The volatile (and sometimes destructive) emotions associated with ADHD can manifest as frustration, sensitivity, or tendency to feeling sad. Here’s what you need to know about rejection sensitive dysphoria, and how to control it.
You can’t manage the impairments of attention deficit disorder (ADHD or ADD) until you understand how you process emotion. Researchers have ignored the emotional component of ADHD because it can’t be measured.
Yet emotional disruptions are the most impairing aspects of ADHD at any age. Find out how your emotions affect your life and happiness and how you may be able to manage them.
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Sensitive to Criticism
Nearly everyone with attention deficit disorder answers an emphatic yes to the question: “Have you always been more sensitive than others to rejection, teasing, criticism, or your own perception that you have failed or fallen short?” This is the definition of a condition called rejection-sensitive dysphoria (RSD), which many individuals with ADHD / ADD experience.
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Feeling Blue with RSD
For many years RSD has been the hallmark symptom of an atypical mood disorder — this is the ADHD nervous system’s instantaneous response to the trigger of rejection.
The emotional response to failure is catastrophic for those with the condition. Perceived criticism and withdrawal of love and respect are just as devastating as the real thing. The term “dysphoria” means “difficult to bear,” and most people with ADHD report that they “can hardly stand it.” People with ADHD are not wimps; disapproval hurts them much more than it hurts neurotypical people.
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Always Tense and on Edge
Many individuals with ADHD say the same thing when you ask them about their emotional life: “I am always tense, I can never relax. I can’t just sit there and watch a TV program with the rest of the family. Because I’m sensitive to other people disapproving of me, I am fearful in personal interactions.” Most people with ADHD don’t show much overt hyperactivity after age 14, but it’s still present internally.
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How the Pain Expresses Itself
If emotional pain is internalized, a person with ADHD may experience periods of sadness and loss of self-esteem in the short term. If emotions are externalized, pain can be expressed as rage at the person or situation that wounded them. Luckily, the overly emotional response passes relatively quickly.
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ADHD Emotion: How It Affects Personality
Because of their innate sensitivity to emotional pain, people with ADHD might become people pleasers, always making sure that friends, acquaintances, and family approve of them: “Tell me what you want, and I’ll do my best to become it. Just don’t get mad at me.” After years of constant vigilance, the person with ADHD becomes a chameleon who loses track of what she wants for her own life.
Some individuals with ADHD find that the pain of failure is so bad that they refuse to try anything unless they are assured of a quick, easy, and complete success. Taking a chance is too big an emotional risk. Their lives remain stunted and limited.
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ADHD Emotion: How It Affects Relationships
RSD can wreak havoc on relationships. Since the wounds of RSD are almost unbearable, the only way to deal with the situation is to deny that the person — teacher, relative, coworker, or spouse — who is rejecting, critical, or teasing has any importance to the person with ADHD. Rather than suffer more wounds at the hands of an authority figure, he devalues the importance of the other person. The person with ADHD has to find occasions several times a day to remind the other person how worthless, stupid, and even harmful they and their opinions are.
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Treating RSD: Counseling
Most people with ADHD have learned to hide RSD, but it is vital for clinicians and patients to be aware of this emotional intensity that is so much a part of the ADHD experience. It is equally important to recognize when a patient is attempting to hide this component of his or her emotional life out of fear of being wounded further if the truth were known.
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Treating RSD: Medication
Until recently, all that a person could do was to wait for his dysphoria to dissipate over time. In my clinical experience, I've found that patients can get some relief from the alpha agonists, either clonidine (Kapvay) or guanfacine (Intuniv). Talk with your doctor about these medications.