Watch Out for Rejection Sensitivity

People with ADHD tend to have something called rejection sensitivity or rejection sensitive dysphoria. Watch out for this!  

What is rejection sensitivity?

It’s the tendency to perceive a situation negatively, when in reality it is not meant to be negative at all. It can lead to significant anxiety or low self esteem. 

For example

An example of this may be that you attempt to text a friend multiple times. There may be many reasons they don’t reply, but you automatically assume they’re mad at you or don’t value your friendship. Even after hearing that their phone died or they didn’t have it with them, you still may feel that their delayed response was somehow due to them not wanting to answer your text.

Stress response

When you have ADHD, your nervous system overreacts to things from the outside world. Any sense of rejection can set off your stress response. This leads to an emotional reaction that is out of proportion to the situation. Sometimes whatever really occured was not a negative thing at all, but your reaction to it is negative. 

Symptoms of rejection sensitivity. Learn to recognize them so you can work on it.

Why does this happen?

It’s estimated that the typical 12 year old with ADHD has received 20,000 more negative messages than other kids their age.

They are constantly reminded that they’re not on task.

Chores are often forgotten.

Homework is lost.

They may interrupt others and speak without a filter.

Sitting quietly without constant movement is expected in certain situations, but very difficult for many kids with ADHD.

Each of these situations is due to all of the executive functioning shortcomings, not intentionally bad behavior. But the scoldings and reminders make kids feel like they were bad. All that criticism can take a real toll on their self-esteem.

Over time people who are chronically made to feel like they didn’t meet expectations grow more sensitive to all situations. They might attempt to be perfect in what they do to cover up real or perceived shortcomings. Since it’s impossible to always be perfect, they fail, which serves to further lower their self esteem.

What does low self esteem look like?

When people experience repeated failures to do things as expected, they may lose the drive to try. They often give up. This can look like laziness, which can lead to more shame. 

Only when people who are affected in this way are guaranteed success will they even try. There aren’t many situations in life that we’re guaranteed anything, so this can be a big problem.

Many people are afraid to ask for help when needed, so they simply don’t do perceived difficult tasks. Some children fail to do homework because they’re ashamed to ask for help when they don’t understand it. Parents may mistake this for willfully not doing homework or being lazy, which isn’t the case. Often kids wish to do the work, but they’re overwhelmed and too embarassed to get help.

Some people try to overcompensate and show more confidence than they have. They might state that they are really good at something when they don’t really believe it. The overconfidence can backfire when it hurts someone else’s feelings or when they fail to live up to the set expectation. People can simply view their statements as bragging. No one wants to be around someone who thinks they’re better than others. The irony is that in this situation, the person really doesn’t think that. They have a low self esteem and are overcompensating or simply trying to hide their fears about themselves. 

How does this affect relationships?

It’s not surprising that rejection sensitivity leads to a lot of problems within relationships. 

Blaming

Many people with very low self esteem attempt to blame others for all of their problems.

They are unable to accept responsibility for their shortcomings. This prevents them from learning from their mistakes.

It of course also affects how the other person feels – which isn’t good.

No one wants to stay around someone who makes them feel bad, so it can strain relationships.

Drive people away

With the texting example above, if you accuse your friend of not valuing your friendship, they will be annoyed. Maybe not at first. With the first occurance, they might simply blow it off and say you’re being silly. But if you consistently treat them like they need to be at your beck and call because you get angry or jealous when they’re not, they’re likely to get tired of it. They’d have every reason to ask for space and intentionally stop making plans to do things with you. 

Jealousy

Dating relationships can be even more affected, since it’s a one on one situation. Many people with rejection senstivity easily get jealous. If their boyfriend/girlfriend talks to someone, they might misinterpret the situation and jump to the conclusion that they’re cheating with – or at least have a crush on – the other person. Relationships should be based on trust, but when there’s jealousy, all trust is lost.

When a person gets jealous easily, they often become very controlling. This can lead to emotional abuse of the partner. It brings forth negative emotions in both people in the relationship. It isn’t healthy to stay in relationships like this. Even if you really care for one another, it is important that everyone in a relationship is safe and respected. 

Failed relationships

It is not uncommon for people with ADHD to have more failed relationships (including marriages) than people without ADHD. This is not exclusively due to rejection sensitivity, but rejection sensitivity certainly plays a part. Recognizing this trait and working to improve self esteem and decrease the rejection sensitivity can help with maintaining strong relationships. 

What can be done to treat rejection sensitivity?

Recognize it 

The first step in treating this is recognizing what is going on when your extreme negative emotions are driving your thoughts and actions. If people tell you you’re being too sensitive, reflect on it with an open mind. Don’t just get angry, blame others, or avoid the issue.

Treat your ADHD

Treating the underlying ADHD can help some of the issues with rejection sensitivity, but not all of the symptoms.

Impulsive behaviors can exacerbate the emotional response to a perceived negative situation. Controlling the impulsivity appropriately can help with the response directly, as well as to help preserve your self esteem by allowing you to think before acting and speaking.

Improving your focus can help you be successful in completing tasks without rushing through them. Again, this helps to preserve your self esteem because you achieve success. 

If you don’t think your ADHD symptoms are properly managed, talk to your parents and your doctor.

Talk to others

It’s important to not hide or cover up your negative thoughts and concerns. Doctors, therapists, and loved ones can help if they can be told what is going on in a way that helps the understand. Too many people are afraid to talk about why they stop trying, are negative or jealous, and about their overall low self esteem. Many might not even realize what is going on and why they feel like they do, but if the above list of symptoms reminds you of yourself, talk to someone you trust about it.

If the person you tell is not familiar with rejection sensitivity, they might not understand what you’re trying to tell them. Please don’t let that knock down your self esteem even more because they don’t understand. Show them this post and and other information about rejection sensitivity. Help them learn rather than accepting their ignorance and going further down in your own self esteem. Talk to your doctor, a school counselor, or a therapist. If they don’t know about the condition, show them the resources you have too.

Accept yourself for who you are

Learning to accept yourself for who you are – faults and all- can be difficult for anyone, but it’s possible.

Focusing on the positives can help.

Take the time each day to think about and write down what you’re grateful for from that day.

Also write down the things you did that day that made you proud or accomplished. Don’t focus on the tasks that you haven’t finished – think about all the parts you have done.

Humor can be a good healer

Learn to use humor when situations get tough. It’s okay to laugh at situations to help avoid negative thinking.

Don’t forget to learn from the situation, but keeping the mood light helps to not have negative self talk.

Medications

Rejection sensitivity is sometimes treated with medications such as guanfacine and clonidine (both are blood pressure medicines now approved to treat ADHD), and MAO inhibitors.

These treatments should be discussed with and managed by a physician knowlegable in this treatment.

How can you get better sleep?

We’ve all heard that sleep is important for our mental and physical health, yet it always seems we don’t get enough. Screens, homework, activities, and our natural circadian rhythm all seem to get in the way. What can you do to get better sleep?

Go to bed when tired at night.

Fighting sleep initially will make it harder to go to sleep when you finally go to bed.

If you miss the tired phase, you will hit a second wind and be up for much longer in a wired phase. You won’t necessarily feel tired past bedtime, but you body will suffer the effects of sleep deprivation if you miss out on needed sleep.

Attempt to follow a regular sleep schedule.

Going to bed and getting up at about the same time every day really helps you get better sleep overall.

While sleeping in on weekends can help repair a sleep deficit, it can make it harder to get to sleep Sunday night and getting sufficient sleep every night is better than just getting more sleep a few days/week.

Try to sleep in no more than 2 hours past your school day wake up time. Sleeping in too late makes it hard to get to bed on time that night.

Follow the same routine each night at bedtime.

Brush teeth, read a book, color, take a bath or shower — do whatever helps you wind down and relax.

Repeating this every night can help your brain get ready for bed. The routine itself helps. Your body anticipates sleep is coming.

Nap to help make up missed sleep.

A short 15-20 minute nap after school can help revitalize the brain to get homework done. Just don’t sleep too long or it can interfere with bedtime.

Turn off the screens an hour before bedtime.

All lighted screens keep your melatonin levels too low. A gland in our head makes melatonin in response to darkness. The melatonin helps us feel tired.

This means that television, computer games, computer/tablet use for homework, and smartphones for socializing all keep you awake. Turn them off at least an hour before bedtime. Don’t even check your social media accounts during that last hour of your day.

Try to get all your homework that requires a computer or tablet use completed earlier in the evening. Save the homework that only involves paper books and assignments for last if needed.

If you must be on a screen close to bedtime, use night mode screen lighting and apps that take the blue lights off of the screen. I personally use the f.lux app – it’s free and easy to set up. It works well!

What about melatonin supplements?

Melatonin is available as a supplement in many forms. It is commonly used in children to help with sleep. Since up to 70% of kids with ADHD have problems falling asleep, it is especially common to be used in this group.

It’s generally considered safe, but there are some cautions. It isn’t regulated by the FDA, so what the label says and what you get might be different. Studies in children are also lacking, so specific interactions, dosing, and best uses are not known.

In my experience, there are few side effects from melatonin. Some kids still don’t sleep well with it and others are still tired the following day. It can also interact with other medications, so if you take it, be sure to talk to your doctor about it.

To learn more about melatonin, check out this great post from Dr. Craig Canapari.

Avoid caffeine in the later afternoon.

The time it takes half of the caffeine to be removed from your body is 5-6 hours.

Ideally teens would sleep and never drink caffeine, but I know that isn’t reality. Any caffeine in the later afternoon can make it harder to fall to sleep.

Don’t forget “hidden” sources of caffeine, such as chocolate, energy bars, and workout supplements.

Coffee nap

One interesting concept that has scientific backing (but goes against the “no caffeine after 3 pm” rule) is the coffee nap.

Basically, you drink coffee (or another caffeinated drink – but be careful of those loaded with sugar).

You then quickly nap for 15-20 minutes. Sodas and teas don’t work as well as plain coffee due to too much sugar and too little caffeine.

The coffee nap has been shown to be more effective than either a nap or caffeine alone. The basic premise is that your brain gets a nap before the caffeine kicks in, then you wake as the caffeine is taking effect to help you wake up.

Cautions for the coffee nap

Use the coffee nap only at times you really need it.

Don’t do this too late in the day or the caffeine will inhibit your regular night’s sleep.

Caffeine + stimulant medicines don’t mix

Be very careful using caffeine if you take a stimulant medication, such as methylphenidate or amphetamine.

When you add caffeine to this, it can cause an elevation in your heart rate and increase anxiety.

If you take a stimulant medicine most days but don’t take it other days, it would be acceptable to use caffeine for short term benefits when off your medicine. Caffeine is not a good substitute for medications long term though. The medications have a more consistent dose effect.

Talk to your doctor if you do drink caffeine so they can help you adjust your medicine if needed.

Skip the snooze button.

Set your alarm for the last possible moment you can, which allows your body to get those extra minutes of sleep.

If you need to get out of bed by 6:45, but set your alarm for 6:15 and hit snooze several times, you aren’t sleeping those 30 minutes. Set your alarm for 6:45!

Skip the late night studying.

Studying too late is ineffective.

When the brain’s tired it won’t learn as well and you will make mistakes more readily. It takes a lot longer to get anything done when you’re tired.

Go to bed and get up a little earlier to get the work finished if needed.

Of course you should also look at your time management if this happens too often. Are you involved in too many activities? Do you work or volunteer too many hours? Did you waste too much time on tv, games, or socializing? Do you put off big projects until the last minute?

Homework needs to take priority when you’re more alert in the afternoon and evening. If you have problems with this, talk to parents and teachers about what you can do.

Charge your phone in another room. 

Friends who decide to text in the middle of the night keep you from sleeping. Even phones on silent have blinking lights that can spark your curiosity.

It’s too tempting to look at your social media apps one more time if you have your phone with you as you go to bed. Your brain gets a dopamine hit every time you play a game or interact on social media. This reinforces more and more phone use, which means one last check can turn into an hour or more of playing on the phone.

Don’t use the excuse that you need your phone as an alarm. Alarm clocks are cheap. Get one and put your phone elsewhere!

If you lay awake for hours or wake frequently, try these techniques to help fall asleep: 

If these fail, talk to your parents and doctor to help find a solution.

Use your bed for sleep only.

Don’t do homework in bed.

Stop watching YouTube and Netflix in bed.

Train your brain that your bed is where you sleep.

Exercise.

Exercise helps our bodies sleep better, but it should ideally be earlier in the day.

Exercising too close to bedtime can wire us up, so if you can exercise earlier, that’s a better choice. I know some sports and dance require late practice and class, but if you can schedule exercise earlier, do it.

Get natural sunlight in the morning. 

Natural sunlight helps to set your circadian rhythm. It’s a tried and true method to reset your internal clock when traveling out of your time zone and also helps when you need to adjust your sleep schedule at home.

Keep the bedroom cool and dark.

It’s harder to sleep if the room is too warm or too bright. A fan can be used to circulate air. (The fan also can double as background noise, which is often helpful.)

Use blackout shades if needed.

Keep pets out of the bedroom. 

Your animals might love you and you love them, but if they keep you up, it’s just not worth having them around at night. They’ll still love you in the morning if you keep them away from your room.

Nicotine and alcohol affect sleep.

Nicotine and alcohol should not be used by teens in an ideal world, but I know teens will not always follow the rules.

Everyone should know that if they are using nicotine or alcohol, their quality of sleep will be affected.

Nicotine is a stimulant (like caffeine), which leads to more time sleeping lightly and less time in deep sleep. And yes, vaping and chewing lead to this problem too since it’s the nicotine that causes the problem. Don’t start these habits!

Alcohol reduces the time it takes to fall asleep but it increases sleep disturbances in the second half of the night, often leading to early wakening. Alcohol relaxes muscles, which can lead to sleep apnea (often noted as snoring). Sleep apnea does not allow the body to have restful sleep. Alcohol is also a diuretic, which might increase the need to wake to go to the bathroom during the night.

Get help if needed

If you are addicted to any substance, talk to your doctor for help stopping.

Your doctor must maintain confidentiality under most circumstances, so you can trust that they will help you and not cause more problems. The exception to confidentiality is if they think you are in immediate harm from a substance.

We all need to to prioritize our sleep. Learn how you can get better sleep.

What happens when we’re sleep deprived?

Problems from sleep deprivation are seen everywhere. I hear parents say they need more and that their kids need more. Even teens often admit that they don’t get enough. But why is it such a big deal? What problems are really caused by sleep deprivation? There are many! When we’re sleep deprived, it can lead to many problems that are often not attributed to poor sleep. This can include irritability, poor academic performance, accidents, obesity and more.

Last week we discussed why so many tweens and teens get too little sleep.

You’ll have to learn what your real sleep needs are. Too many people think they’re “used to” less than recommended amounts of sleep, so they’re okay. Once you know your needs, learn the problems with sleep deprivation so you can recognize symptoms in yourself.

Next week we’ll talk about how you can get better sleep.

How much sleep is needed?

Sleep experts recommend nine to ten hours for growing tweens and teens, with a minimum of eight and a half hours until the mid-twenties as our brains continue to mature.

Remember that when we’re sick or in a growth spurt, we need more than usual. Listen to your body!

Find your specific need.

You can estimate how much you need by experimenting over a school vacation time. Go to bed when you’re tired at night and wake on your own. Talk to your parents to let them know what you’re doing so they don’t try to wake you too soon.

Initially you will probably need a lot to catch up on sleep debt, but after a few nights of adequate sleep, see how much your body needs regularly. Don’t lay around all day watching tv or playing on your phone. Get moving! If you have too much down time, it can make your body feel tired, even when you’re not.

Count the hours you sleep naturally once your sleep debt is paid. When it’s time for school or other activities, adjust your bedtime to allow for that much sleep. If that’s impossible you’ll have to work with parents, coaches, and teachers to find solutions.

When you fall asleep within 20 minutes of going to bed and wake up without an alarm, you’re probably getting the right amount of sleep. If you fall asleep immediately upon hitting the pillow and always need an alarm to wake up, you’re probably sleep deprived.

Problems of sleep deprivation

Hormone changes

Sleep deprivation can lead to increased levels of cortisol (a stress hormone), decreased activity of human growth hormone (which is active during tissue repair), and decreased glycogen synthesis (energy). Hormones that regulate appetite are affected by sleep duration. Sleep also influences the release of insulin, which is important in our sugar metabolism

These hormone changes are all implicated in the sleep problems we recognize, and we’re still learning more effects.

Moodiness

We all associate the teen years with angst, so we can easily attribute a teen’s moodiness to just being a teen. But being chronically tired can lead to emotional dysregulation. This will look like irritability, frustration and anger.

Chronic sleep deprivation is associated with developing depression. Depression affects our ability to sleep well and poor sleep can increase the risk of depression, so it can have a snowball effect.

Growth

Growth hormone is released as we sleep. Chronic sleep deprivation can affect your overall height if you don’t get enough sleep during your rapid growth tween and teen years.

Growth hormone isn’t just needed for growing. It also stimulates muscle growth, muscle repair, bone building and fat burning. Sleep loss may affect healing time and weight due to less growth hormone.

Obesity

Obesity has been associated with sleep deprivation. Specific appetite hormones are altered by sleep. Our appetite can be increased when we fail to get enough sleep.

Sleep deprivation can lead to eating more calories than needed because of increased appetite. This increases the risk of obesity and all the health consequences of being overweight.

Diabetes

Sugar metabolism is directly affected by sleep. People who don’t get enough sleep are at increased risk of Type 2 diabetes from this direct effect as well as from carrying excess weight.

School problems

Getting proper amounts of sleep can help with focus and learning. When we fail to get enough sleep, problems with attention, memory, decision making, reaction time, and creativity start to show. As if ADHD wasn’t enough to cause these things – sleep deprivation compounds the issue!

Grades can easily fall, which leads to anxiety and depression, which in turn leads to more moodiness and trouble sleeping.

Sleep deprivation mimics ADHD. If you think the medicine to help your ADHD that’s worked for years suddenly isn’t working, think about your sleep needs and amounts. Increasing the medicine isn’t the answer!

Injuries

Teens with chronic sleep deprivation are more likely to be accidentally injured due to poor focus and slowed reaction time. Sleep deprivation also slows healing after injury.

Drowsy driving is comparable to drunk driving. Tired teens are at high risk for falling asleep at the wheel. Drowsy driving is the most likely to occur in the middle of the night (2-4 am), but also in mid-afternoon (3- 4pm) as teens drive home from school.

Athletes are more likely to be injured while playing their sport, so it is in the best interest of the team to get enough sleep. And yes, I know with the busy practice schedule and homework it’s hard. But athletes need sleep.

Sports Performance

It’s not just injuries that increase among sleep deprived athletes. Performance also falls when we fail to get sleep.

Less sleep increases fatigue, lowers energy, and leads to poor focus. It may also slow recovery as mentioned above.

In short, sleep helps your sports performance.

Study of 18-27 year old males

Eve Van Cauter, Ph.D., from the University of Chicago Medical School, studied the effects of three different durations of sleep in eleven 18-27 year old men. For the first 3 nights of the study, the men slept 8 hours per night. Over the next 6 nights, they slept 4 hours per night. For the last 7 nights, they slept 12 hours per night.

After 4 hours of sleep per night, participants metabolized glucose least efficiently. Levels of cortisol were also higher during sleep deprivation periods. This can lead to memory impairment, insulin resistance, and impaired recovery.

After only 1 week of sleep restriction the previously young, healthy males had glucose levels that were no longer normal. They showed a  reduced ability to manage glucose, similar to the way elderly people metabolize it.

Study of female university athletes

Cheri Mah of the Stanford Sleep Disorders Clinic and Research Laboratory has studied college level athletes for many years. Her research shows that getting more sleep leads to better sports performance for all types of athletes.

One study of the Stanford University women’s tennis team focused on increasing sleep to 10 hours per night. Those who increased their sleep time ran faster sprints and hit more accurate tennis shots than while getting their usual amount of sleep.

Illnesses

Too little sleep increases the risk of getting sick. Your immune system needs sleep to perform at its best.

Risky behaviors

Teens with chronic sleep deprivation have been shown to participate in more risk taking behaviors. These behaviors, such as driving without a seatbelt, drinking alcohol, skipping the bike helmet and tobacco use, add to the problems of sleep deprivation.

Next Up:

Now that you understand the many problems with sleep deprivation, come back next week to learn how to get more sleep.