Rejection Sensitive Dysphoria (RSD) and ADHD

[@lunette9]

I think the problem is that too many people take this out of context. Dr. Barkley is not saying that these symptoms are not real, my interpretation is that he is saying that they are actually already included in the list of symptoms of ADHD, under the emotional dysregulation part. It’s hard, because I think that position can be seen as invalidating.. I think for me, “emotional dysregulation“ is a large umbrella term, and it doesn’t describe the fact that I can look like I have severe depression with very very dark thoughts, for a period of an hour or two and then it will go away. That is a very unusual symptom picture. Other than this, I am fairly functional, I have a good job, good working relationships, pay my bills, etc. I have good medication and treatment for my ADHD, but this thing is still there. I’ve gone to therapy for most of my adult life and I still have this issue. my family has gone to therapists who have diagnosed me as BPD without knowing about ADHD or having me in the room, and it has resulted in rejection. I feel like I’ve worked most of my life super hard to be loving and valuable member of society and my family and this stuff has been my Achilles heel. It’s super painful. Simply stating that this is just included in “emotional dysregulation“ doesn’t for me, adequately describe my experience. It’s super hard. Right now, I am engaged in dialectical, behavioral therapy, group and individual weekly. After that, I will do some trauma therapy. Meanwhile, I’m getting old! I can’t do this forever and that part is hard as well. I hope it works, and I hope I can manage better in the future. One thing I know I have done is burdened my family with my super dark thoughts, and that has been very tough on them. But it has not been for lack of loving.

[@the_quiet_eye]

Learning about RSD was like a light going on. It explained the behaviour of my mother in law, my husband and my son, which most ADHD descriptions never really did. Even though diagnosed with ADHD as a child, my son doesn’t believe the diagnosis to this day because it’s too painful for him to consider. My husband doesn’t believe it either and though he’s undiagnosed he has intense RSD and other ADHD symptoms, as did my poor old mother in law. Emotion Dysregulation , yes, but the descriptions of RSD are more accurate to the lived experience. I can’t help them if they refuse to believe they have it. Even though it’s so obvious to everyone close to them. Thankyou for being on KZbin, you are a real light in the dark for many.

[@sarahs7669]

This makes SO much sense, that RSD is a result of the emotional dysregulation we deal with all the time. Thank you, Dr Barkley.

[@arethajb6105]

37 jobs, two failed marriages and no friends later, I discovered RSD in ADHD online by accident, which is well-camouflaged under the umbrella of emotional dysregulation. I appreciate Dr. Barkely's argument regarding duplicity and I believe RSD deserves a highlight, an honorable mention, an asterisk or smthg. I have seen therapists who were aware of my ADHD diagnosis but none ever mentioned RSD. Highlighting the importance of recognizing this symptom in particular could have absolutely improved the quality of my life and the lives of my children who've had to suffer through this with me.

[@xjuhox]

Do you ruminate decades old events when people have been mean to you? Sometimes big, small and even very small negative memories just pop into my consciousness and cause anxiety and irritation. I feel stupid but I can't stop ruminating.

[@lilkoo93]

Imagine the rejection felt by people who identify with rejection sensitivity disorder..😅 But seriously, as someone who identified very strongly with RSD on my ADHD journey, I’d like to thank you for this talk. After the initial shock, anger and rejection I felt about your talk, I had a look at some of the scientific evidence and considered the logic of your claims, and I have come around to what you’ve said. Thanks for not being afraid to challenge the status quo.

[@erajemail]

In my ADHD self-awareness journey, yesterday I reached the zenith where my fifty four years of life just got explained--from elementary school to yesterday got explained with the ADHD STMD model. I realized in a flash that .... a. I was not morally forgetfull, my short-term memory disorder did not even allow me to register things b. I worked so hard in my Math, and would solve all the problems at home and even teach others. But in the exam hall, everything was forgotten. I was not derelict. I never even stood a chance to do math well. c. I was not morally careless, lazy, or irresponsible. Badges that others and I gave to my behaviors and outcomes. My Short-Term Memory Disorder was responsible. d. Over the years, I have lost so much time/money/effort, without realizing the ADHD-culprit lurking behind all that.

[@russellbarkleyphd2023]

So sorry to learn of all these travails in your history but hopefully things will go much better for you now.

[@JAndersonGhost0326]

Hello friend, ADHD engineering student here. Just wanted to chime in and say that studying math is entirely possible for people like us. In my case, I've struggled a lot and had to coax my brain into paying attention the same as you might with a toddler, but it is totally possible. I would hate for you to miss out on something as beautiful and poetic as mathematics because you didn't think you could do it.

[@sekeacoach]

I’m late diagnosis also. It’s been so enlightening to finally understand myself and know why I have to work so hard in the neurotypical world. Applying the ADHD framework to my perspective has given me so much insight, understanding and compassion for myself.

[@Thesteadfast]

From my reading of Dodson and RSD I was never under the impression that it was meant to be a disorder in itself. I think it is a useful concept because it speaks to the social effects and experience of having poor emotional self regulation. Heightened emotions and less control leads to more social rejection. Having a track record of social rejection can add a considerable amount of anxiety in social situations. Having a concept to explain it can be helpful. I agree with you that it isnt necessary for diagnosis or criteria but for ADHD individuals it can be extremely uplifting to have validation and understanding in this area.

[@lizwebb8223]

Yea I agree w you here. I think Barkley is fully missing the benefits of the relief which can come from being able to put a name to what you’re experiencing. If we consider the hypervigilance and reactivity that can result with “little t” traumas, RSD makes perfect sense. I don’t think it necessarily needs to be a diagnosis or a specific feature of ADHD (it can also be a thing for other populations as well), but recognising it as a real experience is important to the recovery of many people with ADHD or other neurodiversities. Being able to name what you’re experiencing is powerful. I haven’t seen much scientific literature on RSD (probably bc it’s a fairly new term and researchers such as Barkley discounting its validity), but I can attest to the relief I’ve seen in so many of my clients when they’ve learned about it. I just think he’s wrong and kiiiinda doesn’t know what he’s talking about when it comes to understanding the true lived experience of what it’s like to have little micro/sometimes macro-rejections which get in the way of one’s connection to others. Humans need human connection to achieve mental wellbeing. If that connection is threatened, one can easily develop a trauma response in the face of further rejections. TLDR: Barkley doesn’t get it. RSD is a thing bc trauma.

[@NatureOhmNurture]

Interesting if not a little repetitive. I can see his argument and that of some people in the comments. At some point the scientific community didn’t think we needed the diagnosis of trauma. I only heard the term last night and this is the first video I watched on it and will continue my discovery. May you all be well!

[@justinparker776]

Respectfully, I think you miss the point here, Dr. Barkley. Yes, we don't need a term or disorder for every situation that causes emotional distress, but perhaps we need a distinction when the resulting reaction of the individual is decidedly different from other types of emotional reactions. Having ADHD myself, I can say that the reaction I feel from social rejection is unique in its intensity; a nearly indescribable shot to the gut, often causing confusion, panic, and a nearly physical pain. I'd argue that looking at this in the interest of keeping the classifications simple is a disservice to those experiencing it. To and ADHDer, this *feels different.* I can understand that I have emotional regulation issues, but why, in this particular situation, are things well beyond worse? I believe it's a question worth addressing.

[@lizwebb8223]

THIS COMMENT. “Little t” traumas such as social rejections can cause hypervigilance too. When you have a series of those throughout your life, you’re going to develop a much more intense reaction to them when experiencing anything even remotely reminiscent. It’s just different. I think Dr. Barkley is out of touch on this one.

[@jessipanda]

7:35 I almost broke down laughing here because as a tiny 115lbs woman with ADHD, it surprised me how much I could actually relate with a bodybuilder ripping a door off to get his car keys out of frustration. That feeling is too real 🤣🤣

[@xjuhox]

My mother with severe ADHD broke a key in the ignition lock when her car didn't start and she was late for work. Every morning was chaos.

[@zedthefish]

Very interesting to see this kind of opinion/information, especially when backed by statements that currently conclude that RSD should not or is not officially recognised. While I agree, respect, and accept the information you have provided here - I will say that due to my personal experiences it is my opinion that RSD should be recognised as a useful defintion specifically adresses rejection within the emotional regulation spectrum. The definitions of RSD can clearly provide a seperate and specific indentification of the symptoms, effects, and consequences of rejection. Researching the RSD definitions has personally provided me with a great deal of clarity and explanation for my experieinces with rejection, both within and outside of the various other symptoms, behaviours, and consequences of ADHD. It is my strong opinion that any clarification, identification, or information that benefits those with ADHD is worth verifying and made available. I believe dismissing RSD and simply placing it within the recognised definitions of ADHD and emotional regulation is counterproductive.

[@susansimmons6576]

I agree that it should be mentioned one way or the other. Especially the fact that the rejection is often a figment of the ADHD persons imagination. That they PERCEIVE they are being rejected when they are not being rejected at all. It is such a painful feeling to live with and to see those I love suffer with the same issues.

[@MaxwellKelley]

I am no expert, but I do have ADHD and I feel that perhaps from a purely analytical point of view you have a point, but the concept of RSD is quite useful as a way to help people understand the connections that are in this video. Personally, I never seemed to have an issue handling my emotions. I’m very calm and often diffuse situations. Compared to my brother who also has ADHD and who has shown that he has immense difficulty controlling his emotional responses to things, I look a-ok. But, approaching my later teen years, I’ve started to notice that I constantly avoid uncomfortable and embarrassing situations, especially ones relating to potential or actual rejection. This has become such an issue that I am practically unable to go out of my way to talk to people I think will judge me. This includes people that I have romantic interest in, even if I am almost 100% sure that the feeling is mutual. The distinction between RSD and Emotional Impulsiveness could help people identify, understand, and ultimately learn to cope with their social inhibitions. Again, I don’t know what I’m talking about, and I respect your opinion as it seems to be well informed and supported, but RSD does feel like a helpful (even if unnecessary) distinction for my personal experience with ADHD.

[@Kennikus]

Scientifically and on paper this makes sense. I think to a lot of people (men) don't get the tools to deal with their emotions or gain emotional intelligence, etc., and just having a way to explain serious dysregulation with physical consequences, etc. might be helpful. Having said that, I do appreciate your assertion that the remedies for such strong emotional reactions are the ones you use for adhd.

[@FarmerGwyn]

Have just come across Dr Russell Barkley, it's been a whole new level of understanding, I realised a few years ago I had ADHD of some sorts, and that it had led to certain events in my life in general, but now I understand exactly why I did what I did. For me CBT therapy did work very well for me, for my emotional self control especially, and with an indirect effect on my emotional self regulation in the way that with CBT I understood other behaviours like Narcissism which were my Achilles heel looking in hindsight, in a calm and rational and reasonable environment I was fine, I have very rational thought processes usually but under stress and irrationality, those thoughts are totally bypassed leading to police cautions, fines etc. I'm 50 now, 3 weddings later, a few car crashes, excessive drinking, bad money management, the emotion bit I have totally nailed, CBT helped me with that directly but also to help me create the environment for me to start thriving. A massive thank you Dr, it's just too bad the thinking in our NHS in the UK is 20 years behind at least.

[@russellbarkleyphd2023]

So glad you found my work to be informative. Thanks!

[@sensitiveself]

It's an interesting view and I hadn't thought of it this way. I saw RSD as a short hand description of how it feels to be sensitive to social things and like feeling rejected when there's no rejection happening. Agree it's covered in ADHD research already as these things.

[@ranc1977]

"when there's no rejection happening" What is called when there is a real rejection?

[@russellbarkleyphd2023]

Yes. My commentary was not to say RSD reactions didn't h happen but that we didn't need a new diagnosis to explain it. Best wishes.

[@Summersong2262]

@@russellbarkleyphd2023 I mean descriptive language is still useful, surely? Even if it doesn't have it's own page in the DSM.

[@lawnerd9263]

@@Summersong2262His answer above, a view sadly not expressed in vid, agrees it’s a useful term, just not one to be included in DSM as a separate disorder bc it falls under disorder of “ADHD.”

[@Chizuru94]

Yup, this. Also since it's not in the DSM (the emotional dysregulation). That's also a reason we use RSD among each other etc. to make clear what is meant and what we felt etc.

[@erajemail]

Yeah, in flash all this dawned on me and overwhelmed me when I saw you face yesterday. I wondered how the heck I even made it through life this far in life. I should have been washed out long ago. Thankfully, I am very successful in personal, financial, and relationship wise. You may have actually saved my life Dr. Russel. I have stopped using the phone when I am driving. You are God to me doctor. Thank you for sharing your knowledge!

[@russellbarkleyphd2023]

Thank you and stay safe!

[@neithere]

​​​@@russellbarkleyphd2023 I'm so happy that you're reading these comments, so I can thank you too. I've only discovered your older lectures last month or so. I wish I did it earlier. On the other hand, it was good timing. After four decades of barely keeping afloat I stumbled upon CBT, tried it (self-guided) and was able to get rid of my depression, then social anxiety, and finally began tackling GAD which I considered the root cause of my problems. However, something was still not right, I hit a wall. Spent a few months developing a system of routines and so on that helps me function - and it worked! After more than ten years of failed attempts. However, I still have to spend a lot of time on these routines and rules while others don't. And although I've eventually internalised some of these things and my anxiety dropped due to clarity (apparently I'm not forgetting something important all the time), I was not making more progress towards the "normal". Something was not right. Then I decided to double-check the symptoms of some possibly relevant disorders, and when I was checking ADHD... wait, what... tried some tests, started watching videos (Jessica McCabe's short videos were among the more useful ones)... it was all too familiar... and finally I found your lecture. And it all clicked. My system is the "prosthetic environment" you talked about. Almost exactly the same. And all my observations fit in your explanations. I don't need my fragmented theories anymore. ADHD is not what I thought, its name is really unfortunate, but you definitely described what I've been struggling with all my life. And now I have validation, explanation and a plan. Thank you for not only learning but also sharing such incredibly important information with us, and for free, and presented in the best possible way. Thank you for all your work!

[@MichaelBerthelsen]

Altnough nobody argued for RSD to be a separate diagnosis, it would still be HIGHLY useful as a detailed symptom within Emotional Dysregulation. ED is very broad, while RSD is an extremely focused and far more painful and severe symptom than most others in general ED in ADHD patients. RSD is also VERY useful for clinical discussion between medical practitioners and their ADHD patients. It gives a far more detailed understanding of what aspect of ED the patient struggles with in particular, and what they are most likely to require assistance with.

[@DanielleWoods-k8z]

I also disagree with this talk, and feel disappointed by the boarder-line ridicule of RSD exhibited in this video. I’m a woman with primarily inattentive type ADHD, and I would say I have quite a bit of control over my outward display of emotions. People often tell me I’m incredibly patient and grounded. I can prevent myself from crying in front of people every time, can quell my anger with relative ease, and can dial down my outward display of stress when needed. However, when it comes to rejection sensitivity, this is the one area in which I am truly out of control. When I first read about RSD as a symptom of ADHD, I cried and cried because I could not believe how accurately it was describing my life. All of my relationships (partners, coworkers, friends, strangers) finally made sense with this perspective. I agree with the line of thinking that RSD is a causative result of ADHD that comes from constantly feeling like you’re letting people down. And I think RSD is quite distinct from other forms of emotional dysregulation, and needs to be called out as such. I get that this video was about the categorization of rejection sensitivity, and not its existence, but I really do believe it’s distinct from other kind of emotional dysregulation

[@k726slick]

Really love the balance here. I am a therapist that works primarily with clients experiencing borderline personality disorder and I get questions about rejection sensitivity frequently. My response? Isn’t it true that threat of rejection or abandonment is highly distressing to most people? I dont think it’s true that clients with BPD have an unusual sensitivity to rejection, and also, I do think that clients with BPD experience greater emotional dysregulation in general. We are hard wired for connection to others, thus, it makes sense to me that anything threatening desired social connection is likely to be the especially distressing. So, if you are a person who struggles with emotional dysregulation, it is likely that social threat will be the most dysregulating.

[@MapsLab-u5z]

I think its more the reaction to rejection that differs?

[@Lena-zo2tl]

Yes, exactly! Rejection is an extremely painful emotion for everyone.

[@Lena-zo2tl]

The intensity and duration of the reaction is what differs.

[@nickers0077]

"Isn’t it true that threat of rejection or abandonment is highly distressing to most people?" Yes, however, for some people - as I'm sure you're more than aware - their reaction is extreme. Extreme to the point of taking their own lives. "Most people" do not react in such a way. People who suffer to such an extent with rejection sensitivity (real or perceived) should never be reassured that their hypersensitivity is not unusual. Such intense feelings (and the dangerous reactions that can occur in response to such extreme feelings) should never be normalised. Feeling so distressed to the point where a person feels suicidal IS highly unusual and indicative of a serious mental condition that requires professional help. People who feel suicidal over rejection need to understand that it is in no way a normal human reaction - it is extreme, and beyond the distress which 'most people' feel. These people would likely benefit from extensive therapy - usually Dialectical Behaviour Therapay (DBT).

[@Lena-zo2tl]

​@@nickers0077Yes, their reaction is extreme but this doesn't necessarily mean that the level or intensity of pain they feel is necessarily higher. In many, if not most, cases people with BPD threaten or even attempt suicide as a manipulation, (I have seen this first hand) but unfortunately some do succeed in taking their lives, accidentally. I also have read about this in the literature.

[@samyabibia]

Instead of simply dismissing it, I believe it is valid to understand how rejection or perceived rejection affects a ADHD person and how to develop tools to cope with that. No need to create a new DX, but also makes no sense to ignore something that you can clearly pinpoint cause and effect to effect help.

[@Lentilboots]

All the comments from people who have lived experience of RSD prove the point that it exists 😅 I think he is trying to say the DSM doesn't need a separate diagnostic criteria for a separate disorder. But as a non-clinician it sounds like he's saying "calm down, youre already diagnosed as no good at everything else"

[@grace-n-mercy5426]

I have both quiet/discouraged BPD, along with innatentive type ADHD. My RSD becomes heightened to the extreme when it comes to my favorite person. I have just recently learned that quiet BPD can carry traits of both Dependent Personality Disorder and Avoidant Personality Disorder; along with low aggressiveness. I personally believe this to be true, from my own experience. I like what one person said about quiet/discouraged BPD, that the anger comes out in pockets. This means that more than most of the anger is eternalized, but it can come out in extreme explosiveness. When I get angry, after the internal anger begins to seethe and pour out from the inside, I become a whole DIFFERENT person. I will start to yell and curse, and this usually stems from uncontrollable crying. I will begin to even curse someone out even if their not there, but I do so as if they are. I might be talking with someone else and say something like: "I came to this person for help and they totally disregarded me", and almost being brought back to that moment, I will say, "FUCK YOU", And I can say that phrase over and over again. I then start crying again uncontrollably (oh and I start moving my hands a lot and having body jerks when I try to supress my anger). After all this, I become exhausted to the point where I can't even keep my eyes open; and then I feel embarrassed and shameful that an outside person saw me react in this way and I begin to think they are judging me as a bad person and from there I seek for their reassurance. And sometimes this reassurance still does not take away the full effect of the "what if" intrusive thoughts. I might still think in my head that internally this person is still thinking bad thoughts about me, and secretly they don't like me, and therefore they are going to end up distancing themselves from me because I am becoming too much.

[@alafairxvx]

Dr. Barkley, I think it is important to have the component RSD included in the disorder of ADHD [which I believe needs to be renamed for many reasons] RSD is a huge part of ADHD and I am glad someone put a label on these series of symptoms. Prior to reading about the RSD symptoms I felt as if I had something additional wrong with me and now feel relieved that this is just part of ADHD and for me, it is one of the biggest parts. RSD is a pattern of symptoms that pushes me to the edge and often brings me to feeling suicidal. It is also one of those things that if you never suffered from ADHD then I can see a professional, like yourself, wanting to minimize these symptoms back into the general symptom list of ADHD and not thinking it was as important as it is to highlight the symptoms of RSD.

[@russellbarkleyphd2023]

Yes, as I noted in the video and above in a different Reply, the behaviors of RSD are certainly there but we really don't need a new diagnosis to u understand why the happen in many with ADHD. I certainly was not minimizing them but just not wanting to overcomplicate ADHD with a separate unfounded diagnosis when ADHD alone can account for these reactions. Be well.

[@zainmushtaq4347]

He, among other ADHD scientists, is pushing for "emotional dysregulation" to be a part of the diagnostic criteria, which "RSD" would fall under (Emotional Self-regulation encompasses RSD as he explains in the video) :)

[@lklk5140]

My problem not formally recognizing RSD is that my brain was not able to equate difficulty self regulating with rejection sensitive dysphoria. To me they are 2 different things and so I struggled to identify with My inattentive ADD until I learned about RSD. While the approach to dealing with them might be the same, experience of RSD is not the same, and not having it listed as it's own symptom, might be difference between someone recognizing themselves when looking into the possibility of having ADHD / ADD and not.

[@Helen-xl7vs]

You are wrong. RSD is the only description that is anywhere near how I feel. Your explanation does not meet the extent of the pain that is felt. It's not comparable to losing your temper over losing your keys. The pain is so extreme it's the most awful experience. And it's not adding another disorder but a component of ADHD.

[@Lena-zo2tl]

Rejection is painful for everyone, but non-Adhd folk have the brain skills to not let it destroy them.

[@suzysoso5234]

To the speaker, Thank you for your insights, but I’d like to share a perspective based on my own experience and what I’ve heard from others with ADHD. I believe Rejection Sensitivity Dysphoria (RSD) should be recognized as a distinct experience, rather than just a part of general emotional dysregulation. Many of us with ADHD have learned ways to manage our overall emotional dysregulation, but rejection is different-it hits on a much deeper level. For me, rejection can leave me feeling depressed and unable to engage in related activities for weeks. Additionally, I’ve noticed that a lot of people with ADHD seem to carry trauma from feeling repeatedly rejected or inadequate, and I believe this is strongly tied to RSD. For those of us who experience it, RSD disrupts motivation and self-esteem in ways that feel uniquely intense and far more difficult to manage than typical emotional dysregulation. Recognizing RSD as a separate issue could lead to more effective, tailored support and a more complete understanding of ADHD. I hope you might consider this perspective. Thank you.

[@cameoappearanc3]

Great video and very informative. As someone with adhd who struggles with emotional regulation, it doesn’t make sense to throw RSD into the mix when it’s just a part of a lack of execution function.

[@OldRaver]

I greatly respect you, Dr Berkley, and was IMMEDIATELY about to say I disagree vehemently (classic ADHD🤣), but after listening to the whole thing I DO understand where you are coming from. I am sensitive to rejection, (I always felt like it was paranoia til diagnosed at 52!!) But I became a joker and a people pleaser to try to prevent what I felt was my lack of tact /social awkwardness from upsetting friends. However my son does not have the ‘charm’ that I was gifted with (or learned as spoiled youngest of 6!! I had to learn to fight for attention in my huge noisy family! But as the undeniably cute blonde blue eyed youngest of 5 dark haired, brown eyed siblings, I definitely had an advantage!! As an only child of a single mum my son did not have this social melee as a child, did not have to fight for attention. I am CONVINCED that poor socialisation is the trigger for the extreme sensitivity we have now titled RSD. When he was little I always had the neighbours kids over, or we were at friends’ houses who had kids. He had no problem getting on with them when it was a regular thing. But when he was about 7 or 8 my job situation changed, I had to travel more, and got aupairs to look after him when I was not home (I did work from home) And THAT is when I saw the ‘RSD’ creep in. I thought he had social anxiety. So stopped ‘forcing’ him to go to things. I feel now this was a mistake.💔 He became more and more isolated as the years went on (to the point in School holidays he wouldn’t go out!!! Refused to let me invite his small handful of hard earned stoic mates over, and refused to go to theirs 💔 I watched my adorable bubbly little boy vanish in front of my eyes. Tried once to get him to a child psychologist, he was so sad he initially agreed, but in the way there melted down SO badly the psychologist refused to even try to talk to him on his own to see if she could calm him down! (That infuriated me!! KNEW that all he needed was for me to leave the room ,and her to offer him a drink and let him calm down and he’d have been fine! If a qualified child psychologist doesn’t know reassure an emotional kid then who the hell can?? Within minutes of us driving off he said “I’m sorry mum” 💔 worried he’d let ME down 💔 and I stopped the car and gave him a huge hug. I WISH I had the words to manage his emotional dysreg better… but having it myself did not help!! (Both undiagnosed til I was 52 and he was 16!! Took 3 years to get him diagnosed after that though! I had to go private because UK mental health has had almost ZERO funding for 14 years!! ) The best book I read (in desperation!) was’ Calm Parents, Happy Kids’. TOTAL gamechanger!! But could you PLEASE write a book for parents on how to talk to their ADHD kids (and young adults!!) properly? ESPECIALLY around how to help them manage their sometimes extreme emotional dyregulation? And on aimed AT 17-21 year olds would be a LIFESAVER for them. Teach them to understand and manage their over sensitivity, paranoia and rage response. From a MEDS point of view, INTUNIV has been a TOTAL gamechanger for us both. OMG,gave us BOTH SUCH a physical RELIEF inside our heads! Makes our brains SO much quieter and less paranoid/ over sensitive! Should be the STANDARD med for emotional regulation!! 🏆🏆🏆🏆🏆

[@tylerelstrom]

I appreciate what’s being said and I was put on guanfacine to help with RSD in tandem with my stimulants and it changed EVERYTHING for me. I believe RSD is 100% real and it’s something that shouldn’t be used as an excuse or overdone

[@grace-n-mercy5426]

Same for me. I started Gaufacine not to long ago, and a stimulant about 2 months ago. RSD has went down significantly. It used to be so so bad for me, I absolutely hated it.

[@Fatalfog]

Hi Russ, I’ve been watching tons of videos on ADHD and I haven’t found one that talks about the effects of anxiety on ADHD. I’m wondering if it can suppress some of the impulsivity and mask the memory, inattention etc. if you have the time could you please cover this? Thank you!

[@andymellor9056]

I don't think your alone. I find my volatile emotions one of the biggest distractions. I can ruminate unproductively for hours.

[@ranc1977]

​@@andymellor9056 "I can ruminate unproductively for hours." This could be a sign of high IQ - brain that has ability to process large quantities of information and struggle to find solution - which cannot be found due to lack of education and needed data. What then? Should be block our natural gift - should we suppress it and pretend we are not smart? Instead of suppression and denial and stifling it down - I would rather go in the direction of Emotional Regulation and allowing our brain to do its thing that comes naturally to it.

[@FarmerGwyn]

@@andymellor9056 One CBT technique helped me a lot with that, it's thought challenging.

[@russellbarkleyphd2023]

Yes, I will try. I do touch briefly on the overlap in the lecture on comorbid disorders. But more information is available. Anxiety can reduce the impulsivity in the disorder under some circumstances which is why that is the group most likely to pass neuropsychological tests presumed to evaluate ADHD (as are those with above average IQ). Be well.

[@ranc1977]

​@@FarmerGwyn "thought challenging" This leads to hypervigilance. You end up noticing thoughts - and this leads to OCD issues. Now you will watch over thoughts like a warden in prison - instead of living your life you will become prisoner inside prison of your own mind. Instead of chasing your goals in life you will develop both compulsions and obsessions over your thoughts - and you will prune them end destroy them as they sprout. Similar to democracy in free speech in North Korea - you will be state agency which destroys anything deemed as strange, weird and unacceptable. Now at this stage - this idea of CBT will end up as personality disorder and mental illness. In the end - if you are not serial killer, if you are not anti-social, if you do not have urges to harm and cause pain or take advantage of other people - why would you police your mind? CBT ought to be banned.

[@Davids3DProjects]

My son was labeled "Oppositional Defiant Disorder", however, the term "Rejection Sensitive Dysphoria" came to light during ADHD testing. He was border line ADHD without the "H" and "RSD" fit his mood swings better. However, I do see where Barkley is coming from if you list the many many pieces in ADHD.

[@sarahf.1036]

I’m a huge Dr. B fan. But I have over 30 years experience as a therapist, and teacher with two children of my own. Maybe it shouldn’t be categorized with ADHD, but RSD is ABSOLUTELY a thing. It’s not just ‘not managing disappointment’ nor is it a ‘low self esteem’ issue. It’s like the brains of these kiddos view their own efficacy in the world completely differently, beginning in toddlerhood. I predict that with more research(please!) we’ll figure it out.

[@camronchlarson3767]

Heard someone say somewhere that RSD will only be recognized if there's a clear path to make money off of it lol

[@andymellor9056]

Excellent summary of how Occam's Razor whittles back RSD to an expression of Emotional Disregulation. Personally I find emotional disregulation to be one of the more difficult aspects of the condition to live with. When if ever do you think we will see in in diagnostic manuals?

[@ranc1977]

Never, due to pharma mafia making huge money profit on Status Quo.

[@russellbarkleyphd2023]

My hope is that the quantity of research supporting this view is more than enough to justify its inclusion in DSM-6, whenever that may be developed.

[@susansimmons6576]

The difference I see that I hope could be mentioned because I know, that the PERCEIVED REJECTION is a huge problem. No matter how I try to let my adult children know that I love, respect, and admire them, they still feel judged and it causes them so much stress in our family. I am the same way. Luckily my husband helps me with it. We feel rejections so clearly when it is not there. It is so painful. It is different than not throwing a fit or controlling my reaction. It is feeling like whoever is judging me negatively and it makes me feel shame, no matter how successful I am in my business or my marriage or my art, no matter what, I feel judged by others, and so do both my ADHD adult children.

[@lawnerd9263]

Makes sense. I’ve personally never advocated for classifying RSD as a disorder in DSM. I use “RSD” as shorthand for a particular manifestation of ADHD dysregulation that involves DISTORTION, as opposed to a manifestation *commonly* seen in NTs as well, but to a lesser DEGREE. (Using “NT” and “ND” for brevity.) NTs will also get upset abt locking keys in car - and let’s just say *frustrated* or *angry*, since RSD is a general term, nothing like “Reading a Text Sideways Syndrome” or “Concocting an Entire Narrative Around a Single Facial Expression Disorder.” Most NTs, however, won’t go so far as to send themselves into a shame spiral or have a meltdown. Yes, NTs can also read too much into things, but the frequency with which someone with ADHD will exhibit this “small ‘p’” paranoia, warrants, in my layman’s opinion, a term. MDs determine what goes into DSM, but the ADHD community chooses the language with which to describe our lived experience.

[@lawnerd9263]

And while an MD came up with term, we adopted it.

[@chrisakins692]

I wonder if the challenges many children with ADHD have in socializing, frequent rejection by peers, being "different," etc. may make kids with ADHD more vulnerable to RSD, in addition to their already impaired executive functioning? I'm not arguing for a new disorder, just acknowledging rejection trauma as another variable that may enhance reactions to perceived rejection.

[@sfllaw]

I'm curious, is there a push for RSD to be made a formal diagnosis? My understanding is that it is a descriptive name for a certain type of emotional dysregulation. What is your opinion on popular labels that ADHDers use to describe their internal experiences? It seems like RSD might be one of these labels.

[@russellbarkleyphd2023]

No, there is no push at all among clinical scientists to my knowledge as they view it as an unnecessary invention of a diagnosis for which there is little empirical support apart from the well known link of the disorder to poor emotion regulation. Thanks for watching.

[@sfllaw]

@@russellbarkleyphd2023 Thanks for your response, I suspected as much. I wonder if these terms get invented because ADHD is misunderstood, whereas RSD is more specific and relatable? Someone might recognize that they are very sensitive to rejection, but cannot recognize that they have impaired executive function because that term is too jargony.

[@lotsofspoons]

In addition, considering the stigma ADHD still carries, perhaps people sensitive to strong emotional deregulation caused by societal rejection prefer to be associated with RSD rather than ADHD (perhaps similar to people still insisting on ADD instead of ADHD, which also feels like they are adopting the lesser stigma).

[@mariec.mauter8640]

Good to hear this from you! He does seem click bait-y. Glad to see you on you tube with updates. I subscribed.

[@russellbarkleyphd2023]

Thanks so much. I hope you find all this useful

[@matthewspindler14]

this is a very real disorder. I have this and I'am also HSP. My level of RSD makes employment difficult.

[@alvaronavarro4890]

I would love to see a video on SCT (now CDS) with up to date information. I know there is still much research to be done, but it would be extremely valuable to both patients and parents alike so we could understand better this disorder and the state of current research. Sadly, information about SCT is scarce outside of academia and your most recent lecture on KZbin is 5 years old. I can understand if it lies outside the scope of this KZbin channel, but in any case I wanted to express my personal interest in this (yet unofficial) disorder.

[@russellbarkleyphd2023]

I will do my best to post one soon. Meanwhile, a review of all of the research on SCT can be found at the website for the Journal of the American Academy of Child and Adolescent Psychiatry. Search either by SCT or by Becker (the first author) for the review with which I assisted in writing.

[@Doza31]

As others has mentioned, while I think I understand what Dr. Barkley is saying about having another term as RSD for Emotional Dysregulation might be unnecessary, theres definitely something about the RSD term that seems to resonate with people. I've had full mental breakdowns followed by intense depression and anxiety, and suicidal thoughts, from certain rejections. Emotional Dysregulation didn't seem to adequately cover such intense reactions. Further, I also think RSD better supports my (completely unscientific😅) theory that RSD symptoms exist because of how extra difficult certain tasks already are for ADHDers. So a 5x effort, followed by failure/rejection, leads to a 5x emotional impact.

[@sarahwilley7471]

Hello! I was recently diagnosed with ADHD and SAD and have been wanting to learn more about how the two might affect each other. I wonder if there is any relationship between RSD and social anxiety.

[@jakeku2662]

This cleared up some misconceptions I had . Thanks Doc

[@Lena-zo2tl]

I wonder if it’s a combination of emotional dysregulation plus a propensity to ruminate that causes “RSD” symptoms?

[@olgavysotska]

Sounds a bit like Avoidant Personality Disorder as well. Strong need to be liked by everyone can lead to bigger frustration.

[@russellbarkleyphd2023]

Perhaps. But we also see some of these reactions in Borderline Personality as well. Thanks!

[@ranc1977]

RSD is social anxiety all over. Dr Dodson claims that the difference between social anxiety and RSD is that social anxiety does not have post-mortem rumination, which is untrue statement. GoodTherapy verbatim quote: "RSD is often mistaken for social anxiety, since both involve a fear of rejection. However, social anxiety generally happens before the experience, not after" Along with social anxiety this is issue of Alcoholic abuse and dysfunctional families ambient (AcOA) and it all stems from exposure to narcissistic abuse (constant relentless criticism of narcissists who is abusing others around him due to insecure self worth and plenty of toxic shame internalized). Narcissism of the abuser over others - being the motor of all mental health challenges which DSM and CBT pathologize and unnecessarily complicate with hyper-cognition (quick stigma on anything that moves).

[@pete_nana]

I enjoyed your lecture on this topic. I am wondering how to address persistent interpretations of vague or neutral interactions as rejection.

[@ilovenycsomuch]

A big distinction that makes me disagree with this is sure we can react very emotionally to any negative thing that happens big & small. But the distinction with RSD is that specific comments made by ppl we do & don’t care about even far back into our childhood left us with deep feelings of betrayal, we ruminate on it for probably the rest of our lives, & it affected our core beliefs about ourselves or may have affected us the way a traumatic event could. I used to be very affectionate to my mom & say I love you as a young girl until her & my sibling laughed at me & she called me a suck-up. For as long as I can remember up until the point, I avoid hugs when possible, I’m never affectionate & even avoid showing any care for them, & I never ever tell my family I love you. I realized looking back that event could be the reason why I became the way I am, since my RSD perceived it as a massive betrayal & rejection that hurt me & changed certain behaviors long-term. Random other things that I have a poor reaction to cuz of my emotional regulation deficiency, such as crying cuz a backpack I ordered online wasn’t big enough (yep that happened to me recently) don’t leave that same effect on me like the specific rejection events/interactions

[@francisturney2938]

What about this notion of hypersensitive people? I've read that only ~30% of ADHers are hypersensitive and non-ADHDers can be hypersensitive as well. Is this a real concept? I find that I tend to pick up on other people's states of mind (or my perception of them) very quickly, and often may find myself matching their energies whether they are calm or exited in a sometimes unusual way, even off putting at times, especially when I was younger. Also I have a very high threshold for overstimulation and a low threshold for boredom. I seem to just be mirroring the state of things internally very rapidly and it can be intense or relaxing. When others are getting upset or irritated my heart rate will speed up, and I'll have all the physical symptoms for anger while in my head I've trained myself to try and stay disconnected. I feel like hypersensitive is a good way to describe the feeling, but I'm not sure if it's the same as emotional dysregulation from ADHD.

[@QuantPsychNZ]

Very nice explanation! Thank you

[@ride-or-DIY]

The automobile and soccer disorders had me rolllllling 😂 signed, a PhD student

[@davidrichards9898]

I think he only addresses the immediate response to rejection. Self soothing? I feel like he is discussing the part of rejection I can deal with or I can work to improve. It's the malignant shame that this rejection generates that one cannot unload. I think ADHD / Autistic want to be accepted more than anything else. This is exactly what breaks something inside of us and as we outwardly struggle expressing empathy but inwardly it runs very deep its this much deeper aspect of rejection and the exaggerated impact we are trying to describe. The hardest part of my teenage years was being turned down when asking a girl on a date. I did not have any problem self regulating or self soothing. I would be quiet respectful and avoid mentioning it to anyone. Inside would be broken. Rejection almost always lead to the iceberg situation so why is he addressing the one fifth above the water

[@patriciajump9511]

Please read!!!! We start one step behind, in clearheaded-ness, such that the AVERAGE emotional reaction impairs our thinking more than in others who do not have adhd. Emotion affects the thinking of people with and without adhd, but those without adhd have a cognitive reserve, and those with adhd do not have that reserve. Then, it escalates, because WE KNOW THIS IS HAPPENING! And that realization magnifies our emotion which in turn further impairs our clear-headedness. Please read this comment. You are asking us to be stronger against our emotional reaction than other people in order to hold our own. Okay, yes, we made need to learn tricks to get around this, but it is not because we deliberately or carelessly or inattentively fail to hold our own. It is a symptom, not a character failing.

[@Adrian-dl9nb]

So, would "rejection sensitivity" (due to poor emotional self-regulation) be a more appropriate term? Are "dysphoria" and "disorder" at the same hierarchical level?

[@russellbarkleyphd2023]

Yes, I think so.

[@Adrian-dl9nb]

​@@russellbarkleyphd2023Thank you for the reply!

[@sumanpremkumar1832]

Thank you so much sir for sharing your wisdom. I’m doctor practicing in India how can I personally DM you

[@ranc1977]

USA doctors are not here to help, they are only interested in profit and making money, they don't care about people.

[@russellbarkleyphd2023]

I don't do such personalize consultations but if you have a short question about ADHD just write to me through my website (Contact Us)

[@sumanpremkumar1832]

Okay thank you so much for getting back to me. Im reading your book on adult adhd. Its god send book sir

[@TheMikefarny]

There's something about RSD / ADHD debates that bothers me. Nobody seems to bring up unrealistic expectations. I function perfectly well outside civilized contexts. Its when I must participate is society that terms like "emotional disregulation" and "distractability" are tossed around. In the woods I'm just a passionate wildlife photographer "hyper focused" on the novelty of exploration and adventure. Show me one brain that actually thrives in a cubicle. Go ahead. I'll wait. RSD isn't just a symptom of ADHD. At some level we all feel like imposters in an everchanging world. It rises to the level of a disphoria in ADHDers because we stand out in ways that radically hinder our social status and feelings of worthiness. There. I've stated my thoughts.

[@amys5087]

I'm sure that's true, but that doesn't help when I'm dealing with shame because of rejection tonight. I get soooo embarrassed and ashamed.

[@IslandHawaii]

Happy 1 year anniversary of this video!

[@Kbmpb]

I disagreed also. All these years everyone been struggling with my son, the word ADHD is very board and misleading. Even school told me he had more than just adhd that they usually deal with and asked that I have a neuro assessment done on my son. When I came across a webinar of RSD, I felt such a relief. I finally understand what’s going on, and that I know my son isn’t bipolar. We need to put a better focus on RSD. Not every ADHD has RSD, and most professional aren’t trained or even understand what RSD is.

[@jophillipsillustration]

Very informative - thank you

[@ajbrown2013]

I have adhd and I have really bad rad never heard about it till this week but yeah sucidal issues when dealing with rejection and lose of issues sometimes doing things I would never do and leading to sever ruining of life and just bad choices things I would never do if thinking clearly

[@Brett5ive]

Thank you

[@1a2b3c4az9]

Hello, I really appreciate your videos and I was wondering if you could comment on this scientific article: Dodson, William & Modestino, Edward. (2024). Have We Placed the Cart Before the Horse by Using Alpha-2 Agonists to Treat Rejection Sensitivity Dysphoria in ADHD?. Current Psychopharmacology. 12. 10.2174/0122115560297397240404071044. It seems to me that the authors insist on the concept of Rejection Sensitivity Dysphoria even with several problems in the methodology. Thanks.

[@le6360]

This video isn’t for women with RSD. Saving you guys some time 👌

[@Butterflies-are-free]

I totally disagree! As someone with severe Inattentive ADHD… RSD describes my whole life! It helps clarify much more than just “emotional self-regulation” and is a totally separate thing. I am so disappointed to hear his viewpoint on this and feel that although he has been a fore-runner in the education of ADHD, he is falling behind current analysis and studies 😢

[@barbcarbon9440]

I agree. It explains my whole life, too. This feels clinical and dismissive. It also ignores the difference in intensity. Rejection feels like being burned with fire.

[@terapia.desenredada]

I don’t understand your comment. Everything he mentions as “emotional self-regulation” is the same symptoms of rsd, he is just saying that we don’t need another disorder because the symptoms of rsd are already part of the symptoms of adhd. At least, this is what I understand from this video.

[@terryplatt8340]

Exactly it's just that rsd is a pop culture way to explain the emotional disregulation. So he's right in that the disorder already implies emotional disregulation and you're right because rsd is a great way to describe it. I just had a great dose of my own rsd, or "less talked about part of adhd" so I think this video brings it back to basics, like guys, we don't need another acronym within an acronym. But it's a lay term th at least te s people talking about it. BTW adaptiv gels and aspirin are a good reset for that. (or just sleep, if you can)

[@agaragar21]

He is good ,but he doesn't know everything...you may be right on this subject ...but time will prove it to be the case !

[@b3n048]

I don’t think so, I believe Dr. Barkley isn’t trying to invalidate your experiences here, he is, as I understand it, simply saying that we don’t need a new concept (that being RSD), given that we already have something that encompasses or explains the “RSD experience”. And to your last point I also don’t think Dr. Barkley is falling behind as far as I know he is very educated on the current scientific consensus on ADHD, he’s showing this for example with his weekly updates on ADHD research (which he does even after having retired might I add).

[@420gzuz]

I respectfully but emphatically disagree with your stance. ADHD, by the suggestive nature of its title, reaches far beyond short attention and hyperactivity, and aside from clinicians the layman does not become aware of this.

[@CB19087]

I always forget I have adhd. I'm also autistic and thats my main symptom. Then I get obsessed with thinking I have BDP, then I remember I also have adhd! Ffs 😂

[@ElaE-o8c]

I totally agree with you! RSD is nonsense.

[@sethfoster7603]

Completely disagree and your comparisons with the car key incident are just not the same. RSD is woven right through your human experience as you intract in relationships and thoughts of rejection all day. You might lock your car keys in your car once a year. Not to mention you can't be rejected by an inanimate object. You really don't seem to know what you're talking about.

[@barbcarbon9440]

The sports analogy is rude. You don’t get it AT ALL.

[@bpolonifis]

First all it is a very political correct way to explain something that is going to dissatisfy a number of people. And it makes great sense as an approach. But let's break down 2 things. 1) If from your knowledge background it takes 2-3 slides to break down why it doesn't work and how it works, it means that it is complex and there is a lot of research in it. 2) Adult ADHD is at the forefront of mental health research so saying something about ADHD have no empirical bases in scientific literature, it is like asking who was created first the chicken or the egg. And the answer as irrelevant as it is, is the domesticated dinosaur bird who is the one who gave birth to the first chicken egg.. What RSD explains is the above, outside of ADHD executive and emotional disregulation which exists and is as you referred above. There is also the social root of the problem "being a chicken, in a society of dinosaurs". That's why all the chicks (ADHD patients) agree to have rejection sensitivity disorder. Thank you for your time to explain things.

[@JessieOwen-o3p]

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[@JosephDavis-w2m]

Whitney Fords

[@EmmaBoykins-o1j]

Estell Pines

[@FredJoy-l7k]

Hettinger Forges

[@christinepanus8194]

I don't think the intent is to create a separate disorder. I think it is to highlight a hugely impactful and frequently ignored part of the ADHD experience. I wonder if Dr. Barkley's belief that it is already so readily apparent that it doesn't need to be highlighted is an example of the cognitive bias the Curse of Knowledge.

[@BrandyByhoffer]

People’s RSD getting triggered by this video 😅 (me)

[@TitusChristopher-b7z]

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[@KimberlyDavis-t9e]

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[@JanelleWilliams-i2d]

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[@erajemail]

Posting a test message

[@grill-surf-bust]

Great video. Reducing RSD to existing criteria of ADHD makes sense, and your examples make it clear that you aren't rejecting the pain experienced when patients fail to regulate emotions. My only feedback is to consider your word choices more carefully. "Ridiculous" is an inherently critical word often associated with emotional disregulation; meaning it's very likely to trigger the exact responses described by the (non-clinical) keyword RSD! I know you only used the word "ridiculous" in relation to changing the DSM, but because of past association I mistook that word as describing my experiences. As soon as I heard you say "ridiculous," I stopped engaging analytically and began reacting emotionally and defensively. Thankfully, this is a video; I could pause, calm down, and rewind. But in a physical situation I'd likely have withdrawn or argued (especially if I were unmedicated, less mindful, or simply younger.)

[@Turglayfopa]

I'm thinking if RSD is to be its own thing then its more accurate to say its ADHD plus psychological trauma from repeated rejection. That repeated rejection is also expected in ADHD kids so that would still not add something new or different to the mix. It would just describe a ADHD life experience and outcome more specifically. It being "Percieved Rejection" is more accurate then. I think its better to call it that because the onus is put on the person experiecing it, so they can't put it on others to "solve their personal problem". That might sound rude, but I mean it in a productive way. If we don't manage our stuff and expect others to handle everything for us then we're definitely gonna be rejected.

[@NeedhamUla]

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[@DanielleWoods-k8z]

I also disagree with this talk, and feel disappointed by the boarder-line ridicule of RSD exhibited in this video. I’m a woman with primarily inattentive type ADHD, and I would say I have quite a bit of control over my outward display of emotions. People often tell me I’m incredibly patient and grounded. I can prevent myself from crying in front of people every time, can quell my anger with relative ease, and can dial down my outward display of stress when needed. However, when it comes to rejection sensitivity, this is the one area in which I am truly out of control. When I first read about RSD as a symptom of ADHD, I cried and cried because I could not believe how accurately it was describing my life. All of my relationships (partners, coworkers, friends, strangers) finally made sense with this perspective. I agree with the line of thinking that RSD is a causative result of ADHD that comes from constantly feeling like you’re letting people down. And I think RSD is quite distinct from other forms of emotional dysregulation, and needs to be called out as such. I get that this video was about the categorization of rejection sensitivity, and not its existence, but I really do believe it’s distinct from other kind of emotional dysregulation I