I'm a psychiatrist with ADHD, EVEN I spiralled before my TED Talk

Added: 2026-05-05

[00:00:00]Oh my god, he's [music] sweating. Why?

[00:00:02]He's nervous for me? Okay, that means he clearly doesn't believe in me. He thinks [music] I'm a failure. Everybody else in the audience probably thinks I'm a failure. This talk is going to bomb.

[00:00:14]This is it. I'm going to lose literally all of my medical credibility that I've spent years building because of this.

[00:00:20]Okay, let's rewind. I'm Dr. Sasha I'm Nani. I'm a psychiatrist who specializes in ADHD. [music] I also have This thought spiral happened when I was standing backstage at my TED Talk. And if your brain does this to you as well, it's not a character flaw. Today, we're talking about RSD. Let's first talk about what rejection sensitive dysphoria actually is. The word dysphoria comes from the Greek of hard to bear. It is this intense RSD is a neurological phenomenon which causes this intense emotional, sometimes physical, response to rejection or criticism. And here's the kicker, it doesn't even need to be real rejection or criticism. It can be perceived rejection or criticism that you're just putting on yourself. This is not a personality thing. This is not being too sensitive. This is not being too fragile. This is your underlying wiring. Here's [music] the thing, almost 100% of people with ADHD experience some aspect of RSD. It's common enough that we should be talking about this. And if you're wondering, and if you need more information on this topic or something resonates with you in this video, I quite literally just wrote a book on this called Too Sensitive. I'll put a link below for it. So, let's get to the bottom of this. Why does this happen? It can happen for many different reasons, but when you look at that crossover between ADHD and RSD, it boils down to dopamine and norepinephrine regulation.

[00:01:42][music] ADHD brain does not process emotional signals the way that other brains do. And I know that if you're experiencing this, you know that. Big feelings hit faster.

[00:01:53]>> [music] >> They are stronger. They last longer.

[00:01:57]They can feel very overwhelming. When you're looking at a brain that doesn't experience RSD, there's a gatekeeper in place which [music] allows that brain to take a pause and soften the signal before they figure out what to do with it. ADHD gatekeeper? Where? Where is that? Unreliable at best. This is something that has been researched and studied and talked about, but we just haven't quite wrapped our arms around it. Here's Dr. William Dodson talking about RSD in relation to ADHD.

[00:02:26]>> ADHD are terribly sensitive to all that criticism. Now again, nobody likes being rejected or criticized. Nobody likes it.

[00:02:33]For a person with ADHD, it is devastating. And part of the pain is that people [clears throat] feel utterly alone, utterly cast out. And so, the word dysphoria is from Greek meaning unbearable. Here's the trigger that nobody talks about with RSD. Everybody assumes that you need actual rejection for this to kick off and trigger and fire. Here's the problem. A brain experiencing RSD is ready to rewrite that narrative. It'll take a neutral piece of information and spin it into something that feels very negative, very heavy, very urgent. Let's go back to the example of the TED Talk. Right after I finished my TED Talk, gotten off the stage, I was feeling a little bit panicky cuz I kind of tripped in the middle of >> [laughter] >> Sorry. In the middle of my Actually, you know what? I'm just going to show you a clip of that because it it's I'm just taking ownership of it. Cave painting, handprint, fingerprint, criminal, smooth criminal, Michael Jackson, moon moonwalk.

[00:03:40]moon Can you guys imagine if I'd fallen there? I would have had to explain everybody that I fell while attempting to moonwalk during a TED Talk.

[00:03:51]Okay. So, right after that happened, I don't remember much of the talk afterwards, but I ran off the stage, took off my mic pack, and then I I went to go into the lobby. I saw my husband who was waiting there because we had arranged before he wasn't allowed backstage, so I arranged to meet him afterwards, and I gave him a big hug, and he was sweating. He was sweating so much, and [music] it it made me spiral.

[00:04:12]It made me freak out because I was like, why are you so nervous? Clearly, I did something wrong, and you're embarrassed of me. And I should be embarrassed of me, and this was all Everybody's laughing at me. That's exactly what I thought. And again, that's not I mean, first of all, the reason he was sweating was a bazillion degrees in there. Number two, he felt [music] that he was reading through my talk with me, and he was like, "I was getting nervous, and it was you know, as you were getting close to the end, I just had stage fright for you." But he was like, "I was I never doubted that you could do it. I thought you did a great job." I didn't hear any of that. So, it's not about the action, it's what your brain attaches to it. If you're having a hard time relating, let me give you some other examples that you probably have experienced. That physical discomfort when you're waiting for an answer or text, when you finally get it, a response that isn't as enthusiastic as you would have hoped, maybe like down to just like they didn't use the right punctuation, and that kind of gives you that pit in your stomach. Maybe you're in a work setting and someone's tone you pick up on before anybody else does, and you feel like that it's pointed at you for disappointment. Maybe even silence.

[00:05:21]I still like I have slipped out when there's silence just because [music] like I attach my own narrative to that space. Our brains are really good at finding the threat even when there isn't one. So, let's break down an RSD spiral [music] because in real time, it can be really difficult to identify these moving parts because it all feels so urgent and so sudden while it's happening. I am running off stage. Hug my husband. I ask. The piece of information I'm getting at that point is he's sweating. So, my brain, instead of saying "It's hot in here. I'm sweating also. So, he sweats all the time. So, he just runs hot." The narrative I'm attaching is >> [music] >> he's sweating because he's embarrassed for me. He's sweating because I did something wrong. He's sweating because I made a fool of myself. I ask, "Why are you sweating?" He responds cuz he's kind of thrown off, and he's like, "I guess I was nervous for you." Uh-uh.

[00:06:14]>> [laughter] >> Uh-uh.

[00:06:15]To me, that corroborates what I was thinking because [music] I'm like, "Okay, he was nervous for me. Why is he nervous for me?" Not because you're public speaking on a huge stage, and that's really anxiety-provoking. Not because I know how much this means to you, and I wanted you to do well. Not because >> [music] >> I get nervous when I see loved ones performing. I read that as the talk was bad. My credibility's gone. This was not only a waste of time, but it harmed me.

[00:06:42]What happened? That span of time from "I guess I was nervous for you" to me spinning out felt instantaneous for me.

[00:06:51]I didn't have any >> [music] >> break or space where I could slow down and say, "Wait, let me think about this." I took neutral input, attached catastrophic conclusion, and ran with it. Now, if that [music] was where it ended, maybe I would have been able to navigate my way through. Maybe I would have listened to when other people were giving me other pieces of information.

[00:07:11]But there is a certain familiarity when you have this over and over and over again that you start to feel like, "Why am I like this? Why does this always happen to me? Why can't I do anything right? Why do people hate me?" And as I was spinning, I felt very, very alone. I felt like I knew that the inside of my head was spinning out of control, yet I'm supposed to smile and get flowers and and get ready to go for a celebration dinner when all I want to do is throw up and hide in a hole. And that's what makes that RSD so exhausting. That [music] spiral is invisible, and you're expected to mask your way through it. So, I tell my patients who have never heard of RSD that knowing the name of it is extremely validating cuz they might have been floating around their entire life and not have known that there's a term for this, that there's a name for this.

[00:08:02]There there is a phenomenon that is neurological in nature that many, many, many people experience. To me, that was comforting. I didn't feel as alone knowing that that's something that was >> [music] >> well-documented, but it didn't stop the spirals. This is something that would happen, and I would get triggered, and I would spin, and I knew it was RSD, but it wouldn't >> [music] >> stop that from happening in the first place. And this is why. RSD is not a thinking problem. It's a biological problem. You can't logic your way mid-spiral because your body's running the program at that point. Your heart's racing, your cortisol's spiking. Body's producing physical evidence that the threat is real, and that makes the story feel more true, not less. Knowing the name of the wave doesn't stop you from getting knocked over. So, if this is happening to me, who's a psychiatrist, who's an ADHD specialist, who has obsessively researched RSD for 3 years, fully aware of its mechanism, you'd think that I'd be the most prepared to handle this, but it can still happen.

[00:09:03]So, when it happens to you, know that this is not your fault. That being said, there are ways that we can cope with this. For the TED Talk example, I was spiraling, spiraling, spiraling. I had two of my very best friends who were in town to come and watch me speak, who were showering me with nice things [music] to say and flowers and taking pictures, and I felt so unwell that I just wanted to run away. If I could redo those moments, this is exactly what I would have done. When I initially hugged him and felt that sweating, and he admits, "Yeah, maybe I was nervous for you." Instead, I should have paused for a second, and as my brain was jumping into those conclusions, I should have stopped and said, "Run those by him. Why were you nervous? Were you nervous because I failed? Were you nervous because I was embarrassing?" And he would have said, "No, I was nervous cuz you were on stage and this was a big deal, but you did a really good job." If I had heard that, if I had stopped and actually just run it by him, that would have helped tremendously.

[00:10:09]And I think at this point, he's seen me go through this so many times that asking those questions, he would have understood. Say I still felt that physical unease, then I could have stopped [music] and in my own brain said, "Okay, this is RSD. I know I'm running off a cliff here. Maybe I'm just attaching this negative narrative to something. Maybe this didn't play out like I thought. Why don't I just try to be present in this moment? People are handing me flowers, I should enjoy this.

[00:10:35]Look at how beautiful these are." Part of the issue is that RSD moves really fast. Real information moves slower.

[00:10:41]Like what it would have actually made me feel better would be to watch my TED Talk over.

[00:10:47]And the footage came out 45 minutes later cuz my mom had taken an entire video of the thing and sent it to our family in a group chat. A 16-minute group chat. I could have just looked at it and seen how I did and looked at it and looked at it with my husband and and kind of done reality and I was just too scared. One of the most important things that I think is helpful in this kind of episode would be to remind myself of times that I've gone through [music] the same thought spirals of failure, of embarrassment, of disappointment, and I turned out to be wrong. And it turned out to be a really special moment. And that's what I would have reminded myself of in that moment. And if things still weren't sitting well with me, I would have told my husband. I would have told my two friends, "This is what I'm experiencing in this moment. This is the physical stuff I'm feeling. I [music] just need a little time. I need some patience and maybe we can instead of going out to a restaurant, maybe we can eat at home." That's what I [music] should have done. The problem with RSD is that when you are experiencing episode, you feel so out of control and you forget all [music] of this. Like I guarantee if you've made it this far in the video, next time an RSD spiral comes along, you are going to forget literally everything I have said.

[00:11:58]That's just the name of the game. What [music] helps is that if there is a slow, steady practice and knowing the right types of tools. In my book, Too Sensitive, we actually go through a set of 12 tools that you can use. And that's distilled [music] from every corner of psychiatry and psychotherapy to figure out what actually did work in that moment or right after that moment to calm things down. And then how to use it. And so the second part of the book is just real life examples and it's goes from things [music] just things that might have triggered your self-worth or things that are happening in a relationship setting or things that happened in friendships or things that happened at work and they're broken down by real, real life examples with real quotes, what's happening in the brain, and what tool to use right in that moment. I think the more you read about it, the more comfortable you get practicing these tools, the more likely you are going to shorten those spirals and potentially [music] be able to identify RSD before you spin out of control. We just talked about what RSD looks like inside of your head, but here's what nobody tells you about what it looks like to the people closest to you. In the next video, I break down how RSD, masking, and emotional dysregulation quietly erode your relationships and what to actually do about it without pretending to be someone you're not.