It’s common knowledge that people with Attention-Deficit/Hyperactivity Disorder (ADHD) have trouble focusing and sustaining attention, but what else is going on for them? ADHD Awareness Month is celebrated every October and provides us the opportunity to increase awareness and challenge misconceptions about the diagnosis. This year’s theme of “understanding a shared experience” highlights the various ways in which ADHD can differ from one person to another.
People living with ADHD struggle overall with executive functioning skills and are often chalked up to “focusing and sustaining attention”; children struggle to sit in seats, adults struggle to remain on topic in conversation. Yet people with ADHD may also face additional challenges with emotion regulation that can often be misinterpreted as evidence of some other condition. In my therapeutic work I’ve found that the impact of ADHD on someone’s emotional health can often be overlooked or viewed as evidence of some additional mental health concern.
Challenges with emotional reactivity are reported in 30% of adolescents and adults with ADHD and typically fall into 3 categories. The first two types, overreaction and shame/guilt, can be considered more universal symptoms that are present in a variety of conditions. The third type, Rejection Sensitivity Dysphoria (RSD), is more exclusive to ADHD and can be broadly defined as a “triggered, wordless, emotional pain that occurs after a perceived or real loss of approval, love, or respect”. RSD is often misdiagnosed as Major Depressive Disorder, “Rapid cycling”, Borderline Personality Disorder or Social Phobia. People living with ADHD that additionally experience RSD may feel they constantly run the risk of misinterpreting someone’s tone of voice or facial expression as harsh judgment or criticism. Some others may build defenses against perceived “painful” rejections and become “people pleasers” in order to avoid the disappointment of others, minimizing their own feelings as a result.
Signs of RSD include:
Struggle with low self-worth or self-esteem
Easily embarrassed or ashamed
Quick to anger or blow up when perceiving a rejection or getting hurt by someone
Sets high expectations that are difficult to meet
Experiences social anxiety and relationship challenges
Sees themselves as a failure when they disappoint others
May consider self-harming behaviors
Anticipate rejection in new situations
While an ADHD-RSD combination can have a significant impact on someone’s overall quality of life, I believe in the ability to transform any “weakness” someone has into a strength that bolsters resilience. As people with ADHD have been found to possess “superpowers” of hyperfocus, resilience, creativity, conversational skills, spontaneity and abundant energy, could emotional sensitivity be included? There may be a hidden strength in being wired to feel things on a deeper level than others, though it may require some attention and fine-tuning in order to appreciate it.
If you’re looking for that first step, some helpful resources can be found at these links below:
Rejection Can Be More Painful with ADHD, uncredited
Emotional Regulation and Rejection Sensitivity, by William W. Dodson, MD
Strategies for Managing Emotions; The Process Model of Emotion Regulation, by Mark Katz, PhD
Create Calm: It Really Matters! byCindy Goldrich Ed. M., ADHD-CCSP
Cognitive-Behavioral Therapy, uncredited
Ask The Expert: Emotions and Motivation in ADHD webinar hosted by Thomas E. Brown PhD
Angela Carlson, LMHC, received her Master’s from Lesley University in Clinical and Mental Health Counseling with a specialization in expressive arts therapy. She has worked in both inpatient and outpatient settings doing case management, crisis intervention, psychiatric day treatment, and therapy for individuals, groups, and families. She is experienced in providing services to people struggling with depression, anxiety, bipolar disorder, ADHD, substance abuse and addiction, dual-diagnoses, trauma and stressor related disorders, obsessive compulsive traits, borderline personality traits, eating disorders, and other mental health symptoms.
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