"You're Just Overly Sensitive"
My AuDHD Experience with Rejection Sensitive Dysphoria
“You’re just overly sensitive.”
That’s what I was told growing up. And, it seemed I was “overly sensitive” to nearly everything.
Physical Sensitivities
At first, it was my sensory processing differences that stood out. Light, including sunlight, was too bright. As a young child, I would cry when I went outside on a sunny day because my eyes hurt so much from the bright light. Sounds and noises were too loud also; I would cover my ears and scream at times because different sounds were just too loud. Certain kinds of touch, especially light touch, were too uncomfortable and ticklish, especially on my legs and back. And, finally, some smells could make me physically ill in just a few short seconds. It just seemed that my senses were hyperactive and amped up looking out for danger in my environment.
Side note: As the video clip from Chris Packham’s BBC documentary “Inside Our Autistic Minds” shows sensory processing and input can be paradoxical. I wrote about this in a previous article as well.
The Paradox of Loud Music
As a neurodivergent person with sensory processing differences, I find certain types of sounds and noises distracting, disturbing, overwhelming, and even painful in my body, not just my ears. However, I do experience times when loud music (especially music that I like) can soothe and calm me down and also provide a joyful and fun experience. In this art…
Next, it was my skin’s sensitivity to cleaning products including laundry detergents and soaps. I was frequently told that I had very “sensitive” skin. My parents couldn’t use certain products in the house or I would have red and raw skin while experiencing terrible reactions along with eczema, itching, or hives. When I was about 8 years old, my mother kept buying different laundry detergents because each one caused a worse reaction in my body than the other one before it. This was the time BEFORE companies created fragrance and dye-free soaps and detergents.
Not only was my skin ultra “sensitive”, but my digestive system was too. When I was young, I hardly ate anything. This worried my parents and they tried everything to make me eat. I refused. Partly it was my sensory processing differences. Some textures were gross to have in my mouth or even to consider swallowing. The other issue was that my digestive system didn’t feel good when I ate. Again, this is a time before anyone talked about food sensitivities including casein from milk and gluten from certain grains.
I can’t tell you how many visits to the doctor I had when I was in middle school and high school because I had “stomach aches” that wouldn’t go away. They did every test available back in the 1980s and couldn’t find anything wrong.
All of these physical manifestations had one thing in common–a very active nervous system. From the cranial nerves that connect each of my sense organs directly into different regions of the brain, to the somatic nervous system, part of the peripheral nerves that connect my skin to the brain and spinal cord (aka, central nervous system), to the vagus nerve that interfaces with many of my internal organs including my digestive system signaling to the brain any potential internal bodily danger1, my brain and nervous system were always on heightened alert.
Emotionally Sensitive
If my body and nervous system were already on heightened alert, is it any wonder that my emotional reactions and responses would also be highly sensitive?
Ever since I was a young child, I’ve experienced intense emotional sensitivity to both real, perceived, and anticipated rejection, criticism, and failure. Today, this common experience among both the ADHD and Autistic communities has a label–Rejection Sensitive Dysphoria (RSD). In fact, up to 98-99% of ADHDers2 and many autistics describe their intense experiences of RSD (which in the UK is called emotional dysregulation3).
According to Dr. William Dodson, MD in a recently published ADDitude article:
“Rejection sensitive dysphoria is not a formal diagnosis, but rather one of the most common and disruptive manifestations of emotional dysregulation — a common but under-researched and oft-misunderstood symptom of ADHD, particularly in adults. Rejection sensitive dysphoria is a brain-based symptom that is likely an innate feature of ADHD. Though the experience of rejection sensitive dysphoria can be painful and even traumatic, RSD is not thought to be caused by trauma…One-third of my adult patients report that RSD was the most impairing aspect of their personal experience of ADHD, in part because they never found any effective ways to manage or cope with the pain.”4
Looking back, I realize that my difficulty navigating neurotypical social relationships and my inability to accurately read facial and body language cues along with my trauma history of being bullied set me up to anticipate poor social outcomes. Combined with my heightened nervous system “sensitivities,” I am no longer surprised why I had so many meltdowns, tantrums, and hurt feelings growing up. Both my body and mind felt completely overwhelmed nearly all the time for one reason or another.
When I began receiving counseling in the early 1990s while a first-year student at college, the field of psychology was still using the DSM-III-R5 published in 1987. It wouldn’t be until the DSM-IV was published in 1994 that ADHD would for the first time be considered a condition that may affect adults.6 It would take another nearly 20 years before, as a society, we were ready to admit that ADHD is a neurodevelopmental condition or neurotype much more common among adults than the scientific community had originally thought when I first entered counseling. The same is true for autism; beginning in 1994 and making greater headway in the 2000s, the understanding of autism evolved and became known as a spectrum neurotype.7 Suffice it to say, at the time when I entered counseling, there was no language or understanding in the counseling field for either ADHD or Autism in an adult who heavily masked and presented as I did. I’ve written about my generation as the “Lost Generation” in a previous post.
The Lost Generation
Many of us late-diagnosed autistic ADHDers are part of a group called, “The Lost Generation.” According to a 2020 study, the lost generation is, “A population segment of autistic adults [who] are under-identified due, in part, to historic changes in criteria for diagnosing autism and diagnostic biases related to gender, socioeconomic status, and other i…
When I was 18 years old, because I didn’t meet the criteria of any specific condition, I was initially diagnosed as being emotionally “overly sensitive.”
Ironically, because of my rejection sensitivity, I took my being “overly sensitive” to mean that there must be something wrong with me. This added to my feelings of being inferior. “Why am I overly sensitive,” I would think. I took it to heart and would ruminate about this for days and weeks. I hoped that somehow counseling could help me get “more tough” and be “less sensitive.” But, regardless of the amount of counseling and the depth of self-discovery, I could never change how I felt. I still felt overly sensitive as before. This compounded my feelings of low self-worth and feelings of being “different” from others, especially from other boys and men (at least many neurotypical males that I grew up around who didn’t have any of my sensitivities).
I never felt like I fit in with most other boys growing up as a young child. Most of them were very loud, obnoxious, and too insensitive. I had lots of sensory processing challenges with loud sounds, rough textures, and anticipated or real physical pain. I hardly played sports because I was always afraid of getting hurt. Even the idea of getting physically hit by the ball, let alone by another player, freaked me out. It also didn’t help that as a younger child, I had some signs of dyspraxia and challenges with coordination so I usually was much slower and less agile in physical activities. This too kept me away from sports and being picked as a top favorite on team activities in school. Generally, other kids thought that I was “weird.” Unfortunately, this led to teasing, and bullying, and contributed to my feelings of low self-esteem.
As a consequence, I mainly kept to myself as a child.
Some Common Signs of RSD8
Experiencing sudden and intense emotions such as rage or sadness due to hurt feelings, perceived or real rejection, or criticism
Being one’s own harshest critic
Being a people pleaser
Avoiding opportunities or starting projects due to fear of failure
Being called emotionally “overly sensitive”
Being a perfectionist to make sure the work has no mistakes
Experiencing emotions as an intense physical sensation such as a “wounding”
Feeling shame about one’s emotional “lack of control”
History of mood disorders before being diagnosed with ADHD
Fearing if people “know the real you” they won’t like you
Assuming the worst in social interactions
There is an online self-test to determine if your symptoms match those of RSD.
When I took this test, I scored very high. Even to this day, despite years of psychotherapy, being in a loving relationship, and having lots of wonderful people around me, I struggle with these feelings. There isn’t a day that goes by that I don’t feel pain due to perceived rejection, criticism, or failure.
My experience goes along with what Erika Sanborne, autistic, award-winning educator, researcher, and founder of Autistic PhD wrote about rejection sensitivity,
“RSD is not something that therapy can do much to alleviate in general, as this is a physiological response to a trigger.”9
Part of my ongoing challenge is that I’m a complex trauma survivor and an AuDHDer who continues to experience challenges with neurotypical social encounters, has difficulties reading faces and body language, and continues to have poor interoception (this means that I also have high alexithymia and difficulty with naming and processing emotions).
Ultimately, it means that my nervous system goes into sympathetic (aka, fight-flight-freeze-fawn) mode many times during a regular day whenever I get triggered. Unlike depression and other mood disorders, RSD has specific triggers, comes on quickly, and is fairly short-lasting in comparison to clinical depression.
Many people are misdiagnosed with depression before getting an ADHD or Autism diagnosis. One way to know the difference is that treatments for depression don’t work for RSD. In my late 20s, I was treated with both counseling and drug therapy for depression with no significant changes. Eventually, after a year of treatment, I told my psychiatrist to take me off the Prozac, and I never looked back. Now, I know why nothing worked for how I felt at the time.
What Works For Me
What’s mainly worked for me is to take care of myself both before and after I get triggered. This means different things at different times and circumstances. If I’m able to take time to rest, go for a walk, do some heavy work, or do yoga, I’ll do it. Otherwise, I attempt to stay present with my body sensations and focus on my breath. By slowing down my breathing, I find that I can start to calm my nervous system. This helps to at least reduce the intensity for me. This doesn’t always work, but I at least try it to see if it makes any difference to how I’m feeling in my body.
Honestly, when I feel emotionally dysregulated, the best thing for me is to be active and engage my body in physical work. This is where heavy work outside in the garden has been most helpful for me. This activity helps me to organize myself internally and allows me to truly feel my body with other sensations than the painful aftermath of RSD. The sensory input doesn’t completely resolve the rejection sensitivity, but it helps me to cope with it better.
How about you? Please like, share, and leave a comment about your experiences with rejection sensitivity and any recommendations that have worked for you.
Endnotes
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859128/
2. https://www.additudemag.com/symptoms-of-add-hyperarousal-rejection-sensitivity/
3. https://autisticphd.com/theblog/what-is-rejection-sensitive-dysphoria-rsd-with-autism-or-adhd/
4. https://www.additudemag.com/rejection-sensitive-dysphoria-adhd-emotional-dysregulation/
5. The Diagnostic and Statistical Manual of Mental Disorders
6. “When I started doing work in this area in the early 1990s, there was a belief that ADHD diminished with age and much consternation in the scientific community about the validity of the diagnosis in adults. Then, in the 1990s, the increase in diagnoses of childhood ADHD led to greater public awareness. More adults began to recognize and report symptoms in themselves, and in 1994 adult ADHD (aged 17 years and older) was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for the first time. A major issue, however, is that older psychiatrists were not schooled in the evaluation and treatment of adults, and even now younger clinicians can go through their residencies without getting much training or experience treating this population. Additionally, primary care practices are typically the first point of contact when adults with ADHD need care, and the creation of uniform standards will address a critical need for health providers, patients, and the public.” (Dr. Frances R. Levin, MD; https://www.columbiapsychiatry.org/news/effort-underway-develop-first-u-s-guidelines-adhd-adults)
7. https://www.spectrumnews.org/news/evolution-autism-diagnosis-explained/
8. https://www.additudemag.com/quiz/rejection-sensitive-dysphoria-symptom-test-for-adults/
9. https://autisticphd.com/theblog/what-is-rejection-sensitive-dysphoria-rsd-with-autism-or-adhd/
This is such an important topic to talk about, thanks so much for sharing your experience, David.
I think it's so difficult to express how much rejection sensitivity can affect us and how physically painful it can feel when you're in that moment. I manage mine in a very similar way to you, being aware that it's happening is key and then breathing techniques or changing what I'm doing really helps.
There was a great episode of The ADHD Women's Wellbeing Podcast recently where Dr. Ned Hallowell was a guest and he talked about 'changing the channel' when the DMN part of our brains has taken over and you might be stuck focusing on negative thoughts. I really liked the idea of changing the channel, which is essentially what we're doing when we focus on breathing or go for a walk.
I thought the discussion around food sensitivities was so interesting too, it wasn't until my ADHD diagnosis that I also sought help for my digestive issues and found that I'm intolerant to quite a lot of foods which had been causing discomfort and it's fascinating to realise that our individual sensitivities can be physical as well as emotional.