WEBVTT
NOTE
This file was generated by Descript
00:00:00.100 --> 00:00:03.570
Hello, this is Jonathan Murphy,
psychiatric nurse practitioner , and
00:00:03.570 --> 00:00:08.730
I'm here at the Compass Point Institute,
which is a great place to discuss clinical
00:00:08.730 --> 00:00:13.550
ideas that come up in my practice as a
psychiatric nurse practitioner, I just
00:00:13.550 --> 00:00:18.775
released a video on hyper focus for people
that are interested in ADHD content.
00:00:19.211 --> 00:00:20.981
You can check that out
on my YouTube channel.
00:00:20.981 --> 00:00:24.011
Focus Path Systems for Growth.
00:00:24.111 --> 00:00:24.891
Let's get into it.
00:00:24.891 --> 00:00:26.511
What are we gonna talk about here today?
00:00:26.611 --> 00:00:29.771
I wanted to talk about something that
I've been thinking about lately, this
00:00:29.771 --> 00:00:34.671
idea of rejection sensitivity dysphoria
In my work as an ADHD clinician, I have
00:00:34.671 --> 00:00:37.931
a lot of patients come to me and they
say, you're never gonna believe it.
00:00:37.931 --> 00:00:38.891
I just figured it out.
00:00:38.991 --> 00:00:41.871
I have rejection, sensitivity, dysphoria.
00:00:41.971 --> 00:00:44.991
And in the beginning when I
heard this, this bothered me.
00:00:45.111 --> 00:00:45.561
Why?
00:00:45.591 --> 00:00:46.161
Lemme tell you.
00:00:46.261 --> 00:00:50.641
Fresh outta school, you get tested
and you have to learn how to diagnose
00:00:50.761 --> 00:00:55.811
psychiatric disorders from the DSM,
the Diagnostic Manual and it's fifth
00:00:55.811 --> 00:00:57.771
edition, many people know about this.
00:00:57.871 --> 00:01:01.941
A committee of people create a book
and it has clinical purposes and
00:01:01.941 --> 00:01:03.791
it has, , billing purposes too.
00:01:03.891 --> 00:01:07.211
So when we're talking about these
diagnoses, we're, we have to understand.
00:01:07.311 --> 00:01:10.981
In psychiatry and psychology we're
operating in the realm of symptoms,
00:01:10.981 --> 00:01:16.611
clusters of symptoms rather than a broken
arm or, a brain bleed or a heart attack.
00:01:16.681 --> 00:01:18.151
These are psychiatric symptoms.
00:01:18.201 --> 00:01:21.951
These clusters of symptoms, they're
categorized and ideally this is
00:01:21.951 --> 00:01:25.371
gonna help the patient, find a
treatment that is successful and
00:01:25.371 --> 00:01:27.051
lead to better understanding.
00:01:27.151 --> 00:01:31.021
So rejection sensitivity
dysphoria is not in the DSM 5.
00:01:31.091 --> 00:01:32.441
So why does that matter?
00:01:32.521 --> 00:01:35.831
I think that I have to break it
down simply is that rejection,
00:01:35.831 --> 00:01:39.481
sensitivity dysphoria, it's something
that spread on the internet and.
00:01:39.581 --> 00:01:40.601
How did it start?
00:01:40.601 --> 00:01:43.841
It started with one psychiatrist, Dr.
00:01:43.841 --> 00:01:47.771
William Dotson, and in the nineties
he started talking about rejection
00:01:47.771 --> 00:01:51.581
sensitivity dysphoria, and then one of
these, um, sort of publications attitude,
00:01:51.681 --> 00:01:56.101
just sort of one of the main voices,
especially pre-internet, about ADHD.
00:01:56.201 --> 00:01:57.191
And Dr.
00:01:57.191 --> 00:02:01.961
Dotson describes rejection, sensitivity
dysphoria as a vague observation.
00:02:01.961 --> 00:02:03.731
He's written about it a lot in attitude.
00:02:03.731 --> 00:02:06.131
There's no, to my
knowledge, published work.
00:02:06.231 --> 00:02:08.541
There's no real studies on it.
00:02:08.541 --> 00:02:09.891
There's nothing validated.
00:02:09.991 --> 00:02:11.281
It's just basically.
00:02:11.381 --> 00:02:15.631
His, clinical and personal professional
opinions, which he's totally entitled to.
00:02:15.731 --> 00:02:20.181
But the problem is, is that they're
propped up and then shared by YouTubers
00:02:20.181 --> 00:02:21.981
like how to ADHD and so forth.
00:02:21.981 --> 00:02:25.591
And then you have people saying, oh, I
have rejection, sensitivity, dysphoria.
00:02:25.691 --> 00:02:27.261
So what's the problem with that?
00:02:27.261 --> 00:02:29.291
Well, people do have validation.
00:02:29.351 --> 00:02:29.891
That's good.
00:02:29.891 --> 00:02:31.271
Being validated is good.
00:02:31.371 --> 00:02:35.041
So for the purposes of being
validated, having a community, having
00:02:35.101 --> 00:02:39.071
an ability to name things, , it's
good, but it's not understanding.
00:02:39.171 --> 00:02:40.101
Lemme put it this way.
00:02:40.201 --> 00:02:43.396
If you were at a party, let's just
say you're back in your college
00:02:43.396 --> 00:02:47.606
days and you're partying all
night long in the dorm rooms and.
00:02:47.706 --> 00:02:50.286
You wake up the next day and
people are still hanging out and
00:02:50.286 --> 00:02:51.306
you're feeling a little fuzzy.
00:02:51.306 --> 00:02:55.256
You don't remember which couch you passed
out on, and you start walking around
00:02:55.256 --> 00:02:58.536
and everyone just starts laughing at
you and you don't understand why, and
00:02:58.536 --> 00:02:59.826
you're like, oh, maybe this was fun.
00:02:59.826 --> 00:03:04.056
And then you eventually make it to the
bathroom and you get writing all over your
00:03:04.056 --> 00:03:06.496
face, Sharpie, , use your imagination.
00:03:06.596 --> 00:03:10.776
So we want to make sure that we
understand what's actually going on.
00:03:10.876 --> 00:03:13.966
We don't want to think it's one
thing and then it's not another.
00:03:14.066 --> 00:03:17.196
So when we're thinking about rejection
sensitivity, we're thinking about
00:03:17.196 --> 00:03:19.746
people in a very, , isolated state.
00:03:19.896 --> 00:03:21.996
We can't think of people
as merely individuals.
00:03:21.996 --> 00:03:24.806
We have to think about
people in the group context.
00:03:24.806 --> 00:03:26.606
It's the missing link group dynamics.
00:03:26.606 --> 00:03:28.136
It's our survival response.
00:03:28.236 --> 00:03:30.526
So rejection, where does it come from?
00:03:30.526 --> 00:03:33.616
Well, ADHD is your executive functioning.
00:03:33.646 --> 00:03:38.196
It's your, your logical, linear,
brain, ability to carry out
00:03:38.196 --> 00:03:40.386
tasks with directed attention.
00:03:40.436 --> 00:03:43.306
With medication, people are gonna
have greater impulse control,
00:03:43.406 --> 00:03:47.866
greater awareness, and also a greater
ability to process complex thinking.
00:03:47.966 --> 00:03:51.686
So therefore, it's not uncommon
for people to notice these
00:03:51.686 --> 00:03:54.626
automatic responses and reactions.
00:03:54.726 --> 00:03:57.576
We have what we see, what we smell,
what we taste, what we hear, and
00:03:57.576 --> 00:04:02.786
we touch The sensory input leads to
automatic involuntary reactions, and
00:04:02.786 --> 00:04:05.496
then only after the fact, much later.
00:04:05.496 --> 00:04:08.476
In the grand scheme of things,
do you become aware of it?
00:04:08.476 --> 00:04:13.366
Think about when you put your hand
on a really hot pot that's been on
00:04:13.366 --> 00:04:17.786
the stove, your hand's burning before
you realize it's the same idea.
00:04:18.166 --> 00:04:22.486
So it's not ADHD, therefore we can't
call it rejection sensitivity dysphoria
00:04:22.486 --> 00:04:26.506
because rejection sensitivity dysphoria
is associated with ADHD, but there's
00:04:26.506 --> 00:04:28.046
no real clear connection either.
00:04:28.046 --> 00:04:28.451
Dr.
00:04:28.451 --> 00:04:32.156
Dotson himself talks about searing,
emotional rejection in the veins.
00:04:32.726 --> 00:04:36.576
Or in the guts, which is very much
of the peripheral nervous system.
00:04:36.676 --> 00:04:36.976
Dr.
00:04:36.976 --> 00:04:41.176
Russell Barkley is one of the sort of
godfathers of ADHD he agrees with me,
00:04:41.276 --> 00:04:45.966
he also doesn't think it is associated
with So , the jury is far from out
00:04:46.026 --> 00:04:49.136
yet the crowd of public opinion
it's not working out in this case.
00:04:49.136 --> 00:04:51.416
So I want to aid my
clinical voice in this.
00:04:51.466 --> 00:04:53.686
So what it was, what is
rejection sensitivity?
00:04:53.786 --> 00:04:56.846
Well, I actually think about two
separate domains 'cause we're
00:04:56.846 --> 00:04:58.376
a lot more complex than that.
00:04:58.476 --> 00:05:03.216
You have interpersonal vigilance, so this
is like when you walk into a room and
00:05:03.216 --> 00:05:07.061
you might feel on edge, there's people
around, you're walking on eggshells.
00:05:07.161 --> 00:05:11.636
This is hypersensitivity or vigilance
in a group setting, and then we
00:05:11.636 --> 00:05:13.316
have relational vulnerability.
00:05:13.416 --> 00:05:17.506
What I would consider to be how
vulnerable someone is to the behaviors,
00:05:17.506 --> 00:05:19.786
actions, or words of other people.
00:05:19.786 --> 00:05:23.996
And I'd consider this to be a more
one-on-one relational dynamic.
00:05:23.996 --> 00:05:26.106
So we have one-on-one attachment.
00:05:26.156 --> 00:05:27.836
You're born from one person.
00:05:27.836 --> 00:05:32.646
So that maternal attachment is our
prototype for individual relationships,
00:05:32.646 --> 00:05:36.746
but it's really the group relationships
that define us the most because
00:05:36.746 --> 00:05:38.816
we survive within group dynamics.
00:05:38.916 --> 00:05:42.736
So there's two different domains there's
no relationship between the two of them.
00:05:42.836 --> 00:05:46.886
Someone could have high interpersonal
vigilance in a group setting, but if
00:05:46.886 --> 00:05:49.826
someone says something to them or does
something to them one-on-one, they're not
00:05:49.826 --> 00:05:51.906
very vulnerable to that and vice versa.
00:05:51.956 --> 00:05:52.646
So there you go.
00:05:52.646 --> 00:05:54.206
So that's the why in it all.
00:05:54.206 --> 00:05:55.406
Why does it matter?
00:05:55.436 --> 00:05:58.766
Because there's individual adaptation
that needs to be considered.
00:05:58.866 --> 00:06:02.696
We need to consider our
individual adaptive responses.
00:06:02.796 --> 00:06:04.806
To individually understand ourselves.
00:06:04.806 --> 00:06:07.236
So ADHD is gonna lead
someone to medication.
00:06:07.336 --> 00:06:10.216
It indicates that there's a
therapeutic response to a stimulant,
00:06:10.316 --> 00:06:11.876
but it's often the starting point.
00:06:11.976 --> 00:06:16.216
And, um, that's just what I wanted to take
the time to talk about with you today.
00:06:16.266 --> 00:06:17.886
Don't to check out my blog.
00:06:17.886 --> 00:06:21.260
I talk about this a little
bit, my Focus Path blog.
00:06:21.360 --> 00:06:23.910
And until next time, this is
the Compass Point Institute.
00:06:24.010 --> 00:06:25.390
Let the compass point the way.
NOTE
This file was generated by Descript
00:00:00.100 --> 00:00:03.570
Hello, this is Jonathan Murphy,
psychiatric nurse practitioner , and
00:00:03.570 --> 00:00:08.730
I'm here at the Compass Point Institute,
which is a great place to discuss clinical
00:00:08.730 --> 00:00:13.550
ideas that come up in my practice as a
psychiatric nurse practitioner, I just
00:00:13.550 --> 00:00:18.775
released a video on hyper focus for people
that are interested in ADHD content.
00:00:19.211 --> 00:00:20.981
You can check that out
on my YouTube channel.
00:00:20.981 --> 00:00:24.011
Focus Path Systems for Growth.
00:00:24.111 --> 00:00:24.891
Let's get into it.
00:00:24.891 --> 00:00:26.511
What are we gonna talk about here today?
00:00:26.611 --> 00:00:29.771
I wanted to talk about something that
I've been thinking about lately, this
00:00:29.771 --> 00:00:34.671
idea of rejection sensitivity dysphoria
In my work as an ADHD clinician, I have
00:00:34.671 --> 00:00:37.931
a lot of patients come to me and they
say, you're never gonna believe it.
00:00:37.931 --> 00:00:38.891
I just figured it out.
00:00:38.991 --> 00:00:41.871
I have rejection, sensitivity, dysphoria.
00:00:41.971 --> 00:00:44.991
And in the beginning when I
heard this, this bothered me.
00:00:45.111 --> 00:00:45.561
Why?
00:00:45.591 --> 00:00:46.161
Lemme tell you.
00:00:46.261 --> 00:00:50.641
Fresh outta school, you get tested
and you have to learn how to diagnose
00:00:50.761 --> 00:00:55.811
psychiatric disorders from the DSM,
the Diagnostic Manual and it's fifth
00:00:55.811 --> 00:00:57.771
edition, many people know about this.
00:00:57.871 --> 00:01:01.941
A committee of people create a book
and it has clinical purposes and
00:01:01.941 --> 00:01:03.791
it has, , billing purposes too.
00:01:03.891 --> 00:01:07.211
So when we're talking about these
diagnoses, we're, we have to understand.
00:01:07.311 --> 00:01:10.981
In psychiatry and psychology we're
operating in the realm of symptoms,
00:01:10.981 --> 00:01:16.611
clusters of symptoms rather than a broken
arm or, a brain bleed or a heart attack.
00:01:16.681 --> 00:01:18.151
These are psychiatric symptoms.
00:01:18.201 --> 00:01:21.951
These clusters of symptoms, they're
categorized and ideally this is
00:01:21.951 --> 00:01:25.371
gonna help the patient, find a
treatment that is successful and
00:01:25.371 --> 00:01:27.051
lead to better understanding.
00:01:27.151 --> 00:01:31.021
So rejection sensitivity
dysphoria is not in the DSM 5.
00:01:31.091 --> 00:01:32.441
So why does that matter?
00:01:32.521 --> 00:01:35.831
I think that I have to break it
down simply is that rejection,
00:01:35.831 --> 00:01:39.481
sensitivity dysphoria, it's something
that spread on the internet and.
00:01:39.581 --> 00:01:40.601
How did it start?
00:01:40.601 --> 00:01:43.841
It started with one psychiatrist, Dr.
00:01:43.841 --> 00:01:47.771
William Dotson, and in the nineties
he started talking about rejection
00:01:47.771 --> 00:01:51.581
sensitivity dysphoria, and then one of
these, um, sort of publications attitude,
00:01:51.681 --> 00:01:56.101
just sort of one of the main voices,
especially pre-internet, about ADHD.
00:01:56.201 --> 00:01:57.191
And Dr.
00:01:57.191 --> 00:02:01.961
Dotson describes rejection, sensitivity
dysphoria as a vague observation.
00:02:01.961 --> 00:02:03.731
He's written about it a lot in attitude.
00:02:03.731 --> 00:02:06.131
There's no, to my
knowledge, published work.
00:02:06.231 --> 00:02:08.541
There's no real studies on it.
00:02:08.541 --> 00:02:09.891
There's nothing validated.
00:02:09.991 --> 00:02:11.281
It's just basically.
00:02:11.381 --> 00:02:15.631
His, clinical and personal professional
opinions, which he's totally entitled to.
00:02:15.731 --> 00:02:20.181
But the problem is, is that they're
propped up and then shared by YouTubers
00:02:20.181 --> 00:02:21.981
like how to ADHD and so forth.
00:02:21.981 --> 00:02:25.591
And then you have people saying, oh, I
have rejection, sensitivity, dysphoria.
00:02:25.691 --> 00:02:27.261
So what's the problem with that?
00:02:27.261 --> 00:02:29.291
Well, people do have validation.
00:02:29.351 --> 00:02:29.891
That's good.
00:02:29.891 --> 00:02:31.271
Being validated is good.
00:02:31.371 --> 00:02:35.041
So for the purposes of being
validated, having a community, having
00:02:35.101 --> 00:02:39.071
an ability to name things, , it's
good, but it's not understanding.
00:02:39.171 --> 00:02:40.101
Lemme put it this way.
00:02:40.201 --> 00:02:43.396
If you were at a party, let's just
say you're back in your college
00:02:43.396 --> 00:02:47.606
days and you're partying all
night long in the dorm rooms and.
00:02:47.706 --> 00:02:50.286
You wake up the next day and
people are still hanging out and
00:02:50.286 --> 00:02:51.306
you're feeling a little fuzzy.
00:02:51.306 --> 00:02:55.256
You don't remember which couch you passed
out on, and you start walking around
00:02:55.256 --> 00:02:58.536
and everyone just starts laughing at
you and you don't understand why, and
00:02:58.536 --> 00:02:59.826
you're like, oh, maybe this was fun.
00:02:59.826 --> 00:03:04.056
And then you eventually make it to the
bathroom and you get writing all over your
00:03:04.056 --> 00:03:06.496
face, Sharpie, , use your imagination.
00:03:06.596 --> 00:03:10.776
So we want to make sure that we
understand what's actually going on.
00:03:10.876 --> 00:03:13.966
We don't want to think it's one
thing and then it's not another.
00:03:14.066 --> 00:03:17.196
So when we're thinking about rejection
sensitivity, we're thinking about
00:03:17.196 --> 00:03:19.746
people in a very, , isolated state.
00:03:19.896 --> 00:03:21.996
We can't think of people
as merely individuals.
00:03:21.996 --> 00:03:24.806
We have to think about
people in the group context.
00:03:24.806 --> 00:03:26.606
It's the missing link group dynamics.
00:03:26.606 --> 00:03:28.136
It's our survival response.
00:03:28.236 --> 00:03:30.526
So rejection, where does it come from?
00:03:30.526 --> 00:03:33.616
Well, ADHD is your executive functioning.
00:03:33.646 --> 00:03:38.196
It's your, your logical, linear,
brain, ability to carry out
00:03:38.196 --> 00:03:40.386
tasks with directed attention.
00:03:40.436 --> 00:03:43.306
With medication, people are gonna
have greater impulse control,
00:03:43.406 --> 00:03:47.866
greater awareness, and also a greater
ability to process complex thinking.
00:03:47.966 --> 00:03:51.686
So therefore, it's not uncommon
for people to notice these
00:03:51.686 --> 00:03:54.626
automatic responses and reactions.
00:03:54.726 --> 00:03:57.576
We have what we see, what we smell,
what we taste, what we hear, and
00:03:57.576 --> 00:04:02.786
we touch The sensory input leads to
automatic involuntary reactions, and
00:04:02.786 --> 00:04:05.496
then only after the fact, much later.
00:04:05.496 --> 00:04:08.476
In the grand scheme of things,
do you become aware of it?
00:04:08.476 --> 00:04:13.366
Think about when you put your hand
on a really hot pot that's been on
00:04:13.366 --> 00:04:17.786
the stove, your hand's burning before
you realize it's the same idea.
00:04:18.166 --> 00:04:22.486
So it's not ADHD, therefore we can't
call it rejection sensitivity dysphoria
00:04:22.486 --> 00:04:26.506
because rejection sensitivity dysphoria
is associated with ADHD, but there's
00:04:26.506 --> 00:04:28.046
no real clear connection either.
00:04:28.046 --> 00:04:28.451
Dr.
00:04:28.451 --> 00:04:32.156
Dotson himself talks about searing,
emotional rejection in the veins.
00:04:32.726 --> 00:04:36.576
Or in the guts, which is very much
of the peripheral nervous system.
00:04:36.676 --> 00:04:36.976
Dr.
00:04:36.976 --> 00:04:41.176
Russell Barkley is one of the sort of
godfathers of ADHD he agrees with me,
00:04:41.276 --> 00:04:45.966
he also doesn't think it is associated
with So , the jury is far from out
00:04:46.026 --> 00:04:49.136
yet the crowd of public opinion
it's not working out in this case.
00:04:49.136 --> 00:04:51.416
So I want to aid my
clinical voice in this.
00:04:51.466 --> 00:04:53.686
So what it was, what is
rejection sensitivity?
00:04:53.786 --> 00:04:56.846
Well, I actually think about two
separate domains 'cause we're
00:04:56.846 --> 00:04:58.376
a lot more complex than that.
00:04:58.476 --> 00:05:03.216
You have interpersonal vigilance, so this
is like when you walk into a room and
00:05:03.216 --> 00:05:07.061
you might feel on edge, there's people
around, you're walking on eggshells.
00:05:07.161 --> 00:05:11.636
This is hypersensitivity or vigilance
in a group setting, and then we
00:05:11.636 --> 00:05:13.316
have relational vulnerability.
00:05:13.416 --> 00:05:17.506
What I would consider to be how
vulnerable someone is to the behaviors,
00:05:17.506 --> 00:05:19.786
actions, or words of other people.
00:05:19.786 --> 00:05:23.996
And I'd consider this to be a more
one-on-one relational dynamic.
00:05:23.996 --> 00:05:26.106
So we have one-on-one attachment.
00:05:26.156 --> 00:05:27.836
You're born from one person.
00:05:27.836 --> 00:05:32.646
So that maternal attachment is our
prototype for individual relationships,
00:05:32.646 --> 00:05:36.746
but it's really the group relationships
that define us the most because
00:05:36.746 --> 00:05:38.816
we survive within group dynamics.
00:05:38.916 --> 00:05:42.736
So there's two different domains there's
no relationship between the two of them.
00:05:42.836 --> 00:05:46.886
Someone could have high interpersonal
vigilance in a group setting, but if
00:05:46.886 --> 00:05:49.826
someone says something to them or does
something to them one-on-one, they're not
00:05:49.826 --> 00:05:51.906
very vulnerable to that and vice versa.
00:05:51.956 --> 00:05:52.646
So there you go.
00:05:52.646 --> 00:05:54.206
So that's the why in it all.
00:05:54.206 --> 00:05:55.406
Why does it matter?
00:05:55.436 --> 00:05:58.766
Because there's individual adaptation
that needs to be considered.
00:05:58.866 --> 00:06:02.696
We need to consider our
individual adaptive responses.
00:06:02.796 --> 00:06:04.806
To individually understand ourselves.
00:06:04.806 --> 00:06:07.236
So ADHD is gonna lead
someone to medication.
00:06:07.336 --> 00:06:10.216
It indicates that there's a
therapeutic response to a stimulant,
00:06:10.316 --> 00:06:11.876
but it's often the starting point.
00:06:11.976 --> 00:06:16.216
And, um, that's just what I wanted to take
the time to talk about with you today.
00:06:16.266 --> 00:06:17.886
Don't to check out my blog.
00:06:17.886 --> 00:06:21.260
I talk about this a little
bit, my Focus Path blog.
00:06:21.360 --> 00:06:23.910
And until next time, this is
the Compass Point Institute.
00:06:24.010 --> 00:06:25.390
Let the compass point the way.
