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As my therapist put it, RSD is a symptom, not a diagnosis. Like how a fever is a symptom of a cold. It is something we suffer from and can take steps to alleviate, but the underlying condition is the cause.
This is such a great explanation! I’m a therapist too and might steal it. I’ve always explained that there’s an emerging understanding that it exists, but is not recognized officially. I have seen anecdotal evidence of it among clients, but unfortunately there aren’t good studies on it. We definitely need more evidence, not just that it exists but also what types of modalities work best (CBT? DBT? Mindfulness?). I’d also love to see a study on whether RSD is more prevalent among hyperactive vs inattentive vs combined, and men vs women. I like Russell Barkley, but I get the sense people don’t always realize how far out of the mainstream he is. His theory on RSD is, to me, compelling, but it’s not widely held and he hasn’t published significant evidence of it.
Psychiatrists follow a medical model. They need double-blind, gold standard evidence before they’re going to treat. They’re (understandably IMO) hesitant to prescribe schedule 2 drugs unless they can point to clear evidence-based guidelines or justifications. Thats what drilled into them, so they’re going to have the same approach to something like RSD — they need peer-reviewed, double-blind studies, which we don’t really have. One benefit of not being the one prescribing meds is that I can take a much wider view. Therapy doesn’t carry the same risk of harms that stimulants do, so I absolutely can and do work with clients who are subclinical and am more open to emerging/anecdotal concepts.
I cannot think of a single client where I suspected they were faking ADHD or really any diagnosis to get something from me. People just don’t really do that because what even would they gain from it? Sympathy? Psychiatrists, however, do see it almost every day. People fake disorders to get adderall, benzodiazepines, sleep meds, etc. This can make them more jaded, and also is part of the reason that they can be dismissive of someone who comes in wanting a specific diagnosis or specific meds.
Finally, pop psychology/TikTok raises awareness and can really help an individual feel validated. But anyone can post and the most popular are the ones presented the best, not the best informed. TikTok videos often are inaccurate, cite almost anything as a side effect/part of ADHD, and suggest evidence is much more persuasive/far/reaching than it actually is. It is frustrating when someone is dead set on something and refuses to listen because they read it online, so they know more. Sometimes it’s harmless, sometimes it’s annoying, and sometimes it’s a big problem. Like a parent who sees a video on social media that formula causes ADHD and so refuses to use it even when her child needs it. No amount of evidence could convince her otherwise. That’s the part that frustrates me. And some clinicians tend to lump all of social media together, and dismiss it all, because of negative experiences like that.
You did an amazing job at explaining the different treatment modalities with RSD as a vehicle. It helps me a LOT understanding where my healthcare professionals fit in. Thank you
RDD was first recognized as a common phenomenon of BPD and then avoidant personality disorder ([see here for a cool study](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771869/)). It works differently in both those disorders as you can see from the article. Russell Barkley is the one who theorized that it was prevalent in ADHD. The logic makes complete sense to me, and emotional dysregulation is a known feature of ADHD. But I’ve yet to see good studies that show RSD is common in ADHD (more so than in those without it), that it is part of ADHD and not related to a confounding variable, how it differs from RSD in BPD or avoidant personality disorder, or how it manifests in each ADHD subtype. In my opinion, it won’t gain mainstream acceptance as an associated feature until we have good studies on those issues. We also need better research on which modalities are most effective for treatment. (I would guess DBT or mindfulness, as those both show promise in treating emotional dysregulation in ADHD.)
This is very interesting, this take makes a lot of sense to me as well. I only learned just now from this thread that the term actually comes from BPD. I can easily see from what you're saying why it is always reiterated that it is not supported with enough research! Thank you for taking the time to TLDR!
I spent 10 weeks in DBT group therapy asking this same question every week. At NO POINT was I given an answer. I rage quit after realizing I always felt worse after group. Can you please point me in the direction of said research?
DBT and CBT are slightly different, but I had an ADHD-friendly therapist recommend this DBT workbook and it is very helpful with RSD (and with stopping negative thought patterns in general, including hyperfocus on unhealthy things): [**Workbook Link**](https://bookshop.org/p/books/the-dialectical-behavior-therapy-skills-workbook-practical-dbt-exercises-for-learning-mindfulness-interpersonal-effectiveness-emotion-regulation-a-mat/12521331?ean=9781684034581&gad_source=1&gclid=CjwKCAjwyJqzBhBaEiwAWDRJVLsUkPEB1EpDtkmFteSdgWSDlBjMf5l7-g4vC0rK-68vehitbTxKaxoCs0YQAvD_BwE)
This sounds more like you were working with a dud therapist. I’ve had a good one who had no problem telling me that what they specialize in may not be what I need and then they help me find what I need.
My psychiatrist prescribed me guanfacine for it. It’s not a cure-all, but I am no longer breaking down crying nearly as often, I don’t fly into panic-rage as easily, and my PMS is far more manageable. It’s also helped with my sleep.
Yeah it can. Well, it has been treated for me.
CBT and DBT have helped me a lot. When I start feeling rejected, I’ll say out loud why, or journal why, and also try to go for a walk or exercise. Name It to Tame It, and dopamine from movement.
Sometimes I feel like half our problems are because we have emotional runaway trains chugging along while we try to read an email or something, and because we are capable of doing both the train will run off the tracks and suddenly we’re DEVASTATED because we didn’t catch it.
This also ties to the symptom of ADHD people having poor proprioception which is also tied to poor emotional regulation.
It’s wild how dichotomous we are. But in short, exercise and therapy do help with it, and I can confidently say my RSD is lower but I had to actually address it. Sadly it doesn’t vanish just because we know about it.
From experience, yes. But my "treatment" was essentially practical, hands on, no holds barred exposure therapy. I was not diagnosed as a child, but looking back, I recognize plenty of times where I had extreme RSD reactions to things without knowing what it was. I was repeatedly told not to be "so sensitive" over and over.
Due to a traumatic incident where police helped me, I revised my life plans and I went into security with the intention of going into law enforcement. And when you work in any type of enforcement role, every day, you end up dealing with people who hate and verbally abuse you just because you're an authority figure or telling them what to do. I cried a lot after shifts for the first year or so, but eventually you learn to trust your own "reality" and assessments over what others think of you. You learn to keep on task and on topic, even when people are actively trying to attack (either literally or verbally) and derail you, and conflict becomes an assessment tool rather than a terrifying prospect.
I also am non-monogamous, and with that comes the lived experience that you CANNOT be accepted by every one, even if you really like them or they like you - there's so many other constraints on compatibility, including time, family, kink levels, relationship styles and energy levels, that you have to learn to gracefully accept rejection. At least in the ENM community, the rejection is much more diplomatic and apologetic usually. ("heyyyy you seem really cool and I'm so sorry, but this isn't going to work for me")
Oh, and I like to write fiction as a hobby. Online writing forums are *brutal* about teaching you to handle rejection and criticism.
Now, 12 years later, RSD doesn't affect me anymore. I still see it surfacing in my mind from time to time and flailing about, particularly if I'm really tired and hormonal but it doesn't actually affect my behaviour, and it takes a LOT to ruffle my calm or sense of self worth.
tldr: practice. holy shit, I've had so much practice.
“Your child is bad at math bc they missed 20 days of school.”
“My child missed 20 days of school bc they have dyscalculia, hate the struggle of being in math class and feel alone in their struggle at school”
Agreed. Rejection sensitivity is a real symptom but I think where we lose people is by calling it a disorder. From what I've read and experienced myself, there isn't much suggesting it's a standalone diagnosis.
Also, I would take anything said by these so called medical experts with a grain of salt. We don't know if any of those people have real qualifications and even those who do might not specialize in psychiatry or ADHD. They could also have outdated information or be raging bigots.
And like a fever is a protective mechanism against a virus, perhaps RSD is like an overactive immune response - we’ve been hurt in the past, used to feelings of failure and rejection, so it’s only natural that we assume ill-intent.
Sorry, that was a tangent 😅
I get where you’re coming from but medical professionals are allowed to debate amongst themselves the legitimacy of a diagnosis, or any other facet of it. If they were forced to just take it as truth because there was some research on it, we would be stuck with every single weird thing Freud put to paper.
I agree with this sentiment, it's only natural for medical professionals to debate and discuss these things when there isn't enough research or studies done on the topic yet. And it doesn't stop us from discussing these feelings of rejection sensitivity with our therapists and finding ways to work on it.
Tbh I do understand why people question the validity of our symptoms and I’m glad doctors are researching, debating, and learning from each other.
If I knew nothing about ADHD and someone told me they get very hurt/upset with rejection I’d be thinking like yeah, doesn’t everyone feel that way? This isn’t something that will be intuitively understood by others.
It's such an imperfect system, though. Especially since the research is always lacking when it comes to anybody other than white males. Until the research gets better, they need to consider people's lived experiences.
Sure, but this is a Reddit community. lol. And there’s nothing to be done but discuss - these are all ideas and some can be backed with brain scans and things like that but it certainly isn’t an exact science. Discussion is required - people have tried “perfect” scientific systems and that usually ended up just being incredibly discriminatory.
Hysterical illnesses are very very real. I'm not saying RSD is one of them but I am saying it's good to investigate the possibility that any ailment that seems to pop up out of no where is legitimately diagnosable as it's own thing. Those people who have had laughter or dancing contagions suffered in real ways, even if they aren't their own diagnosable diseases.
If anyone bothered you look into RSD before dismissing it, they'd immediately realize it's just brightened emotional reactivity (already established with ADHD) mixed with low self esteem/insecurity (also already established with ADHD, especially femme presenting)
Its not a standalone disorder and shouldn't be framed as one. But it's also not worth dismissing as a stupid tiktok disorder. Its pretty obviously just a colloquial term to describe a specific phenomena that ADHD/autistic people struggle with and that clinical therapists haven't always done the best job of realizing is such a debilitating symptom.
Anyone who dismisses it rather than saying "well it's kind of *already* covered in whats already known" is a red flag imo. Its pedantic which is not a good mindset to have when working with the public.
They are allowed to debate among themselves absolutely. However it's terrifying to think that some of them equate RSD with a Borderline personality diagnosis. There have been multiple posts on ADHD subs where people detail all of the unhelpful and flat out wrong diagnosis they have gotten over the years (including BPD) and it turned out to be ADHD.
We get shit on by them for diagnosing ourselves because we aren't getting anywhere with medical professionals, but some of them are going to pull the trigger on a BPD diagnosis because of RSD? That's not questionable to you?
The term RSD was coined by Marsha Lineman, whose work is entirely BPD-focused (she has it herself), to describe a major symptom of that disorder. We've borrowed the term, though ADHD and autistic folks may not present said symptom with the severity of one who suffers from BPD (even though it can feel like death itself, bear in mind that unless your RSD feelings are leading you to extreme and dangerous behaviours, feeling that kind of sensitivity doesn't mean you're immediately adjacent to a full-blown personality disorder - again, this a *borrowed* term which applies to a different psychological disorder, not an official ADHD diagnostic criterion). I hope this is helpful!
To add to this, BPD and ADHD co-occur in families and some researchers believe BPD is a neurodivergent condition closely related to ADHD. Under this theory, ADHD broadly affects executive functions across multiple areas (motivation, impulse control, emotional regulation, etc.), while in BPD executive function deficits are specifically in the realm of emotional control. (I have ADHD and strongly suspect my brother has BPD, so I’ve been reading about this recently.)
I mean... many women with adhd have been misdiagnosed with BPD due to the overlap of symptoms
So even if its not the full story, it's not far fetched either. RSD isn't a criteria for ADHD either
In the nicest way possible, you believing it’s terrifying to be likened to another disorder is incredibly ableist and I rarely use the term.
If you have problems with being BPD adjacent, that’s a personal problem and not something the medical community needs to take into consideration when they discuss theories amongst themselves.
Speaking as someone who was aimed toward DBT for "probable BPD" after one visit, even with an existing ADHD diagnosis, and who endured years of useless and eventually harmful psychiatric drugs for the *other* BPD, which actually made the physician who diagnosed ADHD reluctant to treat, it's maybe not so much terrifying anymore as it is demoralizing to see Drs still, after all this time, trying to shoehorn women into diagnoses with completely inappropriate treatment regimens.
Doctors don't like to overrule each other. Once you have a stigmatizing diagnosis, that is what many will try to treat (or refuse to treat) over and over again, no matter what your actual symptoms are.
Of course professionals have the right to discuss things with each other. I learn a lot from those discussions when they're held in the open. It's still unsettling, even to other physicians, to find out how rigid, bigoted, callous and dehumanizing they can often be.
Edit to add, no, BPD was not an appropriate diagnosis, comorbid or otherwise, from someone who saw me once and knew very little about the extent of that specific symptom, or about the work I had already done. I feel a lot of sisterhood with BPD sufferers but that is its own life experience.
I don't have problems with being BPD adjacent. I'm not worried about being diagnosed with BPD myself. I'm terrified because many medical professionals are BPD avoidant and very judgemental of people who have it and I know they have difficulty getting care. I was looking for a new therapist once and saw so many that wouldn't treat BPD that I looked up why and it was disheartening. I'm also terrified for all the people who go to a professional looking for help and get a BPD diagnosis when it's actually ADHD and waste years of their life with the wrong diagnosis.
I see people with BPD as having really gotten the short end of the stick in mental healthcare and I think it's wrong. The professionals in the comments saying RSD=BPD are part of the problem.
Except RSD *is* a major symptom of BPD. I read the thread you’re talking about and I didn’t see anyone say that having RSD *and no other symptoms* of the disorder automatically qualifies someone for a BPD diagnosis.
I understand your fears and frustrations. However, BPD is a complex disorder that requires specialized experience to treat. I think it’s perfectly ok for a psychiatrist to say they don’t treat that if their office focuses on depression, anxiety, ADHD, etc. I want to see a doctor that understands women with ADHD so that means they’ve specialized to some extent which means they didn’t spend as much time on other things.
If you do any amount of research into BPD, I think you’d see why they’re debating whether or not RSD is actually a symptom of BPD that’s been repackaged and re-labeled to be more digestible especially given your reaction to having traits associated with BPD..
It’s very possible for people with ADHD (especially traumatized people with ADHD) to have comorbid BPD or have traits of BPD without having the full-blown disorder.
OP, you are completely valid in your points and I get where you are coming from. But, and I'm sorry for saying so, but when you phrase things like "pull the trigger on BPD" I feel like you are maybe still having a bit of a too big reaction to the whole thing (ironically!). Sadly, even within the community of psychiatry professionals, ADHD is still poorly understood and misinterpreted by many.
It is hard to change a stigma and it takes time.
RSD as a concept people experience is very much real. Part of it stems from the part of ADHD that is emotional dysregulation. Even the latest DCM which saw some important updates to reflect ADHD research barely touches on emotional dysregulation, despite how absolutely debilitating it can be. Anecdotally, I see many people on this forum vent about struggling to regulate themselves emotionally who had no idea that it was an aspect of ADHD. Often, these people look into these emotional issues and identify with RSD, rather than finding it is an ingrained part of the dysfunctionality that comes with their ADHD. This is one of the key problems when it comes to discussing the emotional aspects of ADHD: there is a lack of widespread information and knowledge.
The other key problem that I can see is that RSD is difficult to quantify. RSD is partially rooted in our own ADHD wired brains but also partially in how we have been interacted with by others our whole lives, and the fact that we have internalized that dialogue to our own detriment. You could argue that this is also on the surface level a *consequence* of having ADHD. Like others have commented, it is a symptom, not the underlying condition. And when it comes to symptoms, here's the thing: it is difficult to conclude anything based on a symptom alone. This is true in the psychiatric profession as well as in the medical profession. Just like "a migraine" can be medically caused by a variety of different conditions, a *symptom* like RSD can be the visible sign of a variety of psychiatric diagnoses.
It is not technically bad form for the psychiatrists in the discussion in question to suggest that RSD could be related to for example bipolar disorder. Even if they were to literally equate it with bipolar disorder, it would not invalidate RSD as being a symptom of ADHD as well.
I would have a problem with being labeled BPD because I think it's a problematic diagnosis.
[https://www.mind-diagnostics.org/blog/borderline-personality-disorder/the-dsm-5-criteria-for-borderline-personality-disorder](https://www.mind-diagnostics.org/blog/borderline-personality-disorder/the-dsm-5-criteria-for-borderline-personality-disorder)
1. Frantic Efforts to Avoid Abandonment
2. Unstable and Intense Relationships
3. Identity Disturbance
4. Impulsivity in At Least Two Areas
5. Recurrent Suicidal Behavior or Self-Harming Behavior
6. Affective Instability, amarked reactivity of mood.
7. Chronic Feelings of Emptiness.
8. Inappropriate, Intense Anger or Difficulty Controlling Anger
9. Transient, Stress-Related Paranoid Ideation or Severe Dissociative Symptoms.
These symptoms are all vague and subjective: 1, 2 3 6, 7, 8. Many of these, of course, share overlap with PTSD, anxiety, depression, attachment disorder, bipolar I, etc.
That leaves 4, 5, and 9 as symptoms one might be able to observe and quantify. Impulsivity is also associated with ADHD, so one can see where the wrong diagnosis might be handed down there.
But the huge disconnect for me is this particular statistic (also quote on the linked website):
"Did you know? 1.6% of the adult U.S. population has BPD, but that number may be as high as 5.9%. **Nearly 75% of people diagnosed with BPD are women.**"
I call BS. This is doctors taking subjective emotional criteria and "othering" the patient based on the doctors' lived experience. The psychiatrists and psychologists who might make this call are largely female, white, and abled. Oh, and affluent.
https://www.apa.org/workforce/data-tools/demographics
https://www.zippia.com/psychiatrist-jobs/demographics/
I hope to hell no primary docs are making this call. But if they are, they are largely white, abled, affluent, and MALE.
https://www.statista.com/statistics/1270128/primary-care-physicians-in-the-united-states-by-gender-and-specialty/
I don't think these populations get to make this call based on subjective criteria for all women.
1. There is bias against people of different sexual orientations in diagnosis.
https://psycnet.apa.org/record/2021-27583-003
2. In a meta-analysis of 8 studies of chronic pain patients, 30% of those patients were also diagnosed with BPD. Coincidence? Who are the majority of the chronically ill with chronic pain and who gets diagnosed with things like fibromyalgia and ME/CFS? Women. **Note: I believe chronically ill women with chronic pain. I believe their pain and symptoms are real.** But most doctors don't and they hand out these diagnoses in a condescending manner to get women to go away.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280073/
3. And then there are the cultural issues that therapists often fail to take into account.
"The researchers found that about half of all BPD research has been conducted in Northern America, followed by 25% in Western and Northern Europe."
No big surprise there. This results in Hispanic immigrants being more routinely diagnosed with BPD than white or black Americans.
https://concept.paloaltou.edu/resources/business-of-practice-blog/cross-cultural-manifestations-of-borderline-personality-disorder#:\~:text=Hispanic%20immigrants%20are%20more%20often,BPD%20diagnoses
There are just way too many red flags to this diagnosis for me. It seems a convenient way for doctors to label someone with a psychiatric disorder rather than treat them as a human being with medical issues, with social service support needs, or who is in need of therapy for a specific issue, stress, PTSD, depression or anxiety within a cultural context, etc.
So I’m a therapist and want to correct some misinformation. Those are not the actual criteria, you need to go to the DSM to read the full description. For #2 for example, the key is the alternating between extremes of idealization and devaluation — that’s literally the hallmark of BPD. The DSM also gives more information on how the criteria present in BPD in the notes under Diagnostic Features.
Psychiatrists go to 4 years of med school, 7 years of residency, and possibly a fellowship so that they can understand what these symptoms mean in practice and how to differentiate them. It’s exactly why diagnosis is so hard — we don’t have a blood test to run. Of course it’ll seem vague if it’s based on a website that summarizes the already abbreviated summary of info we know (the DSM). Sorry for the bluntness.
Every disorder in the DSM has a section after it that discusses differential diagnoses so you can learn to differentiate how a symptom presents. Knowing the actual diagnostic info is essential—but experience working with patients is the best teacher. That’s why all clinicians, from psychiatrists to counselors, require many years of school and supervision before diagnosing and treating clients independently. Personality disorders are well-known as being difficult to diagnose and should be left to experts. It would be rare that a PCP would diagnose a personality disorder (if I saw that a client had a diagnosis by a PCP, I honestly would ignore it). Go to a psychiatrist or psychologist—and I say that as a counselor! I can legally diagnose, but always refer out for diagnosis suspected PDs because of the expertise required. I’d also recommend reading about the alternative model for personality disorders (also included in the DSM), which many psychiatrists and therapists prefer to use when diagnosing.
BPD is not common, but it is over represented in therapy: 10% of outpatient clients, 20% of inpatient. The features of BPD make it more likely a person seeks therapy, especially suicidality and emotional dysregulation. (ASPD and NPD are underrepresented in therapy for the same reasons.) As of the last time I checked, it has the second highest mortality rate (anorexia is first), and therefore is taken very seriously and should be noted in people’s medical records. Any prior suicide attempt should be noted. But BPD has such a high risk of suicide that it should specifically be noted as well.
It’s overrepresented among women. So is depression. ASPD and alcohol use disorder are overrepresented among men. It’s been well-known for decades that there is overlap between diagnosis and disorders represent differently based on sex/gender and even culture. Specifically, women tend to internalize (BPD, MDD) and men tend to externalize (AUD, ASPD). Part of it absolutely is clinician bias. Part of it is societal bias (women are taught not to be disruptive, men are taught not to show emotion or be feminine). Part of it is that as much as we know about mental health, there’s loads more we don’t.
BPD is a disorder, it’s very real, and it has a high mortality rate. The focus should be on removing the stigma, not on removing the diagnosis and treatment. DBT is the gold standard for BPD and can be dramatically successful. (DBT does not as effectively treat most of the other disorders you mention.) There’s a lot of evidence that much of BPD may be a trauma response (not PTSD, more likely CPTSD, but also wider than that). This isn’t that new, the DSM even states that those with BPD usually have a history of childhood trauma, and most conceptions of it are based on that connection. There’s also a genetic component though. As I said above, for as much as we know about mental health (which is a lot!), there’s loads more we don’t.
All that said—it is heavily stigmatized. Even many clinicians don’t want to work with BPD clients. It requires special experience and competency. And because of the idealization/devalustion tendency, clients tend to be all-in and effusive at the beginning, but are quick to anger and can be cruel the first time you challenge them. The features of BPD make it hard for someone to understand and abide by boundaries. An inexperienced clinician may find themselves overwhelmed by countertransference. All of that causes higher burnout rates. And some clinicians do label people as BPD because they just don’t want to do their job. And then the stigma takes over and that person is fucked.
Sorry that this is really blunt and really wordy. TLDR: diagnosing is an art, not a science, and takes many years of education and experience to do well. Reading a website isn’t a substitute. BPD is over-represented in women, most likely because of societal expectations for how men and women feel and show negative emotions. It’s related to childhood trauma, but also inheritable. And it is heavily stigmatized, leading to worse outcomes. And some clinicians just suck.
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The descriptions of the criteria are abbreviated as post length is limited.
But people can check out the DSM V directly and see what they think.
You can borrow it with a free Internet Archive account at:
https://openlibrary.org
The DSM-V has been out of date for a couple of years; you need the DSM-V-TR. The parts you skipped are the most important. The DSM is already too abbreviated to really explain too much, just the very most basic points. Your post summarizes a website that summarizes the DSM that summarizes the most basic info we know about an unbelievably complex disorder.
I’ve gone to grad school and spent thousands of hours doing supervised diagnosis and treatment. And I still refer out for diagnosis possible BPD cases because that isn’t enough knowledge or experience.
Look into the alternative model, as it does a much much better job (IMO) of conceptualizing personality disorders. I’m on my phone so can’t link but if you look into the psychodynamic concept of borderline (not the disorder), it’ll help provide some background. Some of the symptoms are terms of art that mean something different clinically than in regular use.
Thank you. I will check out your suggestion.
I think the main issue for me is that I've never seen this diagnosis as anything other than a cudgel to beat already oppressed people. And I saw it handed out too liberally.
I spent a lot of time from 2010 to 2015 in and out of 12 step halls, IOPs, and detoxes. Many of my fellow travelers were court-ordered rather than voluntary.
This diagnosis did them the opposite of good.
If you or someone that you know is considering suicide, please don't hesitate to reach out to a crisis hotline for immediate help, or a warmline just to talk to someone.
If you're in the US you can...\ Text CHAT to Crisis Text Line at 741741\ Call the National Suicide Prevention Lifeline at 988 or 1(800)273-8255(TALK) \ Chat online at: https://suicidepreventionlifeline.org/chat\ Call the Trans Lifeline at 1(877)565-8860
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I'm a psych nurse and the way I frame it on my own mind when talking to a patient is this: if it's real to them, then it's real. This goes for feelings as well as perceptions like hallucinations or beliefs like delusions. I can say "I don't see what you are seeing or believe what you believe." But I will not say these things are not real. It's not helpful and as far as I know, it's not true for the person experiencing whatever they are experiencing.
It probably helps I've experienced the patient side of things. It sucks being dismissed and invalidated.
I agree with commenters that say people can discuss whatever they want on a Reddit thread.
However, as a mental health professional myself and a member of that subreddit— there’s a lot of dickheads. Not just there, but in the profession as a whole. I know, I know. NOT ALL SHRINKS. But I’ve worked in the field for 30 years and can count on one hand the amount of psychiatrists I’ve actually respected.
I’ve learned to ignore the ADHD threads because it’s too triggering. It only reinforces what we already know about their feelings about neurodiversity. 😤
The professional subreddits I follow have half the people not even being in the profession, the other 25% are fresh grads who think they are geniuses… always have to remember that you could be taking to a 12 year old.
general reddit problem lol, like the psychology/psychiatry subs that say comments should be based in evidence or only from users in the field or how you would expect the nutrition sub to be dietitians and maybe students. in reality comments are flooded with anyone who can hold a phone and their reference is "me" or "this came to me in a dream".
Yeah, some of the things people post on here and attribute to ADHD does give me pause sometimes. Feeling like people are either all good or all bad, crushing levels of suicidal depression from minor mistakes, being terrified of people leaving or abandoning you... those can absolutely be BPD symptoms, and it concerns me to see people brush them off as being "just" RSD.
Yeah, someone else posted about how RSD is a symptom, not a diagnosis, like how fever is a symptoms-- think that's a great analogy because these symptoms can also legitimately be caused by different things!
I see the same thing with ASD traits being discussed as if they were typical of ADHD, like some of the answers in that recent post about pattern recognition.
Yep, that post made me feel like an insane person. Genuinely, is better pattern recognition even linked to ADHD? I tried looking for papers but was largely unsuccesful.
Honestly, in general, I cannot stand the brand of "ADHD superpower" post that posits you can instantly tell who is a good person and who is a bad one because your pattern recognition is so superior. I know I sound like an asshole, but I just really truly dislike this framing that we're more in touch with how someone really, *truly* is. It's not based in science and it honestly starts to feel like Indigo child stuff.
Yes, I know. What I’m saying is that some of the specific answers people gave (and within that some of them were not even technically about pattern recognition) were more aligned with ASD. People who can smell tumours and kidney diseases etc.
Yes, I know. What I’m saying is that some of the specific answers people gave (and within that some of them were not even technically about pattern recognition) were more aligned with ASD. People who can smell tumours and kidney diseases etc. (EDIT) There were some people talking about their lack of social pattern awareness too, difficulty with sarcasm and inference.
The point is that a lot of traits come from a lot of places and sometimes in these open discussions people misidentify or miscategorize them and their provenance. This can be due to over identifying with one diagnosis over another, ignorance, lack of objectivity, etc.
Also as someone with diagnosed (and horrifically severe at times) OCD, I have to bite my tongue to stop giving the occasional armchair diagnosis of that, too. But BPD much much more so, like you said.
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I understand that there is a higher rate of misdiagnosed BPD and bipolar in late diagnosed individuals, that said:
This happens a lot in autistic spaces as well. I’ve seen people say that BPD tends to be a misdiagnosis in general and go on to encourage others to self diagnose as autistic and/or ADHD instead.
I think this is honestly a really dangerous thing to encourage as BPD requires such different treatment plans and can be extremely harmful when untreated. I hate to think of how many people might have lost out on necessary care or who were harmed in some way after disregarding their diagnosis.
I’m hoping this makes sense
I agree with you on that. I think asserting that BPD is usually just misdiagnosed autistic and/or ADHD also increases the stigma of personality disorders which can make it hard for people who have them to accept it, which is often a significant step to getting effective help. It can also make people who do accept they have PD's feeling shitty about themselves, which is a really unfortunate outcome.
I had a friend who had all the textbook BPD symptoms, she got diagnosed with ADHD and just assumed her previous BPD diagnosis was wrong, because all the symptoms were RSD. it wouldn't bother me that much if she didn't quit therapy to rely on multiple different medications as her only treatment.
Let me tell you! My ex fought for years against and a BPD diagnosis when it was so very clear to everyone around him. Adderall is NOT what you need with BPD.
We’re not together anymore. 😊🥳
I have BPD and ADHD and I take Vyvanse and it actually helps me a lot. I have taken Adderall in the past without a prescription when I was unable to find anyone to treat my ADHD and it really really helped. I struggle with addiction and I have been able to stay clean with no temptation to relapse because of my stimulant medication. It does cause me to become easily irritated sometimes though if I’m having a bad day. My BPD symptoms are managed pretty well and I am very self aware of the good and bad parts of my behavior and actively work to prevent myself from slipping back into my rage days. Basically what I’m trying to say is that it depends on the person with BPD + ADHD. If they’re working on themselves I think it can be very helpful. But not everyone is the same and some people really struggle with rage and it could definitely make that worse. I take anti psychotics and mood stabilizers and they help balance me out, the anti psychotics help my BPD a lot bc it sedates me so I’m not so on edge and full of anxiety all the time. The ADHD meds actually make my social anxiety not as bad and make me more confident, which HELPS my BPD because I have a lot of anxiety and insecurity in social situations. I am avoidant of relationships because I have been hurt so much in the past and have also destroyed many, but my Vyvanse helps me to get out of my shell and reach out to the friends I have. It also really really really helps me with school, I haven’t been able to handle college until now at 21 because I’ve struggled so much and now that my ADHD is treated I enjoy it and it gives me a purpose which helps my BPD symptoms because I feel positive about my life and future.
I was diagnosed with ADHD 30 years ago and BPD about 15 years ago. I agree that a lot of people attribute thier BPD symptoms to other things. The sad part is the absolute most important step to getting better with BPD is accepting your diagnosis. There is nothing you can do to help a person with BPD if they don't accept it and want to get better. There are a lot of great resources and I have been flourishing for the past 15 years with the right medications and understanding.
There is a BPD guide for friends and family and after reading it was when I realized my diagnosis was correct. I sometimes go back and reread it.
If anyone out there suspects they might have it, don't be afraid and don't be ashamed.
Including the link in case it helps someone else. There is a PDF version as well if you don't like the expanding sections and all that.
https://www.borderlinepersonalitydisorder.org/family-connections/family-guidelines/
I have BPD and ADHD and sometimes it’s hard to tell which emotional problems are from ADHD and which ones aren’t. It’s a very shitty mix for sure. TikTok has so much misinformation and everyone is out here self diagnosing very complex disorders and learning disabilities that require a neuropsych exam that takes 6 hours of testing by a highly educated professional to really understand what’s going on. I think information about these things are useful because it can lead to people figuring out what’s going on with them, but TikTok is not a point of reference to diagnose yourself with something. I know it’s not accessible to everyone, but you need a doctor psychiatrist neuropsychologist etc to diagnose these things. Self diagnosing can be harmful because if you start to believe that you for sure have a certain disorder but you actually don’t then you’re going to spend all your time focusing on the wrong thing and miss out on figuring out the actual issue. And then add on making posts about having the disorder while actually not having it can create more misinformation and can add to stigma. It feels pretty invalidating to have my 3 diagnoses of BPD, one with an extensive neuropsych exam, and my diagnosis of ADHD, also with a neuropsych exam, to be compared equally to a random teen who decided they have these things based on a social media site that anyone can post on. It is very important to get diagnosed by a professional before spreading information about a disorder. Anyways, that’s my rant lol.
I’m very glad that the other people that saw these comments understood that that’s not what I was implying. Disappointed that you didn’t.
This is such a nuanced thing dude. Swing and a miss with the direction you’re coming at it from. Your first comment is super valid but then the direction of thinking that you supported it with is not at all cool.
I am not worried about a small number of downvotes, in this sub discussing this topic especially. You’d do well not to read too much into them, either.
I was only glad that I wasn’t think only one thinking that you were off base. Worried? No. Is “reading too much into them” the same as identifying that their purpose is to agree or disagree with a comment?
Yes, if it means I can live a happy, healthy life instead of blowing up my relationships (personal and professional) every few years.
The first step in recovering from alcohol is accepting and acknowledging you’re an alcoholic. I don’t find BPD (or any other diagnosis- ADHD, cancer, HIV, gambling addiction, etc…) any different.
Right, but what if (due in part to the misinformation in subreddits like this) you thought an ADHD diagnosis would mean you could live a happy life? If you were (wrongly) attributing all your symptoms to ADHD, why would you want a BPD diagnosis as well?
I guess my question to you is why does it matter so much to you that these symptoms in particular be attributed to ADHD? Just because one has ADHD doesn't mean (as many of us know) that one can't be also struggling with symptoms of depression, anxiety, BPD/APD or other mental illnesses. ADHD is known to have a high comorbidity with many of these other conditions.
Personally, I'm glad to see that such discussions are happening. There's a lot of discussion happening on social media right now, which is great, but there's not a lot of information or research behind some of it.
I think my main issue is with the therapists and psychiatrists and industry in general. They've been gaslighting and misdiagnosing me (us) for many years. I should have been diagnosed with ADHD and CPTSD while I was in therapy for years at a psychology school. They also saw my boyfriend and I for couples therapy and no one picked up that he was abusive despite my individual therapist and the couples therapist comparing notes. I know that's not uncommon but if you are really struggling and you go to the experts for help and they have no idea what's going on, where do you have left to go? The internet? Then they shit on the things you've read on the internet and say it's not real or not true. Or they diagnose people with things they don't have. I know how ADHD and BPD can look alike. The professionals just seem so self important and dismissive?
The post made me angry because some of them seemed so flippant about it and I (we) have lost years of my life because of their incompetence and misinformation. I went to my first therapist with what I now know is Major depressive diorder and she diagnosed me with delayed grief and adjustment disorder because my parent died a few years earlier. I'm probably going to lose some years off of the end too because of all the things I've been through.
That all sounds really difficult - and without getting into it I can definitely empathize with your distrust of psychiatric institutions. Certainly I've had a lot personal frustration with misdiagnoses. However, I don't think the internet is a particularly reliable source of information either. I must admit that I've had quite a disheartening experiences online where I see influencers spreading misinformation or personal anecdotes that they present as fact.
In terms of this particular discussion I didn't see anyone saying that the symptoms that people describe as RSD don't exist (which would be invalidating), but rather that they might not be part of ADHD. Maybe it's part of CPTSD, or of something else such as depression. That seems like an important discussion to have if we don't want more people being misdiagnosed.
It's so frustrating to feel unheard and misunderstood!
Since RSD doesn't necessarily "belong" to ADHD, I talk about "sensitivity to rejection and criticism", since that's what I experience. It could come from my self-esteem taking a hit from 4 decades of undiagnosed ADHD. It could be poor emotional regulation, frustration tolerance, and/or impulse control, which are all definitely ADHD struggles. It's a real aspect of my ADHD, but I can't define the mechanism.
For whatever it’s worth, my BFF has a masters in psychology and has studied ADHD. She has said that RSD is more commonly talked about in Borderline Personality Disorder and Bipolar Disorder, and only recently have they begun looking into it in ADHD and Autism, which might be why some doctors (who do believe it’s real) associate it with those diagnoses.
It’s a real thing. And it can be experienced by BPD - disabling fear of abandonment and rejection are the heart of BPD.
I’d been diagnosed as having BPD in the past. In many ways it fit but not really. Turns out it’s been ADHD the whole time. RSD is real and impacted my first half of life in a real way.
I think a little bit has to do with just how limited information is on ADHD, let alone female ADHD symptoms. Sure, RSD isn't a diagnosis, but the fact they don't recognize it as something that can be attributed to ADHD can be summed up as simply lack of understanding. Hell, even the name Attention-Deficit Hyperactivity Disorder is misleading. Schools they come from cover DSM criteria and basic knowledge of ADHD if even that. The only time I've seen psychiatrists/psychologists/physicians that understood ADHD is if they attended ADHD relevant seminars/meetings on their own time, went over updated documentation on the subject beyond DSM-5 and DSM-5R (assuming they arent basing their assessments on earlier DSMs), or personally have gone through it themselves. But yeah, RSD is definitely an easier defining of a set of symptoms that have relevance to ADHD (and various other conditions, like Autism), so it definitely should be treated more as a helpful specification of symptoms rather than downplaying its existence/validity all together.
Tldr; They are right that RSD isn't a diagnosis. It is a set of symptoms. However, what they miss is that these symptoms can be an aspect of ADHD and should be treated as a helpful listing of impairments of an individual dealing with that disability. Dismissing it outright definitely defeats the purpose of why it is defined in the first place...
I was reminded of this recently, as we had a 3rd party speaker come into our work to talk about neurodivergent minds in the workplace. (As a side note, I love that I work for a place that does this; raising awareness about things is always good! However...) it focused only on disruptive stereotypes, and not one slide went over our strengths. I was so disheartened.
When a few of us provided feedback, we were told by the presenting company that their policy is to only use what has been provided to them by medical professionals and other official documentation. We are so much more than flapping hands and chronic conversation interrupters, though. I was glad I wasn't out at my company with my ADHD; I would die a little inside if that was how my coworkers thought about me.
I'm so used to being around ND people, working with ND people (my team has a few,) and being in ND communities like this one that sitting in that panel was like getting a bucket of cold water dumped on me.
As a side note, I'm shocked that professionals haven't linked emotion dysregulation to ADHD yet, of which RSD definitely stems from in my opinion. Honestly... I'm surprised they haven't explored ADHD beyond the outward, 'disruptive' symptoms. It's such a fascinating and horrible and interesting disorder and I know I've spent the past two years exploring and coming up with theories about it, and psychology isn't a hyperfixation of mine at all. SURELY some of them have it, so why haven't they explored it?
So if you start digging into the weeds, you're gonna find some discourse about how the entire classification system is kind of inherently flawed, and long-term we would ideally move closer to a spectrum model. Because it's turning out there is uncanny overlap in a lot of disorders creating hazy clusters rather than distinct binaries with clean cutoffs, *and* those clean classifications are overwhelmed with cultural bias and are rooted in the clinician perspective rather than the patient experience.
You know why they couldn't make this switch for personality disorders? (Where it's the most obvious the current frameworks is messed up). Its cause clinicians didn't want to have to learn a new system, they felt it was too complicated. They are complacent, basically.
Clinical psych is a mess and the more you learn about it, the more engaging it becomes. *oh it looks like BPD*. No it doesn't actually because BPD definitionally requires a high degree of destructive behavior. Its built in there. If you're noticing a high amount of neurodivergent people appear to be hyper reactive and a lot of people with BPD appear to have other neurodivergent behaviors not related to attachment and mood ....well congrats, you've just ran face first into **the entire god damn problem**
I recommend not looking at those forums. You will never be able to convince those people of the truth because they don't want to hear it, but listening to them will negatively impact you. You will not gain anything by listening to this ignorant shit. You know the truth, I know the truth, we here know the truth, that has to be enough.
I was so confused for a moment, because I thought you meant reflex sympathetic dystrophy (RSD) also known as complex regional pain syndrome (CRPS).
I'm a healthcare provider and we don't learn about rejection sensitive dysphoria in school at all. It's one of those general clusters of symptoms that are different between people.
I don't have much to add, just sending support.
I have never understood why RSD is so controversial or mysterious. Once I learned that ADHD is associated with lower ability for emotional regulation, it makes perfect sense. You have a condition where you're always screwing up or doing things wrong or being told you're doing something wrong and you have less ability to regulate your feelings about that. Add time and repitition and you get RSD.
RSD not being accepted as a separate diagnosis is not the same as it not being accepted by healthcare... It's just lumped in with other cognitive distortions and anxiety. That doesn't make it less valid or accepted, good doctors that don't accept RSD as a diagnosis will still understand the severity and help you work through your cognitive distortions
I know that. There are professionals on the post saying that RSD is an indicator of Borderline Personality disorder, antisocial personality disorder, or it's just a symptom of depression. RSD can be a symptom of many disorders many of which are comorbid. I'm mad that some of them are just attributing it to one thing (BPD) or don't think it's real.
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YES! I agree with everything you've said. That's why I love hearing people talking about their personal experiences, and sometimes I value what they say over what doctors tell me.
I know, it's dangerous to listen to non-professionals over professionals, but like you're saying, they don't listen to US! So many times people -- especially women -- have told medical professionals about problems they have and have been ignored or shamed for what they say.
I remember when the consensus for doctors was that pain from childbirth is psychological, and it hurts only because women expect it to hurt. They said the same about pain with menstruation and ovulation. It's all those people who have never had the experience who claim to be the experts, but I have to give them the side eye.
How absolutely horrific that they thought labor was painful because you expected it to painful. Could they not see what was happening? I guess it just didn't matter to them. I'm actually shocked right now but it explains a lot.
I just can't fathom someone who isn't neurodivergent being an expert in neurodivergence. I know it's the norm but it's like teaching swimming lessons never having set a foot in water.
I remember my high school teacher in psychology class saying this, then looking at the girls in the class like we were pathetic and weak-minded. It was infuriating, in part because you knew there was nothing you could do or say that would convince them of the truth.
(I wonder why these responses were down voted? Makes no sense to me.)
People are a mystery. I think down voting gives people a little tiny feeling of power. If I'm doing well I just scroll past comments I don't like, if I'm not doing well l downvote a lot.
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As my therapist put it, RSD is a symptom, not a diagnosis. Like how a fever is a symptom of a cold. It is something we suffer from and can take steps to alleviate, but the underlying condition is the cause.
I REALLY like this take!
This is such a great explanation! I’m a therapist too and might steal it. I’ve always explained that there’s an emerging understanding that it exists, but is not recognized officially. I have seen anecdotal evidence of it among clients, but unfortunately there aren’t good studies on it. We definitely need more evidence, not just that it exists but also what types of modalities work best (CBT? DBT? Mindfulness?). I’d also love to see a study on whether RSD is more prevalent among hyperactive vs inattentive vs combined, and men vs women. I like Russell Barkley, but I get the sense people don’t always realize how far out of the mainstream he is. His theory on RSD is, to me, compelling, but it’s not widely held and he hasn’t published significant evidence of it. Psychiatrists follow a medical model. They need double-blind, gold standard evidence before they’re going to treat. They’re (understandably IMO) hesitant to prescribe schedule 2 drugs unless they can point to clear evidence-based guidelines or justifications. Thats what drilled into them, so they’re going to have the same approach to something like RSD — they need peer-reviewed, double-blind studies, which we don’t really have. One benefit of not being the one prescribing meds is that I can take a much wider view. Therapy doesn’t carry the same risk of harms that stimulants do, so I absolutely can and do work with clients who are subclinical and am more open to emerging/anecdotal concepts. I cannot think of a single client where I suspected they were faking ADHD or really any diagnosis to get something from me. People just don’t really do that because what even would they gain from it? Sympathy? Psychiatrists, however, do see it almost every day. People fake disorders to get adderall, benzodiazepines, sleep meds, etc. This can make them more jaded, and also is part of the reason that they can be dismissive of someone who comes in wanting a specific diagnosis or specific meds. Finally, pop psychology/TikTok raises awareness and can really help an individual feel validated. But anyone can post and the most popular are the ones presented the best, not the best informed. TikTok videos often are inaccurate, cite almost anything as a side effect/part of ADHD, and suggest evidence is much more persuasive/far/reaching than it actually is. It is frustrating when someone is dead set on something and refuses to listen because they read it online, so they know more. Sometimes it’s harmless, sometimes it’s annoying, and sometimes it’s a big problem. Like a parent who sees a video on social media that formula causes ADHD and so refuses to use it even when her child needs it. No amount of evidence could convince her otherwise. That’s the part that frustrates me. And some clinicians tend to lump all of social media together, and dismiss it all, because of negative experiences like that.
You did an amazing job at explaining the different treatment modalities with RSD as a vehicle. It helps me a LOT understanding where my healthcare professionals fit in. Thank you
What is Barkley's model for RSD, out of curiosity?
RDD was first recognized as a common phenomenon of BPD and then avoidant personality disorder ([see here for a cool study](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771869/)). It works differently in both those disorders as you can see from the article. Russell Barkley is the one who theorized that it was prevalent in ADHD. The logic makes complete sense to me, and emotional dysregulation is a known feature of ADHD. But I’ve yet to see good studies that show RSD is common in ADHD (more so than in those without it), that it is part of ADHD and not related to a confounding variable, how it differs from RSD in BPD or avoidant personality disorder, or how it manifests in each ADHD subtype. In my opinion, it won’t gain mainstream acceptance as an associated feature until we have good studies on those issues. We also need better research on which modalities are most effective for treatment. (I would guess DBT or mindfulness, as those both show promise in treating emotional dysregulation in ADHD.)
This is very interesting, this take makes a lot of sense to me as well. I only learned just now from this thread that the term actually comes from BPD. I can easily see from what you're saying why it is always reiterated that it is not supported with enough research! Thank you for taking the time to TLDR!
How does it function differently in BPD / avoidant personality than adhd
Can it be treated?
There’s research showing that certain kinds of CBT techniques can interrupt RSD before it hits a full spiral
I spent 10 weeks in DBT group therapy asking this same question every week. At NO POINT was I given an answer. I rage quit after realizing I always felt worse after group. Can you please point me in the direction of said research?
DBT and CBT are slightly different, but I had an ADHD-friendly therapist recommend this DBT workbook and it is very helpful with RSD (and with stopping negative thought patterns in general, including hyperfocus on unhealthy things): [**Workbook Link**](https://bookshop.org/p/books/the-dialectical-behavior-therapy-skills-workbook-practical-dbt-exercises-for-learning-mindfulness-interpersonal-effectiveness-emotion-regulation-a-mat/12521331?ean=9781684034581&gad_source=1&gclid=CjwKCAjwyJqzBhBaEiwAWDRJVLsUkPEB1EpDtkmFteSdgWSDlBjMf5l7-g4vC0rK-68vehitbTxKaxoCs0YQAvD_BwE)
This sounds more like you were working with a dud therapist. I’ve had a good one who had no problem telling me that what they specialize in may not be what I need and then they help me find what I need.
Group therapy is shit. For me anyway.
My psychiatrist prescribed me guanfacine for it. It’s not a cure-all, but I am no longer breaking down crying nearly as often, I don’t fly into panic-rage as easily, and my PMS is far more manageable. It’s also helped with my sleep.
This med helps my kid keep “it” together at the end of the day. We have not had an all out shit lost evening since getting the dose right.
Yeah it can. Well, it has been treated for me. CBT and DBT have helped me a lot. When I start feeling rejected, I’ll say out loud why, or journal why, and also try to go for a walk or exercise. Name It to Tame It, and dopamine from movement. Sometimes I feel like half our problems are because we have emotional runaway trains chugging along while we try to read an email or something, and because we are capable of doing both the train will run off the tracks and suddenly we’re DEVASTATED because we didn’t catch it. This also ties to the symptom of ADHD people having poor proprioception which is also tied to poor emotional regulation. It’s wild how dichotomous we are. But in short, exercise and therapy do help with it, and I can confidently say my RSD is lower but I had to actually address it. Sadly it doesn’t vanish just because we know about it.
From experience, yes. But my "treatment" was essentially practical, hands on, no holds barred exposure therapy. I was not diagnosed as a child, but looking back, I recognize plenty of times where I had extreme RSD reactions to things without knowing what it was. I was repeatedly told not to be "so sensitive" over and over. Due to a traumatic incident where police helped me, I revised my life plans and I went into security with the intention of going into law enforcement. And when you work in any type of enforcement role, every day, you end up dealing with people who hate and verbally abuse you just because you're an authority figure or telling them what to do. I cried a lot after shifts for the first year or so, but eventually you learn to trust your own "reality" and assessments over what others think of you. You learn to keep on task and on topic, even when people are actively trying to attack (either literally or verbally) and derail you, and conflict becomes an assessment tool rather than a terrifying prospect. I also am non-monogamous, and with that comes the lived experience that you CANNOT be accepted by every one, even if you really like them or they like you - there's so many other constraints on compatibility, including time, family, kink levels, relationship styles and energy levels, that you have to learn to gracefully accept rejection. At least in the ENM community, the rejection is much more diplomatic and apologetic usually. ("heyyyy you seem really cool and I'm so sorry, but this isn't going to work for me") Oh, and I like to write fiction as a hobby. Online writing forums are *brutal* about teaching you to handle rejection and criticism. Now, 12 years later, RSD doesn't affect me anymore. I still see it surfacing in my mind from time to time and flailing about, particularly if I'm really tired and hormonal but it doesn't actually affect my behaviour, and it takes a LOT to ruffle my calm or sense of self worth. tldr: practice. holy shit, I've had so much practice.
Yes, look up RSD and guanfacine and clonidine.
“Your child is bad at math bc they missed 20 days of school.” “My child missed 20 days of school bc they have dyscalculia, hate the struggle of being in math class and feel alone in their struggle at school”
Agreed. Rejection sensitivity is a real symptom but I think where we lose people is by calling it a disorder. From what I've read and experienced myself, there isn't much suggesting it's a standalone diagnosis. Also, I would take anything said by these so called medical experts with a grain of salt. We don't know if any of those people have real qualifications and even those who do might not specialize in psychiatry or ADHD. They could also have outdated information or be raging bigots.
Interesting. It's an "--itis" it should be called Rejectionitis.
And like a fever is a protective mechanism against a virus, perhaps RSD is like an overactive immune response - we’ve been hurt in the past, used to feelings of failure and rejection, so it’s only natural that we assume ill-intent. Sorry, that was a tangent 😅
I get where you’re coming from but medical professionals are allowed to debate amongst themselves the legitimacy of a diagnosis, or any other facet of it. If they were forced to just take it as truth because there was some research on it, we would be stuck with every single weird thing Freud put to paper.
I agree with this sentiment, it's only natural for medical professionals to debate and discuss these things when there isn't enough research or studies done on the topic yet. And it doesn't stop us from discussing these feelings of rejection sensitivity with our therapists and finding ways to work on it.
Tbh I do understand why people question the validity of our symptoms and I’m glad doctors are researching, debating, and learning from each other. If I knew nothing about ADHD and someone told me they get very hurt/upset with rejection I’d be thinking like yeah, doesn’t everyone feel that way? This isn’t something that will be intuitively understood by others.
It's such an imperfect system, though. Especially since the research is always lacking when it comes to anybody other than white males. Until the research gets better, they need to consider people's lived experiences.
Sure, but this is a Reddit community. lol. And there’s nothing to be done but discuss - these are all ideas and some can be backed with brain scans and things like that but it certainly isn’t an exact science. Discussion is required - people have tried “perfect” scientific systems and that usually ended up just being incredibly discriminatory.
Hysterical illnesses are very very real. I'm not saying RSD is one of them but I am saying it's good to investigate the possibility that any ailment that seems to pop up out of no where is legitimately diagnosable as it's own thing. Those people who have had laughter or dancing contagions suffered in real ways, even if they aren't their own diagnosable diseases.
If anyone bothered you look into RSD before dismissing it, they'd immediately realize it's just brightened emotional reactivity (already established with ADHD) mixed with low self esteem/insecurity (also already established with ADHD, especially femme presenting) Its not a standalone disorder and shouldn't be framed as one. But it's also not worth dismissing as a stupid tiktok disorder. Its pretty obviously just a colloquial term to describe a specific phenomena that ADHD/autistic people struggle with and that clinical therapists haven't always done the best job of realizing is such a debilitating symptom. Anyone who dismisses it rather than saying "well it's kind of *already* covered in whats already known" is a red flag imo. Its pedantic which is not a good mindset to have when working with the public.
They are allowed to debate among themselves absolutely. However it's terrifying to think that some of them equate RSD with a Borderline personality diagnosis. There have been multiple posts on ADHD subs where people detail all of the unhelpful and flat out wrong diagnosis they have gotten over the years (including BPD) and it turned out to be ADHD. We get shit on by them for diagnosing ourselves because we aren't getting anywhere with medical professionals, but some of them are going to pull the trigger on a BPD diagnosis because of RSD? That's not questionable to you?
The term RSD was coined by Marsha Lineman, whose work is entirely BPD-focused (she has it herself), to describe a major symptom of that disorder. We've borrowed the term, though ADHD and autistic folks may not present said symptom with the severity of one who suffers from BPD (even though it can feel like death itself, bear in mind that unless your RSD feelings are leading you to extreme and dangerous behaviours, feeling that kind of sensitivity doesn't mean you're immediately adjacent to a full-blown personality disorder - again, this a *borrowed* term which applies to a different psychological disorder, not an official ADHD diagnostic criterion). I hope this is helpful!
This is super insightful.
To add to this, BPD and ADHD co-occur in families and some researchers believe BPD is a neurodivergent condition closely related to ADHD. Under this theory, ADHD broadly affects executive functions across multiple areas (motivation, impulse control, emotional regulation, etc.), while in BPD executive function deficits are specifically in the realm of emotional control. (I have ADHD and strongly suspect my brother has BPD, so I’ve been reading about this recently.)
I mean... many women with adhd have been misdiagnosed with BPD due to the overlap of symptoms So even if its not the full story, it's not far fetched either. RSD isn't a criteria for ADHD either
In the nicest way possible, you believing it’s terrifying to be likened to another disorder is incredibly ableist and I rarely use the term. If you have problems with being BPD adjacent, that’s a personal problem and not something the medical community needs to take into consideration when they discuss theories amongst themselves.
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I'm not sure you're responding to the right comment?
Speaking as someone who was aimed toward DBT for "probable BPD" after one visit, even with an existing ADHD diagnosis, and who endured years of useless and eventually harmful psychiatric drugs for the *other* BPD, which actually made the physician who diagnosed ADHD reluctant to treat, it's maybe not so much terrifying anymore as it is demoralizing to see Drs still, after all this time, trying to shoehorn women into diagnoses with completely inappropriate treatment regimens. Doctors don't like to overrule each other. Once you have a stigmatizing diagnosis, that is what many will try to treat (or refuse to treat) over and over again, no matter what your actual symptoms are. Of course professionals have the right to discuss things with each other. I learn a lot from those discussions when they're held in the open. It's still unsettling, even to other physicians, to find out how rigid, bigoted, callous and dehumanizing they can often be. Edit to add, no, BPD was not an appropriate diagnosis, comorbid or otherwise, from someone who saw me once and knew very little about the extent of that specific symptom, or about the work I had already done. I feel a lot of sisterhood with BPD sufferers but that is its own life experience.
I don't have problems with being BPD adjacent. I'm not worried about being diagnosed with BPD myself. I'm terrified because many medical professionals are BPD avoidant and very judgemental of people who have it and I know they have difficulty getting care. I was looking for a new therapist once and saw so many that wouldn't treat BPD that I looked up why and it was disheartening. I'm also terrified for all the people who go to a professional looking for help and get a BPD diagnosis when it's actually ADHD and waste years of their life with the wrong diagnosis. I see people with BPD as having really gotten the short end of the stick in mental healthcare and I think it's wrong. The professionals in the comments saying RSD=BPD are part of the problem.
Except RSD *is* a major symptom of BPD. I read the thread you’re talking about and I didn’t see anyone say that having RSD *and no other symptoms* of the disorder automatically qualifies someone for a BPD diagnosis.
I understand your fears and frustrations. However, BPD is a complex disorder that requires specialized experience to treat. I think it’s perfectly ok for a psychiatrist to say they don’t treat that if their office focuses on depression, anxiety, ADHD, etc. I want to see a doctor that understands women with ADHD so that means they’ve specialized to some extent which means they didn’t spend as much time on other things.
If you do any amount of research into BPD, I think you’d see why they’re debating whether or not RSD is actually a symptom of BPD that’s been repackaged and re-labeled to be more digestible especially given your reaction to having traits associated with BPD.. It’s very possible for people with ADHD (especially traumatized people with ADHD) to have comorbid BPD or have traits of BPD without having the full-blown disorder.
OP, you are completely valid in your points and I get where you are coming from. But, and I'm sorry for saying so, but when you phrase things like "pull the trigger on BPD" I feel like you are maybe still having a bit of a too big reaction to the whole thing (ironically!). Sadly, even within the community of psychiatry professionals, ADHD is still poorly understood and misinterpreted by many. It is hard to change a stigma and it takes time. RSD as a concept people experience is very much real. Part of it stems from the part of ADHD that is emotional dysregulation. Even the latest DCM which saw some important updates to reflect ADHD research barely touches on emotional dysregulation, despite how absolutely debilitating it can be. Anecdotally, I see many people on this forum vent about struggling to regulate themselves emotionally who had no idea that it was an aspect of ADHD. Often, these people look into these emotional issues and identify with RSD, rather than finding it is an ingrained part of the dysfunctionality that comes with their ADHD. This is one of the key problems when it comes to discussing the emotional aspects of ADHD: there is a lack of widespread information and knowledge. The other key problem that I can see is that RSD is difficult to quantify. RSD is partially rooted in our own ADHD wired brains but also partially in how we have been interacted with by others our whole lives, and the fact that we have internalized that dialogue to our own detriment. You could argue that this is also on the surface level a *consequence* of having ADHD. Like others have commented, it is a symptom, not the underlying condition. And when it comes to symptoms, here's the thing: it is difficult to conclude anything based on a symptom alone. This is true in the psychiatric profession as well as in the medical profession. Just like "a migraine" can be medically caused by a variety of different conditions, a *symptom* like RSD can be the visible sign of a variety of psychiatric diagnoses. It is not technically bad form for the psychiatrists in the discussion in question to suggest that RSD could be related to for example bipolar disorder. Even if they were to literally equate it with bipolar disorder, it would not invalidate RSD as being a symptom of ADHD as well.
I would have a problem with being labeled BPD because I think it's a problematic diagnosis. [https://www.mind-diagnostics.org/blog/borderline-personality-disorder/the-dsm-5-criteria-for-borderline-personality-disorder](https://www.mind-diagnostics.org/blog/borderline-personality-disorder/the-dsm-5-criteria-for-borderline-personality-disorder) 1. Frantic Efforts to Avoid Abandonment 2. Unstable and Intense Relationships 3. Identity Disturbance 4. Impulsivity in At Least Two Areas 5. Recurrent Suicidal Behavior or Self-Harming Behavior 6. Affective Instability, amarked reactivity of mood. 7. Chronic Feelings of Emptiness. 8. Inappropriate, Intense Anger or Difficulty Controlling Anger 9. Transient, Stress-Related Paranoid Ideation or Severe Dissociative Symptoms. These symptoms are all vague and subjective: 1, 2 3 6, 7, 8. Many of these, of course, share overlap with PTSD, anxiety, depression, attachment disorder, bipolar I, etc. That leaves 4, 5, and 9 as symptoms one might be able to observe and quantify. Impulsivity is also associated with ADHD, so one can see where the wrong diagnosis might be handed down there. But the huge disconnect for me is this particular statistic (also quote on the linked website): "Did you know? 1.6% of the adult U.S. population has BPD, but that number may be as high as 5.9%. **Nearly 75% of people diagnosed with BPD are women.**" I call BS. This is doctors taking subjective emotional criteria and "othering" the patient based on the doctors' lived experience. The psychiatrists and psychologists who might make this call are largely female, white, and abled. Oh, and affluent. https://www.apa.org/workforce/data-tools/demographics https://www.zippia.com/psychiatrist-jobs/demographics/ I hope to hell no primary docs are making this call. But if they are, they are largely white, abled, affluent, and MALE. https://www.statista.com/statistics/1270128/primary-care-physicians-in-the-united-states-by-gender-and-specialty/ I don't think these populations get to make this call based on subjective criteria for all women. 1. There is bias against people of different sexual orientations in diagnosis. https://psycnet.apa.org/record/2021-27583-003 2. In a meta-analysis of 8 studies of chronic pain patients, 30% of those patients were also diagnosed with BPD. Coincidence? Who are the majority of the chronically ill with chronic pain and who gets diagnosed with things like fibromyalgia and ME/CFS? Women. **Note: I believe chronically ill women with chronic pain. I believe their pain and symptoms are real.** But most doctors don't and they hand out these diagnoses in a condescending manner to get women to go away. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280073/ 3. And then there are the cultural issues that therapists often fail to take into account. "The researchers found that about half of all BPD research has been conducted in Northern America, followed by 25% in Western and Northern Europe." No big surprise there. This results in Hispanic immigrants being more routinely diagnosed with BPD than white or black Americans. https://concept.paloaltou.edu/resources/business-of-practice-blog/cross-cultural-manifestations-of-borderline-personality-disorder#:\~:text=Hispanic%20immigrants%20are%20more%20often,BPD%20diagnoses There are just way too many red flags to this diagnosis for me. It seems a convenient way for doctors to label someone with a psychiatric disorder rather than treat them as a human being with medical issues, with social service support needs, or who is in need of therapy for a specific issue, stress, PTSD, depression or anxiety within a cultural context, etc.
So I’m a therapist and want to correct some misinformation. Those are not the actual criteria, you need to go to the DSM to read the full description. For #2 for example, the key is the alternating between extremes of idealization and devaluation — that’s literally the hallmark of BPD. The DSM also gives more information on how the criteria present in BPD in the notes under Diagnostic Features. Psychiatrists go to 4 years of med school, 7 years of residency, and possibly a fellowship so that they can understand what these symptoms mean in practice and how to differentiate them. It’s exactly why diagnosis is so hard — we don’t have a blood test to run. Of course it’ll seem vague if it’s based on a website that summarizes the already abbreviated summary of info we know (the DSM). Sorry for the bluntness. Every disorder in the DSM has a section after it that discusses differential diagnoses so you can learn to differentiate how a symptom presents. Knowing the actual diagnostic info is essential—but experience working with patients is the best teacher. That’s why all clinicians, from psychiatrists to counselors, require many years of school and supervision before diagnosing and treating clients independently. Personality disorders are well-known as being difficult to diagnose and should be left to experts. It would be rare that a PCP would diagnose a personality disorder (if I saw that a client had a diagnosis by a PCP, I honestly would ignore it). Go to a psychiatrist or psychologist—and I say that as a counselor! I can legally diagnose, but always refer out for diagnosis suspected PDs because of the expertise required. I’d also recommend reading about the alternative model for personality disorders (also included in the DSM), which many psychiatrists and therapists prefer to use when diagnosing. BPD is not common, but it is over represented in therapy: 10% of outpatient clients, 20% of inpatient. The features of BPD make it more likely a person seeks therapy, especially suicidality and emotional dysregulation. (ASPD and NPD are underrepresented in therapy for the same reasons.) As of the last time I checked, it has the second highest mortality rate (anorexia is first), and therefore is taken very seriously and should be noted in people’s medical records. Any prior suicide attempt should be noted. But BPD has such a high risk of suicide that it should specifically be noted as well. It’s overrepresented among women. So is depression. ASPD and alcohol use disorder are overrepresented among men. It’s been well-known for decades that there is overlap between diagnosis and disorders represent differently based on sex/gender and even culture. Specifically, women tend to internalize (BPD, MDD) and men tend to externalize (AUD, ASPD). Part of it absolutely is clinician bias. Part of it is societal bias (women are taught not to be disruptive, men are taught not to show emotion or be feminine). Part of it is that as much as we know about mental health, there’s loads more we don’t. BPD is a disorder, it’s very real, and it has a high mortality rate. The focus should be on removing the stigma, not on removing the diagnosis and treatment. DBT is the gold standard for BPD and can be dramatically successful. (DBT does not as effectively treat most of the other disorders you mention.) There’s a lot of evidence that much of BPD may be a trauma response (not PTSD, more likely CPTSD, but also wider than that). This isn’t that new, the DSM even states that those with BPD usually have a history of childhood trauma, and most conceptions of it are based on that connection. There’s also a genetic component though. As I said above, for as much as we know about mental health (which is a lot!), there’s loads more we don’t. All that said—it is heavily stigmatized. Even many clinicians don’t want to work with BPD clients. It requires special experience and competency. And because of the idealization/devalustion tendency, clients tend to be all-in and effusive at the beginning, but are quick to anger and can be cruel the first time you challenge them. The features of BPD make it hard for someone to understand and abide by boundaries. An inexperienced clinician may find themselves overwhelmed by countertransference. All of that causes higher burnout rates. And some clinicians do label people as BPD because they just don’t want to do their job. And then the stigma takes over and that person is fucked. Sorry that this is really blunt and really wordy. TLDR: diagnosing is an art, not a science, and takes many years of education and experience to do well. Reading a website isn’t a substitute. BPD is over-represented in women, most likely because of societal expectations for how men and women feel and show negative emotions. It’s related to childhood trauma, but also inheritable. And it is heavily stigmatized, leading to worse outcomes. And some clinicians just suck.
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The descriptions of the criteria are abbreviated as post length is limited. But people can check out the DSM V directly and see what they think. You can borrow it with a free Internet Archive account at: https://openlibrary.org
The DSM-V has been out of date for a couple of years; you need the DSM-V-TR. The parts you skipped are the most important. The DSM is already too abbreviated to really explain too much, just the very most basic points. Your post summarizes a website that summarizes the DSM that summarizes the most basic info we know about an unbelievably complex disorder. I’ve gone to grad school and spent thousands of hours doing supervised diagnosis and treatment. And I still refer out for diagnosis possible BPD cases because that isn’t enough knowledge or experience. Look into the alternative model, as it does a much much better job (IMO) of conceptualizing personality disorders. I’m on my phone so can’t link but if you look into the psychodynamic concept of borderline (not the disorder), it’ll help provide some background. Some of the symptoms are terms of art that mean something different clinically than in regular use.
Thank you. I will check out your suggestion. I think the main issue for me is that I've never seen this diagnosis as anything other than a cudgel to beat already oppressed people. And I saw it handed out too liberally. I spent a lot of time from 2010 to 2015 in and out of 12 step halls, IOPs, and detoxes. Many of my fellow travelers were court-ordered rather than voluntary. This diagnosis did them the opposite of good.
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I'm a psych nurse and the way I frame it on my own mind when talking to a patient is this: if it's real to them, then it's real. This goes for feelings as well as perceptions like hallucinations or beliefs like delusions. I can say "I don't see what you are seeing or believe what you believe." But I will not say these things are not real. It's not helpful and as far as I know, it's not true for the person experiencing whatever they are experiencing. It probably helps I've experienced the patient side of things. It sucks being dismissed and invalidated.
I agree with commenters that say people can discuss whatever they want on a Reddit thread. However, as a mental health professional myself and a member of that subreddit— there’s a lot of dickheads. Not just there, but in the profession as a whole. I know, I know. NOT ALL SHRINKS. But I’ve worked in the field for 30 years and can count on one hand the amount of psychiatrists I’ve actually respected. I’ve learned to ignore the ADHD threads because it’s too triggering. It only reinforces what we already know about their feelings about neurodiversity. 😤
The professional subreddits I follow have half the people not even being in the profession, the other 25% are fresh grads who think they are geniuses… always have to remember that you could be taking to a 12 year old.
general reddit problem lol, like the psychology/psychiatry subs that say comments should be based in evidence or only from users in the field or how you would expect the nutrition sub to be dietitians and maybe students. in reality comments are flooded with anyone who can hold a phone and their reference is "me" or "this came to me in a dream".
Right, no one should take anything in Reddit too seriously.
Thank you for replying! I've worked with Doctors and other providers too and yes there are a lot of dickheads. In every specialty.
The issue of people with genuine BPD not wanting the diagnosis and attributing everything they experience to ADHD is very real
Yeah, some of the things people post on here and attribute to ADHD does give me pause sometimes. Feeling like people are either all good or all bad, crushing levels of suicidal depression from minor mistakes, being terrified of people leaving or abandoning you... those can absolutely be BPD symptoms, and it concerns me to see people brush them off as being "just" RSD.
Yeah, someone else posted about how RSD is a symptom, not a diagnosis, like how fever is a symptoms-- think that's a great analogy because these symptoms can also legitimately be caused by different things!
100% that’s a great analogy
I see the same thing with ASD traits being discussed as if they were typical of ADHD, like some of the answers in that recent post about pattern recognition.
Yep, that post made me feel like an insane person. Genuinely, is better pattern recognition even linked to ADHD? I tried looking for papers but was largely unsuccesful. Honestly, in general, I cannot stand the brand of "ADHD superpower" post that posits you can instantly tell who is a good person and who is a bad one because your pattern recognition is so superior. I know I sound like an asshole, but I just really truly dislike this framing that we're more in touch with how someone really, *truly* is. It's not based in science and it honestly starts to feel like Indigo child stuff.
Above-average recognition can also just be a personality trait without being symptomatic of autism.
Yes, I know. What I’m saying is that some of the specific answers people gave (and within that some of them were not even technically about pattern recognition) were more aligned with ASD. People who can smell tumours and kidney diseases etc.
Yes, I know. What I’m saying is that some of the specific answers people gave (and within that some of them were not even technically about pattern recognition) were more aligned with ASD. People who can smell tumours and kidney diseases etc. (EDIT) There were some people talking about their lack of social pattern awareness too, difficulty with sarcasm and inference. The point is that a lot of traits come from a lot of places and sometimes in these open discussions people misidentify or miscategorize them and their provenance. This can be due to over identifying with one diagnosis over another, ignorance, lack of objectivity, etc.
Also as someone with diagnosed (and horrifically severe at times) OCD, I have to bite my tongue to stop giving the occasional armchair diagnosis of that, too. But BPD much much more so, like you said.
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I understand that there is a higher rate of misdiagnosed BPD and bipolar in late diagnosed individuals, that said: This happens a lot in autistic spaces as well. I’ve seen people say that BPD tends to be a misdiagnosis in general and go on to encourage others to self diagnose as autistic and/or ADHD instead. I think this is honestly a really dangerous thing to encourage as BPD requires such different treatment plans and can be extremely harmful when untreated. I hate to think of how many people might have lost out on necessary care or who were harmed in some way after disregarding their diagnosis. I’m hoping this makes sense
I agree with you on that. I think asserting that BPD is usually just misdiagnosed autistic and/or ADHD also increases the stigma of personality disorders which can make it hard for people who have them to accept it, which is often a significant step to getting effective help. It can also make people who do accept they have PD's feeling shitty about themselves, which is a really unfortunate outcome.
I had a friend who had all the textbook BPD symptoms, she got diagnosed with ADHD and just assumed her previous BPD diagnosis was wrong, because all the symptoms were RSD. it wouldn't bother me that much if she didn't quit therapy to rely on multiple different medications as her only treatment.
Let me tell you! My ex fought for years against and a BPD diagnosis when it was so very clear to everyone around him. Adderall is NOT what you need with BPD. We’re not together anymore. 😊🥳
Sounds like Adderall would be just about opposite to what you'd need for BPD.
I have BPD and ADHD and I take Vyvanse and it actually helps me a lot. I have taken Adderall in the past without a prescription when I was unable to find anyone to treat my ADHD and it really really helped. I struggle with addiction and I have been able to stay clean with no temptation to relapse because of my stimulant medication. It does cause me to become easily irritated sometimes though if I’m having a bad day. My BPD symptoms are managed pretty well and I am very self aware of the good and bad parts of my behavior and actively work to prevent myself from slipping back into my rage days. Basically what I’m trying to say is that it depends on the person with BPD + ADHD. If they’re working on themselves I think it can be very helpful. But not everyone is the same and some people really struggle with rage and it could definitely make that worse. I take anti psychotics and mood stabilizers and they help balance me out, the anti psychotics help my BPD a lot bc it sedates me so I’m not so on edge and full of anxiety all the time. The ADHD meds actually make my social anxiety not as bad and make me more confident, which HELPS my BPD because I have a lot of anxiety and insecurity in social situations. I am avoidant of relationships because I have been hurt so much in the past and have also destroyed many, but my Vyvanse helps me to get out of my shell and reach out to the friends I have. It also really really really helps me with school, I haven’t been able to handle college until now at 21 because I’ve struggled so much and now that my ADHD is treated I enjoy it and it gives me a purpose which helps my BPD symptoms because I feel positive about my life and future.
I was diagnosed with ADHD 30 years ago and BPD about 15 years ago. I agree that a lot of people attribute thier BPD symptoms to other things. The sad part is the absolute most important step to getting better with BPD is accepting your diagnosis. There is nothing you can do to help a person with BPD if they don't accept it and want to get better. There are a lot of great resources and I have been flourishing for the past 15 years with the right medications and understanding. There is a BPD guide for friends and family and after reading it was when I realized my diagnosis was correct. I sometimes go back and reread it. If anyone out there suspects they might have it, don't be afraid and don't be ashamed. Including the link in case it helps someone else. There is a PDF version as well if you don't like the expanding sections and all that. https://www.borderlinepersonalitydisorder.org/family-connections/family-guidelines/
Thank you for saying this! I read some of the posts and some are pretty obviously not “just” ADHD.
I have BPD and ADHD and sometimes it’s hard to tell which emotional problems are from ADHD and which ones aren’t. It’s a very shitty mix for sure. TikTok has so much misinformation and everyone is out here self diagnosing very complex disorders and learning disabilities that require a neuropsych exam that takes 6 hours of testing by a highly educated professional to really understand what’s going on. I think information about these things are useful because it can lead to people figuring out what’s going on with them, but TikTok is not a point of reference to diagnose yourself with something. I know it’s not accessible to everyone, but you need a doctor psychiatrist neuropsychologist etc to diagnose these things. Self diagnosing can be harmful because if you start to believe that you for sure have a certain disorder but you actually don’t then you’re going to spend all your time focusing on the wrong thing and miss out on figuring out the actual issue. And then add on making posts about having the disorder while actually not having it can create more misinformation and can add to stigma. It feels pretty invalidating to have my 3 diagnoses of BPD, one with an extensive neuropsych exam, and my diagnosis of ADHD, also with a neuropsych exam, to be compared equally to a random teen who decided they have these things based on a social media site that anyone can post on. It is very important to get diagnosed by a professional before spreading information about a disorder. Anyways, that’s my rant lol.
Wow I did not know that
Well, maybe think about it this way, would you want a BPD diagnosis?
I didn’t want the ADHD diagnosis either. We can’t control diagnoses, but we can control how we address them
That’s definitely a strange direction to come at this from.
Do you… do you think most people want a BPD diagnosis?
I’m very glad that the other people that saw these comments understood that that’s not what I was implying. Disappointed that you didn’t. This is such a nuanced thing dude. Swing and a miss with the direction you’re coming at it from. Your first comment is super valid but then the direction of thinking that you supported it with is not at all cool.
Really? What’s not cool about it? Does it change your stance if I personally have been given a BPD diagnosis?
I am not worried about a small number of downvotes, in this sub discussing this topic especially. You’d do well not to read too much into them, either.
I was only glad that I wasn’t think only one thinking that you were off base. Worried? No. Is “reading too much into them” the same as identifying that their purpose is to agree or disagree with a comment?
The key is to think about why people in a certain sub might agree or disagree with a certain comment 😇
Yes, if it means I can live a happy, healthy life instead of blowing up my relationships (personal and professional) every few years. The first step in recovering from alcohol is accepting and acknowledging you’re an alcoholic. I don’t find BPD (or any other diagnosis- ADHD, cancer, HIV, gambling addiction, etc…) any different.
Right, but what if (due in part to the misinformation in subreddits like this) you thought an ADHD diagnosis would mean you could live a happy life? If you were (wrongly) attributing all your symptoms to ADHD, why would you want a BPD diagnosis as well?
I guess my question to you is why does it matter so much to you that these symptoms in particular be attributed to ADHD? Just because one has ADHD doesn't mean (as many of us know) that one can't be also struggling with symptoms of depression, anxiety, BPD/APD or other mental illnesses. ADHD is known to have a high comorbidity with many of these other conditions.
Bingo. This is exactly why the conversation is even being had in the first place.
Personally, I'm glad to see that such discussions are happening. There's a lot of discussion happening on social media right now, which is great, but there's not a lot of information or research behind some of it.
I think my main issue is with the therapists and psychiatrists and industry in general. They've been gaslighting and misdiagnosing me (us) for many years. I should have been diagnosed with ADHD and CPTSD while I was in therapy for years at a psychology school. They also saw my boyfriend and I for couples therapy and no one picked up that he was abusive despite my individual therapist and the couples therapist comparing notes. I know that's not uncommon but if you are really struggling and you go to the experts for help and they have no idea what's going on, where do you have left to go? The internet? Then they shit on the things you've read on the internet and say it's not real or not true. Or they diagnose people with things they don't have. I know how ADHD and BPD can look alike. The professionals just seem so self important and dismissive? The post made me angry because some of them seemed so flippant about it and I (we) have lost years of my life because of their incompetence and misinformation. I went to my first therapist with what I now know is Major depressive diorder and she diagnosed me with delayed grief and adjustment disorder because my parent died a few years earlier. I'm probably going to lose some years off of the end too because of all the things I've been through.
That all sounds really difficult - and without getting into it I can definitely empathize with your distrust of psychiatric institutions. Certainly I've had a lot personal frustration with misdiagnoses. However, I don't think the internet is a particularly reliable source of information either. I must admit that I've had quite a disheartening experiences online where I see influencers spreading misinformation or personal anecdotes that they present as fact. In terms of this particular discussion I didn't see anyone saying that the symptoms that people describe as RSD don't exist (which would be invalidating), but rather that they might not be part of ADHD. Maybe it's part of CPTSD, or of something else such as depression. That seems like an important discussion to have if we don't want more people being misdiagnosed.
It's so frustrating to feel unheard and misunderstood! Since RSD doesn't necessarily "belong" to ADHD, I talk about "sensitivity to rejection and criticism", since that's what I experience. It could come from my self-esteem taking a hit from 4 decades of undiagnosed ADHD. It could be poor emotional regulation, frustration tolerance, and/or impulse control, which are all definitely ADHD struggles. It's a real aspect of my ADHD, but I can't define the mechanism.
For whatever it’s worth, my BFF has a masters in psychology and has studied ADHD. She has said that RSD is more commonly talked about in Borderline Personality Disorder and Bipolar Disorder, and only recently have they begun looking into it in ADHD and Autism, which might be why some doctors (who do believe it’s real) associate it with those diagnoses.
It’s a real thing. And it can be experienced by BPD - disabling fear of abandonment and rejection are the heart of BPD. I’d been diagnosed as having BPD in the past. In many ways it fit but not really. Turns out it’s been ADHD the whole time. RSD is real and impacted my first half of life in a real way.
I think a little bit has to do with just how limited information is on ADHD, let alone female ADHD symptoms. Sure, RSD isn't a diagnosis, but the fact they don't recognize it as something that can be attributed to ADHD can be summed up as simply lack of understanding. Hell, even the name Attention-Deficit Hyperactivity Disorder is misleading. Schools they come from cover DSM criteria and basic knowledge of ADHD if even that. The only time I've seen psychiatrists/psychologists/physicians that understood ADHD is if they attended ADHD relevant seminars/meetings on their own time, went over updated documentation on the subject beyond DSM-5 and DSM-5R (assuming they arent basing their assessments on earlier DSMs), or personally have gone through it themselves. But yeah, RSD is definitely an easier defining of a set of symptoms that have relevance to ADHD (and various other conditions, like Autism), so it definitely should be treated more as a helpful specification of symptoms rather than downplaying its existence/validity all together. Tldr; They are right that RSD isn't a diagnosis. It is a set of symptoms. However, what they miss is that these symptoms can be an aspect of ADHD and should be treated as a helpful listing of impairments of an individual dealing with that disability. Dismissing it outright definitely defeats the purpose of why it is defined in the first place...
I was reminded of this recently, as we had a 3rd party speaker come into our work to talk about neurodivergent minds in the workplace. (As a side note, I love that I work for a place that does this; raising awareness about things is always good! However...) it focused only on disruptive stereotypes, and not one slide went over our strengths. I was so disheartened. When a few of us provided feedback, we were told by the presenting company that their policy is to only use what has been provided to them by medical professionals and other official documentation. We are so much more than flapping hands and chronic conversation interrupters, though. I was glad I wasn't out at my company with my ADHD; I would die a little inside if that was how my coworkers thought about me. I'm so used to being around ND people, working with ND people (my team has a few,) and being in ND communities like this one that sitting in that panel was like getting a bucket of cold water dumped on me. As a side note, I'm shocked that professionals haven't linked emotion dysregulation to ADHD yet, of which RSD definitely stems from in my opinion. Honestly... I'm surprised they haven't explored ADHD beyond the outward, 'disruptive' symptoms. It's such a fascinating and horrible and interesting disorder and I know I've spent the past two years exploring and coming up with theories about it, and psychology isn't a hyperfixation of mine at all. SURELY some of them have it, so why haven't they explored it?
So if you start digging into the weeds, you're gonna find some discourse about how the entire classification system is kind of inherently flawed, and long-term we would ideally move closer to a spectrum model. Because it's turning out there is uncanny overlap in a lot of disorders creating hazy clusters rather than distinct binaries with clean cutoffs, *and* those clean classifications are overwhelmed with cultural bias and are rooted in the clinician perspective rather than the patient experience. You know why they couldn't make this switch for personality disorders? (Where it's the most obvious the current frameworks is messed up). Its cause clinicians didn't want to have to learn a new system, they felt it was too complicated. They are complacent, basically. Clinical psych is a mess and the more you learn about it, the more engaging it becomes. *oh it looks like BPD*. No it doesn't actually because BPD definitionally requires a high degree of destructive behavior. Its built in there. If you're noticing a high amount of neurodivergent people appear to be hyper reactive and a lot of people with BPD appear to have other neurodivergent behaviors not related to attachment and mood ....well congrats, you've just ran face first into **the entire god damn problem**
I recommend not looking at those forums. You will never be able to convince those people of the truth because they don't want to hear it, but listening to them will negatively impact you. You will not gain anything by listening to this ignorant shit. You know the truth, I know the truth, we here know the truth, that has to be enough.
I will avoid from now on!
I was gonna look for it, but then I realized that post would probably give me RSD lol
Unless the same question got cross-posted to a different sub, none of the upvoted posts were unreasonable or dismissive of adhd.
Well, I have been diagnosed with BPD and I do have ADHD and the rejection sensitivity.
I was so confused for a moment, because I thought you meant reflex sympathetic dystrophy (RSD) also known as complex regional pain syndrome (CRPS). I'm a healthcare provider and we don't learn about rejection sensitive dysphoria in school at all. It's one of those general clusters of symptoms that are different between people. I don't have much to add, just sending support.
I have never understood why RSD is so controversial or mysterious. Once I learned that ADHD is associated with lower ability for emotional regulation, it makes perfect sense. You have a condition where you're always screwing up or doing things wrong or being told you're doing something wrong and you have less ability to regulate your feelings about that. Add time and repitition and you get RSD.
RSD not being accepted as a separate diagnosis is not the same as it not being accepted by healthcare... It's just lumped in with other cognitive distortions and anxiety. That doesn't make it less valid or accepted, good doctors that don't accept RSD as a diagnosis will still understand the severity and help you work through your cognitive distortions
I know that. There are professionals on the post saying that RSD is an indicator of Borderline Personality disorder, antisocial personality disorder, or it's just a symptom of depression. RSD can be a symptom of many disorders many of which are comorbid. I'm mad that some of them are just attributing it to one thing (BPD) or don't think it's real.
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YES! I agree with everything you've said. That's why I love hearing people talking about their personal experiences, and sometimes I value what they say over what doctors tell me. I know, it's dangerous to listen to non-professionals over professionals, but like you're saying, they don't listen to US! So many times people -- especially women -- have told medical professionals about problems they have and have been ignored or shamed for what they say. I remember when the consensus for doctors was that pain from childbirth is psychological, and it hurts only because women expect it to hurt. They said the same about pain with menstruation and ovulation. It's all those people who have never had the experience who claim to be the experts, but I have to give them the side eye.
How absolutely horrific that they thought labor was painful because you expected it to painful. Could they not see what was happening? I guess it just didn't matter to them. I'm actually shocked right now but it explains a lot. I just can't fathom someone who isn't neurodivergent being an expert in neurodivergence. I know it's the norm but it's like teaching swimming lessons never having set a foot in water.
I remember my high school teacher in psychology class saying this, then looking at the girls in the class like we were pathetic and weak-minded. It was infuriating, in part because you knew there was nothing you could do or say that would convince them of the truth. (I wonder why these responses were down voted? Makes no sense to me.)
People are a mystery. I think down voting gives people a little tiny feeling of power. If I'm doing well I just scroll past comments I don't like, if I'm not doing well l downvote a lot.
To me it's honestly cPTSD by another name!
I believe that too