628- On Living and Loving with ADHD and RSD: A Live Conversation

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1:04Welcome to the Attention Deficit Disorder Expert Podcast Series by Attitude Magazine.

1:14I'm Carol Fleck, and on behalf of the Attitude team, I'm delighted to welcome you to our special presentation titled Living and Loving with ADHD and RSD. Today, we're going to talk about a specific kind of emotional dysregulation that is often overlooked in the medical field. It's called Rejection Sensitive Dysphoria or RSD with our special guest, Alex Partridge. When a person believes that they've been rejected, belittled, criticized, ignored, or feel that they've fallen short or failed in some way, RSD hijacks their emotional control. Their mood shifts instantaneously. What takes over is red-hot anger, deep frustration or sadness, relentless self-loathing, or a person might withdraw altogether.

2:07The pain from RSD is often described as unbearable, catastrophic, and debilitating. After an episode has blown over, many people say they are overwhelmed with shame and humiliation. RSD is the most debilitating aspect of my ADHD. It is usually triggered by social interactions that involve criticism and rejection, and when I have thoughts of feeling not good enough. My triggers are the experience of being rejected or judged, real or imagined, and falling short of standards that are expected for neurotypical peers. It literally feels like agony, like I'm the worst person in the world. When I experience RSD, it feels completely overwhelming, like I become trapped in my body with no way to escape the intense physical discomfort or my spiraling thoughts and emotions.

3:07And finally, the physical pain is shocking and sudden. Once my treatment for ADHD was adjusted, I was able to return to handling it better. You can read more on the survey findings by going to attitude mag.com. The article on the survey is live on the homepage. Dr. William Dodson, a leading psychiatrist, was the first person to coin the term RSD after many of his patients told him about their crippling emotional reactivity, and he says they were perplexed by it. Dr. Dodson has conducted research on RSD for many years now, and he's writing a groundbreaking book about it. He says it's the intensity that defines RSD and separates it from so-called normal responses to everyday rejections.

3:58Today, our special guest, Alex Partridge, knows what RSD feels like because he has been living with it, and he wrote a book about it. It's called, Why Does Everybody Hate Me? His first book was called, Now It All Makes Sense, which he wrote after he was diagnosed with ADHD just a few years ago. Alex is the host of the UK's popular ADHD Chatter podcast. Before we begin our conversation with Alex, I have a few housekeeping items. For answers to common webinar questions about transcripts and certificates of attendance, click on the FAQ tab of your webinar screen. And I hope you know by now that Attitude Magazine is a quarterly print publication and resource that can be delivered to your mailbox or the mailbox of your in-laws and other adults who would benefit from greater ADHD understanding.

4:54So without further ado, I'm so pleased to welcome Alex Partridge. Alex, thank you so much for being here today. Oh, such a joy to be here. Thank you so, so much for the invitation. We're so happy to have you. So we have lots of questions to get to. First, you wrote a book, Why Does Everybody Hate Me? Explain this title to us. And are you half joking or not so much? Such a fantastic question. Thank you so much. So no, sadly, I wasn't joking. I think for so much of my life, I truly believed that people did hate me. And now with my understanding of ADHD and RSD, I know why. And that's because the slightest criticism or sense of a bad vibe from someone truly makes you believe that in the moment.

5:52When I get a, if I send a WhatsApp and it blue ticks and then the person doesn't respond and half an hour goes past. I thought that the person was going to cancel our friendship and never speak to me again. And it's one thing thinking that and being okay with thinking this might be a suspicion, but the reality was it was completely overwhelming, this fear and anxiety that this person who had left me on read didn't want to be friends with me anymore. And it was a debilitating anxiety of worry and dread and fear that I had somehow done something wrong, that I had upset them, that I had disappointed them in some way.

6:45I had not met their standard of friendship in some way, all because they didn't reply to a WhatsApp in half an hour. and of course every single time a response came back at some point within the next day or two and everything was fine but it was this constant pattern of disproportionate responses to everyday events like that like a text message not being replied to within a period of time or it being replied to, and it was a short reply, like a few words or just an okay. And the physical response that it triggered inside me was really, really debilitating to the point where I couldn't do anything until I had some reassurance about what I was thinking was not based in reality.

7:38So absolutely debilitating. Yeah. And that's how so many people describe it. What makes you go down that path of distorted thinking. Well, that's why I was keen to understand it, because I had no idea. I had no understanding of why I could be having a relatively nice day, going to work, walking my dog, tidying my flat, and then I would get an email from somebody or a text message, and it was it was instantly triggering and the the difference between the mood i was in 30 seconds ago to the mood i was in now after i had seen this thumbs up emoji in response to a text message it was totally it was like a massive swing and i would call it debilitating i desperately wanted to understand what it was and that's why i interviewed william dodson and other people in the space and you know They educated me and opened my eyes to RSD and where it comes from.

8:46And we know that kids with ADHD get criticised a lot. I think every ADHD child has had horrible comments from maybe their parents, their teachers, people on the playground. they don't always mean ill intent but if you add them up over a childhood you're too sensitive you're not enough you're too dramatic stop fidgeting stop biting your nails why are you doing it like that that's not how that's not how it's done sit still be normal even a non-verbal rejection like an eye roll or a sigh or like putting an idea to somebody a group your parents at the dinner table and then not really acknowledging it they don't mean a lot in their standalone form just one comment two comments you can absorb those but when you get a bombardment of them like a tsunami of them 20 000 extra william dodson estimates than a neurotypical child then you start to believe them and you create a core narrative around them and you internalize that and you truly believe that's who you are.

10:01You believe that you're defective, you are broken, you're fundamentally flawed at a basic human character level. And any hint of a reminder of the compounding effects of those 20 ,000 horrible comments, like a friend not replying straight away or a short response or an email from your boss saying, can we have a chat on Monday morning with no context the compounding effect of those 20 ,000 horrible comments hit you all at the same time like a tsunami and it's physically debilitating sometimes to the point where I've been on the floor lying on the floor outside my podcast studio in the corridor because a guest text me saying Alex I'm really sorry can we reschedule today something's come up and I fell to the floor with shame and absolute paralysis and I was thinking they hate me they don't want to do the interview ever again then they're never going to reschedule of course they did reschedule and everything was fine but in the moment those 20 ,000 comments hit you right in the heart at the same time and it's brutal and I think it's the hardest part of ADHD and I'm so glad that it's finally being spoken about.

11:18Yes, even though it's not in the DSM, maybe yet. And hopefully more clinicians will be able to understand it better so that they can help patients when patients describe these feelings that are really more than just emotional dysregulation. Intrusive unwanted thoughts, paralyzing fears and self-doubts, perseveration and overthinking even small decisions, overanalyzing past conversations and interactions, though you know you can't change the past. We hear about these challenges often from attitude readers with ADHD and or anxiety. For a lot of people, that's not just anxiety, that's OCD, and most of them have no idea.

12:13Not the organizing stereotype. Real OCD is persistent, unwanted, intrusive thoughts that feel totally out of character, along with mental or physical behaviors you feel driven to do to get relief, even when it never actually comes. These thoughts can feel very real, which is what makes them so upsetting. OCD is highly treatable with the right kind of specialized therapy. It needs ERP, exposure and response prevention therapy, proven to be the most effective treatment. NoCD is the world's leading provider of OCD treatment, covered by insurance for more than 138 million Americans. Licensed therapists specialize in ERP therapy in live face-to-face virtual sessions with support between sessions so you're never facing OCD alone.

13:10If you're struggling with OCD or unrelenting intrusive thoughts, NoCD can help. Book a free 15-minute call to get started at nocd.com. How do you describe RSD to people who don't understand it or who don't have ADHD or who might be on the receiving end of some of these episodes? i think you have to describe the emotional and the physical pain that it causes and i think sometimes you can only do that by explaining the actions of the person who is experiencing them i always tell the story of a lady that i know from my alcoholics anonymous meetings i'm a recovering alcoholic and i i go to meetings and and i shared this story with absolute permission and I've changed her name.

14:12And she told me, she put her hand up in a meeting and she said, my name is Bethany and I'm an alcoholic. I have ADHD and I was sober for seven months. But last weekend I relapsed. And she said that she was in the office. It was Friday afternoon. She was ready to clock off for the weekend. And her email pinged. And it was an email from her boss. And the email simply said, Bethany, have a lovely weekend. Can we have a chat on Monday morning? And that's all it said. And she instantly filled with catastrophic thoughts such as, everyone in the office hates me. Everyone has tolerated me all of this time.

14:50I am definitely going to get fired on Monday morning. And she told me that the only way to soothe this intense emotional and physical pain was alcohol. And she drove home that Friday afternoon, got a bottle of wine, and she got absolutely drunk on Friday night. and she drank again on Saturday night and she didn't sleep Sunday and she went into work Monday morning shaking and she went in sat down in her boss's office and the boss said Bethany we would like to offer you a promotion it's it's it's absolutely bonkers but it it shows like in the absence of context and clarity RSD it's such a brutal full body experience the negativity takes over and it was enough to derail her sobriety i would describe it as a total emotional eclipse and it can show us as you said in the beginning deep deep sadness and whether that comes out is how good you are at masking so you can just shut down sometimes you can just go absolutely silent because you feel it you feel that deep emotion but because you have masked so well in your past, you know that perhaps you're going to get told off if you cry.

16:07So you keep it inside. That's one manifestation and that's heartbreaking. The other one is rage, huge internal anger. And again, sometimes that just doesn't come out. Sometimes it's internalized and you're sat there, your blood is boiling. You just feel so hurt and angry that somebody has reminded you of all of those comments. And you just feel completely, there's a justice sensitivity to it. And you feel tremendously angry. And sometimes that does come out. A lot of the time, you know, you can't hold it in. And you say angry things to your boss or to your partner or to your parents or to your children.

16:52and a lot of those things you can't come back from because you're so dysregulated you're so angry and you literally see red and sometimes the things you say I spoke to a lady who she was sat at the dinner table with her husband and and she had spent the afternoon making dinner and they were sat at the table and he said this is a really nice spaghetti bolognese but she she she sensed there was an insincerity in in his voice uh there wasn't she told me afterwards but in the moment she sensed there was and she took that tone of voice or the lack of sincerity in it as a as a comment to say that her dinner wasn't very nice she instantly filled with rage she stood up and she threw the plate against the wall like and this is an extreme example and i'm not saying this is this is a typical example but it shows and she said i want a divorce and she filled with rage in the moment she meant it um and and after about half an hour she came down from it he didn't escalate the situation because he had experience with rsd so she didn't really respond but the shame that she felt afterwards after she had become regulated and and come down from that heightened emotional state um you know he helped her pick up the food they spoke about it they really reflected on it but you know that's not an isolated incident she's lost jobs relationships friendships because of that behavior that explosive rage um that can come out when you're triggered it's truly again when you don't understand it and you're just you think it's just who you are and you don't put strategies in place to manage it and you're just going through life shouting at your boss or shouting at your partner or shouting at your children or your parents i honestly think it's the number one reason why people can get into serious serious mental health spirals um because they're already feeling shamed about who they are and then they have these reactions and these episodes to deal with as well and i think it's it's a main reason why people have really horrible thoughts about themselves um yeah it's catastrophic as you know william dodson describes it incredibly well and I can't agree more yeah um when did you what were your earliest memories of having RSD episodes um did you have it in in childhood um thinking back like at what age did you first experience it how did it manifest so my earliest memory was when I was about five years old and I was on the playground and I was digging holes like digging in the dirt I remember it was a sunny day there was a little bit of wind I remember it really clearly and I was like digging holes there was a bunch of us digging holes in this dirt and I think the teacher brought us because we were getting a lot of mud on our hands and getting dirty and then we were that inside.

20:04And the teacher basically said, like, you need to stop digging holes in the dirt because you're making a mess. And I just stood there in front of the teacher. I didn't say anything, but that was my first memory of feeling this like intense rage inside. I didn't show it. I don't think the teacher would have been aware, but I just remember feeling intense anger. And then she said, okay, off you go, carry on playing. And I took myself off to this corner of the playground and just sat down and sort of faced the wall um and i remember that corner really really well there was a brick wall in front of me there was like a drain to my left um i remember looking down and seeing like some ants playing ants crawling around really vivid memory um but what topples it all is is the memory of that that intense like burning sensation in my chest um wow absolute rage and you know the teacher was had a fair point we were making a mess we it was a it was a appropriate you know boundary to assert which for for us but it was just disproportionate so at a young age it was it was there and um did it change for you over the years in terms of triggers and how you responded as you went into your teen years and then adulthood?

21:32So I would put RSD down as the reason why my first three relationships failed. In adulthood? In adulthood, yeah. Yeah, yeah. You know, I've got memories of me just shouting at my partners and the confusion on their face. You know, I remember I can see them now, completely disproportionate responses. And, you know, and eventually they had enough. And I think quite rightly so. You know, it was always just verbal, verbal rage. over really, really small things. I remember I went to Las Vegas when I was about 20. And my current partner then, she wandered off to do some busking and to do some street performing.

22:33And she walked ahead. And I remember feeling like abandoned. And it was such a weird memory. And I remember just stood outside the Bellagio Fountains in Las Vegas, like just shouting at her just stood there like shouting at her and she just looking at me thinking what the hell is wrong with you um you know we got back and we broke up because that was a number of but it's just you know the rage I think does so much damage and it's such a you know I don't it's in back it's often in I think it's hard to talk about because it's just such a point of shame for so many people but the truth is it does a lot of damage in personal relationships i think you know adhd and divorce is is very common and i i pin it on rsd i think that's a huge culprit um you know and i think that's why an understanding of it is so important because the damage it can do and it's it's sad because you know i'm i'm not an angry person 95 of the time i think i'm a nice person but when it's when it's triggered and it comes out it's like this version of me that can it's such a small part of me but it's such a damaging part and i think that's the same with so many people in the community who who typically see themselves as a nice person but when this rsd is triggered the damage that it causes i think is can really derail the stability of someone's life this episode is brought to you by ella ola between classes sports friends and standardized test prep my teen is a blur in high school maybe more than ever nutrition matters for powering her brain and body.

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25:53What strategies have you put in place to, are you able to sort of pause in the moment so that it doesn't escalate? Or have you figured out ways to prevent these disproportionate reactions to situations that you know could trigger you? Yeah, so I'm definitely getting better. And I think the advice is always to say that, look, even if you have the perfect textbook on how to manage RSD and the perfect responses to regulate yourself for the moment, you're not always going to get it right. And that's okay. I think it's just working on the pattern and minimizing the damage that RSD does, I think is the way forward.

26:42and there is not going to be a perfect solution. I think, you know, I name RSD now. That's been really helpful. I call it Dave the Dragon, which sounds quite funny, but I know that, you know, dragons are scary. The fear is real, but they're not based in reality a lot of the time. And the same is true with RSD. Like the feeling in the moment is very real, but the criticism and the slight or the rejection that I am experiencing often isn't real too. So when I am triggered and I feel that rage or that sadness, I can metaphorically hold Dave the dragon out in front of me and say, this feeling that I'm experiencing now is RSD.

27:32It is real. I'm not going to ignore it. It's very vivid and it's painful. But I can also, in the moment, remind myself that this is not a response to what has happened, or it's not a reflection of actually what's been said today. More often than not, what has been said today, like the friend not replying or that email coming in from my boss, that has reminded my nervous system of those 20 ,000 comments. And those 20 ,000 comments were not my fault. um i didn't know that i had adhd i'm not broken i was just different and therefore the compounding effects of those 20 000 comments are not my fault too so being able to remind yourself in the moment that what you're experiencing a has a valid reason and that reason isn't your fault so you go a long way to you can stop yourself in in the moment of us of escalation and say, hey, Dave, like I get what's happening here.

28:39And that does, can you do that in the moment? And does that stop you from escalating? Or does it, does it, I don't know, does it, what does it do? No, it doesn't stop it from escalating because that's the thing with RSD, like it's so intense and when it is triggered your prefrontal cortex is shut off like the logical side of your brain has just said right i'm going to sleep now i'll see you in half an hour the yeah you know the amygdala the emotion is is there whether that's sadness or rage it takes over so i'm not going to say that i can just logically go into problem solving mode when it when i am triggered.

29:22I know that I can't. It's very intense. But I can remove myself from the situation and give space and time to allow the balance to happen for the prefrontal cortex to slowly come back on and the amygdala to slowly turn off and there to be at equilibrium again that I need to address what has just happened with a regulated mind and not just respond when the amygdala is firing on all cylinders and the prefrontal cortex is shut off because that's when you get the big rage, the big like storming out of the office saying, I quit or throwing your plate against the wall and saying, I want a divorce. Look, these things are going to happen.

30:06You can't always make logical decisions. You can't always remove yourself from the situation. If you're driving, for example, or if you're sat at the table eating dinner, it's even reminding yourself to remove yourself from the situation to calm down essentially like that is a logical process so even that is is i would be lying if i said like just remove yourself from the situation and calm down before you respond like that doesn't that isn't going to work all the time but at least give yourself you give yourself a chance when you have this toolbook in your back pocket to to give you options and i think the awareness is so important because if you didn't have the awareness, then you don't know that you need to remove yourself from the situation.

30:53You don't know that your amygdala is firing and your prefrontal cortex has gone to sleep. And therefore, you don't even have any options other than to throw your plate against the table or to storm out of the office. It's just increasing the probability that you're not going to respond in a way that means you might say something that is nasty, or that you might say something that's going to cause you a huge amount of shame afterwards, or actually do a lot of damage. You know, that's the reality. You can say nasty things to your boss or your children or your partner that even with contextualizing it afterwards to say, look, I was having a moment, I was triggered with RSD.

31:41I didn't mean that. People remember these things, you know, and you can contextualize it and say, I was triggered. I didn't mean to call you those horrible things. But in their mind, they're going to think that you did mean it. You know, there's a famous saying, you know, drunk, drunk words are sober thoughts. And I think the same applies to other people who are on the end of an RSD rage. And I actually think RSD rage and what you say is very different to drunk words. I don't think a lot of the time, I think when you're drunk and you say something to someone and you're mean, I think you do actually mean those things a lot of the time.

32:26And you just have your inhibitions shut off so you're able to say it. I think with RSD, it's often disproportionate and it's actually not appropriate. or not based in truth from my experience the things I've said like on when I'm angry with RSD I genuinely don't mean them like I genuinely don't mean the stuff that I say and when I come down and I become regulated I can look back and think and honestly say like I didn't mean this what I said and I think that's there's there is a distinction there I think between if you're drunk and you and you say nasty things between and being triggered and saying nasty things i think that's important and that's where having the yeah i'm just wondering how you recover from that how you recover from that and how the person on the receiving end whether it's a child or a romantic partner or a friend, like how do you recover and move on?

33:27And how do you make them feel safe so that it doesn't happen again or happen with the same intensity or that they understand it so they know it's not personal? I think addressing moments like that after the event has passed is so important and really intentionally giving time as often as you can to really talk about the triggers that have happened and to really as a couple or as a parent and child relationship to really make RSD a part of the conversation and to make it known that make it clear the reason why what was said was said i think that's the way to heal and and to give a chance to contextualize what was what was spoken about because it really is hurtful but if you're able to contextualize it and and the person who's on the receiving end understands rsd um and knows how much you are struggling and to know that in a way in in the moment you weren't speaking to that person you weren't speaking to your partner you were speaking to the 20 000 people right wow and that's and they were just kind of a vessel for you to get a message back in time to 20 ,000 delivery people who gave you one of those comments.

35:02And look, that doesn't mean that it's not going to be hurtful for the child or your partner today who is hearing it. But at least if they can understand that, and you can reinforce that understanding every single time because you owe it to them, they deserve to have that reinforced. You know, hopefully these RSD big blow ups don't happen too often, but, you know, maybe once a week, then you need to sit down with them every single week and remind them of RSD. And what I've just said about, look, I know what happened last night or last weekend. I love you. I wasn't speaking to you. I was speaking to you because what you said reminded me of what I've been through.

35:53And I'm sorry. And I think over time, they'll absorb this pattern, which will make the next one make sense a lot faster. And you still need those communication sessions to make sense of it and to reinforce the RSD explanation. but over time they'll almost be able to look at you in the moment when you are being triggered and they'll see it they'll see it that they're just a vessel they're just a source of you to get a message back in time to to all of those people um and you know it's it's not a nice thing there's no like way to window dress this and say look this that's that's the perfect solution to it but i think with that you stand a chance um and there's got to be a a willingness and a maturity within you as a person and an accountability and a responsibility to constantly reinforce that message and that reminder to that to your son or your daughter or your partner or whoever it is um because i promise otherwise it will you it will push them away.

37:04If you don't give time to reinforce that message that I'm not speaking to you, I'm speaking to all of those 20 ,000 horrible people, and I'm sorry that I'm using you as a vessel to get to them. That's so important. And I think that could really change a person's perspective. When you know where people come from, you become so much more empathetic and understanding, you know, it's that it's not you. It's all that you have suffered until this point. I think that would be, that would really go a long way.

37:43I wanted to ask you how RSD, how it's affected your decision-making. um has it had an impact on your productivity um if you if you fear that you've fallen short in some way um does it prevent you from making goals

38:06yes so i have always remind myself with rsd of the consequences of living with a brain that experiences it so in the past I've been very fearful of asserting boundaries because I didn't want to come across like I was upsetting or offending anyone so I would say yes to things that I didn't want to do I would overwork I would I would stay up all night to complete a project to such a high standard that my so that my boss couldn't make a tiny correction to it essentially I was just making sure everything was perfect and uncriticizable or unrejectable and you know that was exhausting so I'm very conscious now that when I'm making a decision whether that's in my current business that I'm doing it because I actually want to do it rather than doing it because I don't want to upset somebody you know there was a time when I was making decisions based off what I wanted to do what do I want to do to make Alex happy and then at some point I started changing that question to what do I want to do to make other people happy so I'm reminding myself whenever there is a question or an opportunity in front of me to make sure that I'm doing it for the for what the right reasons and it's something that I want to do.

39:32But I think, you know, it goes back to me really having to pay attention to my feelings. And I was sat with a therapist recently, and we were talking about RSD. And she said, Alex, why did you used to say yes to things that you didn't want to do? And I said, oh, well, it's because I didn't want to upset anyone or disappoint people. And she said, you have so many explanations for your behavior and so much intellectualization of your actions that you've forgotten how to feel like actually feel your emotions and that's a really important part of making decisions in your life today so when you when someone asks you to do something rather than thinking i i need to do this because i don't want to upset anyone you really need to experience your feelings in the moment.

40:25So for example, when you asked me to do this talk, I'm very happy to do it. I got very excited. But I also paid attention to how I felt, like physically felt in my body. And I actually felt like a rush in my chest. My palms went a bit sweaty, which was a bit of anxiety. But that's absolutely fine. But it was about putting my feelings at the decision-making table. for so much of my life I was making decisions based off what other people thought and felt and not what I thought and felt and I think healing and making decisions with RSD now is just making sure that you your feelings have a seat at your table because I think for so many people in the community for decades they didn't.

41:14Can you talk about how you regulate in different settings like at work or at parties? So I try to go to as few parties as possible. So I, for me, it's, I make sure that I've got my exit plan sorted. I think that's important. I say to myself or who I'm with, you know, as long as they're happy too, that I typically don't, wouldn't stay for more than a couple of hours um i really make sure that i understand having a time restriction on social activity is really helpful because you know it's not going to last forever um i make sure i i use the toilets quite a lot actually you know i make sure that i get i know where they are because you know rsd aside i still get very socially anxious and I worry about upsetting people and offending people so I make sure that I know where the toilets are so I can go and do some breathing exercises in the toilet run my hand under cold water shake my hands around jump on the spot I often lock myself in one of the cubicles to do this and then I come back and I'm able to socialize for a bit more but you know it's it's it's not easy a lot of the time and that's why I don't typically like to go to too many social events.

42:45Um, but I tend to find people who I, you know, if I, if I find someone at a social event who I really like that, I kind of, I'm glue and I'm stuck to them, uh, for, for quite a while, but yeah, it's, you know, a lot easy, know where the exits are and find a place to regulate is my advice. Wow. Okay. Um, we have lots of questions. Um, but before we, Before I get to the questions from our audience, I do want to remind people that Alex isn't a medical professional or psychotherapist, but he is someone with lived experience. So, Alex, a woman writes, I'm a divorced woman with RSD and a teen daughter.

43:31How do I enter into a new relationship being myself while knowing that RSD can ruin everything? gosh yeah i mean that's you know that is the heartbreaking reality of of this conversation but it's so glad that we're having it because you know if you go through your life and you you have enough evidence of how much rsd can actually cause damage then of course you're absolutely right to be fearful uh of starting again i think having a conversation about rsd uh you don't need to name it but even putting that conversation on the table early on in a relationship is is is important um you can just call it rejection sensitivity or or you know you're sensitive to to criticism you don't need to necessarily use clinical language like rsd um but putting your cards on the table i think because that will let you know if you're in a safe space and give you information about the person that is probably worth paying attention to if you say early on that you experience sensitivity to rejection and you would like to to talk about it if they are empathetic and they allow that conversation to happen then that's amazing that's a green flag you know and that's a good step if you sense that they're a bit like pushbacky on it or they don't really accept it then that might be a clue that maybe it's it's it's you know a red flag and it's not a relationship that is going to be accommodating um for someone with with adhd so i think communication from the outset is so important really listening to your own body as much as you can feeling those feelings um when you feel something is is off or on you know really pay attention to it your gut feeling is is right most of the time don't ignore it um and I think having an accountability buddy is really helpful somebody who you can share your experiences with your your new partner with and getting a second opinion um and just letting them know that you value their opinion because a lot of the time you know with ADHD you can get into limerence you can get really excited you can often and your amygdala can take over again.

45:56So it's a good idea to have like another person to get a second opinion of when you're dating. Yeah, that's a great idea. Someone writes, our son is 12 and lives with RSD. He's tenderhearted and RSD makes him operate from a place of self-criticism and thinking others are critical of him. RSD beats him up before any triggers are even at play. Based on your experience, what is the best way to help our child recognize when his RSD is running the show? Yeah, I mean, it's such a big question. I think RSD in children is heartbreaking, but there are things you can do. You know, there is hope. I think it's so important to validate the hurt.

46:43I think when the child is criticized or rejected or they're experiencing these intense emotions, like make sure that it's validated. it you know you can say things like not being included really hurt didn't it um let them know that you understand i think avoid things like i mean obviously you know but i see some parents still do it you know saying words like you're too sensitive or oh it's nothing um but you could acknowledge their feelings without agreeing that everyone hates them um and i think using fewer words during the upset is really important um you can stay calm and offer a sentence like would you like me to sit with you um or give you some space and i think you save explanations and problem solving for after the trigger has passed and you know you can have those communication sessions again you can sit with your child after they've become regulated but during the moment it's just offering an ear and some space and some time even if you don't communicate even if you just sat with them um i speak to a lot of parents who have real issues with physical um aggression with children and i think a child might start punching or things like that and i think you can keep boundaries gentle and really clear um you can say something like it's okay to be angry i won't let you hit but i'm here to help so it's sandwiching the boundary within two sentences that validate the experience um and i think the most important thing with children and and anyone with rsd is to always separate like the moment to separate the moment from their whole self separate the incident that's happening right now from their worth.

48:39If a child has submitted a piece of work or has done a piece of art and you have to correct it in some way or form, make it really clear that this little bit of work is a tiny, tiny, tiny bit of who they are as a person. RSD will make you think that if anything is criticised, if a piece of work is criticised, then that's a criticism of your whole self. And I think obviously that's not true. And just reminding the child or the partner or the colleague in the workplace that yes, it's a tiny correction to one piece of work, which is a tiny, tiny extension of who you are as a person. So separating the piece or the thing that is being criticised from the whole person.

49:26And just finally, I think, you know, making feedback private, specific, and manageable. Focus on one behavior to change. Avoid labels such as lazy, obviously. And really notice effort. Don't put the outcome or don't put what you're praising or criticizing always based off the output. Like criticize or praise the actual process or the effort that goes into it. because otherwise when they're older, they might think that everything that they submit has to be perfect. And that can cause a lot of issues later on. Yeah, with perfectionism, as you explained that you experienced. Someone writes, thank you so much for all you have done for RSV awareness.

50:21I'm curious what your breaking point was. The moment where you went, I need to find out what the hell is going on with me. Can you recall if there was a moment or period in time that pushed you toward your diagnosis and more specifically the RSD component? Yeah, absolutely. So, I mean, it nearly killed me, you know, no joke at all. I started a business when I was at university called Unilad. it was successful I needed help to expand it I met two men we were going to go into business together and they presented me with a partnership agreement to sign and I remember that day like it was yesterday my intuition was screaming at me telling me run don't trust these two guys but I didn't know how to say no um something inside me that day ignored that gut feeling and I picked up the pen and I signed the piece of paper very shortly afterwards I had been removed from the business, kicked out of this company I had started when I was at university.

51:28I went to see a solicitor. He said, look, they're not allowed to have done this, but if you want to fight this, this is going to be won or lost in a courtroom. And you're going to have to give evidence on a witness box. And the idea of me giving evidence in a busy courtroom, my emotional side of my brain panicked. And I ran out of my solicitor's office and I went to buy a bottle of vodka and I can only explain what the nurse told me when I woke up in hospital the following morning which was that two members of the public had found me in an alleyway clutching a bottle clutching the bottle still I wasn't interested I I tripped I hit my head on a wall and they called an ambulance and as the nurse was explaining what happened in the hospital I felt this huge shame, huge anxiety.

52:17And I knew what I needed in that moment to cure that shame, which was more alcohol. I jumped up from the hospital bed, ran out of the ward, tried to escape the hospital. And security had been called. And before I knew it, I was being restrained on the floor with my face pressed against the cold surface. And my mum was there. And I remember looking out at the world sideways. And I looked at her face and I saw absolute fear and desperation. That took me to Alcoholics Anonymous, where I first heard those four letters, ADHD. But I was so focused on the court case, I didn't really think too much of it.

52:57Fast forward two months, the trial happened in London. And I was cross-examined for six days. But I got through it. and then my telephone rang about two months later and it was my lawyer and he said Alex you've won everything you've won the company back and I remember just falling to my knees and bursting into tears because yes it was a four-year legal battle but it was a huge mental health battle that nearly cost me my life and you know that led me to get my ADHD diagnosis um when i discovered about rsd and those 20 000 horrible comments and the people pleaser that it can turn you into and the conf and the conflict avoider that it can turn you into it straight away made sense that that was the reason i signed that piece of paper you know that day in brighton where i was given an option to to go into business with these two guys and i was like something's not right here these these guys I don't trust them um like walk away but I couldn't do it because I was too I was too worried about upsetting them and offending them in the moment that I signed this piece of paper um and it nearly killed me you know the stress of that court case it was four years and many hospital visits and I pinpointed it down to RSD um and you know it starts young because I After the victory, I remember thinking, why did I sign that piece of paper?

54:27And it hit me. I had always been like that. I had never had any self-esteem. It had been eroded over years of a consequence of feeling different. And I did always feel different. You know, I remember my earliest memory of feeling different. I was in the playground at about six years old, and someone tapped me on the shoulder and said, Alex, you could be one of the cool kids if you weren't so weird. you know and I've but I've always had this like hyperactive mind um I describe it as having 10 highly caffeinated squirrels barreling around in my head each one pulling me in a different direction each one with a different idea and you know sometimes those squirrels can be brilliant they can turn into creativity and pattern recognition and being calm in a crisis but in other environments like a classroom where they had nowhere to go they caused me a lot of anxiety.

55:20And I remember one day in the classroom, I was sat in the back daydreaming and the teacher said, Alex, do you know the answer to this question? And all of the attention was on me. Suddenly my heart rate sped up and I ran out of the classroom. And luckily I called someone, I found someone in the corridor and I said, please call an ambulance. I'm having a heart attack. And then the paramedic reassured me that I wasn't, I was having an anxiety attack at six or seven years old. So, you know, it all made sense. The reason I signed that document, that piece of paper. And yeah, no, I thought I knew what ADHD was when I started my podcast.

56:03But learning about RSD completely made me rethink my entire life. Wow. What has blown you away most about learning about ADHD, living with ADHD and RSD? Like what is absolutely has been, what's been jaw dropping for you that you learned in all of the interviews you've done on your podcast and all the people you've spoken with? Yeah. So I honestly think, look, it would be easy for me to say that RSD and the people pleasing and the perfectionism and the avoiding certain situations does the most damage. They are very, very hard. All of those things. They're exhausting. But I think the thing that blew me away the most was joining all the dots together.

56:59look rsd being criticized for who you are so many times means that you hide who you are um you suppress your true self um you know when i was a kid i started i asked loads of questions in the classroom you know i put my hand up all the time um and you hear stop asking so many questions enough and you turn into a child who stops raising their hand in the air and you realize that it's safer to be less of yourself um and that's fine you know you can get through life and you can achieve interesting stuff um but if the mask is really thick then you can get incredibly lonely you can interact with a ton of people and go to parties and go to business meetings and a load of stuff but if the person that's not interacting with people or connecting with people isn't really you because you have suppressed yourself then you don't really get any connection with anyone and you can get incredibly lonely um you know i think the opposite of addiction is connection and i think my lack of connection is a huge driver behind my alcoholism um and part of my journey to sobriety is has been as a matter of urgency to reconnect with who I really am and enable Alex to come back to the surface and enable Alex to start raising his hand in the air again.

58:31Because that was essential. I think it would have cost me my life if I didn't. I think loneliness is a huge driver for depression and really horrible thoughts. And I think it's a huge issue with the ADHD community because mainly because of RSD. you hide yourself and you ultimately don't end up connecting with anyone like a version of you does a version of you goes to work a version of you is in a relationship a version of you is is interacting with the world but if it's not you if there's many many layers of mass between that version and you then then the loneliness hits really hard um and i think that's the biggest consequence of RSD.

59:17And sometimes it creeps up on people without them even realizing like how lonely they are, how desperate they are for some intellectual stimulation from people. You know, I ask a question, I'm so curious. I'm so naturally curious, naturally inquisitive. I think if you ask a question like how vast is space? Is the universe infinite? You know, I love questions like that. And it's like playing tennis and you serve the ball. That's me asking a question. And throughout so much of my life, the ball was never returned. No one asked the question back. So you eventually stop asking questions. And I think you crave this intellectual intimacy as someone with ADHD.

1:00:00You want someone to play tennis with. You want to ask a question and then go, that's really interesting. Space has always fascinated me. How many stars are there in the sky? And you find someone like that and you can play tennis for hours. and you can lose so much time and you can reconnect with yourself and someone on an intellectual level that you've been missing for so long. And all of this stems from RSD. You know, you're criticized, you're told to feel that who you are is not enough and that you need to hide yourself. And ultimately you end up disconnected from yourself to such an extent that you feel like you're just so lonely.

1:00:38And I feel like that's the heartbreaking reality of RSD if steps aren't taken to understand it and to reconnect with who you are. But it's an amazing thing when you do. And when you reconnect with yourself and then you find people that you truly can play tennis with, it's an amazing thing. And I think that's why this conversation is so, so important. Yeah. How do you recommend people bring RSD to the attention of their medical providers, healthcare providers? Yeah, so you hope that there's a base level of understanding, but I fear there is not. So it's really hard. I think it's got to be about describing it in a way that they understand.

1:01:33It's intense anxiety a lot of the time. And really it's a conversation around trauma and recovery um you know you don't really want to go and get prescribed anti-anxiety medication which is which is i've been on a lot of people have been on because that's really not addressing the problem um from my experience with things like rsd you know you you need to be you know perhaps that opposite a therapist or someone who gets it and to really have these deep conversations around reconnecting with self and and experiencing your feelings and allowing them to make decisions going forward um and that's sometimes a nuance and complex conversation to have with a with a first instance care provider who perhaps doesn't understand it but i think it's you know don't let them just fob you off with with an anxiety disorder um or bpd or or other things because that's what it will look like and that's what they're trained to say it is um a lot of the times you know and look maybe some of the times it is that but i think it's just worth having going in with what you know to be true even if that and you know i really recommend going in with notes um really recommend going in with like written down stories of your experiences um so there's clarity in what you're saying a lot of the time i can go into a see a doctor and you know the mask comes on he's like hey Alex how are you and I'm like I'm fine it's like you're not fine but you say you are um having having stuff written down is so important um and look go in with as much information as you can um mention RSD but don't be shocked if they don't recognize it immediately but just describe the feelings describe the emotions and if they say look this is an anxiety disorder or this is BPD or something else like listened, but don't be afraid to push back a little bit.

1:03:31And sometimes, you know, we as a community, we can know more than the medical professions a lot of the time. Yes, yes. I'm going to end with this comment. Someone wrote, thank you, Alex. This is my first time hearing about RSD. In all my many years of therapy, trying to explain what I called abandonment issues, and not one of them told me about this. So many of my past explosive episodes make so much sense to me now. So yeah, thank you so much for sharing your story and your experience with RSD, with our ADHD community. We really appreciate it. Absolute pleasure to be here. And thank you so much, everyone, for listening.

1:04:15Yep, thank you everyone here today. Hopefully for those of you living with RSD, today's conversation brought you some comfort and validation and perhaps some of the strategies that we talked about will lessen the pain of RSD for you and your loved ones if you'd like to access today's event resources visit attitudemag.com and search for podcast 628 the slides and recording are posted a few hours after each live webinar if you're listening in replay mode simply click on the episode description. And please know that our full library of Attitude webinars is available as a podcast. It's called the ADHD Experts Podcast, and it's available on most streaming platforms.

1:05:02Get alerts for future Attitude webinars by signing up at attitudemag.com slash newsletters. Thank you, everyone. For more Attitude Podcast and information on living well with attention deficit, visit attitudemag.com. That's A-D-D-I-T-U-D-E-M-A-G.com.