and I work very closely together, she did this really quite groundbreaking study in autism where people assume that autistic people don't want friends or can't socialise. and she showed that actually autistic people experience a lot of loneliness and fundamentally we do want connection but it's about being able to regulate that so that's sort of myth busting about loneliness but I think rejection or emotion dysregulation which is a really massive feature in ADHD and other neurodevelopmental conditions, but it's just not in the diagnostic criteria.

43:41Dr. Jessica Eccles:I mean, they are impulsivity, hyperactivity, inattention, but the things that people, especially adults, complain about or say, you know, I really wish could be changed is the motion regulation problems. But I also think that they are potentially amenable. to intervention i think there is hope uh in that recognizing it the very that you know you you describe this idea of seeing the thumbs up and kind of thinking i'm not sure what this thumbs up mean and withdrawing if you can at least recognize the pattern um then you are in a position where you could potentially revise it but I think the problem for a lot of neurodivergent people is integration so not only sort of brain body integration but also time integration and you know you've talked with Hallowell and Dobson and this idea of now and not now I think applies to to the neurodivergent emotional experience that it's actually sometimes quite hard to integrate the past and the future.

45:13Dr. Jessica Eccles:And I see this a lot in our NHS neurodevelopmental service. We only well, we see a lot of patients who are inpatients or have had mental health crises. and a for many of them actually in the moment being able to say well you know actually the past me you know to integrate the past and the future when something emotionally catastrophic happens is such a hard task i speak to a lot of adhd adults at events and a story i just hear time time again is they'll go to a party it'll go reasonably well socially they'll meet new people but then they get home and then the overthinking starts they'll start saying to themselves things like i laughed weirdly at that joke or that conversation was awkward and they'll ruminate and they'll stay up all night and can this create a degree of pattern recognition which then you'll say to yourself well i know now that social event equals weeks of anxiety therefore i will just withdraw from all social events ah so you mean like a form of conditioning like pavlov and his dogs sure that you um uh basically associate social situations with turmoil and rumination and mental recrimination and so you actively um avoid them i think that certainly happens for a lot of people um but i think it's also there's a lot of overlap with adhd and autism and um we know that you know they're just as almost just as likely to occur together as they are singularly teasing apart what is um an adhd social difficulty from another neurodivergent social difficulty i think is very hard but that experience is very very common for neurodivergent people and also the sheer exhaustion that that can generate but I think we were talking or or I was talking about you know this you know we were talking about the accents and taking on other people's accents or taking on other people's body language this kind of compulsivity it is almost as though sometimes we are compelled to replay those situations and it may also be that some neurodivergent people are not necessarily accurate but they um have a very high level of recall so sometimes we talk about idactic memories or photographic memories um i think of it as like being an elephant you know this idea of remembering everything and when um when you were compelled when you remember everything and you were compelled to try and read patterns into it you can you can see how that that could just end up being exhausting, absolutely exhausting.

48:29William Dodson, who coined the phrase RSD, he described RSD, the emotions, as catastrophic. But I wonder, from your experience and your research on RSD, is there a way to objectively measure the emotional response to criticism?

48:50Dr. Jessica Eccles:Well, that is really interesting. So what is RSD? We don't really know. People have described it. It definitely seems to be something that resonates with people. in the paper we asked people you know to describe their experiences but that's not necessarily generalizable and also our participants although they had ADHD some of them also autistic or had other neurodivergences what we can do is we can ask people questionnaires and we have done some questionnaire studies that show that rejection sensitivity is linked to emotion regulation problems in the context of neurodivergence what would be really interesting and as you are you know as you and I are talking about it I'm kind of thinking about how this could play out is you could devise a series of experiments I mean experiments in the scientific way whereby you take brain measurements, you know, you could do brain imaging.

50:05Dr. Jessica Eccles:And at the same time, and this is where my mentor, Hugo Critchley, has been really pioneering, is in combining those types of brain imaging with physiological monitoring. So heart rate, blood pressure, what you think of as the lie detector test, you know, galvanic skin response. We could put all of that together. So we are measuring all of these things and you could get people, some people with ADHD, some people without ADHD. And people have done this in the psychological literature over the years. you could make them do something in the brain scanner or in the you know just around it or in a virtual reality kind of scenario in a headset where you experimentally induce feelings of rejection so there is a a paradigm I'm not sure I mean I'm sure it would elicit RSD where you basically say to someone you have 10 minutes to give a to prepare to give a speech and people think this is called the TRIA stress test and so people think that that's actually really going to happen to them and you measure their physiology and you can see their heart rates and and all of that and so I imagine you could you could you could absolutely adapt something like that to rsd and what would be interesting is not only to adapt it to look at the difference between neurodivergent people or non-neurodivergent people or you know people who seem to have a propensity for trauma versus those who don't you could also if you had the money and the research funds and the resources you could um have an intervention to um try and reduce it so interesting just you saying about that you got to do a talk in 10 minutes my foot started at a faster rate yes there's an objective measurement right there well it is and this is a really interesting thing so um i remember being fascinated years ago at a conference um where people talked about self-harm and imaging self-harm not yeah imaging uh people who um undertook self-harm so these people had a diagnosis of borderline personality disorder, which is a very contested thing.

52:38Dr. Jessica Eccles:Could be ADHD, could be neurodivergence, could be trauma, could be complex trauma. Who knows? But what they did is they took people who harmed themselves and people who didn't, and they put them in the brain scanner and they looked at their pain thresholds. So you might be thinking, well, what point is that? But they showed that at baseline, the people who would self-harm actually had slightly higher pain thresholds. That means they are more disconnected from their bodies, potentially. And what they did was they stressed them out. And you think, well, what was the stress? Was it the TRIA stress test where they told that they were going to have to give a speech?

53:27Dr. Jessica Eccles:Were they told that a loved one was going to abandon them? No, the stress they underwent, which is a reliable stressor of the autonomic, the involuntary nervous system, was minusing sevens from a thousand. So mental arithmetic. And that caused people's pain thresholds to become even higher and their heart rates to become higher and their activity in parts of their brain involved in fear. to increase and it really shows I think to me that you can you can conceptualize these difficulties as a sort of brain body disintegration that they literally lead to dissociation and that stress could be performance stress, but it could also be social stress.