How I work with rejection sensitivity in adults with ADHD

A colleague replies to your message with one word. "Fine."

By the time the next patient is in the chair, you have decided you upset her. You have found the sentence where it went wrong and you are already composing the apology. It runs through the afternoon and most of the evening, and you never send it.

I see this differently from the way you do. You are good with people.

You hear a change in a voice before the person knows it themselves, and you notice who has gone quiet in the staff room and which patient is dreading the chair. That is a real strength, and in my experience it is common in adults with ADHD. Call it a superpower if you like. I do.

"Fine" carries no tone to read, so your mind supplies one, and it supplies the worst. The feeling for people keeps working long after the information has run out. It has no off switch.

The sensitivity is what makes you good with people. The flood is what costs you the evening.

My job is to keep the first and change the second.

What I ask first

The first conversation is mostly questions. I ask for the most recent time it happened, not the worst. You tell me what the message said, what you did next and how long it took to settle. I ask where you felt it, because people nearly always point to a place: the chest, the stomach, heat in the face.

Almost everyone apologises before they answer. "I know it's silly." I tell them the size is exactly what I want to measure. I ask for a number from 0 to 10, and it is usually far bigger than the message deserves.

Most people arrive with a theory that they are simply too sensitive, as if it were a flaw to be sanded off. I hear the other half of that theory every week: it is how they have kept friends and jobs, by spotting trouble early and putting it right before anyone had to say a word. I am not trying to take that away.

Then I ask about the earliest time something like this stuck. People expect something dramatic. Mostly it is small and ordinary: a teacher's tone, a friend who stopped waiting at the gate, a parent's silence after a mistake.

Years of hearing that you were too much, too slow, too forgetful teach a bright, quick child to scan every face for the verdict. The scanning gets very good, and it gets very tired.

What I do with it

There are two sources of the flood, so the work has two parts. One is a habit. The other is a memory.

For the habit I use clinical hypnotherapy. You are relaxed, focused and fully aware, and I speak to the part of you that runs the automatic reaction. Flat message, verdict, flood: that is a pattern, and behaviour pattern reprogramming changes a pattern at the level beneath conscious thinking. While you are calm, I rehearse a different sequence with you, again and again, until it is the one that arrives first.

Many people expect to lose control. They do not. Afterwards they usually describe it as being very settled and listening hard.

When the flat reply comes, the first thing to arrive is a gap, and in the gap sits a plain thought: busy day.

I do not tell you to stop feeling. The aim is a pause long enough for the plain thought to get in ahead of the verdict. Most people are surprised how little is needed.

For the memory I use EMDR, which stands for eye movement desensitisation and reprocessing. It is a way of reprocessing one specific memory so that it stops firing as though it were happening now.

When the earliest memory is a particular afternoon and a particular tone of voice, I hold up my hand and move it from side to side, and you follow it with your eyes while you keep the memory in mind. I check the number again between rounds. Usually it drops. The memory moves from something you feel to something that happened.

Between rounds I ask what you notice and mostly stay out of the way. People expect to describe the memory in detail. A few words is enough for me to follow, and the processing does its work in the quiet between.

What people notice first

The gap. The reply comes in and the drop in the stomach is smaller, or arrives later. People tell me they reached the end of the day before they remembered the message at all.

The sensitivity stays. You still know when someone is off, and you are still the one who notices.

Evenings come back. The apologies stop being drafted over the washing-up. Some start asking the colleague a plain question instead of guessing, and the answer is almost always an ordinary one.