RSD Reflections: From a Mom & Therapist
Part Three - The ConversationBefore you jump in, if you haven't read part one or part two, I encourage you to start there.
Coming home from the conference, I couldn’t wait to talk to Liam about what I’d heard. Thankfully, now that he’s a bit older, he’s happy to sit with me and learn (being a psych major also doesn’t hurt). I asked him some pointed questions about his moods, his rages, and his emotions, (very calculated questions and you’ll see why in a minute!)
I asked him to think about his rages over the years and what may have contributed to the instantaneous blow-ups. After considering the different scenarios, he said that he always felt hurt, felt like a failure, that he was letting people down, that others were letting him down, or that people were picking on him. So even when we pointed out a tiny mistake on a project, or there was a small stain on the shirt, or again, that cute little cowlick, it felt like a huge slight against him. When he couldn't answer a question on a test, (even if he was asking it) it meant he was stupid so why even try?
When I asked him if he could describe the feeling to me of feeling “hurt”, he said he couldn’t.
He told me that the pain was physical, like he’d literally been punched in the gut, like chest pain and pressure, and the energy building inside of him hurt so badly to internalize – like actual stabbing pain - that if he didn’t let it out, he thought it might actually kill him, literally. There was no other way to articulate the feeling of being hit by the trigger.
Did he know what was happening? When he morphs into the rage, he reported that it was actually blind. He didn’t see things the same way, sometimes didn’t see anything at all. Let me stop here and paint you a picture… Have you seen the Disney movie “Brave”? Do you remember when Merida has a spell placed on Mom and she turns into a bear? Poor mama-bear is harmless and scared, but as they get closer and closer to the time in which the spell can’t be reversed, mama-bear starts to flip back and forth into a wild bear and back again into mama-bear without realizing it. When she’s about to go wild, her eyes dilate to full black like a cat who’s just gone into pounce mode, and you can’t actually get her under control. Okay, now you get it.
He couldn’t control it, couldn’t control what he did or said, and really didn’t realize the magnitude until he’d calmed down and could look around at the aftermath. When he did manage to calm down, the shame and remorse was almost as unbearable as the pain of the rejection.
So, why my questions to Liam? Let’s see what Dr. Dodson has to say about all this.
90% of clients who worked with Dr. Dodson in his RSD research reported the following:
1. There is always a trigger, even if no one else sees it
2. There are typically a limited number of triggers – rejection, teasing, criticism, perception of failure
3. Mood matches the perception of the trigger
4. Change from one mood to the next is instantaneous
5. Can look like Major Depression Disorder if internalized. If externalized it becomes a rage at the person or situation that wounded them so severely
6. Age of onset is usually in early childhood but may not appear until adolescence.
7. Emotional pain is not describable in words – they talk about the intensity but can’t tell you what it feels like
8. The pain is often physical as well as emotional
9. People commonly report being dissociated/cut off from the rest of the world
10. Once an episode starts, most have no control over it
11. Afterwards, the person is overwhelmed by shame and humiliation – a weakling, defective, cannot control themselves, etc.
Sound familiar?
So, as a mom, my heart wants to say “We’ve figured it out!!” “Let’s get him back into therapy!” “Let’s start new meds!!” As a therapist, I also have to tell myself (and you!) to “sloooow down, here!” This is a great opportunity to start having a conversation. (Yes, a conversation.)
Parenting a child with ADHD, or Tourette Syndrome, or RSD, or… etc. etc. comes with unique challenges, particularly when it comes to emotional regulation.
Key takeaway: I was NOT the perfect parent when it came to Liam’s rages.
In fact, I sometimes felt like his rages created mine, created his, created mine, created his…(you get it, right!?). We don’t know what we don’t know!
RSD is not a matter of weakness; it is truly an unbearable emotional impairment. And, while not officially recognized as a separate diagnostic category, many individuals with ADHD report experiencing these RSD symptoms. The connection between RSD and ADHD is thought to stem from overlapping neural pathways and neurotransmitter imbalances that are associated with both conditions. Furthermore, the challenges of ADHD, such as difficulty with impulse control and executive functioning, can contribute to the development of RSD symptoms.
That said, it’s important to note that while often associated with ADHD, it can also occur in individuals without ADHD. The ADHD brain really struggles with executive functioning, it’s the most impairing part (see blog on EF); however, by understanding the underlying causes and implementing some effective strategies, we can help our children navigate their emotions more effectively and thrive, with whatever the struggle.
Stay tuned for the fourth & final part next week!
