Episode 27: Inside Rejection Sensitivity Dysphoria: Insights on RSD, Mental Health, and Relationships
Dec 25, 2023
Show Notes:
Do you ever feel like you are more sensitive to rejection, teasing, criticism, or your own perception that you have failed or fallen short? Or maybe you know someone who seems to be particularly hard on themselves and reactive to others?
Everyone experiences some reaction to rejection, but individuals with RSD find themselves more likely to perceive harsh rejection and criticism where there might be none and can sometimes feel like they live in a chronic state of rejection.
In this episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, dive deep into the complexities of rejection sensitivity dysphoria (RSD) and its impact on neurodivergent individuals and the people around them.
Top 3 reasons to listen to the entire episode:
- Understand the impact of RSD and how it can lead to chronic pain, affect relationships, and cause avoidance behaviors in professional and personal settings.
- Hear about some ways that RSD can impact relationship dynamics and major life changes and decisions.
- Learn about treatments and strategies to help with RSD, as well as ways to adapt therapeutic modalities to be more effective with neurodivergent individuals.
Rejection sensitivity dysphoria can be difficult to navigate both internally and externally and can have a profound impact on the way you experience the world, but there are ways to address it that can help with reducing the intensity around feelings of rejection and finding ways to improve relationships through collaborative communication around RSD.
Resources plus Exclusive Coupon Code
- Dr. Neff's Rejection Sensitive Dysphoria Workbook Bundle (Clinical Use): https://neurodivergentinsights.com/neurodivergentstore/p/rejection-sensitive-dysphoria-clinical
- Dr. Neff's Rejection Sensitive Dysphoria Workbook Bundle (Personal Use): https://neurodivergentinsights.com/neurodivergentstore/p/rejection-sensitive-dysphoria-bundle
- Use Code: “DivergentConversationsListener” To get 20% off anything in the shop, including the RSD bundle.
- Dr. Neff's free blog posts on RSD: https://neurodivergentinsights.com/blog/category/Rejection+Sensitive+Dysphoria
- The EFT attachment infinity loop can be downloaded here: https://neurodivergentinsights.com/couples-resources
🎙️Listen to more episodes of the Divergent Conversations Podcast here
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A Thanks to Our Sponsor, Tula Consulting!
We would love to thank Tula Consulting for sponsoring this episode.
Workplace communication can be messy. Considering the lens of neurodiversity can be helpful for understanding this. Maybe you found yourself frustratedly typing "per my last email" in an office communication, perplexed about how a colleague or client doesn't seem to understand your very clearly written email.
Consider this. Visual information processing isn't everyone's strength. Perhaps a quick call could make a world of difference. Or how about including a video or voice message with your email? And this technology exists! Simple steps like these can make your work environment more accessible and bring out the best in everyone.
Tula Consulting is on a mission to help organizations build more neuro-inclusive products and work environments. Tula does this by bringing curious minds to solve curious problems. Find out more by visiting tulaneurodiversity.org.
Transcript
PATRICK CASALE: Hey, so we are about to do an episode on RSD today, which I think we are going to turn into a two-part episode. One, because there's so much to cover. Too, because Megan just wrote a 170-page workbook on the subject. Three, because I am unbelievably jet lagged and haven't slept in days. And Megan is not feeling well and is sick. So, we're going to do what we can today to kind of jump into the introduction to this topic.
But a lot of you submitted questions to our Instagram, a lot of you submitted questions in general, and we want to cover all of them. We just may not get there today. But this is certainly a topic that we are going to circle back to. So, because Megan just wrote a 170-page workbook, I'm going to turn it over to you to kind of set the stage.
MEGAN NEFF: Yeah, well, one problem is when you've been swimming in the literature it's hard to know where to start the conversation. So, yeah, how do I synthesize RSD? Well, RSD stands for rejection sensitive dysphoria. Yeah, I guess I'll go over the history of it briefly.
So, it was coined by Dr. William Dotson, who if you don't know who that is, like, I recommend Googling him. He's got a lot of really awesome articles up. He's got a lot of webinars that are free through ADDitude Magazine. And he's, like, done a lot in really emphasizing kind of the emotion regulation struggle that often happens with ADHD. But yeah, he's the one that coined RSD. Although, you could actually go back to the '60s and there was a psychiatrist before him, Dr. Paul Wender, who was describing symptoms that now we realize are RSD, who's using the language of atypical depression. But looking back, we actually see, like, okay, that was undiagnosed or often undiagnosed ADHD. And it was RSD and emotion regulation struggles that he was describing.
So, there have been breadcrumbs of this in the literature since the 1960s. But it was really in the last 20 years or so that it's become an actual term. It's not a diagnosis. It's not something you'd be diagnosed with. It comes out of the ADHD literature, so there's some debate, like, is this a specifically ADHD thing? And there's several people that say, yes, this is like a distinctive ADHD thing. So, that's the kind of, I guess, clinical definition of RSD. Oh, I guess what it is.
So, the question that Dr. Dotson would ask his… and he's a psychiatrist, he's not a psychologist, he's a psychiatrist. But what he'd ask his people when they come in is this question, "For your entire life, have you always been much more sensitive than people you know to rejection, teasing, criticism, or your own perception that you failed or have fallen short?"
And he said, 99% of ADHDers would have this like, yes. And not just, yes, but like, "Oh, my gosh, I feel like you know something about me that I've been so embarrassed to tell the people in my life." And then about a third of ADHDers said, "This is the hardest part of ADHD to live with." So, it's pretty significant when we think about kind of the clinical picture of ADHD.
Okay, I'll take a breather there. So, that's, I guess, the clinical definition, is it's a really intense, physical, emotional response to the perception of rejection. Or even, like, I guess self-rejection in the sense of like, I didn't live up to my own standards or bar, yes.
PATRICK CASALE: And this is very different than other forms of rejection. And I think that's important. Like, you went over that in your... was it Misdiagnosis Monday that you created the diagram for recently?
MEGAN NEFF: Yeah, so I created a Venn diagram comparing, like, what is normative rejection sensitivity and then what is RSD? And that's actually typically where I start the conversation. Earlier I was like, "Oh, I don't know where to start the conversation. I usually start with like the evolutionary history."
Rejection sensitivity is like a human experience and thank goodness it is. So, if we look at it from an evolutionary lens, the idea that belonging to a group literally meant survival for most of human history. You know, we're pack creatures, and we're not the biggest or strongest species, but it's our ability to think together, to be together, to problem solve together that has meant humans have survived. So, the thinking goes, and this is, you know, any evolutionary psychology is going to be an oversimplification, but kind of the thinking goes, so our anatomy hasn't caught up, right? So, if we perceive rejection, we can experience that as a threat to belonging, therefore a threat to survival on a very kind of automatic level because it's like it's baked into our DNA.
And so we haven't caught up to the fact that we don't actually have to belong to the group to survive in modern life. But our body chemistry or our nervous system hasn't caught up to that. So, I like to frame, like, rejection sensitivity through that lens of, yeah, this makes sense as a human experience and it's a spectrum. Some people have really intense. So, like, if you have RSD, you're going to have a really intense rejection sensitivity, whereas other people have more mild rejection sensitivity.
But yeah, that is what I did on the Venn diagram and the articles. I walk through, like, this is what normative rejection sensitivity looks like and this is what RSD looks like because RSD is above and beyond that normative sensitivity to rejection.
PATRICK CASALE: Yeah, thanks for setting the stage like that because I think it's important to delineate between the two. Like, it's absolutely a process of human experience to feel hurt when they feel rejected, or to feel vulnerable, or to feel insecure, or to feel unsafe. But this takes this to a whole new level, right? Because the symptomology, the struggles that come with RSD can really intensify very quickly and be unbelievably debilitating.
MEGAN NEFF: Absolutely, absolutely. Yes, debilitating. And like, yeah, I think that captures it. And that is part of, like, that's one of the ways I distinguish between, like, RSD versus normative of how much is influencing the person's decisions or daily life. And if, like, a fear of rejection, a fear of putting ourselves out there is significantly influencing our decision, that has a lot of control over our day-to-day. And typically, it's not a great thing for our well-being when fear is controlling. There's a lot of avoidance that can often happen for people when they have RSD. Like, avoidance of social situations, or putting themselves out there for like a job promotion. So, there can be career implications, romantic implications. Like, I can't even imagine asking someone out on a date, right? What if I'm rejected? So, yeah, it can be really debilitating.
PATRICK CASALE: I see it show up a lot in the coaching that I do because of the entrepreneurial side of my business with a lot of my ADHD coaching clients, where it's really hard to even put themselves out there on social media, it's really hard to create content, it's really hard to put their own spin on something because God forbid someone comes in and critiques it or says something that really sends them down that shame spiral.
MEGAN NEFF: So, I actually just had a really interesting consultation around this. And right now I'm working with a psychoanalyst because I'm wanting to… this is a little bit of a divergent trail, I'm wanting to… So, as a psychologist, when I work one-on-one with people, I have a relational framework for the work I do. And I've realized having a framework is really helpful.
So, I'm wanting to figure out how to adapt that relational framework to what I do as a public psychologist. So, I've been consulting with… a lot of people consult with like business coaches, I'm consulting with a psychoanalyst to figure out how do I bring a relational framework to the work I'm doing?
PATRICK CASALE: That's right.
MEGAN NEFF: But part of what came up was this, I've realized in writing this workbook that RSD is probably the number one block when it comes to, especially, social media because social media is just such a vicious space right now. It can be, I shouldn't make global statements, it can be.
And one thing I was talking about was how as an autistic person, my ideas, and my emotions are not separate. So, as an autistic ADHDer, right? Like, and I see that a lot with autistic people, our ideas, and our emotions, our ideas, our values, and our personhood are so integrated. So, when I put my ideas out there, I'm putting a lot of myself out there, and then you layer on top of that RSD, damn, that's hard.
PATRICK CASALE: It is. That's such a great way to kind of just put that out there too. And I know that you've been on the receiving end as I have too, your audience is significantly bigger, so you probably receive more of it, but I've been on the receiving end of text messages with you where someone said something nasty, or really like offensive, or just inappropriate, and how debilitating… why do I keep using that word? How painful that [CROSSTALK 00:10:1]1-
MEGAN NEFF: ...today.
PATRICK CASALE: I don't know, I feel like my brain is moving at like
MEGAN NEFF: Yeah, we're both struggling.
PATRICK CASALE: [CROSSTALK 00:10:19] but how painful that experience has been for you and how it makes you kind of retreat inward, and then a void.
MEGAN NEFF: It does. So, I just recently switched things up. And it's actually been so good for my mental health. Like, the way I joke about is that I've emotionally broken up with social media because what I was noticing, I noticed a few things and it's so helpful to have the RSD lens. Like, probably for the first six months, when I was growing, it was really exciting. I'd open the app, I'd be excited to see like how many like, you know, because I had these little posts that would just go viral. And it'd be exciting to see that.
And then it shifted to where I'd open the app and I would dread like, "Oh, no, did it go viral?" Or like my stomach would drop every time I open the app. Or every time I open a DM or the comments, like, half the time I literally kind of open the comments because I would feel so stuck of like, what am I going to see? 99% of the comments are really incredible things to read. But of course, those aren't the ones that stick to my brain. It's the 1% of it.
Again, I want to tease apart, some of the comments that are critiques have been really, really good learning experiences for me. And then some of them are just like rude, and unkind, and come with a lot of hostility. And I do value the ones that are hard to take in but those have been good learning experiences for me.
Yeah, I got to a point where I would feel physically sick opening the app. So, what I've done is I've turned comments off. I have an auto DM. And I will go days without opening the app. So, I will open it on Monday and Wednesday when I post. And you know how you can see on your phone how much time you've spent, like I spend like five minutes a week on Instagram. And it's amazing. And I feel like I've so much of my nervous system back, I have so much my mental real estate back. And I'm reinvesting that. I've launched my more community-oriented membership. And I'm reinvesting that energy in people who are really committed to showing up and engaging authentically. And I cannot explain what a difference that has made for my mental health.
PATRICK CASALE: I'm really happy that you've done that for yourself because I know the amount of energy it takes. I also know how impactful it becomes. And it becomes a situation where you have… I, typically, in these moments will shut down, I will avoid, I'll turn everything off, I have to disconnect from everything.
And then you're right, there's like this fearfulness of even opening the app back up. There's this like overwhelming dread sensation of like having to look at anything where you may perceive it in any sort of way that feels critical or… and not in a bad way because criticism is not always a bad thing, like you mentioned. But there are just people who like to just say stupid shit just to say stupid shit. And you have free rein to do that on the internet. So, it becomes really hard for people who are in online practices who are therapists who will have to network virtually, who have to show up online because that can really intensify very quickly and all of a sudden that leads to that shutdown or the disconnection.
MEGAN NEFF: Yeah, yeah. No, I love how you're connecting it to entrepreneurship because I think there's a lot of, particularly, ADHD entrepreneurs and RSD is very ADHD thing. And like, that double-edged sword of, yeah, like, you have to put yourself out there to be an entrepreneur. And oh, my goodness, if you put yourself out there, you're going to face criticism. You just are. Like, you can't please everyone. And something I like that's a mantra I remind myself, but when you have RSD you have to.
PATRICK CASALE: Yeah, you're right. And that's why I keep bringing up the entrepreneurial side is because so many ADHDers that I know are entrepreneurs and it makes sense. Like, it works with the way the brain functions, and the creativity, and the spontaneity, and all the innovation. And like, it's also really challenging because it is about showing up.
And you mentioned something before that's sticking in my mind about like, the inner connection of like the inner woven thought, feeling, experience for autistic people. And I get that very much and so much of ourselves when we put ourselves out there in that way, is like this is an extension of how I'm feeling and how I'm moving through the world. So, for it to be picked apart at times of like, "Oh, well, this isn't that character, this doesn't sound right, or like, I don't like the way this came across." All of a sudden it becomes this, like, sensation or this experience of my personhood, like, my sense of self is being under attack right now. And that makes me want to, like, bury my head and hide.
MEGAN NEFF: Yeah, absolutely, absolutely. And then, again, I guess, to bring it back to the AuDHD experience, like, another thing I see and I experience as an autistic person is like the fear of putting something out there and it being factually wrong. Like, I think that's one of my biggest fears. And I see that with a lot of autistic people. Like, what if I write something, and then in five years new research comes out, and like that language, and that, like, I've been talking to my spouse a lot about… my business has just become a huge source of stress if I'm working way too many hours, and I'm chronically sick. So, something has to change. And one of the things I was realizing and talking with my spouse, the reason I'm so stressed is I'm frantically because I have this membership that I've historically published a workbook a month that also means I've got like 20 workbooks, and I'm like, what is wrong in that, that I now want to go back and update? Because the idea of like, anything being out in the world that has my name on it, that might be factually wrong, from an autistic lens is also, like, very unfathomable.
PATRICK CASALE: And I imagine how unmanageable that becomes too, that it's like, "Oh, I have a 170-page workbook. Now I have to go back and add or edit and revise." And like, very time consuming, obviously. But, you know, Luke is obviously a God sent too, so…
MEGAN NEFF: Yes, that's what he is [INDISCERNINBLE 00:16:44] one. But yeah, so I think, especially, the autistic ADHD experience, it gets complicated because there's a lot of different layers that we can feel rejected or criticized.
So, this, I think, is a really important part of RSD. And I think this becomes an important part of learning how to work with RSD when our brain is hyper-vigilantly scanning for signs of rejection, what it means is that, like, the wiring around that is going to become like, and the neural pathways are going to become really forged around, like, perceiving rejection, which means we're going to perceive it when it's not actually there. And this is where I think partnerships and friendships really suffer. Like, let's say two ADHDers, right? So, like, someone forgets to call or someone forgets, like, because working memory, it can be a struggle, and the person with RSD that might trigger, like, that person doesn't care about me, and it could trigger so many narratives, when it's really like, oh, something came up and they forgot. And I think that is part of what causes so much pain around RSD is it's like someone is perceiving it chronically when they're not actually being rejected.
PATRICK CASALE: That's what I come across the most too when people are asking questions around RSD is like, well, if I'm moving through the world where I'm constantly feeling this pain of rejection or experiencing it this way, how do I then move through the world? Because it's so hard to maintain friendships, working relationships, professional relationships, etc. when I'm experiencing RSD so intensely in all of these situations.
MEGAN NEFF: Yeah, yeah, yeah, yeah. I mean, for a lot of people it's like, okay, it's easier just not to put myself out there. It's easier not to be in a relationship. It's easier to make my world small. And that's a really sad solution.
PATRICK CASALE: It is because there's so many feelings of isolation, and loneliness, and disconnection as there is for a lot of neurodivergent people, so intentionally shrinking your world to protect yourself from potential harm, it's really, really hard.
MEGAN NEFF: Yeah, yeah, yeah, yeah. We haven't even talked about that aspect of RSD of, and this is why, like, you also hear autistic people talk about RSD. I'm really curious, we haven't seen a study on this but I'd be curious if we did a study that controlled for the ADHD because we know so many autistic people have ADHD, like purely autistic people, would they still have RSD? I'd love to see a study on that.
But the neurodivergent experience of just perpetual miss-attunement, like we have had more rejection. So, that's another complicating factor, right? We're more likely to perceive it, but partly that's because we are more likely to have experienced social victimization and rejection. And then it becomes this kind of vicious feedback loop of if we show up anticipating rejection, we might have developed psychological defenses and ways of being in the world that actually make it more likely for us to be rejected. And, yeah, it's vicious.
PATRICK CASALE: We've talked before about, like, how we always lay out the pain points because so much of the experience is pain points, honestly. But if we're saying this, right? And then we take a step back from the clinical lens for people to say, okay, this is my experience, this is my world, this is every day, this is how I move through relationships, this is how I perceive conversation and feedback. What do we do?
MEGAN NEFF: Yeah, no, I mean, there are things we can do. And I'm going to kind of put it in two buckets, psychopharmacological. Okay, big words and brain fog don't mix well today. And then kind of psychological treatments or therapeutic, like, more traditional type treatments. And again, this comes from Dr. Dotson's work, but he has talked about, so there's a class of medications, I'm going to actually look it up so I make sure I'm using the right words, that it's a non-stimulant medication, that it's a class of medications that's sometimes used for a for ADHD.
So, alpha agonist is the class, and clonidine and guanfacine are the two medications within that class. Okay, this is really technical, but both have about a 30% response rate. So, a response rate when we're talking about medication is kind of significant reduction of symptoms when the person is on it. So, 30% isn't great. But these two medications are different enough that if you try one, and it doesn't work, and you try the other, there's about a 55 to 60% response rate that one of these will work for you. That's actually a pretty good response rate when it comes to medication.
And Dr. Dotson, and again, he is a psychiatrist, but like, he will talk about how he's worked with people who have maybe been like, psychoanalysts for 10 years. RSD wasn't touched, they go on medication, and it's like they ask a girl out for the first time or they apply for that job. Like, it provides emotional armor that they needed. A, to just get out of that avoidance suit, but B, to actually be able to engage like the talk therapy tools. We often need some sort of armor or just regulation to be able to engage the tools that are useful. So, I think that's a really helpful frame just to realize, like, there are medications out there that might be helpful for some people.
PATRICK CASALE: That is definitely helpful. And then, you know, on the other bucket, the psychological framework and toolkit that we're talking about, what are strategies that you think are useful?
MEGAN NEFF: So, yeah, like a lot of kind of the traditional emotion regulation strategies, but then like, a little bit more targeted. First of all, I think, learning about the rejection sensitivity lens, I say this a lot, and sometimes it gets big reactions, but like, we have to learn to not always trust our minds. Like, our minds are not always helpful. Sometimes, like-
PATRICK CASALE: Totally.
MEGAN NEFF: Yeah, our minds love attention. And so sometimes it'll spew the most mean, negative, alarming things at us to get our attention. And this is one area where I think learning to not trust our minds becomes really important, realizing, okay, I am prone to have like a rejection goggles on or rejection lens on, which means I'm going to see it when, like, maybe my partner isn't actually trying to reject me, or maybe my boss is genuinely giving me… like, is intending good for me in this constructive feedback.
So, I think one really getting clarity on that lens so that we can identify when that's on so that we can unhook from it a little bit more. I would say that's the first step. Other steps like emotion regulation strategies. So, again, if we put this back into the perspective of a threat response, our nervous system, our stress state, our fight, flight, freeze, fawn wherever we go in our nervous system is going to be activated when we're perceiving rejection.
So, I'm a big fan of like nervous system mapping, which I think that comes from polyvagal theory. I don't love all of polyvagal theory, but I like this idea of nervous system mapping of like, let me map where I am in my stress response, and then figure out what tools you need. So, if you're someone who goes, like hyperarousal, you would need downregulation strategies to kind of help cool the body off. So, emotion regulation strategies.
And then, also, things like knowing your rejection triggers, knowing your, like, what I call raw, but what I didn't come up with the term, but raw spots. Like, what are those raw spots or those areas in our life where maybe we have some attachment wounds, or some relational wounds so when they get bumped they pull a big reaction from us, getting a lot of clarity about, like, what are your rough spots? Why? What's the history of those? What happens to you when those get activated? So, also, like a ton of insight, right? Insight into your relational patterns, into your psyche. I'll stop there, that was a bit. There's, I'm sure more.
PATRICK CASALE: Those are good to start out with so that people can implement this stuff and start, you know, doing their own research or incorporating these into their day-to-day because I think it's important to be proactive, too, because I think you're mentioning so many important tips right now and the raw spot suggestion, great suggestion, right? Because if you know what creates these triggers for you, then you can work on, you know, preventing, or at least putting into practice something that will help regulate when you're going into events like that or moments like that.
I actually don't like at all, and I just want to be clear about this, CBT but REBT, rational emotive behavioral therapy, when you do like the ABCDE model of like activating event, behavioral challenge, challenging belief disputation, because what we're talking about is like, my wife's not picking up the phone, she must not love me anymore. And we're jumping to these conclusions, we're catastrophizing a lot, and I like that you said, don't always trust your brain because there are always, and I don't want to use blanket statements either, there are often alternative explanations for behavior.
MEGAN NEFF: Yeah, yeah. Wait, so are you saying you don't typically like CBT but you do like that CBT exercise?
PATRICK CASALE: Yeah, I like that exercise because it allows you to say like, what's the activating event? Okay, she doesn't pick up the phone. My immediate reaction is she doesn't love me anymore, right? Like, and then you've kind of processed it through that lens of like, but what are the other scenarios here for not picking up the phone?
MEGAN NEFF: Yeah, I'm glad you say that because I'm with you. And that, like, I tend to not default to CBT, especially, for neurodivergent or anyone who's had a marginalized experience in the world because I think it can be really invalidating. But then there's these tools from CBT that I really like. And I'm like, well, if you put it in context, this can actually be really helpful. And I don't want us to, like, throw the baby out with the bathwater.
So, I'll talk about that too, like putting your thoughts through a reality filter. And there's certain questions you can ask to be like, okay, is this thought helpful to me right now? Is it like, yeah, are there cognitive distortions that are, like, influencing this? Kind of that detective work of like, let me become a detective of my own mind, and my own experience, and my own thoughts, which even just the act of stepping outside of the experience into that observing detective, ideally, non-evaluative, non-judgmental mode is therapeutic, no matter where you land on the reality filter of the thought.
PATRICK CASALE: Absolutely, yeah. And I'll just piggyback on my statement of saying I'm not a fan of CBT. I know how harmful it is for marginalized communities and for neurodivergent folks in… oh, we could have a whole episode on therapeutic modalities that don't work well for neurodivergent human beings. But if you put it through that lens, and I like that you use that word, you can start becoming that detective, you can start, like, taking that step back because it's really helpful when it feels like almost everything is creating this intensification of experiences that leaves you feeling like you're not able to participate in your life because you just feel like you can't put yourself out there or you can't, you know, speak your mind, or you feel like you just can't show up the way you want to show up. And I think that's really challenging for a lot of ND folks, too, is like, if I can't show up authentically, that really feels uncomfortable and that feels really painful, too.
MEGAN NEFF: Yeah, I mean, that then ties into like masking and RSD which that can be its own, like complex conversation. But yeah, if masking helps reduce RSD you could see how like, okay, I'm going to say this, but then I'm going to unpack it, masking becomes a form of self-care. And I don't mean that masking is actually self-care, but like, in that option of like, I'm either going to, like, spiral, like, the fear of I'm going to spiral with RSD because I'm going to show up authentically and you know, the fear, it's not going to be perceived, or I'm going to mask, I could see how for someone masking feels like the less energy cost of the two. And again, that's assuming that masking is like a choice, which it often is not. But it's just that is an interesting, like, yeah, the masking RSD dynamic.
PATRICK CASALE: Yeah, absolutely. So, I think we could take this in a variety of ways. And I think we could talk about, like, partnership and RSD, I think we could talk about so many different avenues. I also don't know how your energy is and I want to check on that.
MEGAN NEFF: No, I actually feel like I've talked a lot about like content creation in RSD, which is not going to be, like, the majority of people listening to this. So, I'd love to spend some energy to generalize it more to, yeah, relationships, workplace, things like that.
PATRICK CASALE: Yeah.
MEGAN NEFF: Absolutely.
PATRICK CASALE: So, let's talk relationships. Whether it's, you know, different neurotypes, same neurotype, one person is experiencing RSD, one person's not, that can be really challenging because conflict can arise in relationships, and often does. And it can feel really, really painful to feel like you are being critiqued, or you feel really vulnerable, or you're, you know, feeling like you're spiraling often in conversations with your partner. And I imagine then the other partner would then feel that challenge too of like, I don't even know what I can say.
MEGAN NEFF: Yes, yeah. I mean, I think it's painful for both people involved, right? Because if one person feels like they're walking on eggshells, right? That's kind of the famous metaphor, that is not healthy for a relationship if there's not the capacity to talk openly about what is happening, and if hard conversations spiral into, like, emotion dysregulation and conflict. So, that is a really painful scenario for both partners involved. Yeah, absolutely.
With relationships, I'd be curious to kind of like overlay attachment style and RSD. And attachment theory is one that like it gets critiqued for being oversimplified, but I find it a really helpful lens, even with it being, if people know like, okay, this is probably an oversimplification, I still find it really helpful and to someone who has RSD and also, anxiously attached, like, there's going to be some big emotions when they perceive like an attachment injury or where they perceive they're being criticized.
And again, kind of, I'm mapping, I guess, is my word today, but mapping out what are the attachment styles. There's a really great exercise from EFT therapy. It's infinity loop. I have a link on my website, I could link it in our show notes. But it's essentially you map out, like, what happens in the aftermath of an attachment injury. Like, what story does each partner start telling? What did they start doing, right? So, some partners will retreat, some will go to work because it's like, we have to fix this. But then that activates another story, like a secondary story. So, you can map out like, okay, what happens to us in an attachment injury. I think exercises like that become really helpful because then you can understand and name the chaos without a map of like, what is happening here? It's really confusing.
PATRICK CASALE: Yeah, yeah, absolutely. And I'm glad you mentioned that because I think recognizing the attachment style and the pattern and then being able to, again, step back when you're not activated and look at it, and say, okay, now I get a sense of like, what's happening in these moments because what you don't want to do, like you said, it's not a healthy partnership if you're walking on eggshells if you feel like you can't have communication, and it's very different experiences on either side, so each partner is experiencing this painfully but very differently, too.
MEGAN NEFF: Absolutely, absolutely, yeah. Like, I think ideally the RSD could almost be externalized and be talked about as like a thing in the relationship, right? Like, okay, we just hit an RSD wall, or like, we just triggered the RSD. I love externalizing both and like individual techniques, I do it all the time. Like with, oh, my mind is doing this thing, right. That's it. I'm externalizing it. I'm making it less connected to me. I'm saving the relationships when we can externalize it and it's like, let's collaboratively solve the struggle we're experiencing around this RSD trigger versus you versus me. That really changes the conversation.
PATRICK CASALE: It feels much more like teamwork at that point in time. And going back to your detective analogy before, like, you're both putting on that detective hat of like, how can we solve this together? Instead of you're injuring me versus I'm experiencing our relationship this way.
MEGAN NEFF: Yeah, yeah, exactly, exactly. Yeah, yeah, that makes such a big difference when partners can do that, like stand side by side, look at the dynamic together versus… I see that a lot, so much like accusations, and kind of like, I mean, our narcissism episode just came out. Like, you are a narcissist, or you're gaslighting me. Like these huge words get thrown out, or can get thrown out when we're looking at the other person as the problem versus looking at the dynamic, or the issue, or the like the process, content versus process. Like, that's a communication thing of when we're locked in the content, which we typically are during in RSD trigger. That means we're locked in like, the thing we're talking about.
Process is kind of like bird's eye view, like what is actually happening here relationally? You can get unhooked from the content enough to have some process conversation, some process reflection, that is so helpful in relationships.
PATRICK CASALE: Absolutely, 100%. And I think that's also a good transition point into professional relationships. Like, because those things happen in the workplace, too. And it can happen with your co-workers, it can happen from a employee/employer standpoint, and the implications can be pretty huge, like you said, not trying to go for that promotion that you wanted, not talking out in staff meetings because you're going to feel rejected for how you come across. There are so many ways that this can show up in the workplace, too.
MEGAN NEFF: Absolutely, absolutely. And I think it's going to depend like, so I talked about, well, Dotson talks about three ways people can respond to RSD, I've added a fourth one. And I have like a little matrix up of like the different ways people can typically respond to RSD. So, workplace stress is going to depend on like, what is your kind of default response?
So, like, perfectionism is a really common response to RSD. Like, if I just never make a mistake, then I'm fine. No one's ever going to perceive any of this, right? It's totally illogical, except it's not because we're going to make mistakes.
People pleasing, so kind of, like, I put that in under the fawn mode. Like, perpetual people pleasing, like reading, like, what does this person want from me? And a lot of people that are RSD become really good at like, kind of taking in a person, figuring out exactly who they want the person to be. I think that ties back into masking and other things.
And then avoidance. So, just like, I'm going to avoid putting myself out there. I think that's the one we've talked about the most in this episode.
And then the one I added is the like projector or someone who gets like fight mode when they're perceiving rejection. So, yeah, workplace, if you're a perfectionist people pleaser, with RSD in the workplace, you're going to burn out really fast.
PATRICK CASALE: Yeah, yeah. It's going to look like workaholism, right? And you're going to be potentially putting in extra hours that are unnecessary, you're going to be taking on additional tasks that you don't really have the capacity for or don't want to do. And you're going to be one of those employees potentially that goes above and beyond for everything. And then ultimately, it's like, fuck, I can't do this job anymore. This is not manageable for me. This is not sustainable.
MEGAN NEFF: Yeah, yeah. And like I think you and I were probably both in that category. And I think that then resentment can come in. So, I would say it's like a more low-simmer chronic RSD response, right? Because there's this illusion of I can, yeah, evade rejection if I just work harder. But then the resentment that builds up, the burnout that that builds up. Absolutely, yeah.
PATRICK CASALE: Yeah, absolutely. And then it leads to either termination or leads to quitting a job that you may have been able to navigate or find some accommodation for and it can be really challenging. I think that if we're looking at the whole person, this is so impactful interpersonally, in relationships, in employment places, employment places, places of employment, [INDISCERNIBLE 00:39:39] but it's so impactful. So, knowing the triggers, like you said, implementing some of these soothing strategies for your nervous system, being able to have these conversations, being able to externalize. I think there are a lot of good strategies that you're naming and mentioning right now.
MEGAN NEFF: Yeah, yeah. And then also for the avoiders, right? Like getting out of the avoidance loop, which essentially, a lot of anxiety-based treatments are all about targeting avoidance because avoidance feeds anxiety. So, I would add that tool for the avoiders, and especially, with the workplace. Like, avoiders are probably going to be underemployed, they're not going to be going up for that promotion, they're not going to be putting themselves out there. And so really targeting avoidance, using exposure.
Gosh, it's going to be a whole other episode. Actually, I feel some guilt about this because I think I used to be one of the voices that said this, and I'm now seeing it on social media a lot. Like, exposure therapy doesn't work for autistic people. Exposure therapy doesn't work for sensory habituation. But that doesn't mean it doesn't work for PTSD triggers, for anxiety. So, we have to get out of this, I think it's a dangerous mindset to say exposure therapy doesn't work for autistic people. When you're in an anxious-driven avoidance loop, you absolutely have to do exposure. Like, it can be natural, it should be led by you. So, for that person exposure and addressing the anxiety would be a really important part of the toolkit.
PATRICK CASALE: Glad you name that. I think that's a really good tip and also good framework for the recognition that in some instances certain techniques and strategies are useful, like we said before, despite not being useful as like a blanket statement or across the board.
MEGAN NEFF: Yeah, I'm starting to become more gentle in my language use. Like, I think I used to be like, "This kind of therapy is bad." Like, I used to say, like, "CBT is bad for autistic people." I'm now more around like things need to be adapted, right? So, you need to adapt exposure therapy when you do it for an autistic person, 1,000%. If you're using CBT, you should adapt it and consider the marginalized experiences. So, I'm kind of like, yeah, I'm changing my narrative a little bit and how I talk about it. I'm softening it to talk more about adapting and less about what's good and what's bad.
PATRICK CASALE: I think it's also important to like, differentiate between taking one simple tool, or technique, or strategy from something, opposed to saying like, okay, CBT as a whole, we don't like it. But this one technique really is useful if we adapt it in a neurodivergent affirmative way. And I think that you could do that with a lot of different therapeutic interventions and modalities.
MEGAN NEFF: Absolutely, absolutely. Yeah, yeah, yeah.
PATRICK CASALE: Usually, three yeahs in a row from you is like, all right, let's transition out. So, is that where we're at?
MEGAN NEFF: I mean, I don't know how long we've been recording. You're right. Like, you said this before we started recording because we were both feeling really lousy. And I was like, "I don't know if this will be a good episode." You were like, "Usually when we start talking it like works." I feel like I could talk longer. But I also feel like I could be done. I don't know, what do you feel?
PATRICK CASALE: I feel the same way. I think we've been recording now for about 45 minutes so-
MEGAN NEFF: Okay, good length.
PATRICK CASALE: Good length of time. And I think it's a good foundational episode to then build off of for different perspectives. I think we can also have people on here to talk about their own RSD experiences, and how it shows up, and how they work through it, or try to manage, and support themselves. So, I think we can go a lot of directions with this.
MEGAN NEFF: Yeah. And I mean, I love, we should definitely do a like answer questions follow up because I think people have a lot of questions around this topic. And so we could do that.
PATRICK CASALE: Yeah, will say I didn't think about even asking for questions for the episode until like 10 minutes before we started recording. We got like six questions immediately. So, I think that with another day or two, we could compile all that and we can address that the next time we record.
MEGAN NEFF: Let's do that.
PATRICK CASALE: Cool. Well, for those of you who don't know, Megan, and I haven't recorded in like three and a half weeks because I've been gone and I just appreciate being able to fall back into this even though we feel crappy, like connected in that way. So, just want to thank you for that. What was I going to say?
MEGAN NEFF: I think episodes are out every Friday on all major platforms, Spotify, Apple…
PATRICK CASALE: What Megan just said, new episodes are out every single Friday. If you have topic requests, if you have questions you want answered, please email our Gmail address that's attached to our Instagram, which is [email protected]. We do read those. We don't always respond because we just don't always have the capacity or the spoons to do so.
And new episodes are out every single Friday on all major platforms and YouTube. And Megan has a 170-page workbook on RSD that you can purchase from her website at neurodivergentinsights.com. And that will be linked in the show notes as well. Cool. All right, goodbye.
