Dr. Jacqueline Trumbull: 0:00

Hey guys, welcome to A Little Help for Our Friends, a podcast for people with loved ones struggling with mental health. Hello, little helpers, today we have an episode that was requested by one of you and it was a great suggestion. The episode was rejection, sensitivity, dysphoria and its connection to ADHD, and I think this is a very timely episode, because I happened to cry in my supervisor's office earlier today because of ADHD.

Dr. Kibby McMahon: 0:33

Oh my God, okay, let's get into it.

Dr. Jacqueline Trumbull: 0:37

But kicking it over to you for KulaMind.

Dr. Kibby McMahon: 0:43

You always kick it over to me when you, after you, drop a bomb.

Dr. Kibby McMahon: 0:45

So um yeah, really exciting news we the officially launched the KulaMind community. Um, it's been a long time coming, but it's. I mean it's. It's. The origins are from when we taught this at duke to loved ones of people with intense emotions. So it's this community that we built for you guys. It's a place where you can learn all the different skills that we talk about, like how to set boundaries with toxic family members or partners or other people in your life, how to understand emotions and how to make them work for you, how to stay calm and how to deal with emotional crises. So it's really for anybody who has someone in their life struggling with emotions or just kind of like to learn about relationship and mental health skills in general. So, yeah, so I'll.

Dr. Kibby McMahon: 1:36

I'll put the link in our show notes. So if you just want to learn a little bit more, or curious and want to talk to me about it, our website is coolamindcom K-U-L-A-M-I-N-D. com and the link will be in the show notes, where you can learn more about the community, and next week we start the actual course. So it'll be like a weekly live course where we'll do in-depth learning about how to actually apply these skills, how to validate, set those boundaries, speak up for yourself and all these different ways that we support each other and actually practicing them in our daily life. So you get like one-on-one, step-by-step help through actually how to do these skills, how to set boundaries and stuff. So it's really exciting Very relevant to our topic today.

Dr. Jacqueline Trumbull: 2:20

I have a lot of thoughts about this, but first of all, Kibby, do you think that I have rejection? Sensitive dysphoria.

Dr. Kibby McMahon: 2:28

Yeah, I do, I do so. Back in my social psychology days at Columbia there was this amazing researcher named Geraldine Downey who does everything about rejection sensitivity. So I've always heard about rejection sensitivity in terms of like, as just like a trait that we have someone who is more sensitive or scared or react strongly to being socially rejected. But the dysphoria part, I feel like it's kind of new. I feel like now people are talking about it all over the place. I feel like it just happened in the past, like year, maybe like since COVID, not surprisingly, but I, I want to know why you have suddenly heard more about this too.

Dr. Jacqueline Trumbull: 3:12

Um, I've been hearing about it for a few years and always in the context of ADHD, and I'm I'm pretty. I mean we're going to talk about why it's specific to ADHD, but I'm still a little bit not totally convinced, I guess. Um, I mean I'm convinced that it's specific to ADHD, but I'm still a little bit not totally convinced, I guess.

Dr. Jacqueline Trumbull: 3:27

I mean, I'm convinced that it's a thing because there's lots of evidence that it's a thing. It seems to be very, very connected to ADHD, but I don't understand why the specificity is there Like. It seems to me like something that I can see being a common occurrence in people with ADHD, but I don't understand why it's not seen just as often in many, many other disorders.

Dr. Kibby McMahon: 3:52

We'll figure out, we'll break apart what RSD actually is and why it's connected to ADHD. But should we give a general definition? Should we?

Dr. Jacqueline Trumbull: 4:01

Yeah, definition should we? Yeah, um, I mean I'd say like rejection, sensitive sensitivity to psoriasis is kind of referring to this intense social pain experienced, um, sort of in anticipation of, during or after criticism or rejection. It can feel literally like physical People can get stomach aches, headaches, feel, you know like, get really flushed, cry and it can take a while to come down from. But I think what I've seen it described as is like really intense in the moment and oftentimes a story can get attached to it. So you know, if my boss criticizes me for something then it means I'm I'll never succeed, I'll get fired, yada yada.

Dr. Jacqueline Trumbull: 4:51

People with RSD can kind of live in anticipation of criticism or rejection and adjust their behavior around it, meaning they might avoid situations where they could be criticized. So that could mean either extreme people pleasing or it could mean not trying new things where they might fail. It could mean not meeting new people, like all sorts of avoidance behaviors. I think what supposedly differentiate, differentiates RSD from just rejection, sensitivity or not liking rejection, is the intensity of the pain in that moment. What would you add?

Dr. Kibby McMahon: 5:36

I would just think that that is the definition of shame. Yeah, I know, isn't this shame? Isn't this intense shame? Yeah, I know, isn't this shame? This is intense shame. Like isn't this? I mean, we went from like sadness to depression, fear, to like anxiety, and now we're going from like shame to rejection, sensitive activity or sensitive dysphoria. And to be clear for everyone like I, I had to look into this this is not an official diagnosis. It just seems to be like maybe a trans diagnostic, if you will syndrome like almost a symptom of like this really intense despair in response to rejection or criticism. I just feel like it's shame. So do you know why this is different from feeling?

Dr. Jacqueline Trumbull: 6:20

attention. Reading this research it feels anemic to me'm like it I this isn't a very convincing construct to me, I mean, I think for one thing because it's literally talking about just a degree of something like. It's kind of like saying when some everybody when they touch a stove it hurts, but some people it really hurts and they have dysphoria, I don't know. There's just something kind of lacking for me in that. And I agree it is hard to see any difference between this and shame, which is also just a pain at perceived rejection.

Dr. Kibby McMahon: 7:01

Yeah, I mean, when I was reading about it I was like wait a minute. This also describes avoidant personality disorder. This also describes extreme social anxiety and it also describes like BPD I you know we could talk about is you know a lot of it is around avoidance of abandonment and shame and rejection. There seems to be a little bit more of like an impulsivity up and down response with BPD, like the pain might be there but it might be like so dysregulating that they do all sorts of stuff. Like the highs and the lows the idealist right, there's it gets. It feels like a little bit more rollercoastery versus like the R and the lows the idealists right. It feels like a little bit more rollercoastery versus like the RSD sounds like I have this like intense period of sadness, but not necessarily the explosion of BPD. But can you pick?

Dr. Jacqueline Trumbull: 7:59

apart what this is. No, this is my problem. I'm reading this and I cannot figure out why it's specific to ADHD. I can see why people with ADHD have it, but I can't figure out why people with ADHD have it and any other disorder wouldn't. I mean, even looking at the reasons given, it's like, oh well, people with ADHD have different connectivity between the amygdala and the prefrontal cortex, where the prefrontal cortex isn't able to regulate the overactive amygdala. And I'm like, yeah, that's the case in so many other disorders too, I mean, and maybe there's a little bit of a different circuitry with it.

Dr. Jacqueline Trumbull: 8:37

But that explanation alone is not specific at all to ADHD. And then you know, I mean I think it's also making the claim that, like it is interesting when you read ADHD, there's no emotion dysregulation symptom criteria. And yet I think it could easily be considered an emotion regulation issue, right, like if you skip from project to project, if you can't organize, if, um, let's just start with those two, like that might indicate an intolerance of boredom or frustration, for instance, like intolerance of certain emotional experiences. Um, so it's not surprising that there's like an emotion regulation aspect there. But I think, I think what's bothering me a little bit is that, like ADHD, is called a neurodivergent disorder, in part because it's not just emotion dysregulation.

Dr. Jacqueline Trumbull: 9:45

There's something about attention and focus and the supposedly like attentional systems work differently. Is that in any way related to shame or rejection? The only the only connection I can see, which has been made in the literature over and over, is that if you are, if you have attentional issues, focus issues, impulsivity issues, you are likely to get repeatedly criticized and that might make you more prone to fearing that criticism and more sensitive to it. That's like how I feel, but I also think that's true of any other disorders. I don't get it, but it is specifically linked to the research.

Dr. Kibby McMahon: 10:29

I mean, yeah, if you are not, if you have trouble in school because you're disorganized, if you can't hold down a job, can't you have your ADHD symptoms make you smart and creative but yet prevent you from the, you know, traditionally prestigious jobs of being a lawyer, doctor, anything that requires like really focused concentration, then, yeah, in this society and many other societies, people with ADHD will feel a lot of shame, feel a lot of rejection and and almost like maybe there's just a lot more room to criticize someone with ADHD versus anything else. Right, like, if you're depressed, you're probably hopefully not going to get as much criticism of your depressive symptoms as if you were bad at school. So there's like an evaluation, there's like a socially acceptable like I can criticize you for being messy and not doing your homework. It's harder to criticize you for having like trauma symptoms still happens, but you know what I mean. Like there's like only about you being, you know your, your supervising moment. Like what, what happened there?

Dr. Jacqueline Trumbull: 11:40

I mean it's funny because I'm going on this rant but like this is a great example of RSD inaction and ADHD. But I basically I had a professor sorry, I had a supervisor who wanted to watch one of my sessions with a patient and he did and he gave me really really good feedback and I was kind of on a high from that. And then I come back to my desk and earlier in the day a supervisor had said can we meet at 3 PM tomorrow?

Dr. Jacqueline Trumbull: 12:14

But I thought her message had come in the day before or no sorry, sorry, I thought her message had come in that morning but it had actually come in the day before. So I thought we were meeting at 3 PM tomorrow, not 3 PM today. And so she was like hey, are you still free? So I came down and admittedly I've had some scheduling snafus with the supervisor before. Um, I think in part she's really young, she's like just out of stock. I think I'm not like she, she's only supervising me on, like some groups that don't like require a lot of collaboration or like depth or whatever. So I think I've been kind of not taking that as seriously as some others.

Dr. Jacqueline Trumbull: 12:57

And I kind of came in. She was like, hey, how are you doing? And I'm like fine, it's like how are you doing with the workload? I'm like good, it's, you know, more intense than it has been all year. But cause I just got an influx of patients and basically she was tiptoeing around the idea that like something's up with me because I keep being disorganized and kind of talking about it and I can just feel the tears coming. And then they did and it was embarrassing. She was extremely nice, you know.

Dr. Jacqueline Trumbull: 13:30

I mean it wasn't anything I didn't. I didn't feel reject. I think that's the other thing about. I don't. I, I don't. I'm sensitive to criticism. I don't know if that's the same thing as rejection to me necessarily. I think there could be an argument for it, but I don't necessarily I'm sensitive to criticism. I don't know if that's the same thing as rejection to me necessarily. I think there could be an argument for it, but I don't necessarily feel like she was rejecting me so much as, um, maybe indicating though, that there is a behavior of mine that could get me rejected. I don't know, um, it just it seems like it's a mediator more than like the actual thing.

Dr. Jacqueline Trumbull: 14:05

Whatever, the point is, I cried a little bit and it was hard. It was kind of hard to calm down and it was frustrating because I'm like I am not that emotionally attached to my organizational abilities Like the. The supervisor telling me I did a good job in my session was far, far more important to me than somebody saying like you're not organized, like being organized is not something that I need to be part of my self concept, but I will say that I do cry very easily if ADHD specific behaviors are what are being called out and I feel like I'm more regulated in other, like if it's, I actually might be more regulated if you called out my clinical skills than my organizational skills, even though I care more about my clinical skills. Why do you think that?

Dr. Kibby McMahon: 14:56

is I? I? I have seen you get equally upset when other parts of you are criticized, so I don't I'm like wondering if that's true, but what about?

Dr. Jacqueline Trumbull: 15:09

The. Adhd stuff makes me feel helpless and it's like something you hear so repeatedly and it seems to never get better even though.

Dr. Jacqueline Trumbull: 15:18

I think it has. But yeah, I'm just like oh, here we go again. Like yet again I've been found out and I don't, and you know there'll be. Like, what kind of systems do you have in place? I'm like, I don't know Google calendar, like the whole part of my whole fucking problem is that I don't like to be organized. I don't like organizational systems. They make me crazy. I keep falling back on them. It's just another thing added to my plate. It doesn't help me actually get organized. It's just one more thing to fail at. So I never have a good answer for it. I can't handle the medication, so I'm not. I don't have that to help me. I'm just kind of like trying to skate by. I mean, I think a lot of the times when you've seen me get criticized, it's around things like being self-focused or inconsiderate, which I also think can relate back to ADHD. But yeah, like bachelor rejection, shit hit me very, very hard and that's not related to ADHD.

Dr. Kibby McMahon: 16:21

So if it's a helpless thing, like you feel helpless, you feel like you can't do anything about the organizational stuff, but it's not something that it's part of your self-concept, why do you think it hurts you so much? Why do you think it hurts you so much? I could be like oh, I'm going to criticize you for not having blonde hair. Oh, look at dark. Look how dark your hair is. Right, I mean, actually you could probably change that easily, more easily than ADHD. But like, tell me why feeling rejected and criticized for ADHD is something that hits so hard if that's not something that you care about as much?

Dr. Jacqueline Trumbull: 17:03

I mean, I think, if I think, if 50 different people told me that it was gross that I have brown hair, then I would probably feel similarly. Um, the ADHD stuff is something that's noticed by a lot of different people and it just keeps. It feels like my Achilles heel that keeps being like oh there, it is what, what's going on there? Like my Achilles heel that keeps being like oh there, it is what, what's going on there with your Achilles heel? Have you, you know? Have you done anything?

Dr. Jacqueline Trumbull: 17:29

to to heal it, have you? You know how can I heal it when I'm like I don't fucking know how you can help me be more organized. That's not your job. Like I don't know what to tell you. So yeah, and it's.

Dr. Kibby McMahon: 17:58

I think the reason I started off with the story of my first supervisor telling me that I did a good job is there's something about ADHD which makes me feel like, no matter how well I do or how far I climb, this is always going to tear me back down again. I see, I see. So it's like the it's, it's the albatross is the thing that holds you back, no matter how much you like, excel into these other areas, then being knocked down for this is a bummer, yeah. So when you feel this dysphoria from feeling rejected for ADHD, do you like? What does it feel like? Do you have any of these symptoms of RSD, or does it feel different, as we're talking about, physically, or change your behavior differently than any other kind of rejection?

Dr. Jacqueline Trumbull: 18:37

I find this difficult to answer. It's it feels to me like saying what does it feel like when you touch a stove, like when I'm criticized? I feel bad, my cheeks get hot, I feel exposed and vulnerable. I think that's also part of it too is like oh yeah, like you found it, you found my perennial weakness. Like I don't have a good answer for this, I don't know what to say about it. It's, it's just my like. It's an exposed kind of feeling. Um, but yeah, it's this gross kind of like oh no, no, no, no feeling and I blush and tears immediately. It's always tears, I guess, probably hit in my chest stomach, but I guess I just feel like that's what shame feels like. So it feels weird, that's what RSD feels like and everybody has shame.

Dr. Kibby McMahon: 19:34

Everyone listening. Do us a favor, and if you have experienced RSD, rejection, sensitivity disorder, this intense pain, can you send us a message? There's in the show notes. If you look back on the show notes, there's a thing that on the top says send us a text. Can you send us a message telling us what this feels like and if it feels any different from any other kind of rejection, emotional pain or I'm just?

Dr. Kibby McMahon: 19:58

I just really want to hear more people talking about this, just because, yeah, I mean, like shame is so painful. It's so painful that that I remember in one of our emotion classes that taking grad school it's interesting the teacher was saying shame is the emotion that regulates us, even before we feel it. Like we are so socially conscious, like it is so important for us to be connected to a group and not alone, that we are doing it. We're listening to shame without even feeling it. We are not running around naked in the middle of the streets singing our favorite songs, like pooping on the streets because of shame, right, and like we don't even think, right that we there's so many things that we do in order to be like to abide by social norms, yeah, and so I get that shame is just such an intense emotion.

Dr. Kibby McMahon: 21:00

I I do feel like we do so much to not feel it because it's so painful, right Like, we get angry, we blame, we figure out who else is toxic, we, you know like go to the people pleasing, which is more like that fear response. Yeah, so I don't know if I'm just wondering if, like, the feeling of shame is getting overwhelming, maybe because even COVID, we're so, we've been so isolated that so much of social stuff has gotten messed up. Right Like, we're not taking as much risks, like people aren't like people are on their phones all day. They're not like dealing with the world as much, so there's a lot of social withdrawal across the board. I mean, oh my God, the Gen Z is screwed that. They're just like sitting in their rooms all day looking at Instagram. Right, like, talk about, like being locked in shame and not doing approach to it, and so I'm just I don't know, I think I'm just puzzling over like I would just love to do a research study on this.

Dr. Kibby McMahon: 22:04

I was wondering that before we talked and it was funny because you know thinking about it as a connection to ADHD. So I don't know if I feel the same um same rejection or criticism, like I don't feel as bad about my adhd.

Dr. Kibby McMahon: 22:21

I feel like I I've gotten a lot of people have made fun of me over the years. They've called me space cadet, they I think I'm I've maybe because I've lived in anxiety. I've been, I've regulated my adhd with a lot of anxiety and a lot of hyper focus, so I've got a lot lot of like. People have made so much fun of me for my hyper focus, like when I play a video game, when I do one thing, when I'm walking down the street, I'll focus to the point where everything else disappears. I feel like people have made fun of me for that. But I don't know. But I think I've made it work enough that I don't know if it's, I don't know. I just don't feel the same like sting. However, even especially when on my Vyvanse, when I'm on my medication, I feel RSD like I feel the sense of worthlessness more.

Dr. Jacqueline Trumbull: 23:18

On Vyvanse yeah, fascinating yeah, I mean maybe because, okay.

Dr. Kibby McMahon: 23:23

So if, like, if we're talking about it, it's just like an emotion regulation problem linked to ADHD, right, if regulating emotions takes a lot of the thinking skills, right, to be able to go. Oh my gosh, I'm feeling so sad. But let me direct my attention to things that are not about the sad thing. Let me actually like shift gears and go, take a walk, and you know, being able to regulate yourself and take control over your actions is a, like an intentional prefrontal cortex thing. So if you have less of it, your, your emotions are like exploding all over the place. Um, and I don't know, like I think maybe it's because my hyper-focus, but when I'm actually on Vyvanse and I start to have a thought, my like normal automatic thoughts I'm getting so much more aware of because of this podcast, where I'm like I'm worthless. Oh, if I don't do this, I'm terrible, like I. I mean I. Why did I even think I could do this? Why did I even think that I could run a business? Why could I think of doing this? Like, why do I even try? I'm like people can see that I'm broken inside and then they're going to hate me and so I just have those.

Dr. Kibby McMahon: 24:34

I have those thoughts all the time and then, when on on Vyvanse, it's like persistent and impairing. Like I will sit there for hours trying to battle these thoughts of like I'm worthless, I'm always going to be a failure, I'll never do anything successful, I'll never make any, I'll never do anything successfully that I reach. I don't even I'm trying to. I'm now I'm trying to like say them out loud and I don't. I don't know how they feel. Like it just feels like the self-hate of like you'll never be good enough, you'll never, you're never, you're never, that you don't have what it takes, you don't have what it takes, you don't have it takes. That's, that's my. And then I think, like the Vyvanse makes me lock into that thought.

Dr. Jacqueline Trumbull: 25:15

So, yeah, I was gonna because, well, one of the reasons I felt like maybe I cried today also was that I'm switching over to Prozac and Prozac has a slight stimulant quality and when I'm on stimulants which I am extremely sensitive to that's why I don't take them I feel more emotionally dysregulated and it's just a pin drop could get me to kind of unravel my nerves.

Dr. Jacqueline Trumbull: 25:39

I'm afraid you know, and so I could see that you know, having something to do with the by vance thing. I also wonder if it's you. When you are on by vance, yeah, you're so locked into your sphere of like productivity and doing this and you can't find your way out of it as easily, and so all of that work is associated with those thoughts. It would be interesting to see. We should look into the studies and see if these people were medicated or not. Oh, interesting, yeah, because let's see how stimulant medication could increase.

Dr. Kibby McMahon: 26:14

Make it worse.

Dr. Jacqueline Trumbull: 26:15

Yeah. That's a bummer, that would be interesting, right, because it would be the cure for ADHD is actually causing the RSD in some sense, or exacerbating the RSD.

Dr. Kibby McMahon: 26:27

Yeah, and we also do know that stimulant medication helps for some traits, some symptoms of ADHD, not others. Right, like it helps with the focus but it doesn't help with organization, so it's and other kinds of behaviors like that. So it is different. I think yeah. Ooh tricky, tricky stuff.

Dr. Jacqueline Trumbull: 26:50

Yeah Well, ADHD is also kind of two different disorders.

Dr. Jacqueline Trumbull: 26:53

You've got the inattentive subtype and the hyperactive subtype and of course there's a combined. But those two presentations are pretty different so and I could see how they would lead to rejection sensitivity in two very different ways. I mean the hyperactive kid is going to get rejected a lot growing up and that's going to be very painful, and they're going to be rejected by peers. I don't think the inattentive type is going to be rejected by peers nearly as much. That seems more like a work issue, Like they might get negative feedback from teachers. But I don't know why an eight-year-old kid with inattentive ADHD would face a ton of rejection from peers. I mean, it's like I could come up with theories, but it just doesn't seem like nearly the same extent as the hyperactive kid would, who is like bouncing off the walls and very obviously different.

Dr. Kibby McMahon: 27:43

Yeah, just really trying to think about that feeling after you're criticized, like okay, okay, all right, even just talking through all the different symptoms, right, it's like, as you're saying, avoiding situations like avoiding dating, avoiding projects as soon as they, as soon as you feel criticized, and then also that's that how the RSD kind of brings up this, that shame spiral of like I'm always messing up, I'm a failure, right, and then the it's interesting to how rejection says I think we've talked about more about this but how rejection sensitivity can actually lead to more rejection and problems in their relationships. Right, like you're constantly worried about relationships, you want to get reassurance, you are really anxious about you know your connections and whether you're going to get rejected or not. Oh, and the other thing about RSD is that you, if you have RSD, people with rejected sensitivity tend to read neutral, um, they tend to read neutral social information as negative, right?

Dr. Kibby McMahon: 29:15

So if someone texts you okay, period, then people with rejected sensitivity would tend to read that as like negative, like that person's mad at me then, Um, and which now we're ripe for that, because it's all about texting and emailing and really neutral, like communication which you could layer on a ton of rejection sensitivity too.

Dr. Jacqueline Trumbull: 29:38

So well, it's funny, funny. I don't know if this is actually true, but, um, in texting my 17 year old stepson, he will text like happy birthday or thanks, like no emojis or like exclamation points or whatever. And somebody told me that's how gen z, that's just how gen z texts. Now and I'm like, what the fuck? Like how is anybody supposed to understand what tone is being conveyed without some help? But anyway, hey, kibbe, what is it called when somebody reads more into something than there's evidence for?

Dr. Kibby McMahon: 30:15

Oh, it's called a negative bias.

Dr. Jacqueline Trumbull: 30:17

Or a hypermentalization.

Dr. Kibby McMahon: 30:19

Hypermentalization. Yeah Well, hypermentalization I. I thought it was like you're reading more things, but then plus a negative, then there's another negative bias where you're like reading more negative things, right like yeah, I mean, I think.

Dr. Jacqueline Trumbull: 30:33

but I mean if you say okay, dot, and I actually, if you said okay, period, I think I would correctly mentalize that you were pissed about something, because millennials don't text like that. But if you said okay, period, I think I would correctly mentalize that you were pissed about something, because millennials don't text like that. But if you said K and I was like she's mad at me, that would be hypermentalizing and a negative bias, hypermentalizing with a negative bias. Anyways, this isn't interesting to our audience. This is just me nerding out my own dissertation.

Dr. Jacqueline Trumbull: 30:57

But the other point is is, like my dissertation was on this in BPD, right? Like not ADHD, not her shame-based disorder? So this doesn't feel specific at all to ADHD, but yet somehow somehow is, and part of me is like is RSD being defined in a way where it's just not being studied in other disorders? Or something Like we know shame is specific to BPD, we know shame is a huge deal in social anxiety disorder. It makes no sense that it wouldn't, that that it wouldn't be stronger in those disorders than ADHD, or at least just as strong ADHD, or at least just as strong. So I know we've kind of beat that.

Dr. Kibby McMahon: 31:45

I mean, I guess, I guess the. I think, just from reading what we read, I think it's the quality and what people did Like. I think the quality seems to be a period of time like the actual experience of RSD versus any other you know, reaction to reject, sensitivity. It's this period of intense physical pain, right, Like this kind of like when you hear dysphoria. It's this very defined period of time where you feel crappy, right versus borderline personality disorder. Um, that has a lot more like like. They're not like sitting there feeling sad. They're exploding. They're like begging. They're they're doing drugs. They're like having sex. They're like like frantically. So I think maybe it's just like the like, how that pain manifests and what you do with it is different in these different disorders to me.

Dr. Kibby McMahon: 32:50

Okay, let's just let's call it spades, but let's just say like this is just intense, intense, dysregulated, um painful, shame that leads to a lot of avoidance. How about?

Dr. Jacqueline Trumbull: 33:07

that I don't think it has to necessarily lead to avoidance. It just might lead to avoidance. Like, for instance, I don't feel like I avoid getting rejected socially very much. I do avoid conflict, but I don't avoid getting rejected Like I.

Dr. Jacqueline Trumbull: 33:25

I would put myself out there in dating situations all the time I put myself on national TV, Like if I wanted to not get rejected, I probably shouldn't have made some of the decisions that I did. So it didn't. It never felt like I was anticipating, like I had a fearful anticipation of rejection. Yeah, I mean yeah. So it's hard, but of course sometimes I do, but I feel like sometimes everyone does, so I just don't, I don't, I wouldn't say I have severe. Adhd.

Dr. Kibby McMahon: 33:59

Right and I'd like you respond to to life with more approach than other people. So maybe avoidance is just less of the thing. And I'm just looking at now I'm really looking over the common experiences of RSD connected to ADHD A lot of rumination and self-blame, like they couldn't stop brooding over it. Physical and emotional overwhelm like, as you said, the stomach aches and headaches Out of proportion. Reactions like it feels like the end of the world when you get criticized. And avoidance and withdrawal right, avoiding social situations. So it might be that like you just have some of them and not all of them, right, you just don't have the avoidance part as much.

Dr. Jacqueline Trumbull: 34:46

Yeah, and this isn't about me, I'm just saying that as an example. I think I do have the avoidance and in some ways and other ways I don't, but that description feels like the exact same description you would give somebody with social anxiety disorder. I still am just not seeing how it's specific to. Adhd.

Dr. Kibby McMahon: 35:17

You know what? Maybe people with social well, first of all, they could overlap, and people with social anxiety tend to. It's a focus of the fear before the social events. Right, it's like social anxiety is diagnosed not because of how they feel when they get rejected. It's because they're so terrified and they might not even get rejected at all, right, they're just so scared of it before.

Dr. Jacqueline Trumbull: 35:46

So if social anxiety is the problem of before, rsd is the problem of after. Yeah, I think that's the best argument we're going to give for it. I mean, I still think it's just riddled with bullet holes, because we talk about RSD as having an anticipatory component also, and I think when people with social anxiety disorder do get rejected, they are going to feel that very intensely. Anxiety disorder do get rejected. They are going to feel that very intensely. But I think we should go with your idea there, cause I can't.

Dr. Kibby McMahon: 36:15

I just can't think of anything better. Let's play around with potential interventions like therapeutic interventions. So I was wondering as we were talking, I was wondering the different ways that we could regulate that shame. And I was wondering as we were talking, I was wondering the different ways that we could regulate that shame. And I was thinking of like opposite action, where you know, the opposite action to shame is kind of what AA teaches its people Stand up, say I am Kibbe and I am alcoholic. Right To like be instead of like, like hiding, but be forthcoming. So there's that one.

Dr. Kibby McMahon: 36:51

And there's also cognitive strategies of thinking about maybe different alternative hypotheses for the rejection, like if you're reading like oh, that person hates me because they texted me okay, period. Um, maybe there's other things that they're thinking, or maybe they're not rejecting me. So there's that cognitive flexibility. Which one do you like better?

Dr. Jacqueline Trumbull: 37:15

uh, I think this is a package deal. I I think that there are each two second interventions and you can do both. I mean all right. All right, jacqueline, what do it? Hey, yes, you're really disorganized.

Dr. Kibby McMahon: 37:26

You're really bad at All. Right, jacqueline, what Do it? Hey, yes, you're really disorganized. You're really bad at scheduling and you, whenever we schedule something, you know like it is a crapshoot whether you're going to make it and you just can't do it. You're not very good at it. Very disorganized person, not very nice.

Dr. Jacqueline Trumbull: 37:53

Do you feel it? Do you feel it at all, Do you? No, not really, because I know what you're doing, but I mean A tiny, maybe a tiny twinge, whether it's the crapshoot that I'll make it, but okay, whatever. Um, so a good reframe that I read was that if somebody, like at work, criticizes you, it might not be that they think you're stupid and um, unforgivably you know, I have unforgivable deficits but that they actually trust that you are capable of improving and otherwise they wouldn't give the feedback if it didn't seem like there was something you could do with it. So, just in receiving feedback, it means that the other person has some faith in you.

Dr. Kibby McMahon: 38:43

Oh no, I don't have no faith in you. I feel like you're going to be disorganized forever. It's going to really hold you back in life. It's going to hold you back in your future practice. It's going to affect the way people see you. I have no hope that you can improve on this. How am I doing as a behavioral therapist? You're so, you just you're so.

Dr. Jacqueline Trumbull: 39:05

Kitty's a bitch. Blame Okay, coolibbe's a bitch.

Dr. Kibby McMahon: 39:09

Blame. Okay cool, Turn it into anger. Yeah, that's worked.

Dr. Jacqueline Trumbull: 39:16

Oh, kibbe's having a bad day today. You know she's taking it out on me for some reason, but man, am I feeling some shame in this moment. I think I know what this feeling is. That's familiar to me. I mean, look like in earlier today I basically said to her it's ADHD and then I started like tearing up and I just tried to acknowledge my side of the street. In a sense, even in the emotion like even in just in the emotional reaction, I was like you're super nice, you're totally fine. I wish I weren't having this reaction, um, but it'll pass, or something like that. And then afterwards, you know I did, I really didn't dwell on it very long, I think it was more.

Dr. Jacqueline Trumbull: 40:04

I've gotten pretty good at diffusion, in a sense of just being like look like me, ruminating about this isn't going to do anything. I mean, I've cried in front of supervisors before. It's never led to anything terrible. Everyone I know has cried in front of supervisors. Um, what is me worrying about this going to accomplish Nothing? Um, so just kind of being like whatever, I just let it go. I don't know that I needed to. I mean, I guess the re, the, it's not really a reframe, but it's at least just bringing down catastrophic thinking to say like, yeah, I already know this about myself, I already know a. One more person noticed the thing. That is very noticeable and always has been cool, Like that's not news.

Dr. Kibby McMahon: 40:54

So what you're doing is, I would say, like partway opposite action. It's me, it's a little bit more of emotional acceptance, right, you're accepting that this feels painful when you got criticized. I'm wondering, if you, what happens if you go all the way opposite action and say it openly and proudly? Do you remember the Friends episode where Phoebe, like the girls, phoebe and the girls were criticizing each other and you know like Phoebe was like, oh, rachel, you're a pushover and monica, you're high maintenance. And they were like they went into a tizzy and they came back and they were so mad and they were like, well, phoebe, you are flaky. And she was like, yeah, I am, huh, I'm flaky.

Dr. Kibby McMahon: 41:45

I think he's the best yeah, what if you phoebe'd it and just went like, yeah, I'm disorganized, I have, I have wild ADHD uh, I mean, I don't know, that confident don't not not like. I'm apologizing and I understand that I'm sorry that I'm crying, but it's okay, just be like. Yeah, man, I have adhd yeah, I, I, I think that I say I.

Dr. Jacqueline Trumbull: 42:19

I have adhd, I'm disorganized. It's hard for me to stick to schedules, unless you are my patient, even occasionally, then no harder, brag, Brag to me about your ADHD.

Dr. Jacqueline Trumbull: 42:32

Oh, I can brag to you about my ADHD. I mean, I think that it probably makes me a more fun and creative person. It makes me more forgiving of others. I think that being a stickler about times and being organized, it makes some sense. But you know there are lots of cultures in this world that think that it's perfectly okay to arrive two hours late to something, so it's not objectively a bad trait. Why are you making that face at me?

Dr. Kibby McMahon: 43:05

I'm sorry, it's not objectively. A bad trait is your way of bragging, honey.

Dr. Jacqueline Trumbull: 43:10

I've heard you brag more than that I mean, I don't think that being late for shit is something to brag about try it.

Dr. Kibby McMahon: 43:18

Try it just for me, try it just for the fun of opposite action. I want to see what happens.

Dr. Jacqueline Trumbull: 43:22

Humor me uh, I just don't feel like you're to feel this way once I'm late for something with you that you really needed me to be on time for. You're man, you're a tough therapy patient. I think it's hard for well. Yeah, I am a tough therapy patient. I dodge everything. Um, I'll do it.

Dr. Kibby McMahon: 43:45

I have wild amounts of ADHD. I can walk on the street in lost in thought and literally not visibly not see anything. I've had friends wave in front of me and I do not see them. I've played video games or done where I like literally go into another world and the rest of the world I've like most movies that I watched. I don't remember that's why that's you know what.

Dr. Kibby McMahon: 44:14

I love it because I could watch a movie over and over again and it's still surprising, like I'm like what's gonna happen and alex will be like we watched this like two weeks ago so yeah, that's what I mean by option action. What if we leaned into the yes, I have made fun of it, made fun of for it?

Dr. Jacqueline Trumbull: 44:33

I am disorganized and that's okay, because super organized people are often kind of boring and anal and they care too much about stupid things. And I feel like I care about the things that have more substance and matter and I apologize to anybody who's really organized that have more substance and matter and I apologize to anybody who's really organized.

Dr. Kibby McMahon: 44:55

Don't slam other people for it. It's been interesting. I've never actually tried opposite action with you but it is Just so.

Dr. Jacqueline Trumbull: 45:03

Everyone knows my fiance is super organized and I love him more than anyone, so you know it's really. But I do think that sometimes my brain works by filtering out the shit that doesn't isn't as important to me. But other people disagree with those assessments that I make.

Dr. Kibby McMahon: 45:22

How does that feel? I mean like solid B plus. I would say in terms of option action. I didn't hear much bragging. I heard much, like you know, stoic defensiveness, but sure you know.

Dr. Jacqueline Trumbull: 45:40

I don't really know how being disorganized benefits me. I think that's hard to. I'm finding it hard to find. How do you think being disorganized benefits me? I can't think of some ideas.

Dr. Kibby McMahon: 45:57

Not the point. Anyway, everyone is still confused on what we're doing. There could be all these different applications of all the cognitive behavioral therapy skills that we know when you're feeling dysphoric rejection, dysphoric, right so, all these different emotion regulation skills that we've talked about, one is I think this is the one that you're leaning towards which is the cognitive ones of like, talking your way through it and really being like okay, is this the worst thing? Am I, do people? Am I, you know, hateable and rejectable and terrible, and is the world gonna end because of this criticism? Um, is it possible that they're not even criticizing me? They mean something else, right?

Dr. Jacqueline Trumbull: 46:44

these are all, like, different ways of thinking what I just want to make an asterisk about that one. So a lot of the times people are like, yeah, well, arguing with myself doesn't work, but one thing that it can do. I actually worked with a patient earlier today who used a thought record to bring his emotion down and I was actually kind of surprised that it worked no-transcript emotion. So even just like labeling your emotions and, you know, getting more into your control center can be helpful.

Dr. Kibby McMahon: 47:37

That is what I saw in the research, that even just I mean this is the, the name it to tame it principle with emotion regulation, like if you're feeling dysphoria, so sad from being rejected, you can say in that moment to yourself I'm feeling RSD, like right now I'm in a dysphoric state, I'm really, really sad, I'm in pain because rejection is so painful for me. And that's what's going on and I know it will pass. It's not the end of the world, it's not like you know. It might not the end of the world, it's not like you know.

Dr. Kibby McMahon: 48:09

It might not be true, all the different thoughts that are floating through my head right now, but here, here it is, here's my cloud of shame. So they're just labeling. It's just sometimes people knowing that it's called rejection, sensitivity, dysphoria, and maybe that has more power than just calling it shame, right, just having like a psychological word for it, right, like come on gaslighting is like a bunch of different stuff, but now that we have a term for it, we feel a little bit more empowered. So maybe, just like having the term RSD makes it sound more like yeah, it's a thing.

Dr. Jacqueline Trumbull: 48:48

Yeah, I can kind of see that there's also diffusion techniques that can work. Literally singing to yourself RSD, you know, just like. Or like rejection, rejection, rejection, rejection, rejection, rejection, rejection, rejection I'm a failure, I'm a failure, I'm a failure, I'm a failure, I'm a failure, I'm a failure. Like so fast that the words start to lose meaning is a common technique as well. That the words start to lose meaning is a common technique as well.

Dr. Jacqueline Trumbull: 49:12

Talking to yourself in the voice of your least favorite politician Now, donald Trump is not everybody's least favorite politician, but he does make a really, really good one for this exercise because he has such a distinctive kind of voice and cartoonish way of talking. So imagining Trump saying to you like you're fired or you know, that was terrible, whatever the fuck he says, you know, whatever, just like using his voice, can kind of give a humorous bent and also make it seem somewhat ridiculous. The things you say to yourself, like Kibbe just gave us a bunch about how she's worthless and is going to fail at everything, that's actually shit. That Trump says like over Twitter, right, and a lot of us look at that and we're like, wow, like that's ridiculous. When you can give your own voice, that Trump's voice. It can illustrate to you. You know what?

Dr. Kibby McMahon: 50:02

you're doing to yourself? Basically, you're giving the inner critic inside you a different voice than your own and being like oh there, it.

Dr. Kibby McMahon: 50:09

There is the trump voice again, or whatever you want to call it. I, I'm, I'm, I'm realizing that I'm, I wouldn't. I think it's called. I think I would call it opposite action. I think that when I was going into college, I had been so rejected, made fun of. I was just really, I really felt like an outcast coming from high school to college, that I was had a lot of social anxiety, um. But then I think I walked around being like yeah, I'm, I'm awkward, I'm an awkward person, I'm weird, I'm a weird kid, right, and I just like really leaned into it to the point where I feel like that just made me more comfortable with myself.

Dr. Kibby McMahon: 50:49

And then with social rejection, it's interesting as soon as you flip the inside and it's weird, it's a paradox You're constantly looking for acceptance from other people, but when you have that goal, when you're actually like so externally focused for that validation, you're less likely to get it right. Like when you're desperate, so externally focused for that validation, you're less likely to get it right. Like when you're desperate, people don't like that. People smell it, yeah. So as soon as you say like I'm weird, I'm awkward, I have adhd, like yeah, I mean, it might not be like a great quality, but like I feel like the times I've owned up to the qualities I've had as like and even just like, see it as a strength. That usually changes, like my vibe, and then I get that social acceptance from other people.

Dr. Jacqueline Trumbull: 51:41

So I mean I think in general, like I do not hate having ADHD, I think it comes with a ton of benefits. Me needing a constant dopamine fix has meant that I've lived an interesting life, so I maybe have ADHD to thank for it. I think that helps with that shame around it to not just see myself as a broken person. There is something about being called out for it or my behavior being misinterpreted. That's actually more maybe due to adhd is very painful to me, um, but I think probably that is at least modulated by me, not inherently like hating myself for it. So finding pride in your ADHD, I think can be really protective and I mean, like you know, you can do some research about all the good that can come with ADHD. People with ADHD can tend to be more adventurous, more creative, more sociable, extroverted. In some people they're not right because they're avoiding social situations because of this component no-transcript every single day up until the day they do it. Then doing it at the last minute, turning it in and being like well, if only I had done it earlier, then it would have been way better. And it's like maybe, but maybe not Like maybe somebody who would do it earlier actually wouldn't have that big motivational push and like flow state that you get into when there is a lot of pressure, and so maybe it's not a problem to save everything to the last minute If you reliably do get it done.

Dr. Jacqueline Trumbull: 53:45

Our society also punishes night owls. It says that they're, you know, young, immature, whatever it's like why? That's just a circadian rhythm. If you're a night owl, be a night owl until there's a really compelling reason not to be, like having a kid who wakes up screaming at six in the morning. So you know, really think about like Are my symptoms actually a problem or have I just been taught by society that it's a problem? Are my symptoms actually an issue broadly, or is it just this one environment that we're in?

Dr. Jacqueline Trumbull: 54:19

We know that our schools are run in a very particular way that is not best for everybody's learning style. That doesn't mean anybody is stupid. Anybody's stupid. That means that maybe they're. They just don't learn by sitting, being bored for eight hours a day, starting way early in the morning and being droned out for forever. There might be other ways to make your brain have superpowers, so discovering that as well. I like working with people with ADHD and trying to restructure some of these beliefs that they have about themselves, because I think a lot of actually ADHD symptoms can go down, because I think there's a big interaction effect with anxiety and self-hatred. If you have low self-esteem you will do poorer at things generally because you don't believe in yourself to improve.

Dr. Kibby McMahon: 55:09

Yeah, I mean, I think that this extends beyond ADHD. I think we're talking about here is the antidote to RSD. The antidote to rejection, sensitivity, dysphoria, is to try to lean hard into the self-love and self-acceptance. And as we were talking, I was just thinking about my past few weeks and I was like, oh no, I really had some. I was just thinking about my past few weeks and I was like, oh no, I really had some. I had.

Dr. Kibby McMahon: 55:36

I would feel like it's depression or I feel like it's my rumination over, like how I'm not good enough. And I, it was like last week yeah, it was last week I had this spell where I was just, you know, we're trying to be more public, public facing, get on instagram and do this and, you know, start a business. And I was beating myself up because I saw other people online be more braggy about themselves, be just more like this is why I'm amazing. You should follow me, because I'm, I know, more than you and I like I.

Dr. Kibby McMahon: 56:08

I was laying in bed and I and Alex was asking if I was okay and I didn't even. I couldn't even talk, like I was so upset I said I don't, I'm not able to do that. I have been horrible about self-promotion. I I don't even know what my strengths are beyond being able to read and bolster up other people Like I've just been so steeped in thinking about. You know the community and how painful it can be to be like the carer, or like someone or the people pleaser, the someone who's defined their identity through being able to read other people and focus on their needs and just ignore their own.

Dr. Jacqueline Trumbull: 56:53

Right.

Dr. Kibby McMahon: 56:53

And I'm just like I don't know how to stand up and say I'm amazing, I've had this, I'm a dude, I have this quality right, like even just the, the, the bravado and and um ego that actually works. Right, the self-promotion. And then I went into like a spiral for a while and then I and then and you know this cause I've also texted you being like why, like? Why do people like me? But I think I tried to intentionally lean in and decide like I'm not really gonna get this blessing from the universe that I'm worthy or that people like me, but I'm just going to be like, that is my strength, I'm able to read other people really well, and I'm going to lean into accepting and being proud of that and not being like, oh, I'm going to be rejected, not be successful because that I'm other oriented and not be successful because that I'm other oriented. So I think that's just that.

Dr. Kibby McMahon: 57:52

I guess that's my personal story lately of how I'm trying to overcome my RSD by saying this is who I am Like. I have ADHD. I don't notice things around me. I don't remember any movies that we're watching. I tend to focus on other people and I'm way more. I'm way better when I'm bouncing off someone than when I'm alone in a room telling people why they should trust me. That's just who I am, and some days I'm crushed with, like I'm, you know, not worthy for it, and and other days I just have to be like no, this is who I am, right.

Dr. Jacqueline Trumbull: 58:28

Yeah, I think I do find I do feel that way most of the time, and then when a supervisor is like above me on the hierarchy, point something out and then I feel like something's at stake and so there's that element too. I just it's really hard not to take the bait of you saying that there's something wrong with you for not being able to basically have zero humility and like pitch yourself as if you're the messiah, like we would get so punished for that in grad school. It would be unreal right.

Dr. Kibby McMahon: 59:02

that's why I felt very comfortable in, in, in, like the, the, in the therapy setting. That's why I'm comfortable here talking to you, because I feel like I could disappear into you. I'm looking at myself right now. It's making my stomach turn right. So it's really reinforced. And if you're a caregiver, if you're a mom, if you are the parentified kid, yeah, being a people pleaser is really reinforced. But then if you have to, let's say, make a reel on Instagram telling people why they should trust you over anyone else, yeah, you know. So I'm running up against my own like areas of I like don't have what it takes, but then I just have to keep leaning in and being like all right, you know, I, I know we've known in our clients, we've see it.

Dr. Kibby McMahon: 59:54

When people are obsessed with reading rejection and others, it creates the rejection, right, you either don't show yourself. You either act in ways that do get the rejection. You're reading that you'd like if you I hate that this is such a manifestation mindset thing, but like if you have the mindset I'm rejectable. Yeah, you tend to get more rejected and the moment where you're like I'm the shit, like people start treating you like the shit. That's my self esteem, anti rejection.

Dr. Jacqueline Trumbull: 1:00:27

Tip. Oh, we should do an episode on manifestation rejection tip.

Dr. Jacqueline Trumbull: 1:00:35

Oh, we should do an episode on manifestation oh boy, okay, okay, let's see if there's actual research on it. Yeah, well, it works in a lot of. I'm not saying I'm gonna like manifest, you know having a pet pink dolphin, but and then it's gonna magically show up. But anyway, we'll save it for that episode.

Dr. Jacqueline Trumbull: 1:00:48

I think that a lot of times when we feel really rejected, what we're often being criticized for is the dark side of one of our assets. So you gave an example where you have an asset of humility. The dark side of it is that it's difficult to self-promote. I think people with ADHD have, you know, a light side of being fun and spontaneous and a dark side of being disorganized. Or, you know, less methodical, a lot of the times, like the very things we love ourselves for they don't work in every single context, and then we get rejected and then we feel like shit, but we're not really meant to work in every single context, yeah, yeah. So I think maybe just being able to tune into like, okay, this is an example maybe of my asset not working in this exact context, but it doesn't mean that I'm missing an asset.

Dr. Kibby McMahon: 1:01:47

Yep, I would agree. Anything else, no. I think that's good. I think we've figured out that RSD is intense shame. That's our working hypothesis, and maybe we have weird reactions to shame in ways that society is recognizing or grappling with compared to other times. But it'll be interesting. Yeah, this is a really popular topic. It's just interesting to piece apart like how, like from a diagnosis standpoint, like what is this?

Dr. Jacqueline Trumbull: 1:02:25

Yeah, it doesn't feel like a well defined construct. It doesn't feel paired apart from shame enough. It'd be interesting to look more into the neurobiological research to see are there actually like activated brain structures that are unique to ADHD? Truly like.

Dr. Jacqueline Trumbull: 1:02:41

I remember actually growing up my mom said I think you have like a larger anterior cingulate or something which is like a part of the brain that can be sensitive to shame and rejection. Cause I would get like very like I was like a really good kid cause I was terrified of getting called out. I still have a memory of in first grade, the student teacher I was talking to. The student teacher goes Jack, and I was like you know so clearly. I had this going on a long time ago. But yeah, I don't know the jury's out for me on whether this is truly specific to ADHD, even though there's evidence for it. I just wonder if that is an operational Wow, if RSD, maybe, is being studied more in things like ADHD and shame is being studied more in BPD. If it's an operationalization, I can't say that word. Say it, say it. Operationalization, operationalization, no, okay, yeah, I think so Is she?

Dr. Kibby McMahon: 1:03:46

Who hates rejection? Some people hate it a lot. Yeah, it hurts.

Dr. Jacqueline Trumbull: 1:03:52

And people who have been like criticized and picked on their whole lives probably hate it a little bit more. And people who have behaviors that are going to get them criticized and picked on, like people with ADHD, are, you know, good candidates for that? So I don't know. That seems to be the most running hypothesis, but hypothesis.

Dr. Kibby McMahon: 1:04:12

But well, I mean, this is stuff that we do in the community and in the cool of my community we're going to do, um, uh, different kinds of skills and exercises to actually work through this rejection sensitivity. So, because I know that a lot of people who are caring for others, a lot are like people pleasers, so well, if you're interested coolamindcom cool fans, I think this is pretty easy tie-in to.

Dr. Jacqueline Trumbull: 1:04:36

You don't want to make me feel rejection sensitive, so give us five star reading on podcast and spotify.

Dr. Kibby McMahon: 1:04:44

Please somebody tell kibbe what she's good at just follow me on cool a mind at on instagram. That's all I care about. All I care about I'm working so hard folks, this is like a real growth edge okay sign up for the community.

Dr. Jacqueline Trumbull: 1:05:02

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