There is a lot of discussion at the moment about Rejection Sensitive Dysphoria (what RSD is, here) and some number of people in my seminar have noted that this description of what it feels like to have ADHD is spot on.  While Dr. Dodson (the MD who is the primary proponent of thinking about ADHD in this way) would have you believe that RSD is characteristic for virtually everyone who has ADHD, that has not been my experience as I have worked with couples.  But for some, it's quite relevant, and helps provide insight into how their ADHD impacts themselves...and others.

The 'and others' is the topic of this post.

I recently received an email from a woman married to a man she believes has RSD.

"I have read about rejection sensitive dysphoria (RSD) and this explains SO MUCH about my partner. This is just as big as him being diagnosed with ADHD. For our entire relationship I have been so perplexed by why he was such a people pleaser, saying and doing things that he thought the other person wanted to hear/have happen even if he didn't believe it or feel that way. And in the beginning of our relationship, when I would calmly bring up something I was upset about or something that he did that hurt me, broke trust, let me down, etc. he would just mock me and act like a child. He cannot handle anything from me that he perceives to be negative (even if it was small). Conversations that could have been quick and we could have moved through quite easily turn into a huge deal, with him deflecting, making up things that aren't true, turning it back on me and bringing up things that aren't related just to make me feel bad, focusing on my "tone" and the way I said something (if there's just a tinge of what he perceives to be annoyance he can't handle it -- and sometimes I'm annoyed and I want to express that I'm annoyed, I can't say everything in a sing-songy way with a smile on my face, that's just not going to happen). It escalates into an argument and totally gets out of hand.

What do we do in our situation? I really don't feel that I can have a rational conversation with him or bring up anything that he perceives to be negative towards him, I can't work through things with him.

I'm not in denial about my anger, and I acknowledge that I have unchecked anger. But I don't know what to do when I can't even have a calm conversation with him without him twisting things up, deflecting, exaggerating about something, turning on me or accusing me of something, bringing up something completely unrelated, etc. Luckily he doesn't mock me anymore, because I made that clear that that is not okay. But he also does kind of mock the conversation, say things that aren't true or that he knows will get a rise out of me just for the fun of it, and he'll have a smile on his face or laugh. It drives me nuts. I don't feel acknowledged, heard, validated, and nothing gets resolved, I can't work through the issue."

As is often the case in relationships that are struggling, both partners play a role in how their interactions unfold.  In this case, BOTH partners are 'giving themselves a pass' on good behavior, for different reasons.  The non-ADHD partner has allowed her frustration with his extreme sensitivity to become justification for her own 'unchecked anger,' while the combination of the ADHD partner's RSD (i.e. it feels awful when he feels critiqued) and her anger 'justify' the ADHD partner's continued anger and ridicule.

According to Dr. Dodson, medications such as Clonidine and Guanfacine may help diminish the pain of RSD for the ADHD partner in this couple, while the non-ADHD partner needs to engage with the idea that her anger - left unchecked - is also quite damaging to the couple's chances of success.  The special challenge in this relationship is that his RSD means that standard ways of carefully expressing anger don't work as well as they might due to his hypersensitivity.  That makes this a problem that the couple must work on together.  This is a multi-faceted problem, which will take a multi-dimensional approach to treatment.  Here is what I recommend:

• Treat the RSD as a target symptom of ADHD - see if medications can take away some of the rejection sensitivity
• Both parties would benefit form developing a mindfulness practice to help them (eventually) learn to recognize and acknowledge feelings of anger as they set in, but help them engage with those feelings less
• Both partners need to take an objectve look at their own behavior and assess it relative to what a healthy relationship looks like (or the relationship they would like to have).  If you don't want an angry, disconnected relationship, the first place to start improving things is with yourself - so stop blaming your partner and set a high enough standard for yourself
• Use a therapist knowledgeable about ADHD to help keep difficult conversations calm, and learn important conversational skills, including...
• Develop conflict intimacy skills (this is is a specific conversational style that includes non-aggressive speaking and non-defensive listening) 

How to diminish anger in your relationship is a big challenge for many couples impacted by ADHD, not just those with RSD.  I will be releasing a self-study seminar to help couples learn the skills they need to calm their intereactions around May of 2018.  More information is here.