#isn't so hard for the neurotypicals

[kiankiwi]

I am not having a good day. Gonna try and write to calm down while I listen to angry music

vent in tags

[brokentoys]

OK. one last ooc post before attempting replies. but i wanna say that ed. is not a perfect person. he may not be a horrible person - but he isn't exactly a "good" or "perfect" person either. i KNOW i've had ppl unfollow me bc he was rude, and even cruel to their muses. or even insistent on his beliefs and thoughts when they make no sense. eddie is mean sometimes. random things will set him off. but it's also important to know that eddie is mentally ill as well. not only just mentally ill, but usually not even medicated. he has very strong delusions that he firmly believes. anything your muse says can make him believe stronger in his delusions, or upset him. he may go on random rambles that make little sense or is barely coherrent. this is because eddie is very mentally ill. he literally cannot help it nor does he realize what he's doing. that's LITERALLY why he ended up in a mental institution instead of prison. because eddie is often not in control of his actions or words.

just keep in mind of this when anyone writes with me.

[devilboyblues]

[knowing i have several mental illness conditions] ah fuck why am i displaying mental illness symptoms

[poisonandpages]

Non autistic people older than me: Do this thing.

Me: I don't know how to do this thing. I get that some things we learn by doing, but I could cause real harm if I don't do this thing properly. Since you clearly know how to do the thing and I don't, could you give me some more information on what you expect of me?

NAPOTM: No. You just do the thing.

Me: Ok, I'll try with an educated guess...

NAPOTM: WHAT THE HELL HAVE YOU DONE? WHY IS EVERYTHING A MESS? WHY DIDN'T YOU JUST DO THE THING?

Me: I ASKED HOW TO DO THE THING AND YOU REFUSED TO TELL ME! I'M FLYING BLIND AND I DON'T KNOW WHY!

NAPOTM: BECAUSE YOU'RE JUST SUPPOSED TO EITHER MAGICALLY KNOW OR IGNORE MY REQUEST AND FORCE SOMEBODY ELSE TO DO THE THING! EVERYBODY KNOWS THAT!

ME: HOW THE FUCK DOES THAT MAKE SENSE?

NAPOTM: IT'S WHAT EVERYBODY DOES! YOU'RE A FREAK IF YOU DON'T GET THAT!

^^A quick summary of the past 30 years of my life.

[togglesbloggle]

You Aren't Supposed to Win

There's a species of post on Tumblr that's not uncommon: explainers about neurotypical social interactions for the benefit of the neurodivergent. Others, in an adjacent genre, are vent-posts or bewildered people expressing exasperation and impatience with neurotypical social rituals. And these are usually fine as far as they go, but there's a sort of deficit or hole in them that I think tends to go un-addressed.

Basically, a lot of these explainers are very reasonably helping readers to navigate a system for some desired outcome (getting a job, finding a date, or other such things), but with the understanding that a failure to get the desired outcome is a failure of the system. And that's... only kind of true.

Neurotypical social interactions can be a very complex mix of collaborative and competitive enterprises. The ratio between those things can shift on a dime, it can be really hard to figure out where on the spectrum you are at any given moment, and this is the system working as intended. Or at least, as the players in the game intend, which isn't always quite the same thing.

I don't want to overstate this too much; standard social interactions aren't a fight to the death or anything. Typical examples are more like a preponderance of cooperation, but with some jockeying for a larger share of the rewards that follow from a shared project. Or, perhaps, attempts to spend the least effort in a group project, while receiving a full share of the reward.

The thing about this is, the presence of an antagonistic element within these interactions means that perfect legibility is opposed to most participants' goals for the interaction. There is a degree of confusion and uncertainty that is quite deliberate and instrumentally useful. If a particular partnership is going to pivot to 'pvp mode', it is absolutely in each participants' interest to be the first one to defect, and to mask that defection for as long as possible; perfect transparency prevents them from being able to do so, and they can and will interpret requests for perfect transparency as being hostile acts.

At the same time, admitting any of this is also a loss of strategic advantage during adversarial interactions, so it's one of the hardest things to get people to admit. It's even hard for people to notice that they're doing it, because evolution favors mentalities that keep as much of this as possible subconscious; it's easier to defect without warning if you never consciously think of yourself as defecting at all. So explicit discussions of this are quite rare. (There is, however, an entire genre of party games designed to bring them to the fore and let people show off their capacity for adversarial play among shifting alliances and uncertainty, so it's more 'open secret' than 'forbidden lore'.)

The upshot of all of this is, the desire for an explicit, legible system of social interactions that can be exploited for reliable outcomes- can often be a desire for power over others, in a way that I don't think the proponents fully realize. The fantasy of people just doing what you want is a powerful one for everybody, neurodivergent and neurotypical alike. And this isn't an unreasonable fantasy! it's really not fun to be surrounded by people pursuing their own interests at the expense of yours!

But it's important to realize that a lot of the hard work of aligning those values and making a system of interactions 'purely collaborative', such that everybody will be doing their best to help you succeed regardless of skill level or quirks of neurotype, is a really hard problem that nobody has yet been able to solve. And until we get there, a system in which you reliably get everything you want, and which you navigate with perfect confidence, is one that subordinates the people around you.

[lumsel]

I don't strictly "like" taking ADHD meds, the comedown is awful and they play havoc on my appetite. But I kinda need them. I write software for a living. Software requires a great deal of focus that I simply cannot muster up off my meds. If I didn't have my meds, I would lose my job.

Part of this can be blamed on the cruelties of our modern capitalistic system. If the world understood my condition better, maybe I would not need to take stimulants to survive. I read an article once that really went all in on the idea that ADHD's negative perception is a symptom of perception, not an objective truth. Maybe people with ADHD are just as capable, but they do things in a different way to neurotypicals. Maybe all we need is better support, and social solutions, and more understanding of the different way that ADHDers think.

Which is all very compelling. Except.

I often find myself procrastinating activities that I want to do. My apartment has been accumulating dust because I keep forgetting to vacuum. One time I let the dishes in my sink stack too high and it was months before I could get myself to clean the mould off them. The demands of capitalism mean I need to software to pay rent, but sometimes I just want to do software, and no amount of narrative reframing or social support will clear the noise in my head long enough to let me focus on the code.

The notion that ADHD isn't a deficiency, just a different way of thinking, is something I find condescending. The implication here is I shouldn't have to write software, I should be given a different job, and I shouldn't have to maintain my own apartment, I should have the support of my community coming into my room and cleaning my things. But what if I want to do those things? What if I like software, or the privacy of an atomised existence? Maybe society has no right to decide what the correct way to live my life is, but surely I do!

The reason it sucks that it's hard for me to keep my dishes clean is not because the world says so, it is because I say so. It is because sometimes I want to be able to remember to do things and it sucks that I cannot live my life in the way that I want.

[hyperfixatedbastard]

sweet, sweet silence

Vox x Autistic!GN!Reader

Dating the CEO of VoxTek Enterprises has its perks. You always get brand new devices before they even hit the shelves, and occasionally, Vox makes things specifically for you - like noise-cancelling headphones.

Word Count: 1.3k

WARNINGS: none!

A/N: this is for the autistic homies but it works for anyone with sensory issues! 'tis based off of my own experiences so apologies if it feels inaccurate to anyone, i'm projecting so hard rn. this is also my first time writing x reader/2nd person POV so I hope I did alright! also, i do requests if anyone would like to see more of this kind of thing :)

Dividers

"Doll, c'mere for a second, would ya?" Vox calls out to you, gesturing for you to come to his desk with a 'come hither' motion. 

You raise a brow in interest as you approach your boyfriend where he's sitting in his rather eccentric chair, tinkering with...something. You hop up onto the desk, careful to sit in a spot that you know has no important screens or buttons (you learned the hard way). You don't say anything, instead just tilting your head and waiting for Vox to show off whatever he's been working on this time.

He finally lets you see what's in his clawed hands: a pair of headphones. They're clearly a VoxTek product—the blue and red color scheme gives it away—though you're certain you've never seen these on sale before. It's not uncommon for Vox to show off new products to you before they're released, though, so you don't question it.

He smirks as he holds the headphones out to you. It's not that sly, devious smile he so often has on his screen, though; it's that grin you have when you're about to surprise someone and you just know they're going to love it. "These are for you, darling."

On one hand, you get a little excited (free shit, fuck yeah!). But on the other, you're a little worried—you're not good at receiving gifts. It always ends up awkward because you don't really know how to express gratitude in an expected, neurotypical way. But Vox is well aware of that, and he can tell when you're grateful, so you push those worries to the side and take the headphones from him.

You look at them curiously, inspecting the foldable hinges, the ear cushions, and the small assortment of buttons on the speakers. You can tell that the three buttons on the right speaker are for adjusting the volume—increase, mute, and decrease—but you have no damn clue what the button on the left speaker is for.

"Well? Put 'em on," Vox encourages you, still with that expectant grin as he anticipates your reaction.

You do as he says and place the headphones over your ears. They're certainly comfortable, but you don't see what the big deal is. You already have headphones—they’re not great, as it’s damn near impossible to drown out the unbearably overstimulating sounds of Hell, but you manage. Kinda.

Just as you’re about to ask what’s so special about these headphones, Vox presses that mystery button on the left speaker, and everything goes blissfully quiet.

Your eyes widen as you get the first moment of true silence for the first time since you arrived in Hell. The sudden difference is initially jarring, but the relief is downright euphoric. 

During the entirety of your afterlife in Hell, it's been ceaselessly loud and often unbearable. The screams, the explosions, the gunshots—it's incessant, and you never get a moment of peace. The V Tower is not nearly as bad as the rest of the Pride Ring, thanks to a lot of soundproofing, but there's always something. Moans and other lewd noises fill the halls of anywhere within five floors of Valentino's studios. You can hear the screeching and yelling beneath the thrum of music emitting from Velvette’s section of the tower. 666 Studios isn't much better, with the constant chattering of the crew and bickering between newscasters.

Vox's lair office is by far the quietest place in the entirety of Hell, at least in your experience. The soundproofing here is much more effective than anywhere else in V Tower, and Vox is the only person ever here. He does talk and maniacally laugh to himself fairly often, but you don’t usually don’t mind that (and he’ll typically quite down if he can tell you’re having a rough day). But it’s far from perfect—there’s still the intermittent click-clacking of a keyboard, the constant whirring of the computer fans, the low humming of all the tech, and the audio from whatever security camera Vox is spying on. You can tune it out most of the time, but it all overwhelms you so, so easily.

And you aren't very good at hiding it (at least not with Vox, who’s too observant for his own damn good when it comes to you).

Which is why your dear boyfriend has just spent the past several days making you the best noise-canceling headphones Hell has ever seen. He knows what the constant overstimulation does to you, and he sees it far more often than he'd like to. You get irritated and snippy, and sometimes it gets so bad you have a meltdown. It's gotten less common over time, but it still happens way too frequently for either of your likings. 

“So, who’s the best boyfriend ever?” he hints, clearly fishing for a compliment. His voice is surprisingly clear despite the headphones practically deafening you—his words are muffled, but just loud enough for you to understand what’s being said. He's grinning at you like he's the one that just got the excruciatingly heartfelt present. 

Usually, you’d have a witty comeback to Vox’s attempts at getting you to stroke his ego (always followed by an actual, genuine compliment to ease his insecurities hiding behind that ego), but you’re drawing a blank right now. 

The gift is so thoughtful that you don’t even know where to start on expressing your gratitude. Noise-canceling headphones seem so obvious now, but this is Hell! Both you and Vox had died before this technology became commonplace, and not many people in Hell care that much about the noise. Vox made these headphones specifically for you. He doesn’t need them (he can quite literally just turn off his audio input) and he probably won’t make much of a profit with them as a VoxTek product. He’s a busy man, being a CEO and an Overlord, yet he took the time to make this for you himself, not even passing the project off to one of the poor souls that works for him. 

“Babe?” Vox calls out gently, waving a hand in front of your face. Oh, shit—you’re overthinking your response so much that you forgot to actually fucking respond.

You blink a few times, meeting your boyfriend’s gaze. His brows are slightly furrowed, in what you think is a mix of concern and amusement. He’s a little worried he’s fucked up somehow, but he knows you well enough by now to recognize when you’re thinking too hard about something. He actually finds it quite adorable, at least when you’re not about to have a panic attack from it. 

As he looks at you expectantly, you decide to just go with your gut (at least, that’s what you think you’re doing—you’ve never entirely understood what the fuck that phrase means).

You don’t give yourself time to second-guess your actions before you’re practically jumping into Vox’s lap—though it’s more like falling since you were just sitting on the desk. He lets out a little ‘oof’ of surprise before he chuckles and moves his hands to your waist, holding you steady while being careful of his claws. He smirks as you wrap your arms around him and bury your face in his neck, jostling the headphones a little but not enough to fuck with the noise cancellation.

“So…you like them, then?” Vox prompts, just wanting the confirmation even though the answer is already clear. You can tell by his tone that he’s still grinning proudly.

You just gently nod, inadvertently rubbing your face against the fabric of his shirt (fortunately, Vox is a fancy bastard with high standards when it comes to clothing, and he’d long ago thrown out any garment made with fabric that triggered your sensory issues).

“Thank you,” you murmur against his neck. 

His hands tighten ever so slightly around your waist, and his response is so soft you can barely hear it through the headphones. “Anything for you, doll.”

[marblesarelost]

Oh, shit.

Oh, SHIT.

Oh, fucking HELLS.

Yeah, my fuckin therapist needs to get hold of her buddy for me to get reevaluated PRONTO.

@big-ol-bumble-bee read my tags dolly

will you be mad at me if i post markiplier podcast 🥺

[copperbadge]

Feeling a little overly perceived by Dr. Dodson right now, not gonna lie.

I'll throw a transcript under the cut, but both reading the transcript and listening to the video can be difficult as it's quite long, so here's some highlights. As always, these are the opinions of a specialist but only one specialist, so take with a grain of salt, and if you have research to add to this, please feel free to comment or reblog with it. I believe this presentation is from sometime in 2022.

ADHD appears to derive from issues in the corpus striatum in the brain. In most people, the corpus striatum filters out all but the most important input AND output; with ADHD, the things normally handled "outside of awareness" must be handled consciously.

People with ADHD don't see their emotions coming. Emotion is immediate, intense, and unfiltered, making therapies like CBT or ACT difficult, because you can learn the technique but you won't have time to employ it. Because people with ADHD have impulse control issues, expressing emotions "inappropriately" is common, leading people with ADHD to believe they can't trust themselves.

One function of ADHD-typical dysregulation is Rejection Sensitive Dysphoria, which nobody understands even a little. People who have it can't even adequately describe it to people who want to study it. It is intense, painful, and apparently impossible to control. Prevention is based in maladaptive behaviors designed to avoid it entirely (perfectionism, people pleasing, generalized withdrawal). The only currently known treatment is alpha agonist medication.

Lastly, by the age of twelve, a child with ADHD has likely received twenty thousand more "negative or corrective" messages than their neurotypical peers. (This isn't relevant to the rest, I just found it sufficiently horrifying to warrant inclusion. Fortunately for me, if I got 20,000 negative or corrective messages, I wasn't paying attention for most of them.)

Anyway, here's the transcript of the first half. I did this by copying and cleaning up the auto-transcript on YouTube, but I stopped at Question Time, so this is only the first half (the presentation). Transcription of the second half is available at YouTube.

There is suddenly a very large interest in the whole subject of emotional dysregulation and ADHD. That has been driven oddly enough by the Food and Drug Administration, which has just opened up several pathways that drug companies can study emotional dysregulation and whether or not their medications can get an FDA indication for emotional dysregulation. So it's sort of follow the money. Up until then, there was not a great deal of interest for ADHD emotional dysregulation.

We have to understand that the ADHD diagnostic criteria were not made for people like you and me, either practitioners or people who have ADHD or their families. They were designed for and made by people who do research and pretty much that's it. People who do research have to have criteria that they can physically see and count. "Little Johnny was up and out of his chair three times in the last hour," and you can write a three on your clipboard. Things which are invisible, not always there, hard to count, or even hidden by the patient, don't lend themselves to research very easily and so tend to be ignored. And so consequently this is one of the main reasons why emotional dysregulation -- until there was some other motive provided -- was pretty much ignored and disregarded.

Consequently ADHD right now, if you look at the 18 diagnostic criteria, are almost entirely behavioral criteria. What is the person doing? Not how is the person thinking, what is the patient feeling, how are they controlling their emotions, how are they sleeping. Things that are all very, very important to the person who has ADHD but which is essentially ignored by the diagnostic criteria.

Why should you care? Who really cares about this? Well, the definition of what ADHD is and isn't defines who and what will be studied. It defines who will actually get into a study and what questions will be asked. It defines who will be diagnosed with ADHD and who will not. One of the most common problems I get is with a secondary referral to me -- somebody clearly has ADHD but they're not pinging off the walls, they can sit and do their work, especially when they get into a hyperfocus, and so they're told they couldn't possibly have ADHD. When really they just have the inattentive subtype and they're not being driven by their behavior, their overt behavior. Therefore it defines who will get treatment, who will get insurance coverage for that treatment, and who will get accommodations in school when they're young and at the workplace when they're older.

Consequently we should also care because the other major components of ADHD get ignored. These are the ones that if you really stand back and look at it cause the greatest amount of impairment, the greatest amount of embarrassment, the greatest amount of just…problems in general. We're talking about cognition and thinking, that people with ADHD fundamentally think in a different way than do neurotypical people. They are able to engage with the tasks of their lives in a totally different way. Their ability to control their emotions and their behavior, control their emotional responses, tremendously affects their self-esteem and their self-definition. Who am I? What am I worth? What am I valued? Why am I valued in a certain way? What do other people think of me?

It affects tremendously the nature and healthiness of relationships. How you respond emotionally to the people in your realm makes a great deal of difference about the healthiness and gratification you get from your relationships. Being highly dysregulated in terms of your energy and emotions also affects deeply how well you sleep, how easy it is to fall asleep and awake refreshed, and of course it affects emotional dysregulation.

And this is probably, when you look at it in the long term and especially with adults, probably the most impairing part of the ADHD syndrome. The vast majority of people with ADHD have found ways around their academic and work performance, but they haven't found their way around their emotional reactions to the people and events of their lives.

At all points in the life cycle -- child, adolescent, adult, and elderly -- people who have ADHD nervous systems lead intense, passionate lives. Their highs are higher, their lows are lower, all of their emotions are much more intense. And that really is what we're talking about: not really the quality of the emotions -- people who have ADHD have the same types of emotions for the same reasons that everybody else does. What we're talking here, in terms of dysregulation, is two things: one, the expression of emotions, being able to choose whether or not you let an emotion out. And then, when you do decide to express it, how intensely that emotion is experienced and expressed by you as a unique individual.

Consequently just about everybody with ADHD, but especially little children, are always at some sort of risk of being overwhelmed by their own emotions from within themselves. This is something that needs to be really emphasized: a lot of people with ADHD grow up not being able to trust themselves.

So why is this happening, especially to people with ADHD? I think that just about everybody now would agree that ADHD is primarily a problem of insufficient inhibition, being able to slow down and keep things from happening. If you look at the mass of the human brain, 85% of all the nerves in your brain and out in your nervous system are inhibitory in function. We happen to be aware of the other 15% because we can see what happens when those nerves are used: they create movement, they create emotions, they create our experience and memory. We have to remember they are a minority of the actual mass of the human brain.

Most of what happens inside the brain occurs outside of awareness. What happens is the brain starts something, it gets it moving, and then uses inhibition to guide that toward the destination it wants. It's like shooting off a rocket -- shooting it off is the easy part, guiding it to where you want it to go is the hard part.

When you look at where stimulant class medications work, they work solely in the deep areas of the brain down in the basal ganglia, and especially in an area called the corpus striatum, which is just Latin for a "striped body". That's how it looks when you look at it -- it's got many very fine stripes in it. This area, the corpus striatum, is almost entirely inhibitory in function. What it does is that it inhibits neurological input and output to just the one piece of information or one action that happens to be most important at that time. Everything else gets handled, but it gets handled out of awareness.

Probably the easiest place to see this in action is when we're driving a car. Driving a car is the most difficult thing that the average human being ever has to learn how to do. It's a very difficult process, if anybody has ever had an adolescent learning to drive. But once we learn how to drive a car we do it largely outside of our own conscious awareness. We can drive along, talk to the person on the seat next to us, think about what we're going to have for dinner, sing along to the radio, and not really pay attention, conscious attention, to what's going on around us. But if suddenly something is out in front of the car, even before our conscious brain can process what that thing is, our corpus striatum has already handled it. Slam on the brakes, swerve to miss it, start to question that person's parentage, in the twinkling of an eye. The corpus striatum has been scanning everything, handling everything.

So basically what ADHD is, is that relative lack of inhibition that should be there. Inattention, which is a cardinal feature of ADHD, is the relative lack of the inhibition of other inputs or distractions. When we look at physiologically what's happening, we don't actually pay attention to one thing. Neurologically, we suppress every other thing we might engage with except the one thing that we want. It is maximally inefficient in that way.

Impulsivity is a relative lack of inhibition, of the expression of actions and emotions before you can think about them and make decisions about that expression. Hyperactivity is the relative lack of inhibition of physical and mental activity. When the physical activity of the hyperactive little boy who's pinging off a wall goes away in adolescence, they're still very much mentally active in their own brains.

So what? The “so what” for most of us is that when this area of the brain is not working as it should, people cannot regulate the experience and expression of their emotions. Emotions are experienced as completely unmodified and unscreened. The word that most people use is that they are raw. They come out without any modification at all, they go in without any modification at all. People can see this in hyperacusis, where somebody chewing or the conversation across the restaurant comes in loud and clear because it can't be screened out.

All this is tremendously overwhelming. We get overwhelmed by entirely too much input, and the impulse to have entirely too much output. It's exhausting, and when it does get inappropriately expressed it's embarrassing, so consequently people with ADHD must always be vigilant of themselves.

Now, when we look at the traditional therapies that have been used, or tried to be used, with ADHD, they have had very very poor track records. They're largely ineffective in helping people control the expression of what they think and feel. The reason for this is that people with ADHD don't see their own emotions, their own actions, coming. They find out about their emotions and actions the same way everybody else does: it's already out there before they even know that it's coming. Consequently they don't have the time and the warning to use the techniques and new skills that they may have learned in behavior modification therapy, or in cognitive therapy. They learned them, learned them perfectly well, but the cat’s out of the bag before they can make use of them.

Right now, as we sit here today, medications are the only thing we have to offer that have a proven track record, because they're there all the time. We have two basic groups: we have the stimulant class medications which are amphetamine, methylphenidate, et cetera, which help directly with inhibition. They help slow things down, they help inhibit both input that would distract us and output. It gives you the same two seconds that everybody else has, to see an emotion or an action coming up, to play it out in your mind. “If this happens then this will happen, then that'll happen. Oh, I don't want that to happen, I'll redirect it.”

The alpha agonist, of which we have two -- guanfacine and clonidine -- inhibit the energy driving the speed and intensity of response. Interesting enough, when we look at just clean effectiveness, when we measure how effective is this treatment, the alpha agonists are significantly more effective than are the stimulants. Usually that's kind of a false choice, because most people end up taking both classes of medication.

A very special type, I think, of emotional dysregulation is -- again a terrible technical term -- what's called Rejection Sensitive Dysphoria. We actually don't know what it is. It's much too early to tell. But it does seem to be a thing with which many people with ADHD identify. There was a brief article from ADDitude that got posted on Reddit, on their subreddit on ADHD; that particular posting got twice as many responses, in less than a month, than any other posting that had ever been put on that subreddit. It really touched a lot of people in a strong way.

In my own checklist, when I'm asking about Rejection Sensitive Dysphoria, the question I have is: “For your entire life, in other words going all the way back into childhood, have you always been much more sensitive than other people you know to rejection, teasing, criticism, or your own perception that you’ve failed or fallen short?” This is directly from a psychiatric textbook, an old one, and it's the definition of a technical term, for psychiatrists called Rejection Sensitive Dysphoria.

It's important to note, this is all a matter of degree. No one likes being rejected or criticized. Everybody hates it when we fail, we fall short, especially in front of other people. Rejection Sensitive Dysphoria is much more intense, and is much more than this universal discomfort.

When they were originally doing the research on this particular idea, 45 years ago, they wanted to get that intensity right up there in the name, and so they chose the word dysphoria -- which unfortunately happens to be Greek -- but it means “unbearable”. Because that was the description they were getting from people over and over and over again. Again, for reasons unknown, people with rejection sensitivity have trouble describing what the intense emotion is all about. They can describe its intensity -- “it's awful, it's terrible, it's catastrophic,” -- but not the quality of the mood. And so, over and over again, these research subjects would finally just tell the researcher, “Look, man, back off. I can't find words to tell you what this awful feeling feels like, but I want you to know I can hardly stand it.” And so that's where the word dysphoria came from. A researcher at Harvard who decided to put it into Greek, but that unbearable quality is very much a part of what's going on, a part of the experience of Rejection Sensitive Dysphoria.

It's extremely common in people with ADHD; my guess is that about 95% of my patients report it as a significant impairment, and about a third of my patients say that it is by far the most impairing part of their ADHD. For the majority of people, and most occurrences, it is not that particularly disruptive, but when it hits, it turns your life upside down.

So how is rejection sensitivity experienced? There's no warning. It hits out of the blue; there's no way to protect yourself from it. It happens all at once, it goes from zero to a hundred percent instantaneously. It is commonly experienced as being physically painful, as if someone just punched you in the chest or punched you in the stomach -- there's an aching in the core of your being.

Once it gets started it seems to be largely uncontrollable until it's run its course, whatever it is. The quality of the mood is indescribable. Most people struggle to find any words at all to describe this feeling, even though it's massively intense. The duration can be a few minutes to several months. It's a very potent experience and can make it very difficult to risk ever being rejected or criticized again.

If this very intense emotional reaction is internalized, it looks for all the world like an instantaneous major depression, complete with suicidal thinking. And so a lot of times people do get a diagnosis of major depression, because the clinician they're working with fails to pick up the triggered, instantaneous nature of the onset of that depressive-looking syndrome. If it's externalized, it presents as a rage that is directed at the person or situation that wounded them so terribly. In fact, being “wounded” is is a very common description. This sort of sudden trigger change, with an intense emotional response, not uncommonly leads to a misdiagnosis of borderline character organization.

So if you can't see it coming, and you can't do anything once it's happened, how do people try and protect themselves from episodes of rejection sensitivity happening in the first place? Some people use perfectionism; they try to be above reproach. They feel driven to be the very best at everything they do. These are the penultimate overachievers. It works, but it's also an absolutely terrible, driven way in which to live.

By far the most common response is that people become people pleasers. They are constantly scanning everybody around them and trying to figure out what that person wants or would approve of, and that's what they give them, so much so that it is the to the exclusion of what they want for their own lives. These are people who take care of others, please others, to the exclusion of any sort of gratification in their own lives.

Another very common way that people try to deal with this is that they give up trying anything new, giving up anything in which they might fail or be embarrassed. I have hundreds of patients who have never been able to apply for a job or ask someone of the opposite sex out for a date. Just the imagination of being told no is so frightening, so devastating, that they just say, “No, I'm not going there. I'll sit this one out.”

One of the most effective ways of dealing with this are the alpha agonist medications, and when they work they can be almost completely effective. Alpha agonist again is a tongue twisting name, but it's not as tongue-twisting as the full name, which is alpha-2 selective adrenergic agonists. So you can see why we shorten it a bit. They were originally blood pressure medications that came on the market in the early 1980s. They worked very poorly -- when they did work, at most they lowered blood pressure about 10%, which was measurable but it still required other things that needed to be done in order to get most people's blood pressure down into a therapeutic range.

We have two of them, guanfacine which was marketed both as immediate release and extended release under the name of Intuniv, and clonidine, which was marketed under the trade name of Kapvay, both as an immediate release product and as a delayed release product. They have been used as a treatment of the hyperactive component of ADHD for more than 30 years, so these are not new medications for the field of ADHD. They're very much the treatment of choice for the “hyperactive, disruptive, and obnoxious little boy” that is what most people have in their minds when they consider the notion of “What does a person with ADHD look like?”

The exact mechanism of action of these medications both in ADHD and especially in rejection sensitivity is highly unclear. We really don't know -- we have a couple of ideas but they are very definitely theoretical. The only thing that we know for sure is that the stimulants don't work by stimulating anything, and that the alpha agonists don't work by being alpha agonists. How they do work is completely unknown.

We have two medications, they seem to work equally well, so there's nothing that would lead you to choose one over the other. The problem is that the robust response that we're looking for that really changes people's lives, is disappointingly low -- at about 30% to either molecule. Luckily that 30% is a different 30% of people, so that 30% of people get a good response to guanfacine but it's largely a different 30% that get a response to clonidine. So if the first medication tried does not work, it makes good clinical sense that that one should be stopped and the other one tried. There was an unfortunately worded sentence in an article I wrote for ADDitude several years ago that gave the impression that you could use the two medications together; they should not be used together. You try one, if that doesn't work you try the other.

The typical dose of either one is in the range of three milligrams of guanfacine per day or about three tenths of a milligram of clonidine per day. If you take all the people who get a good robust response to either one of these medications, about 80% are going to end up at these doses, so it's by far the most common dose.

There are of course side effects. Anything that's going to adjust the adrenaline system of the body is going to have the potential for sedation as a side effect, and this does occur for about 25% of people. It's usually mild and it does go away -- over a period of several months. So a person has to be fairly patient with that. It can cause dry mouth, and it's by a different mechanism then the stimulants can cause dry mouth, so the two of them together can really make your mouth cottony dry. And the third one is an accentuation of a universal experience we've all had, when we stand up quickly and suddenly and we get dizzy, get kind of a head rush, vision goes a bit gray. The technical term for it is orthostasis. And this can happen more frequently when you take the alpha agonist medications.

The benefits of the alpha agonist medications take a while to develop. When you change the dose it takes five days for the benefits to develop, so once again they're not like the stimulants where what you see is what you get at one hour. It takes a while for these medications to work and to see all that they can do.

Now just as a side note, Strattera has been looked at in two studies for emotional dysregulation and the results have been what they call mixed. If they did work it was only to a very minimal degree, almost undetectable, so Strattera does not seem to be a medication one could use and expect to have it help with emotional dysregulation.

So in summary, emotional dysregulation is a basic feature of ADHD, is almost universal in ADHD, and it should be considered as a core symptom of ADHD that ought to be evaluated in every initial evaluation. Rejection sensitivity…it's unclear yet -- this is an old concept that has only been brought up in the last couple of years. Its exact nature is still unclear. It does seem to be a specific form of emotional dysregulation, especially in regard that it does respond very well to medication. But again, how it fits into emotional dysregulation is completely unclear at this point. It does seem to be something that's really important, though. It is a thing that resonates with a large number of people with ADHD.

[bonefall]

do you have any tips for writing a low empathy character who isn't evil? Or how to make an interesting apathetic character who's a thoughtless sort of evil? These are two different chatacters btw-

I tried looking up examples and stuff but uh. It's been a bit fruitless.

Honestly it's not too hard! Having low empathy just means we're bad at automatically "connecting" to the feelings of other people. You can come to understand it's not even a character flaw once you uncouple the idea that Empathy = Kindness. And apathy, well, that one's a bit more complicated imo.

Low Empathy

In English, it's just unfortunately super common to conflate Empathy and Compassion. To have compassion is to be aware of the suffering of another person, and ergo, want to help stop it. To be empathetic is to identify with and understand the feelings of another person. These are different things.

For an example in action; imagine a medic with a patient whose shoulder is dislocated, and xey'll need to pop that arm back in place in order for the patient to feel better.

A medic feeling EMPATHY for that patient is having an emotional response to what xey're seeing. Xey might have a tingly "ghost pain" thinking about the injury, and xey might feel guilty xey're going to put them in more agony, but also joy because this patient is going to feel much better in just a moment.

A medic feeling COMPASSION for that patient is thinking about how the shoulder must be causing a lot of pain, and knows xey have the skill to fix it. Xey know from xeir own experience that pain sucks and so it is a bad thing that needs to go away. It will hurt a little more for a moment, but then there will be immediate relief.

This is imo, why a lot of low empathy people are "bad at" comforting people without going to Autism College where they give you the scripts of Shit Neurotypicals Say. We're not trying to be selfish when we end up making "comfort sessions" about ourselves-- that's what we think empathy is, because we don't have a lot of it to really know what you want.

Like, doesn't it make sense to you? "I don't know what you're feeling. Here's a similar situation I've been though. I must know what you're feeling-- does that make you feel better? That you aren't alone? I think that's what empathy is, am I right?"

A LOT of low empathy people go into medical fields, the funeral industry, and disaster relief. We often really do want to help people so seek these fields out, or when we get there, just end up not getting burnt out like our high-empathy peers!

Apathy

As for the apathetic character, honestly, I'd suggest thinking about your story's themes. Villains are very special to me and I always try to handle them with care. What are you trying to say is bad to not care about in your work? How does their apathy play into the story you're trying to tell?

A Captain Planet villain is completely selfish, and exists only to benefit itself by exploiting nature in some way. Then the Planeteers show up and punch it in the face. Boiled down to its barest, most simple essentials; "We have conflicting goals and so I will stop you."

Personally I find total apathy to be something not especially compelling in villains, for that reason. Like, if you really don't care about anything, why bother with the trouble of going against the protag? Motivation is meant to be MOTIVATING.

(also ngl I'm on the Shadow As A Hero sort of bandwagon where I find it much funnier for the simple apathetic cool edgy guy to be the funniest person on your tennis team)

Dungeon Meshi has TWO characters who struggle with apathy, and are both antagonists at some points in the story, but never villains. Shuro and Mithrun. The theme of Dungeon Meshi is the beauty and complexity of life, the value of living, and how our connections to others changes the people we are. Food is a metaphor for bonding, self-care, and understanding.

For Shuro, he begins the story as someone who's both been encouraged to bottle up his emotions for the sake of other people, as well as to not actually consider the emotions of those lower-born than him. He's from a very different place than the other members of his party, and this causes friction as class, culture, and sophisticated, refined, weapons-grade autism clashes.

When the woman he loves is eaten by a dragon, he doesn't stop to tell her brother and """childhood friend""" what he's planning, as if they both wouldn't run in and get hurt. He owns demi-humans. He doesn't consider his own needs or the needs of his rescue team of loyal vassals. As a result, he's too weak to continue, losing a fistfight with one of the main characters, Laios.

After this, he connects with him for the very first time, and reaches out to him by giving him an important magic item. There's even a MASSIVE moment where he outright tells Laios that his ability to be so open (read: not have to mask his autism) is something he envies, breaking through that veil of apathy he wears.

The story Dungeon Meshi is telling here is that it is important to value the needs of yourself and of others. Shuro's apathy towards his own needs in a bid to prove his love weakened him. In acting like he was above his old teammates, he never spoke to them like people to smooth out his issues. He's never even noticed how much his vassals love and care for him.

(and the incredible irony is not lost on me, that Shuro's name is because Laios mispronounced it and was never corrected... while Shuro never noticed that Izutsumi had the unwanted name "Asebi" forced onto her when she was "taken in" and made his slave.)

See how that comes back to the theme? Shuro doesn't exist to just "be some asshole" or act like a villain. He has a full character arc that contributes to the narrative.

For Mithrun? I won't even spoil it. Go read Dungeon Meshi. Watch elf depression. We love a king with strabismus.

Anyway,

If you ever need good personal resources on any stigmatized mental condition, I've found it's usually productive to go into the #Actually (Thing) tag here on Tumblr. You can find people posting about basically anything. I found a lot of really good resources on NPD that way.

[m1dori-eyes]

Disco Elysium has legitimately helped me understand my own internal monologue and the way that intrusive thoughts function in real life so much. You always have a voice in your head that's telling you to have sex and do drugs, and you always have a voice in your head that's telling you the correct thing to say in social situations when you want to appear neurotypical, and the key to life is being able to filter out the garbage that your brain is telling you from the useful stuff.

Some context for people who haven't played the game; you play as a character who is HEAVILY affected by intrusive thoughts 24/7, and this isn't portrayed as a fault but rather as an obstacle that he has to overcome every day. Each voice in the protagonist's head is a 'skill' which you can level up, I.E. Electrochemistry, Drama, Authority, but each skill also has its own personality, and will tell you to do different things. If your character is really good at breaking things and fighting people, then your Half-Light skill will try to get you to fight people all the time, even when it's objectively the worst course of action, and a big part of the game is knowing when NOT to listen to the voices, even the ones that help you most of the time. Both in the context of the game, and for people who suffer from intrusive thoughts in real life, all of this is a maladaptive survival instinct, and while it may theoretically be helpful to you sometimes, it usually isn't. Being able to view your own mind as a compartmentalized myriad of components, some of which have your best interests in mind and some of which don't, is so helpful from a mental health perspective. Because my shitty ass brain tries to sabotage me all the time, it can be hard to trust myself, so I take a lot of comfort in knowing that while the Anxiety part of my brain hates me, the rest of it is on my side.

Also when you want to do creative writing, always listen to the wrong voices, and then your short story will come out just the right amount of fucked up in all the best ways. Also play Disco Elysium it's great.

[trans-axolotl]

I think the reason psychosis is always viewed as a crisis by non-schizo effected people is cause neurotypical people are always told and believe that an episode of psychosis is the most terrifying thing that could happen. Like at least from my experience, descriptions, talks, and depictions of psychosis is AS something that's deathly scary to not know (and assumably never again know) what's real and what isn't, some depictions showing any episodes as worse than death. Like obviously that's not true but it stays with people; the telling of "it's the worst thing that could ever happen everytime" and definitely made the first few times I dealt with psychosis and hallucinations a lot worse and a lot scarier

yeah! so much of the messaging around psychosis and schizophrenia is so fucking dangerous because of the way it continually reinforces these ideas that psychosis is always terrifying, life-ending, and the worst case scenario. like that can have materially dangerous impacts on the lives of people living with psychosis/altered states. i think that kind of stigmatizing messaging about psychosis really demobilizes people in our communities and convinces people that they don't have the capability to support their loved ones with psychosis, and instead creates this idea that "professionals" are the only ones who could ever actually support someone through psychosis. and that leads to so much more forced institutionalization, pathologization, violence towards people experiencing psychosis, and just really a lack of the kind of proactive community support that could actually help prevent some kinds of crisis and distress.

i think it also makes it really hard for us, when we start experiencing psychosis/altered states for the first time, because there's really no framework for us to understand and cope with our experiences beyond just "this is the worst thing ever and there's no options for me." i think it creates a lot of forced shame and secrecy, as well as pushing a lot of us into more intense crisis because we have nowhere to go to get support. and like, when you google this half the shit that comes up tells you to call 911 immediately, and when you're someone who can't do that because it's dangerous for you, you're just left with no fucking options or getting pushed into treatment options that don't respect your autonomy.

i wish there was a lot more recognition that psychosis/altered states are something that can happen to anyone, and actually do happen to a lot more people to varying degrees and in different contexts. that psychosis is something that it is possible to live fulfilling and meaningful lives with. that you don't need to be an expert to support someone living with psychosis/altered states. and that there is so many ways of living with psychosis, and that antipsychotics and therapy are not the only options, and should never be a forced option. i also have so many thoughts about how desperately we need informed consent for antipsychotic medications and how fucking mad i am about the amount of information that is withheld from psychotic people about the side effects of our meds, the withdrawal experience, dosages, other options, etc etc etc.

anyway i just really recommend that everyone, whether you're someone who experiences psychosis/altered states or not, learns more about psychosis and do the work to challenge all these internalized myths we learn from society and the psych system. i highly recommend checking out the hearing voices network, and also really recommend Project LETS anticarceral altered states training to learn more ways to help support yourself and your loved ones.

thanks for this ask, i really agree with what you're saying!

[slow-burn-sally]

I hear neurodivergent people talking about "neurotypicals this" and "neurotypicals that", and I have to say that I honestly don't know what a neurotypical looks like. I cannot spot them.

This might be because I thought I was neurotypical for the majority of my life. So many people know so little about ADHD, Autism, OCPD, OCD etc. that I couldn't see myself in those disorders because no one knows what those disorders actually entail.

Additionally, neurodivergents are drawn to other neurodivergents, and literally (and I mean literally) all of my close friends are also neurodivergent. So was/is my family. So I grew up absolutely surrounded. It's very hard to parse out what "normal" or "NT" behavior is supposed to be when literally everyone around you is some form of ND.

What's even MORE bonkers, is that you can be ND, consider yourself NT, and then criticize other ND people for their ND traits. It's totally a thing. I know, because I did it a lot when I thought I was NT. I said so many ableist things, and had so many unfair opinions.

When I came out as autistic to my (literally also autistic) friends, I was met with the exact same gaslighting, disbelief and ableism that you'd expect from an NT.

Being "basic" doesn't make you NT

Being successful doesn't make you NT

Being judgmental of others with disabilities doesn't make you NT

What might make you NT is going to a doctor, getting a broad spectrum of tests that prove you're not ND. No one does this... so, you can't just point to a person with good hair, a job and a partner and shout "Neurotypical!"

This isn't Us vs. Them. It's Us vs. Us and Them.

[batmanisagatewaydrug]

Hi there! So, I'm (26) in a relationship with a typical guy (27). I'm bipolar, on meds. My friends at grad school have been weird since we started dating and outright hostile to my boyfriend. I finally asked them why, and my friend who I've always respected to be the voice of reason said that the relationship was abusive. I asked them why because he's never been abusive, and they said it was because he was a neurotypical dating a neurodivergent woman and there's a power imbalance? Is this true?

hi anon,

this is huge for me: I don't think I've ever had anyone send in an ask where the answer is "you need an entirely new group of friends."

here's the thing: unlike your friends, I understand that you're an adult who's capable of making decisions and deciding which relationships are good for you!!! which isn't to say that adults don't unwittingly find themselves in abusive relationships all the time - they do, it can happen to anyone! - but if the ONLY red flag that your friends can point to is "he's neurotypical and you're not" oooooooooooh my god go to hell???? incredibly infantilizing of you and dehumanizing of neurodivergent people in general. fuck off fuck off fuck off. throw the entire friend group away, this is disgusting.

like this is. this is literally just the faux progressive way to say that you don't think neurodivergent people (which is, for the record, an incredibly nebulous category that's nearly impossible to put hard and fast definitions on) shouldn't date "normal" people! get fucked! sorry I can't put my usual chipper sex witch spin on this, this just sucks and makes me actually sincerely incredibly mad. christ.

[kittydragondraws]

This Fandom is Weirdly Misogynistic and Ableist

Yeah great title there bud.

So originally this was going to be a half-baked rant about how people disrespect V, but the more I brainstormed that I came to realize. This fandom in general has a problem with misogyny and even ableism towards not just V, but Uzi as well. Heck, I would almost say Uzi moreso.

When it comes to personality butchering, I'd say V gets it worse. The number of times I've seen people make her sound like some petty, vengeful ex makes me want to rip my laptop screen off its hinges.

And most of the reason they do this, episode 4.

When Uzi and V are together in the cabin, V tells Uzi that it's better to stay distant because she'll have to kill Uzi next. Afterwards saying that N's made friends with rocks before, and that he'd move on from her death just fine.

Now, I honestly love this scene. It's a moment where Uzi and V get to be together and V gets to show her true colors without having to hide them from N. She expresses her desire to kill Uzi, because she believes it'll keep N safe, and tells her about the rock friends to make her feel like she's just some cheap novelty to N. This scene is great.

Yet apparently, some people looked at this scene and saw it as V being jealous of Uzi's relationship with N and wanting to kill her over it.

Now I just have to ask... why. This scene is so easy to understand when you just sit and think about it, so why did so many people default to it being a ship thing?

Maybe because she's just a pantless whore who exists just for people to thirst over. At least, that's what Reddit bros and Discord trolls would have you believe.

Now, I do feel it's a bit stupid to look at an unpopular female character and say "well you'd like her if they were a guy", but with V I have a feeling that's exactly the case.

V's not fan service, she's not a hoe or some crazy ex. She's just trying to keep herself from losing one of the few sane constants in her crazy, messed-up life.

But of course, she can't be an intelligent or deep character, she's just a petty woman upset at Uzi for stealing her man and who needs to put on some pants.

Now Uzi, I'd have to say her treatment is worse. Not just because it's the same sexist bullshit V has to put up with, but because she's neurodivergent.

Okay, that was a lie, she's not canonically neurodivergent. But she does have a lot of traits of a neurodivergent person. Being a social outcast, thought of as weird because of her interests and behavior.

Most people who headcanon Uzi as neurodivergent seem to agree that she could have autism, ADHD, or BPD (Borderline Personality Disorder), and I just wanna talk a bit more about her unofficial BPD diagnosis because I think that's the most fascinating out of the three.

In this image I highlighted some symptoms that feel very similar to personality traits Uzi has. Like, it's so similar it almost feels weird to say Uzi having BPD isn't canon.

Now I know what you're going to say, "But Kitty this is just people's headcanons."

And you know what? Fair honestly. But even if Uzi doesn't have autism, ADHD, or BPD, she almost definitely has some form of trauma and you'd be hard-pressed to try to argue with me she's neurotypical.

Uzi's not a pick me, she's a traumatized, possibly neurodivergent, girl trying to hold onto the first friend she's ever made.

Or hey? Maybe she should just suck it up and learn to take care of herself.

Honestly, this post is just a TLDR version of this.

[what-if-i-just-did]

Idk who needs to hear this but... you're allowed to make things easier for yourself. You're allowed to half-ass things. You don't have to do things the way you're 'supposed' to. Yeah, you should be doing everything completely, but if you can't do that, then doing some things partly is still better than doing totally nothing.

You can sit down while doing the dishes. You can have wash baskets and trash cans in every room in your house. You can brush your teeth for twenty seconds. You can buy kiddie tooth paste. You can brush your teeth at any time of day. You can get yourself a rubber duck. You can get yourself a huge IKEA shark if you want to. You can leave the curtains closed and your bed unmade. You can shower at any temperature that's comfortable to you. You can shower with the lights off. You can shower long. You can shower short. You can cover the mirrors. You can shower in bathing clothes. You can even shower in normal clothes if it'll make you feel better. You can shower without soap. You can just use soap on the places that need it most. If touching any one part of yourself triggers you, you don't have to wash it. You can sit down while you shower. You can wear the same clothes for a week. You can decide your outfits days before you wear them. You don't have to brush your hair. You don't have to take off your shoes at the door. You can rip out the tags of new clothes.

You can add and remove whatever it is that'll make things easier and less triggering for you, even if it seems silly. Even if it only helps a little. Even if you 'should be doing it better'. You don't owe people as much as you think you do. You don't owe anyone your prettiness, your dedication. Having a mental illness or a disability is hard. Most people don't understand that, but guess what? You don't owe them an explanation. You don't have to conform to neurotypical standards of 'good'. Your depression standard of 'good enough' is allowed to be less than that.

Seeing as this got more attention than I thougght it would, I need to add; I know there's other factors. I know you can't always afford to get yourself a huge IKEA shark, I know you don't always have time to shower for forty minutes, I know sometimes you get less tips/work if you don't look pretty. The point here isn't the details, it's the mindset of the fact that the details don't matter. A job doesn't always have to be well-done, in fact, a half-done job gets you half the way there.

(I wrote this with neurodivergent/mentally ill people in mind, but a lot of this also goes for disabled people so I'll also tag that. If that's like, ableist, in any way, please tell me and I'll fix it!!! I just wanna be helpful but I know that that doesn't always mean I am)