The Psychiatrist Who Discovered RSD: "RSD Dies When You Do THIS!" | Dr. William (Bill) Dodson

This, for me, is very surreal. It's not every day I get to speak to somebody who coined one of the most used, recognizable yet, I think, painful acronyms in ADHD history. ADHD royalty, I truly believe you are. I was saying just before we started, I got my diagnosis 10, half years ago, and your work was one of the first I dived into. So on a personal note, thank you ever so much. My pleasure. Thank you. Let's start off, Bill, with a simple but probably not an easy question about rejection sensitivity dysphoria, and I'll refer to it as RSD from this point on. And then perhaps we'll build up to some more advanced and specific details about RSD. But to start with, what is RSD and how is it experienced? RSD is a phenomenon that I first noticed because I'm a practitioner, I'm never a research expert. And so when you sit with a thousand people, and you hear the same thing coming from every single one of them, you may not know that it's important. I mean, what it is, but you know that it's important. And so I have to give all the credit to my patients because they were the ones who described it to me. And what RSD is, is an exquisite sensitivity to the perception. It doesn't have to be real. The perception that someone has withdrawn their loves, approval, or respect. And I mean, nobody likes being criticized. Nobody likes being rejected. But for people who have an ADHD style nervous system is catastrophic. In fact, that's why the name of it includes the word dysphoria, which is literally Greek for unbearable. And so it's like sort of other people's experience or possession. Only it is suddenly hit. You know, from 0 to 100 and blink of an eye, it's incredibly painful, it's physically painful. You'll see people clutch the chest or hunch over or grimace because it's not just emotionally painful. It's physically painful as well. One of the other odd features of it is that people cannot describe what the pain is like. No, it's wordless. I always think of it as having been so primitive, it came before the word. When people can describe the intensity of it, it's where they use words like it's awful. It's terrible, unbearable, catastrophic, overwhelming. And the person can't just keep going and knocks them to their knees instantaneously. And so that's one of the problems is that it hits so suddenly, so completely that most people can't see it happening in advance and bring up all the stuff that they learned and cognitive behavioral treatment or dialectical behavioral treatment. You just get slammed with it. People report feeling totally cut off from their surroundings, totally cut off from everybody else, just a profound loneliness. And it's that they've been cast out from everybody, every place as they know. If you're totally bereft, when it's an awful, awful feeling. It then will continue, and I know period of time, can be managed, can't be days. But during that time, there's really nothing much that you can do. You just have to let it run its course. One of the most important things I found that people who need to know up front is that it will end. Most people, when they're in an episode of RSD, have the conscious fear, this is never going to end. I'm going to be in torment forever. So letting people know that every time it does come to an end, you will survive. It's just extremely unpleasant. Whether or not it's only seen in ADHD is unknown. Now, we did some research last year. We're turning the numbers on to try and answer that question. So talk to me in six months. I'll be able to give at least the preliminary results. But for right now, in my own practice, when I asked sort of a screening question for RSD, somewhere around 90 to 95% of people say, "Oh my god, yes, you've been following me around my entire life." It's not well known, the name says, "Wow." And about half of the people who say, "No, come back later," and say, "Well, yeah, I sort of lied to you. It just caught me by surprise," and I panicked and masked it and all that. The screening question, now using my practice to the last 15 years, is, "Look back over your entire life." Just about all the members you can't. Have you always been much more sensitive than other people you know to rejection, teasing, criticism, or your own perception that you failed or fallen short? With vast majority of people with ADHD, identify with that strongly. And I was actually surprised just how strongly after the first time I actually put something on the internet, there were, within six months, more than a hundred sites on Instagram talking about it. There were chat routes on Reddit. In fact, the one on Reddit received more involvement in comments and things like that than any other topic in ADHD in their history. So I was, even I was surprised how many people identified were worldwide. I mean, literally from around the world. You've perfectly described the debilitating feeling that comes with RSD, and I think everyone listening or watching will relate to that. When I see someone who has dedicated so much of their career towards a particular topic, I always question and wonder where that passion and motivation comes from. So, why did you coin the phrase RSD? Where did that interest start for you? At the very beginning, or I was listening to people, I recognize that what they were describing was something from way back in my own training that was called rejection sensitivity dysphoria. And at the time, it was part of the very first research on treatment resistant depression. In fact, it was the hallmarked center of treatment resistant depression. And the treatment of toys, then, and now, were the monoming oxidation inhibitor antidepressants, anti-anxiety medications, which, by the way, worked beautifully for ADHD as well. And so, that's my segment. That's what Paul Winder was describing. And because the current state of affairs in ADHD had been allowed to languish for so long, and they lacked so much. Back, you know, 15, 20 years ago, I went back and started over again from the beginning, and that's the work of Paul Winder and Frederick Rimer, who originally described the syndrome. And they just find it very much the same way I approached RSD. They were psychiatrists in Salt Lake City, Utah, who sat with thousands of hyperactive children and wrote down the patterns that they saw. And that's how we got our first diagnostic criteria. They were called the Winder Rimer criteria, then the Utah criteria, and finally, it went into the DSM too. And it replaced a minimal brain dysfunction. Bill, do you think that following on from that, are people with ADHD, are they born more sensitive to rejection, or is it a consequence of exposure to nasty comments? The answer is yes. It's both. ADHD itself is a kinetic, biological, neurologic condition. They're born with it. They'll die with it. It's lifelong. It's how you're wired. And that that statement is always one of the big disappointments for most of my patients, who hope that someday it's going to go away and they're going to be neurotypical. It doesn't have it. On your 18th birthday, it don't give you a nice wrapped up present. Oh, but it's just where they always wanted a new nervous system. It doesn't have that. So it's, you know, you're there, the other. So it is genetic. And you can also tell because it responds so well to two different classes of medication. So in psychiatry, in the medications of psychiatry, it's literally lump them into two groups. One are the neurologic, biological predispositions to certain conditions. These are all big names in the diagnostic criteria. But there's another large group that comes from what happened to you. You're just an average person and you have adverse attempts, head injuries, brain intestines. And of course, the big one, PTSD. Now, it's the average person's response to either a test one, catastrophic emotional experience or thousands of them, a repeated life long. And that really is like categorized as people with ADHD. Dealing it. Who is it? Time to challenge child psychiatry at Harvard. Really paper. He estimated that the average third grader, so starting eight to nine years old, has already heard 20,000 additional negative or corrective messages by the third grade. Okay, who you are? Well, as you have 20,000 messages saying, "Sit down, stop that. Stop visiting. What's wrong with you? You're two intents." But just grab it's fire. You're not okay. You're not acceptable the way you are. And you better change an allegory. Well, of course, they can't do it. They're more of a failure. A guy named McCommie published extensively on the power necessity of having friendships. If you're not going through life alone, being alone is traumatic, tremendous traumatic in and of itself. McCommie published a study again on third graders with ADHD. And he found that 70% of these children did not have a friend. Not a single friend. That's even more damaging. When mothers cry in my office, it's not because their kids are flunking mad. They'll fix that. They cry because their child has never been asked to a birthday party, never been asked to a play date. Now, and they live a life of being ostracized. Now, most of my patients by the time they got to high school, I had soft segregated into a group of other ADHD people. Can it be a lonely experience, Bill? Because if you're exposed to 20,000 extra negative comments, I suppose you quickly understand or realise that the problem to that solution, that the solution to that problem is to change who you are and to hide the version of you that is getting all of those negative criticisms. Absolutely. So if there is a disconnect over time, therefore, after perhaps years of masking between the version of you that is being presented to the world and the version of you that is hiding inside, can that make that in a version of you quite lonely? No, it's seemingly not. That's accurate. You are. And worse than that, people have demanded from you that you find a solution for something that has no solution. They basically say be neuro-typical. Be with ADHD. Let me say, cry all day, every day their entire lives and never retain that. So they go through life with a false front. I believe that what I actually genuinely, authentically am, is unacceptable to anyone. And the big thing that comes out of that is massing shame, shame about who I am. And that's the source of a lot of the incredibly hostile self-talk. There are a lot of people have going on in their heads all day long. When I speak to people who experience RSD, they have told me that in the past, heartbreakingly, people close to them have accused them of making mountains out of mohils. And when they've tried to explain that their intense emotional responses are RSD, it gets dismissed. Do you think this cycle of perhaps someone trying to open up about it and they're getting met with at a smistle only perpetuates that shame? Oh, absolutely. Multiply it. The other place that that happens is at least as worse, but if not worse, is when they go to their clinician, to probably just not read a word and never heard the time. And they come in and said, and here's the thing that gets them in trouble, I read on the internet about this conditions part of ADHD and I've got it in spades and they then describe RSD. As far as I can tell, most of the time clinicians will go, you're just exaggerating. You know, that's, you know, don't get anything from Dr. Google especially. Don't get anything from TikTok. Let's move on. Again, that's because a lot of physicians are clod. Here's a person who's a crotian pulled through if they have found something in their life, the deeply meaningful. And then for them, immediately to discount it, you might just stab them in the chest and wave goodbye to that therapy ever being really an alliance. They're proving themselves are not worthy of being trusted with their own emotions. To go back to what you said, I don't really see that as that much of an exaggeration. I don't see it as a flaw. People with ADHD are very intense, passionate people. Now, if they don't care about something, it's just not in their lives. So everything that's left are things that they care deeply about. And so their highs are higher, their lows are lower. And so they always go through life as setting them about 10 out of 10. So that if something else may, suddenly hips them out of the blue, they've got no reserve. And so it's layered on top of where a typical person will describe as a really stressful day. People with ADHD have a really stressful day, all day, every day. And so it's that layering on top, they don't have any capacity to do it. They just boom, overwhelm them. They can't prepare for it because they don't see it coming. And even if they did, I haven't found anything in my patients of the medication that would prevent it. So yeah, people with ADHD goes through wearing a mask to the world. And the bottom line is who and what I am is unwanted. And sometimes you go down there, I'm bad, I'm terrible, I'm lost, you just really go down the rat hole. I totally agree. People with ADHD certainly go through life wearing a mask. And sometimes when they are triggered by RSD, they can perhaps snap, it can come out as intense sadness or rage sometimes. And the people I've spoken to on my podcast have actually many of them have said that they've been labelled as Dr. Jekyll and Mr. Hyde. Because the version that their friends family perhaps are used to or their colleagues is this masked version of themselves. And then someone says something a tiny comment or they're criticised. And boom, this explosion and this new side comes and this new side of them comes out that no one's seen before. And it can be quite shocking the difference in presentation between the trigger version versus their masked version. The trigger version that perhaps could present as bursting into tears or internalising it or externalising it, perhaps in a huge row in the office or with your partner. Is that the inner child almost trying to scream out in frustration, almost annoyed that they've been seen and the effort that they've put into masking has gone to waste in that moment? Now Erie, it's experienced as a rejection. I have tried so hard, so with everything I have only to be told it's wrong, it's unacceptable, it's immediately cast aside without any appreciation of how hard people with ADHD work and just to get to life. So again, I would draw a distinction between this approach where you see people with ADHD as being good, normal, intact people who are dealing with something that's just extraordinarily strong and the way that people who have devotees of objectively functioned deficit knew it. I think one of the reasons why I'm exactly functioned deficit theory has failed so completely is that it's basic premise as well. Well, exactly sanctioned folks, few people with ADHD as really just being nor typical people, but they're damaged, they're deficit, they're broken and they need to be fixed. And they seem to have absolutely no awareness at all of how hostile and off-putting that is to people with ADHD. And the fact that, again, in all their studies, less than 50% of people have an executive function deficit. And yet they want to explain ADHD strictly in terms of executive function deficits. Can't do that. It's more than half. Don't have them. The other thing is all the therapies as they try have failed to show, and here's the standard, you need detectables lasting benefit to the core features of ADHD. It just hasn't worked at all. So that's why I over, again, I'm thrilled. I work with people. I tend to see them as good people who are dealing with something that nobody's given them any instruction at all about how to deal with it. Now, if you get any ideas, it's from other people with ADHD who have written books or written articles about what the experience is. If you look at all the useful stuff that you probably look at, it wasn't scientific papers. It was other people who got it, who really understood, who really understood what you were going through and accepted you just as you are, and not broken, you're not devastated. You're a hardworking person doing the best thing here. I think it's such an emotional condition, so much more, so than the medical community I still think give credit for. Emotional dysregulation, is that part of the RSD conversation? Damn. I just go back and lay a little historical groundwork. When you're doing research, that you hope has a chance of being published because your job depends on it being published. You can only use things, what you can see, count, which are always there, and you can do statistical analysis on so you need your paper published. ADHD has none of those things. Now, after the hyperactivity dims in early adolescence and goes inside as hyperarousal, it's almost entirely an internal experience that indeed people can and do mask. It also isn't consistent. Now, just about everybody with ADHD, when the situation is just right, can flip and become totally engaged with what they're doing, hyper-focused, Wednesday, whatever you only call it. And when they do, they don't have any problems, they have no deficit. So again, ADHD is a lot of damage-brain. It's just what matters is the situation that the person's in. That's what determines whether or not they're often lowland or in a hyperfocus. So, again, it's not that people with ADHD have bad brains, it's that they have a different secondary system. What's perfectly well? Just by a totally different set of rules, techniques, methods, etc. You know, one of the questions I ask every patient is, look back over your entire life, try to pull it anywhere you can, because it's asking to be life long. If you've been able to get engaged and stay engaged with literally any task of your life, have you ever found anything you couldn't do? Dr. Lister's sort of job now, think back over their lives. That's why everybody I've asked that question too, has an ADHD nervous system? Well, saying, "No, if I can never get engaged and stick with it, I've never found anything I couldn't do." That shoots exactly function deficit theory right out the window. People with ADHD are not deficit. They can do anything if the situation's right. And that's what rejection sensitivity is. It's something outside. Well, something they perceive as being a threat, a trigger. Now, if somebody's going with their other love of approval and respect, they have a catastrophic, they're hardwired in my believe, to have a catastrophic reaction, which is the ground work is already laid from having hundreds of thousands. Objections, corrections, demands that you change. I don't want you the way you are. And also, having very high IQs, struggling with schools, struggling with jobs, knowing from those times when you're doing this that your brain is capable of remarkable things if you're not getting your access to them. That's the problem with ADHD is the traditional ways that everybody's taught, that neurotypical people get engaged and get motivated. Don't work at all for people with ADHD. No neurotypical people use importance and rewards. What do I get out of this? Yep. Ask somebody with ADHD, hook that over your entire life, treasure all the memories you can. Can you remember a single time, even once, in which the importance of the task, all myself, ever wants help to help to get engaged, overcome procrastination, get access to your ability, stick with it, or all the way to the payoff, or has the importance been nothing but a net? Just by everybody, oh god, it's nothing but I just hate it. I know it's important, but it can't get started. So, and then that's the background on which ADHD is layered. Well, good people, incredibly bright people. The average IQ of a person with ADHD is 123. That's all the IQ you need to do. You need to hang in your dark world's green without breaking sweat. Trouble is they don't have absolute access to it on demand. And so it's that lifetime of frustration, knowing that you can do better and not being able to do it. And you layer on top of that and you're all haunted, catastrophic emotional response, and it's a witch's broom. It's really the ugly thing. It's fascinating. I truly agree with you. ADHD is not a deficit of attention. I think when someone with ADHD finds something that truly aligns with who they really are, and what they actually care about, they don't have a deficit of attention, despite what the name wants you to believe. They have an abundance of attention. RSD often stops people, I feel, from starting stuff, though, from sort of opening that door and putting a foot forward because of this horrible fear of your experience, Bill, at its absolute worst, what can RSD look like in a person with ADHD? Since RSD is usually not there, other people don't understand it. They don't know what's happening inside you. And even when you explain it, they don't listen. They compare it to their own experience and it doesn't actually discard it. ADHD is always there, unabated, and so people do everything they can to avoid the occasion of either disapproval or the last feature comes in. Your own perception that you fail to fall in short, because ADHD sets you up to do that pretty much all the time. So the pattern that I've seen is it has a profound effect upon the development of personality. Personality is that set of problem-solving abilities. Their person has that when they're presented with stress or a task in life, it's what do they have to do to contend with that solvent, mastery, etc. And everybody has to do what's set, and that's how we know who they are. You know, somebody who's mounted mannered and very thoughtful has an externalization of RSD and a range at the person or situation that wounded them so severely. People say, "Oh, Fred, I didn't, it wasn't you, I didn't recognize you." So personality is who we are. It's the technical terms and the literature is the mark of the man, the mark of the woman, the mark of the child's, whatever. And so people deal with it in three ways. Some people just decide to quit. They're not going to start anything new, anything challenging, unless they're absolutely a short upfront of quick, easy, complete success. If they don't hear of that, they don't start. And so dozens and dozens of people that have worked with who have never asked somebody on a date, never applied for a job. They're grossly under-employed. And it's because just the imagination of asking somebody and being rejected, being turned down, does the thought of it is so devastating? There's no signs of it, no part of it, no longer so I'm going to stay here. And so, basically, pretty much being a slice. I love me a lot because I can't ask somebody out for a date. Another probably the most frequent one is what I call people pleaser. People learn to scan the room. They can read the room fast for them better than anybody else. Strangers come walking in and in a matter of seconds, they can take what that person likes or proves up praises or words. That's what they give them. They're constantly anticipating the needs of everybody else around them. And fulfilling that need before the person's even aware of it. And this gets some crazy. They lose track of what they wanted in their lives. It's just not a thing. It's just more what you want. I want everybody to be happy. I always say, I want other people to be happy so that they don't get unhappy with me. And when somebody gets on medication for a date, it's essentially gone. Also, they don't have to do this anymore. And when they say, "When is it my turn?" And for other people to meet my needs, and they don't. For range, for madness. Six months and therapy. The other very common one is perfectionism. I'm going to be so good and overachiever, I'm going to do the very best. Nobody's better. And most of all, I'm going to be above reproach. Nobody can find anything wrong with me. It's a trap. Because you have to keep doing it all the time. Today's audience does not applaud yesterday's performance. And it's that you're acceptance, I believe, is entirely conditional. You slip up, launch, you're out. And so, it's a very, very hard life. And you're probably somebody with a mass, perfectionist, live your mass. I feel like there's three consequences. You've described there of RSD or going through live tiptoeing around the possibility of feeling the pain that comes with it. It's avoidance. You just don't put yourself out there. It feels safer to stay indoors and not bother, because therefore you can't experience any criticism. Perfectionism. How can anybody criticise me if I stay up all night, or I stay in the office four hours later than everyone else, and do the work to such a high standard that it's completely bulletproof from criticisms? Or people don't see what it takes for people with ADHD to get by. The old saying people with ADHD have to work twice as hard for half as much. And they're willing to. What do you think Bill, the toll is on someone if they go through years of their life people pleasing? They really don't know themselves. They can tell you all about other people. They can read other people better than they know themselves, because that's what they do all day long. And so when they finally don't need to do that, there's a huge emptiness. First of all, they mourn their life to that point. What would my life have been like if I had only known them? And if my parents had only done something back when I was eight. And so there's a real morning of that. Usually at last six days, weeks, something like that, it's a reactive grieving. And then most people twit fairly suddenly and again, people accused them of being bind-polar to where they said, you know, I regret my life to this point. And henceforth, I'm going to lead a life without regret. I'm going to do everything I want times wasting I'm going to lead the fullest life than that's in the morning. And I'm so okay. With treatment, and you get rid of having to contend with R.S.K. It frees people up tremendously to do what they always wanted to do. Now most people, none say three out of four people really don't know what they desire. I have no idea. They're fourth to do. And so, to those folks, I put it around and ask them what you regret. I'm having a good guided, affected imagery. Imagine yourself you're 85 years old sitting on the front porch in a rocking chair with a lifelong friend. And he starts the following sentence. You know, knowing all that I know now at the end of my life. If I were to have led my life without a single regret, I wish back in 2025 I had any sense of the sentence. Most people don't know what they want, but everybody knows what they regret. And usually it's not something that they regret that they did is forget what they didn't do that when the opportunity was early that passed by. Yeah, that does not help people to make that 180 degree time. They didn't touch for themselves. What do you think some of the biggest regrets are amongst the ADHD/RSD community, if they were to have that conversation? My sincerest apologies for interrupting your hyper focus, but a quick word from our sponsor. 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I don't think the biggest one, and the one that's hardest to talk about, is that they never feel truly loved just as they are. They never feel truly chosen. If they're married or something like that, they feel that their partner chose the mask, because they never show them the genuine person underneath. And so it means that they have to go back and other things accepted themselves as having a second type of nervous system, and dealing with all that that means when we are a nervous system, neurology is destiny. They have to go back and re-evaluate everything, and re-understand their own lives with that important piece of information. And so that's probably the biggest thing. It was, they're not sure if they'd ever been loved. Now they might have been, but they know that what the person saw was not truly down. I think that's probably the biggest. It certainly sounds like it, and it's heartbreaking. It's totally heartbreaking. It's one of the impairments of ADHD that nobody talks about. Or a issue, nobody in science, medicine, book writers, and stuff like that. They're taking to the things that they can see, and research, and stuff like that. And not the stuff that's really important to people. It's not important to people's lives. Many people having that conversation when they are 85 with a lifelong friend, Bill, I'm sure many will have conversations saying similar of I was called too sensitive throughout my life. And I'm sure lots of the audience have been called that. Why do you think being too sensitive is seen as a negative thing? We'll start with the tip. Things back to high school. Who are the popular people in high school? They weren't the smartest. Often they weren't the prettiest. They weren't the most accomplished. It was the kid who was confident. K seemed like he or she'd looked like they knew all the answers to life problems, which of course in high school nobody feels that way. But it's so attractive to find somebody. It isn't hope. Now if you're around and maybe you've rub off on me, again, it's that self-possessed confidence. So the flip side of being just totally knocked off your feet. Help us. Not being able to even crawl out of it. Being thought of this childish immature deficit fraction is the exact opposite. People avoid that. Why do third graders have no friends? One reason. Because of their emotional explosions. Nobody, no other kid wants to be around that. They can put up with the impulsivity, burden, things out. Not being insisting. They can put up with that. If the emotional flooding that hits kids with ADHD ends up having them ostracized. It comes quickly. Whenever I have a parent that said, "Oh, I don't want to put my kid on medication," I said, "Look, your kid is already suffering. You just haven't talked to him about it." Then they're asking. Now, one of your departments has ADHD. Last one is genetic. At least one parent has ADHD. Go and talk to them about what it was really like growing up. And then come back and tell me that you don't want to give your kids some protection from that. Pills are all making them labeled. Your kid is already labeled. As an ADHD kid, that kid is out of control. That kid is of noxious and disruptive. He's already labeled. Help them with holding treatment or holding recognition of what's going on and with holding your educated help is what's damaging him. There's nothing more damaging in the end than being given a lifetime problem that nobody's talked to or had a handle and somebody's leave you alone with it. That's from damage, of course. That's for despair, of course. At that young age or any age with RSD, do you notice a difference in how it presents throughout the two sexes? If there is a difference, all these guys, we'll not talk about, but if they internalize it, they see it as a senior masculinity. What they can tell you about is when they ex-turnalize it and males tend to externalize much more than internalized toy women do. And basically, they get slammed, no one in a white rage at the person or situation that wounded them so severely. They're loosely associated with business where the courts mandated people for anger management treatment from domestic violence, from road rage, that sort of thing. I just have to do a screening checklist for adult ADHD. And 50%, or almost exactly 50%, had previously unrecognized ADHD and RSD. I mean, that's the impact. It's 50% of domestic violence, 50% of road rage, court have been prevented with proper recognition and treatment. So these things have their fingers everywhere in life. Now, nothing remains unchecked. So again, it's the domestic couple, where one of them, when they perceive disapproval in the other person's face, just either clamps or explodes. And it passes. They're humiliated by it. They apologize for it. I'll never let that happen again. And of course, the first time they imagine they see disapproval on their older face, happens again, because they don't have control of it. It's not a matter of willpower. And the other thing is, people don't see it coming. They can't prepare for it. They can't pull together all the things that they've worn to deal with strong emotions. Boom, they're overwhelmed. They're done for. How long do you think an episode of RSD lasts within a person? From that point of unpredictable trigger, explosive rage, sadness, from that point, how long do you think it takes until they're completely over it? Well, it's really like 20 minutes. It's what I hear from my patients. More typical is the couple of hours. And usually what the person does is they can find solitude somewhere. I have people just going to the broom closet just to get out of people's sight. And let it run its course. For some people, it lasts until they get asleep and they wake up the next morning and it's gone. Some people have lasted the next day. I have had people that never came out. I had one woman who was rejected on the day that she thought she was going to be married. And when I saw her two years later, she was still in an RSD episode. I mean, she had just suffered agony for two years. Because it's funny since where she had a clear onset. Stop something, scratch all the time. And it hits. And with her, every time she'd think of what happened, she was back there. Again, it's almost like a flashback in PTSD. In fact, I personally went outside and took the difference. But again, you have to talk to the person. I don't know what's going on, but you do. Now, take that instant and expand it and tell me exactly how it happened. And it's usually very clear. Well, so Fred thought of him, thought of what happened. And it hit me and the pain was just as frozen, better wise, two years ago. Can RSD be comparable to PTSD? Can the effect of those 20,000 horrible extra comments in your early years? Can they compound and to create a similar effect to PTSD? Absolutely. Just a real splitting in hairs. In my experience, thousands of promise to your life don't cause ADHD. They make it much worse. Again, the two of them together are just dreadful. But again, it's when you get nothing but that type of feedback, and it hurts. I mean, over a knee bite, but it really hurts you if you have rejection sensitivity. Damage. It can't help but change the person, the how they view themselves. And, you know, so there's multiple, you know, death of a thousand cuts type of thing. It makes it much worse and people become victims. For the possibility that somebody is going to hurt them. And so they tend to over, interpret, over, respond. Very benign statements. Very constructive criticism. That's being devastated. Now, your boss asks, you know, can I talk to you on private? And you don't know the context or anything like that. Everybody with ADHD says, I'm in deep trouble. I have no idea why. We're in deep trouble. He's telling me he's fighting me. He's, again, testing me out. And so, you know, something doesn't go so there. People with ADHD go through it in their head. Dozens and dozens and dozens of times. It sounds totally exhausting. And I imagine, do you think RSD plays a big part in the breakdown of romantic relationships? And if so, what might be a good remedy if there is one for managing RSD as a romantic couple? One, nobody likes walking on their shelves constantly. Because the response is to me, you wounded me with what you said. It comes back to them as an accusation of your back. That's not good to any healthy relationship. That means that the other partner, all of a sudden, has to wear a mask. They can't be authentic. They have to be checking every word, every tone of voice. And yeah, it loses all the spontaneity, all the jealous. And again, especially if that person is a wonderful, that's not been told what the hell is going on. Harvard knows, you know, this is my crazy ex-girlfriend type of thing. So yeah, it's disruptive. And amazingly, it's also disruptive between the ADHD parent and their children. You know, all they've seen in terms of parenting is what happened to them. And so they respond to their tears, and exactly the same way. And they hate themselves for it later. So in an ideal role, parent would get the diagnosis, but beyond diagnosis, find out what it really means, because our diagnostic criteria is set. That doesn't take anything of what it's like to live that way. Warn all the implications for their own lives, get on some medication that helps the majority of people turn what they call emotional armor. And you still see all the potential rejections and things like that going on that went on last week, but now they bounce off without wounded you. And that's tremendously true. So then they can turn around and be the parent to their child that they wish they had when they were growing up. It stops a generational pattern of destruction. This is a really interesting bill. I want to talk about the medication that can potentially help RSD in a little bit. You said ADHD, you're bored with it, you die with it. Is RSD potentially though a concoction of ADHD and some form of PTSD that comes from all of those criticisms? As I said before, I think it's both. That group of conditions in mental health that come from what happens to you, not how you're genetically predisposed, none of those things respond to medication. They've never found a single medication that makes PTSD better. Not one. Aceric, to believe it, they are soft, the military has been probably foremost in that because they have the most trauma times people. And basically we have nothing. One thing we know is giving benzodiazepines makes it worse, but a lot of things will make it worse. Now what works for PTSD is trauma informed psychotherapy. Or somebody really gets what it's like to have had multiple repetitive traumas when you're a defenseless type, especially. In an ideal world, that trauma informed therapists would also be ADHD informed. That's what all. Because people, I think the prevalence of PTSD in the general population was six percent, something like that. And people with ADHD is, depending on what study you read, somewhere between 60 and 70 percent. And for women, very commonly, this intimate partner violence that is so damaging, and going back to the blood detectives has a couple. So it's telling to help somebody that really understands you, except you're just as you are, so you can take off that mask, relax, be yourself, have a luxury, that is, after a lifetime of being on guard. And so the other things that help PTSD in particular are some of the somatic therapies on EMDRs, particularly good. So it's not medication that helps that. Now medication has a profound benefit for the majority, not everywhere, but the majority of people with ADHD. So to me, it's two ingredients, which is broke, the people with ADHD have to deal with without an instruction book. Is there a medication that can help with RSD specifically? Yes. I stumbled along to it. And there's a second group of medications besides the stimulus, it's called the non-slame illness. And really, I don't have a name, to most people. Medical name is alpha-2a adenis. Again, the real tongue twister, ADHD seems to have tried that. But in the United States and in the United Kingdom, these medications are approved by our government regulatory agencies for the treatment of ADF state. So I mean, they're well-known on the camellum market as blood transfer medications in the 1960s. So we got 65 years worth of experience with these medications, and nothing new is going to come out and buy us at this late day. They're extremely safe, well-tolerated, and blood pressure medications. They've been replaced because we've had better things to come along. And so now, almost exclusively, they're used for the treatment of children and adults with ADHD. And what they're doing is they address the hyperactive impulses components of ADHD. The stimulants handle performance. They really would produce tractability. And that's so good for empathetic, not so good for hyperactivity. And for that, we add in the alpha adenis. Again, when I'm thinking about using an alpha adenis, I ask four questions. I'm big of questions. First thing I ask is the definition of RSD. I ask if that's clean, or I can tell you, I ask more to sleep like. About 75 to 80% of people say, "Dunk, I'm a night owl." When the sun goes down and it gets so dark, everybody's getting ready for bed. I get a burst of energy. And it's the best time of the day. My mood's best. My energy's best. My attention's best. And everybody else is gone. So I'm not being distracted. I can do what I want. And I know that if I get into bed at a reasonable hour, I can't turn my brain and body off to go to sleep. Tossed, I turned my mind, jumped from one thing to another. I replay all of the humiliations of my life and the technicolor. And that goes on until somewhere between two and four in the morning. When finally, do go to sleep, when they try to wake up in the morning, it's out of the sleep of the dead. It's really hard for people with ADHD to wake up before you're learning to engage with things until about noon. So the technical term for that is chronic delayed sleep-based syndrome. Anything that takes a whole breath to say is usually a fairly simple concept. And that is people with ADHD want to sleep a nice little hour sleep-based, is they want to do it from 4 a.m. to noon. Properly, there's a very few school jobs, relationships to tolerate them. And again, the paradoxical thing is it goes away when you treat the ADHD. And I also prevent people from going to other things to treat their insomnia, marijuana, alcohol, barbiturist, that sort of thing. Third question I ask you is, look at how you think. How many simultaneous things, but completely separate thoughts, do you have going on in your head at any one time? Well, at least it doesn't. I've never heard anything listen to it. It's not the only one thing to another. They have three things, they're thinking about at the same time. Again, it's like being in a room and having three to five people talking to you on different subjects, at the same time, demanding that you listen to them and to respond is maddening. Now, they offer agonists when they work or do said to what thought, I just thought that you want. The last question I ask you is, can you remember a period of time, any time in your life? Well, I'm going to think about five minutes and not grugging days back in your wild and well used, in which you have been both mentally and physically at peace. Peace is not a very scientific word, but it's the right one. Most people say, no, my brain is always done, it never lets us. Some people do report that when they're alone in nature, then they're not just now. They want to thought at a time they're peaceful. The otherwise peace is a fairly rare experience for most people with the ESP. So those four things get much better, I'm sure it, with the alpha agonists. The problem with the alpha agonists is that most dogs, even in mental health, don't even know they're there, much less how to use them. Second thing is that the individual response rate to any one of those medications is disappointingly well, at about 30 percent. So if you took 100 people, you started them on whichever alpha agonists, I was lucky with that day, 30 percent of people would have a life changing experience. But 70 percent of the majority of them, what was that? At that point, you stopped the person, you tried the other one, and there's another different 30 percent of people who will get that old wow, where you've been in your life. This is what actually I get more benefit out of this now, do the stimulant. Unfortunately, that still is 40 percent, who tried most medications sequentially. And unfortunately, don't get much benefit. If a person is really, really impaired by their rejection since they've been, I mean, they're not getting old with their life. Now, I will try the old medications from back in the 60s, the monounmene oxidation inhibitors. They work great. In fact, they work better than the alpha agonists, they're just a royal pain to use. And you have to be as old as I am to have ever been trained on them. But they're still the very best antidepressants, very best anti-anxiety medications that have ever come on the market. It's just their pain. They're difficult. And why are they difficult? Two reasons. One is that originally foods that were aged rather than cooked had an amino acid called tiramide that came from the aging process. That usually the body the story is necessarily the story that ends the story by an enzyme called monounmene oxidation, was you inhibit that enzyme. It gets the first thing the body does with it, it turns it into a adrenaline. And also, you have a huge blood pressure, spikes, and several people in Europe, the reason why I just in Europe, had strokes and died, scared the big Jesus out of people because they didn't know why it was happening. Now we know it is charming and that a person eats a balanced diet. They don't excessively eat you know, really expensive teas or something like that. They don't have to make a difference in change in their diet, perfectly size. The other one is that the MAOIs are fairly strongly surging or they really boost the serotonin side. It's part of why they work as though I was anti-depressants. But if you add that in on other drugs, where a VA boosted in serotonin, such as the SSRIs, SNRIs, and just for more forcing, which is the most common costs, there's a list. You risk getting into what's called serotonin syndrome where you're basically your muscles just lock up, dip this board, this orient, sweating, blood pressure bounces all over the place, and again, there have been deaths reported. Well, usually when you tell people there have been deaths reported, that's the end of it. I don't want this. But when you use them, most of that 40% that's an even better response, ultimately you can get close to everybody having some sort of relief from our state. The group of medications that really then become a problem is, you can't take any of the stimulants with it. So, but luckily, one of them drug-cultural supermeans is only one atom different from antithetomy, and it works very well to the treatment of ADHD. In fact, there's a study, more than by Janie Mallins and Matthew, who's a really big name back when I was in my residency, where he looked at multiple oxidation inhibitors versus infarming and found that they worked equally well. So, again, you have to find somebody who's really deep into treating ADHD well, and I can name those people on the fingers of one hand. I want to expand on something fascinating you said earlier, Bill. You said that RSD can cause people to avoid other people or avoid putting themselves forward because of that fear of criticism. And the expansion is, can that avoidance associated with RSD? Can that cause things like agrophobia or OCD? It can be missed for that. Not so much OCD, but certainly agrophobia. And especially social anxiety disorder. Social anxiety disorder is an intense anticipatory. So much for turning off my phone. Social anxiety disorder is an intense anticipatory fear for the environment that I'm either going to say or do something that's going to humiliate me and for a lot of other people. And even if I perform perfectly, everybody's going to be scrutinizing me just waiting for me to make a mistake and then they'll jump me. Now, when they get into the situation, most of that anxiety goes away. It's always before the event. So you can say how that fear of rejection, fear of humiliation, et cetera, could be mistaken for RSD. The difference is that RSD is triggered. So that's the event. Everything comes out. So they look like the timing is totally different. And at some very fine point, let's how you tell the difference because they each have different treatments. Interestingly, very best treatment for social anxiety disorder is back to the M.A.O.I.'s. They just take it away 95% of the time. Again, most docs, none of them need, have never, ever prescribed it, never been trained on it. They're afraid of it. I mean, they have these irrational seers. They have to find an old concert like me, who has experience with it. The other place is, you know, if you have a DSM or just get online, look under the access to personality disorders and find avoidant personality disorder. And you will see an exact description of ADHD. So, again, it gets mistaken as personality disorder. And before medications, if someone isn't quite able to get those, do you have any tools to stop RSD or at least, perhaps, mitigate the reaction or overreaction that might come with that overwhelming sense and feeling of rejection? Absolutely. Now, just generally speaking, the therapeutic one star is D is prevention, prevention and lower prevention. So, once it's happened, you're done and used that for way forward to trans course. So, if you're running on 10 out of 10 all the time, that's going to be exhausting, debilitating, learn to lead a life in balance. Take good care of yourself and pull that, of course, is getting adequate sleep. Everything is better when you had a good night's sleep. Also, you have to take time away when you're feeling stressed, leave it, but somewhere else, you don't get mad at yourself, get relaxed before you go back in. Again, it's basically just leading a life in balance, know its facets and things like that. Know on self-medication, and one of the progress used by people with ADHD is their attempt to medicate ADHD on the run, especially with a hyperactive component. This is a digression. If you ask somebody who has substance use disorder, what do you like about your substance? What do you use? What are you sure it's going to do for you? People who are just not ADHD or addicted drugs are after the high. We have buddies who feel great, we go out and get around, we have a great time. That person don't want to talk about people with ADHD will tell you, "Well, I blew a bowl of dope so I can slow down my brain to study." So I can slow down my brain and body now to fall asleep. They're using it for adaptive purposes. They're using it to lead life better and in more balance by some doing the impulsive hyperactive component of ADHD, which is a whole new person to you. But take good care of yourself, don't get pushed to the edge, don't cry so hard. I have a magnet on my refrigerator, I always do on it. And so remember that all the corpses on Mount Everest once are highly motivated person. So let me think about calming down more. It's an incredible advice. So that was really interesting, Bill, about the non-ADHD addict chasing the high and the ADHD person, perhaps chasing the low. I've spoken to many alcoholics who have ADHD and alcohol is the only thing that quietens the mind. They're not drinking to go out and party, they're drinking to turn the volume down. They're creating an ADHD, but again, the distinction is always better to treat the cause of a symptom rather than nearly suppress the symptom. And so that's what other medications do, is they suppress what's going on and actually impairing you more than a bit. But the trade-offs is worth it to most people. And so that's why, again, going back to the tried and true ADHD medications, that create the cause. And that's why you don't have the tolerance to treating the cause of ADHD. They're not pushing your nervous system in any direction. It's a return to door best functioning. It's not an artificial state. So again, just a big question, because that's an important distinction. Bill, this has been absolutely insightful and truly surreal. I mentioned at the beginning and people know you coined the phrase RSD and I'm generally curious at that point in time, were you toying with any other acronyms? Like, what else could you have perhaps called it? Believe me, if I've known just how tongue-twisting the name was going to be from, I'd have searched for something else, anything else. I did try other things. And I had the sort of reactive in the name. I would have used the word dysphoria, but hand, most people don't know the meaning of that. I mean, the guy's back way back when they were doing the treatment-resistant depression work wanted to emphasize just how bad this was. So it was not normal suffering. It was not normal depression or anxiety. It was unbearable. So they wanted to put it right up there in the name and they did in Greek. They got a lot of the guys in the heart. They wanted people to know that that was the real feature that mattered was the intensity, either normal emotions, that most people felt at some time as just the sudden overwhelming intensity. It certainly is incredibly intense and I've no doubt that this conversation is going to help so many people who will be watching or listening feel less alone and less crazy because, and I don't use that word lightly, sadly, I've spoken to lots of people and that's what they have been called for many years, sometimes even by their doctors, which is really heartbreaking. I missed my diagnosis because I don't even think of it. And we were named the book we were working on. It was diagnosis, treatment of ADHD, crop diagnosis, diagnosis and nonsense together. It's now the recognition and treatment of ADHD. Because that's the problem. It's for most people. ADHD, it's just not on the radar screen. They don't know anything, I don't know if I'm trying, but they don't say, "Oh, that's me." It's for the membership, you know, anything other than the name. And the fact that it's usually mentioned in a derogatory fashion. Sorry to interrupt you. No, not at all. I was going to move on, Bill, just finally, to the audience questions. We have a section at the end of the show called The Washing Machine of Wows, where a member of the audience, it's called The Washing Machine of Wows because typically we do an ADHD item section and my ADHD item, something that represents ADHD for me is a washing machine because it's perfectly summarized. It's my issues with memory because I always leave my clothes in the machine after the cycle finishes, but I digress. This week, Bill, someone has written in and I'll read it from this card, "I have a 12-year-old with ADHD. Like any 12-year-old, she is prone to making mistakes. And, as an overprotective mother, I'm terrified I'm going to give her RSD with my criticisms when she grows up. How can I avoid this?" I was far with some basics, good grounding. And that is, except the kids you've got. Don't have any mind, something you want to make the child into. It's not going to happen. One of the things that was, again, decided science is that parenting does not produce ADHD. Parenting does not produce emotional dysregulation. Your parenting style, as far as I mean, has no effect on the development of RSD. So parents are seriously off the hook. I mean, that was one of the big productions of the MTA study back in the late 1990s. So parents, know, you can make matters worse, but you don't cause ADHD, you don't cause emotional dysregulation. So you basically accept the child the way he or she is. Don't try and change it. Notice, let's face it, that's just possible. You're saying, "I don't like you and I'm going to change you to suit me." Something that I get is, be the parent, but you want it. You desperately need it when you are growing up, rather than criticizing you when you're overwhelmed and all these ADHD things that you've been suppressing all day come out. They get home, they're out of school, and let down, and that's when parents see it. We're asking, "What's wrong with you? How can I help?" Now, I see you're a good person and you're just dealing with more than you can handle right now. How can I help? They're not leaving the kid alone with it. They're not blaming them. You're saying, "This can get better." I'm going to read about the issue about what works on what doesn't, and a lot doesn't. All of a sudden, it totally changes the dynamic on the child. You're actually, again, abuse is important, it's therapeutic. Somebody is going to get better, or at least not worse, if you have that type of response. I have always been interested in the people I don't see. People with ADHD, I have a rip-roaring ADHD, but seem to be well-justed, happy, had good solid marriages, raising good, healthy kids. I want to know what this person knew, that I didn't. The one thing that I've heard from everybody is that sometime in their life, usually in the early years, they have somebody, and it's heard from anybody. Blessedly, it was a parent or grandparent, something like that, but it could be a special teacher, a coach, a neighbor, it doesn't matter who it is. It was a person who gave us three-part message to the child, definitely. I know you, I want you to grow up. I don't know if anybody could have overcome what you're dealing with, through hard work and intellect. I know it would have been you. You're a good person. I know you have known you for a long time, and I know you've thrown through your good, hard work in the person. This is not to fault, it's something you're dealing with almost as if it was outside. Second thing is, we don't know exactly what you're dealing with. And so we will find out, we will master. Third part, and I want you to know that until we are pulling master, I will be with you. We'll go through this together, we'll talk with each other, we'll help each other find out what works and what it doesn't, until you overcome and master this. The message of hope in the future, but most of all, again, I've hit this several times in our discussion. You don't leave the child alone with an insolvable problem that everybody demands that they solve. That person keeps the child alive. That person acts as the vessel that keeps the memory of them as a good person who tries hard. It's not the bad kid. Even when the kid forgets that, they know this person never forgets. They're also gonna have to be alone. Even if we don't figure it out, I'm not alone with it. That's what makes the difference, and that's why some people with ADHD are able to take that and internalize it, do it for themselves, and who on we are perfectly good-life. It takes a long time to get it wrong, but you know, apparently they've never had the need for a prime medication. That's the parents to me. Really, really, really powerful advice bill, and I've no doubt life changing for many of the people watching and listening, so truly thank you. As I said at the beginning, this has been a surreal experience for myself personally. I considered you to be one of the ADHD royalties. You truly are. On behalf of everyone grappling to understand their brains and from me personally, thank you very much. It's really my pleasure to be here. Thank you for inviting me.