Rejection Sensitivity in ADHD: Group Dynamics Insight

Hello, this is Jonathan Murphy,
psychiatric nurse practitioner , and

I'm here at the Compass Point Institute,
which is a great place to discuss clinical

ideas that come up in my practice as a
psychiatric nurse practitioner, I just

released a video on hyper focus for people
that are interested in ADHD content.

You can check that out
on my YouTube channel.

Focus Path Systems for Growth.

Let's get into it.

What are we gonna talk about here today?

I wanted to talk about something that
I've been thinking about lately, this

idea of rejection sensitivity dysphoria
In my work as an ADHD clinician, I have

a lot of patients come to me and they
say, you're never gonna believe it.

I just figured it out.

I have rejection, sensitivity, dysphoria.

And in the beginning when I
heard this, this bothered me.

Why?

Lemme tell you.

Fresh outta school, you get tested
and you have to learn how to diagnose

psychiatric disorders from the DSM,
the Diagnostic Manual and it's fifth

edition, many people know about this.

A committee of people create a book
and it has clinical purposes and

it has, , billing purposes too.

So when we're talking about these
diagnoses, we're, we have to understand.

In psychiatry and psychology we're
operating in the realm of symptoms,

clusters of symptoms rather than a broken
arm or, a brain bleed or a heart attack.

These are psychiatric symptoms.

These clusters of symptoms, they're
categorized and ideally this is

gonna help the patient, find a
treatment that is successful and

lead to better understanding.

So rejection sensitivity
dysphoria is not in the DSM 5.

So why does that matter?

I think that I have to break it
down simply is that rejection,

sensitivity dysphoria, it's something
that spread on the internet and.

How did it start?

It started with one psychiatrist, Dr.

William Dotson, and in the nineties
he started talking about rejection

sensitivity dysphoria, and then one of
these, um, sort of publications attitude,

just sort of one of the main voices,
especially pre-internet, about ADHD.

And Dr.

Dotson describes rejection, sensitivity
dysphoria as a vague observation.

He's written about it a lot in attitude.

There's no, to my
knowledge, published work.

There's no real studies on it.

There's nothing validated.

It's just basically.

His, clinical and personal professional
opinions, which he's totally entitled to.

But the problem is, is that they're
propped up and then shared by YouTubers

like how to ADHD and so forth.

And then you have people saying, oh, I
have rejection, sensitivity, dysphoria.

So what's the problem with that?

Well, people do have validation.

That's good.

Being validated is good.

So for the purposes of being
validated, having a community, having

an ability to name things, , it's
good, but it's not understanding.

Lemme put it this way.

If you were at a party, let's just
say you're back in your college

days and you're partying all
night long in the dorm rooms and.

You wake up the next day and
people are still hanging out and

you're feeling a little fuzzy.

You don't remember which couch you passed
out on, and you start walking around

and everyone just starts laughing at
you and you don't understand why, and

you're like, oh, maybe this was fun.

And then you eventually make it to the
bathroom and you get writing all over your

face, Sharpie, , use your imagination.

So we want to make sure that we
understand what's actually going on.

We don't want to think it's one
thing and then it's not another.

So when we're thinking about rejection
sensitivity, we're thinking about

people in a very, , isolated state.

We can't think of people
as merely individuals.

We have to think about
people in the group context.

It's the missing link group dynamics.

It's our survival response.

So rejection, where does it come from?

Well, ADHD is your executive functioning.

It's your, your logical, linear,
brain, ability to carry out

tasks with directed attention.

With medication, people are gonna
have greater impulse control,

greater awareness, and also a greater
ability to process complex thinking.

So therefore, it's not uncommon
for people to notice these

automatic responses and reactions.

We have what we see, what we smell,
what we taste, what we hear, and

we touch The sensory input leads to
automatic involuntary reactions, and

then only after the fact, much later.

In the grand scheme of things,
do you become aware of it?

Think about when you put your hand
on a really hot pot that's been on

the stove, your hand's burning before
you realize it's the same idea.

So it's not ADHD, therefore we can't
call it rejection sensitivity dysphoria

because rejection sensitivity dysphoria
is associated with ADHD, but there's

no real clear connection either.

Dr.

Dotson himself talks about searing,
emotional rejection in the veins.

Or in the guts, which is very much
of the peripheral nervous system.

Dr.

Russell Barkley is one of the sort of
godfathers of ADHD he agrees with me,

he also doesn't think it is associated
with So , the jury is far from out

yet the crowd of public opinion
it's not working out in this case.

So I want to aid my
clinical voice in this.

So what it was, what is
rejection sensitivity?

Well, I actually think about two
separate domains 'cause we're

a lot more complex than that.

You have interpersonal vigilance, so this
is like when you walk into a room and

you might feel on edge, there's people
around, you're walking on eggshells.

This is hypersensitivity or vigilance
in a group setting, and then we

have relational vulnerability.

What I would consider to be how
vulnerable someone is to the behaviors,

actions, or words of other people.

And I'd consider this to be a more
one-on-one relational dynamic.

So we have one-on-one attachment.

You're born from one person.

So that maternal attachment is our
prototype for individual relationships,

but it's really the group relationships
that define us the most because

we survive within group dynamics.

So there's two different domains there's
no relationship between the two of them.

Someone could have high interpersonal
vigilance in a group setting, but if

someone says something to them or does
something to them one-on-one, they're not

very vulnerable to that and vice versa.

So there you go.

So that's the why in it all.

Why does it matter?

Because there's individual adaptation
that needs to be considered.

We need to consider our
individual adaptive responses.

To individually understand ourselves.

So ADHD is gonna lead
someone to medication.

It indicates that there's a
therapeutic response to a stimulant,

but it's often the starting point.

And, um, that's just what I wanted to take
the time to talk about with you today.

Don't to check out my blog.

I talk about this a little
bit, my Focus Path blog.

And until next time, this is
the Compass Point Institute.

Let the compass point the way.