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“Always respond with THIS when someone calls you ‘too sensitive’” - Harley Street psychiatrist shares RSD management secrets | Dr James Kustow

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January 28, 2025

TLDR: Expert Dr James Kustow discusses Rejection Sensitive Dysphoria (RSD), experienced by many with ADHD, its manifestations, triggers, and coping mechanisms.

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In the latest episode of the podcast, Dr. James Kustow, a Harley Street psychiatrist and expert in adult ADHD, shares valuable insights into the complexities of Rejection Sensitivity Dysphoria (RSD). This condition frequently accompanies ADHD and manifests as intense emotional responses to rejection or criticism, often causing significant distress in personal and professional relationships.

What is RSD?

RSD can feel like an emotional tsunami, overwhelming individuals with feelings of shame, anxiety, and anger. Dr. Kustow describes it as a cycle of intrusive thoughts that can last for hours or even days, making everyday interactions feel like high-stakes situations.

Key Characteristics of RSD:

  • Emotional Responses: Varying ranges of shame, anxiety, and controlled anger.
  • Physiological Reactions: Rapid heart rate, muscle tension, and feelings of being overwhelmed.
  • Cognitive Disturbances: Looping thoughts and ruminations focused on perceived rejection.

Effects of RSD in Daily Life

In Relationships:

  • Interpersonal dynamics can become strained as those with RSD often interpret neutral comments as negative.
  • Family events, such as gatherings, can be triggers, particularly when historical tensions exist.

At Work:

  • RSD can prevent individuals from engaging fully due to a fear of criticism, leading to procrastination or avoidance of responsibilities.
  • Comments from colleagues, even if benign, can evoke a feeling of dread and subsequent spirals of negativity.

Strategies for Managing RSD

Dr. Kustow emphasizes the importance of proactive measures for managing RSD symptoms:

1. Education and Awareness:

  • Understanding RSD can help individuals contextualize past experiences and recognize their patterns of emotional dysregulation.
  • Sharing insights into RSD with family members can foster understanding and support.

2. Self-Care Practices:

  • Ensuring sufficient sleep, balanced nutrition, and mindfulness practices reduces the emotional load one carries daily.
  • Techniques such as movement meditation can help process and regulate emotions effectively.

3. In-the-Moment Responses:

  • Use humor, engage in grounding techniques like deep breathing, or excuse yourself briefly to regain composure after being triggered.

Insights on Vulnerability

Dr. Kustow discusses how allowing oneself to be vulnerable can be an essential part of healing while managing RSD. Vulnerability invites connection but can also evoke fears of judgment and hurt. The conversation emphasizes striking a balance between self-protection and genuine interaction to foster healthy relationships.

The Connection Between RSD and Alcohol

Dr. Kustow elaborates on how alcohol can worsen RSD symptoms by lowering inhibitions, leading to impulsive behavior and emotional outbursts. This emphasizes the need to understand the synergistic effects of substances on emotional regulation, especially for those with ADHD.

The Future of RSD Research

While RSD is currently not recognized as a formal medical diagnosis, it is increasingly acknowledged in psychiatric discussions, with experts like Dr. Kustow advocating for further research. Understanding the mechanics of RSD through research could someday validate the experiences of those suffering from it.

Conclusion: Embracing Sensitivity

With RSD, the key lies in balancing sensitivity and resilience. By fostering awareness, maintaining self-care, and developing effective coping strategies, individuals with ADHD can significantly improve their emotional regulation and overall quality of life. Dr. Kustow’s blend of professional insight and personal experience offers hope and practical methods for managing RSD.

Key Takeaways:

  • RSD is a profound emotional response often felt by individuals with ADHD.
  • Understanding and education surrounding RSD is critical for self-management.
  • Techniques for grounding and humor can alleviate immediate emotional responses.
  • Acknowledging the positive aspects of sensitivity can lead to personal growth and deeper connections.

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