You’re Not Shy or Antisocial. It’s probably Social Anxiety Disorder
Social anxiety is not shyness. Social anxiety is not a personality trait.
What is Social Anxiety Disorder with ADHD?
Social Anxiety Disorder and ADHD frequently occur together, and they are commonly misunderstood. Studies show that roughly 2%-13% of the U.S. population experiences social anxiety at some point in their lives, to the degree that it would be considered Social Anxiety Disorder (SAD). It is the most common type of anxiety disorder in teenagers. It is more common in women and often starts in childhood or early adolescence. Some evidence suggests that, like other anxiety disorders, it occurs more frequently in children and adults with ADHD. At ATTN Center our compassionate team of therapists specializes in treating ADHD and its related issues.
The most common traits related to ADHD and Social Anxiety Disorder include:
SAD symptoms specific to socializing include struggling with the fear of rejection and being negatively judged by people, while ADHD can make someone impulsive, interrupt others, and have challenges picking up on social cues. Someone with ADHD and SAD may therefore find it incredibly difficult to make and maintain friendships and may be uncomfortable talking to anyone outside of their comfort zone.
Difficulty Sustaining Attention
Someone with SAD symptoms may become so preoccupied with their worries that they can appear to zone out, specifically in social situations. They may look like they’re staring off into space, thinking of nothing. But inside their head is a whirlwind of thoughts and emotions, which almost freezes them in their seat. Those with ADHD are usually inattentive and find it difficult to sustain focus for extended periods of time. This means that those with comorbid SAD and ADHD can find it very difficult with concentrating or paying attention.
Difficulty Completing Tasks
Since those with SAD may find it hard to ask for help, they can become stuck on a task that feels unmanageable alone. Likewise, they may find they become extremely anxious about any number of elements during a task, which becomes so overwhelming that it prevents them from completing the task. Those with ADHD often have difficulty sticking to deadlines due to their poorer planning skills and forgetfulness. And structuring a routine is always a challenge. A combination of SAD and ADHD can make it quite difficult to complete tasks on time, leading to a host of side effects, including one’s Self-Esteem.
Those who have both ADHD and SAD often have low self-esteem. Research has found that children with ADHD and SAD had lower self-esteem than those with ADHD only. Because of the combined social anxiety from SAD, and impulse control issues due to ADHD, people with both disorders often feel very self-conscious around others. They also tend to be intensely self-critical, often ruminating on thoughts of not doing something perfectly or not behaving perfectly in an important situation, when really they were fine and no one noticed or cared, despite the fact that they were indeed not perfect.
Due to the difficulties in social interaction and feeling anxious around others, those with SAD and ADHD may avoid experiences or places where social interaction will occur. This can cause issues with isolation, and even depression. If they have to attend a social event, they may worry for days or even weeks beforehand, and they may be more likely to cancel at the last minute to avoid the stressful feelings altogether.
Rejection Sensitivity Dysphoria
Rejection-sensitive dysphoria (RSD) is one manifestation of emotional dysregulation, a common but misunderstood and under-researched symptom of ADHD. Individuals with RSD feel “unbearable” pain as a result of perceived or actual rejection, teasing, or criticism that is not alleviated with cognitive or dialectical behavior therapy. By enhancing your understanding of RSD, we can better deal with Social Anxiety. Then we’ll look at the tools we can use to manage RSD in conjunction with SAD and ADHD.
What Is Rejection Sensitive Dysphoria?
Rejection-sensitive dysphoria is not a formal diagnosis, but rather one of the most common and disruptive manifestations of emotional dysregulation — a common but under-researched and oft-misunderstood symptom of ADHD, particularly in adults. Rejection-sensitive dysphoria is a brain-based symptom that is likely an innate feature of ADHD. Though the experience of rejection-sensitive dysphoria can be painful and even traumatic, RSD is not thought to be caused by trauma.
Dysphoria is the Greek word that means unbearable. Its use emphasizes the intense physical and emotional pain suffered by people with RSD when they encounter real – or more often – perceived rejection, criticism, or teasing. The emotional intensity of RSD is described by many as a wound. And it doesn’t always make rational sense. The response of feeling rejected is highly disproportionate to the nature of the event that triggered it.
What Triggers RSD?
Otherwise referred to as ‘hysteroid dysphoria’ outside of the United States, rejection-sensitive dysphoria is characterized by intense mood shifts triggered by a distinct episode, typically one of the following:
- rejection (the real or perceived withdrawal of love, approval, or respect)
- criticism, no matter how constructive
- persistent self-criticism or negative self-talk prompted by a real or perceived failure
The new mood sweeps in quickly and matches the individual’s perception of the trigger. If these triggered emotions are internalized, the person can instantaneously appear as if they have a full Major Mood Disorder syndrome complete with suicidal thinking. This leaves others around them wondering if they are bipolar, as those close to people with RSD witness dramatic mood swings with some regularity. If the feelings are externalized, they are commonly expressed as rage at the person or situation that wounded them so severely. The moods return to normal very quickly so a person with ADHD can have multiple episodes of mood dysregulation in a single day. Many people with RSD say it’s always been a part of their lives, however some report growing significantly more sensitive as they get older.
What Are the Signs of RSD?
Individuals suffering from rejection-sensitive dysphoria may exhibit the following behaviors:
- Avoidance of social settings in which they might fail or be criticized (for this reason, RSD is often hard to distinguish from Social Anxiety Disorder)
- Sudden emotional outbursts following real or perceived criticism or rejection
- Relationship problems, especially feeling constantly attacked and responding defensively
- Withdrawal from social situations
- Negative self-talk and thoughts of self-harm
- Low self-esteem and poor self-perception
- Rumination and perseveration
- The constant harsh and negative self-talk leads them to become their own worst enemy
What Does RSD Feel Like?
The terrible emotional and psychological pain of RSD is often beyond description. Patients describe the intensity of RSD as “awful,” “terrible,” “catastrophic,” or “devastating,” but they cannot verbalize the quality of the emotional experience. No one likes to be rejected, criticized, or to be seen as a failure. It is unpleasant, so people avoid those situations if they can. RSD is different because of the extreme, unbearable intensity of the feelings of rejection, which is what sets it apart from brains that are neurotypical. This intense pain is often experienced as a physical injury, where the person feels as if they were stabbed or punched in the chest. Commonly, people will hunch over, grimace, and clutch their chests when they describe their RSD events. It’s a very visceral experience.
How to Manage Rejection Sensitive Dysphoria and Social Anxiety Disorder with ADHD
For example, exercise has been shown to be effective at helping to reduce anxiety, with people reporting feeling a lot calmer, specifically after completing an aerobic exercise. In addition, exercise can also help those with ADHD to focus on one task at a time and put a lot of their restless energy into doing something which is also good for their health.
Be kind to yourself
Those with ADHD and comorbid SAD are likely to be very self-critical. Try to limit negative self-talk as much as possible. Come up with phrases you can say to reassure yourself, even writing these down and placing them in a spot that is within sight every day to remind yourself. I am good enough. Or, I am worthy. As well as, I am lovable. If you are finding your negative self-talk is getting hard to control, this can be something to talk to a doctor or therapist about.
One thing at a time
Try to think about what one thing you would like to change that is the biggest struggle right now. Focus on this one goal to fully work on until you feel you have improved in this area. It can be helpful to look for easy wins which can build up self-esteem and a sense of security.
Those who have comorbid ADHD and SAD may find they get into spirals of anxiety or have racing thoughts. When anxious, breathing becomes shallow among other physical sensations being triggered. Completing some relaxation exercises such as meditation, mindfulness, or deep breathing can help to bring down the anxious symptoms. Using these relaxation techniques can help you to slow down and keep you in the present moment instead of worrying about what needs to be done or focusing on future events.
Get Out and Socialize
While it may seem counterproductive because it’s so difficult to socialize, it is important to try to socialize at least once a day to keep building social skills up. It is important to challenge yourself to get out of the cycle of anxiety and overcome your fear of socialization. If you find it too challenging to socialize with people in person, you could start off small by communicating via text messages, until you feel more comfortable building up to face-to-face conversations.
Confide in Others
People with ADHD can have difficulty making and maintaining friendships, sometimes due to their social behavior such as being impulsive in conversations which can be frustrating for others. With comorbid SAD, they can become overwhelmed and fearful in social situations. Often, confiding in those around you about your struggles can help others to be more understanding of your condition and support you to overcome some of your obstacles.
Learn Your Triggers
Anxiety can be triggered by specific events such as public speaking or engaging in one-on-one conversations. Once you have identified your triggers, you can come up with ways to manage your anxiety in these situations. For instance, someone who fears public speaking could prepare notes and practice their presentation to help them feel less anxious speaking in front of others.
Keeping a journal can be a good way of keeping track of feelings and emotions as well as any progress you have made. As people with ADHD and SAD can have a lot of negative and various thoughts, it can be good to get everything written down in a journal to help manage these thoughts and clear the mind. A journal is only for the purpose of the individual so there is no wrong way to do it. It can also be useful to help you pinpoint things you may want to discuss with a therapist.
Create a Schedule
With ADHD, individuals may find it very difficult to complete tasks, especially on time. Tasks with a deadline can make anxiety worse for some people. A way to help avoid feeling anxious is to create a schedule and stick to it. You could allocate a task or goal to complete in each hour of the day, allowing extra time for each task if you think it will realistically take you longer than you think.
It is important not to set unattainable goals for yourself as this can have the opposite effect and cause more anxiety. Another method can be to schedule segments of time where you focus on the task at hand and nothing else. You could set a timer for 30 minutes- during this time you put away any distractions and focus solely on your task. This can take some practice to get used to, but it can be a good way to ensure you get all your tasks done without losing focus.
Overcome Social Anxiety Disorder and ADHD with ADHD-Focused Therapy for Anxiety in NYC
ADHD-Focused Therapy for Anxiety at the ATTN Center is unique because it offers traditional therapy practices to address the psychological and emotional impacts of having ADHD in the real world. This practical support helps you learn to overcome and effectively manage your ADHD-related mental health conditions such as ruminating thoughts.
Our expert ADHD-Focused therapists look forward to speaking with you. We offer a free 20-minute phone consultation to discuss your case and how we can help. Contact us today.
- Learn more about our team and the services offered here!
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- Begin the journey to understanding your diagnosis and living your best life!
Other ADHD Services Offered by The ATTN Center in NYC
We not only offer ADHD therapy, but also other services related to the treatment of ADHD and its side effects. This includes neurofeedback, ADHD-Focused Therapy for Depression, ADHD-Focused Therapy for Anxiety, ADHD Focused Therapy, group therapy, and ADHD testing options. At ATTN Center of NYC, we do everything in our power to treat ADHD without the use of medication, but we understand in some severe cases additional measures may be needed. As a result, we also maintain close relationships with many of NYC’s best psychiatrists.
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