Belinda retweeted
So much damage is done by the idea that there is a majority of people for whom life is straightforward. The world was designed for them, they effortlessly comply with societal demands and get over their life stresses easily. They never wonder whether there is something different about them, or criticise themselves for minor failings. They sail through school and work. They have meaningful relationships with only transient conflict. Their emotions are manageable and in proportion. They are round pegs in round holes.
The neurotypical
Some people look like this from the outside. Hardly anyone reports being like this from the inside. Yet more and more books and training programmes promote the idea that if you’re not like this, you must be neurodivergent. Wired differently.
We have pathologised the human condition.
Belinda retweeted
Someone told me that you can tell how a person felt about you by the way they treated you in the end, and I had to take a minute and process that one.
Belinda retweeted
A new study shows that ketchup and mustard are terrible for you.
The study was done by the Mayo Clinic.
The uncomfortable truth about ADHD diagnoses, according to a leading neurologist telegraph.co.uk/health-fitne…
Belinda retweeted
Professor Fonagy's final report recommends moving from a "diagnosis-dependent" to a "needs-led plus diagnosis" system for ADHD, autism and mental health.
In principle, I agree. And from my own practice, identifying need is the easier part.
In one private service I work with, I diagnose and treat neurodivergence and mental health conditions together, not in isolation. Alongside medication, I can recommend coaching or psychotherapy, so more of a person's needs are addressed. Collaboration with workplaces or schools can be arranged individually depending on needs and patients’ preferences. The downside is obvious: the fee. But a model like this could inspire the NHS. It is perhaps close to how the NHS used to work, before services became fragmented and many interventions were included in the "not commissioned" category, which removed them from routine CMHT practice and from training opportunities for staff.
In another service I collaborate with, which is free for patients, diagnosing, prescribing and drafting a needs formulation is straightforward. The hard part is finding free support to offer afterwards. Some areas have third-sector support groups; many offer only a psychoeducation website. So we may arrive at the most wonderful needs assessment but there is no service free for patients to deliver it.
So my question is:
Once need is identified, who provides and funds the support?
Identifying need is not the bottleneck. Resourcing it is.
Belinda retweeted
I liked it better when people didn't ask what their diagnostic label was and we could blow the question off as " inside shop talk" if they asked. When people started showing up for their first consultation with tabbed copies of " Driven to Distraction", or "An Unquiet Mind" or, heaven forbid, " Michelle Remembers" having already not only diagnosed themselves, but fully identified with a particular label, the whole endeavor was nearly hopelessly contaminated.
Belinda retweeted
We killed 92 of 94 new diagnoses suggested for DSM-IV.
The 2 we added (Aspergers/Bipolar 2) caused more harm than benefit.
I suggest no new disgnoses until we have solid biological tests.
Dumb new labels take on a dangerous life of their own
(see great description below).
Sometime before 2016, a psychiatrist started asking their late-diagnosed adult patients with ADHD whether they thought they were more sensitive to rejection and failure than other people.
They said that they were. He didn’t (as far as I can tell) do any comparison with people with mental health problems, or with those with social anxiety. He didn’t look at children or those diagnosed in childhood. He just asked his patients to self-compare with others.
There were no attempts to test out whether this was specific to ADHD, nor universal in those with ADHD.
In 2016, the psychiatrist, William Dodson, gave this a name - rejection sensitivity dysphoria - and started writing about it. It resonated with influencers who created content talking about their RSD. It quickly multiplied. Articles were written about it on official sounding websites. Qualitative research was done, asking people who had heard about RSD whether they experienced it and what it was like.
By 2024, Dodson was saying that RSD was neurological and genetic, not related to trauma and wouldn’t respond to psychotherapy.
By 2026, bestselling author Alex Partridge wrote a whole book about his RSD, pinning it squarely to ADHD and saying that RSD ‘explained my entire life’. He gave a convincing sounding brain-based explanation about ‘glitches’ in how the ADHD brain processes dopamine and nor-epinephrine, and how these lead to rejection feeling far more brutal than for people without ADHD. There is no evidence of this that I have found.
And in this way a psychological and emotional reaction was framed as a neurobiological symptom. Millions started to think that perhaps they had ADHD, because they were sensitive to rejection and failure. RSD spread, and soon people started saying it was part of autism too.
Why does that matter? Because when people think something is due to how their brains work, they think that it is set in stone and won’t change. They think that medication is their only option, and that psychotherapy has nothing to offer. Emotional sensitivity is a really common psychological symptom, and it hasn’t been shown that it’s uniquely part of ADHD. RSD is an example of how neurodivergence is expanding to incorporate emotional reactions, and in the process turning psychology into neurology.
With RSD, the most basic scientific questions haven’t been answered, but you’d never know that from what you see online. There, it all seems so certain and clear.
It’s not.
Belinda retweeted
Sometime before 2016, a psychiatrist started asking their late-diagnosed adult patients with ADHD whether they thought they were more sensitive to rejection and failure than other people.
They said that they were. He didn’t (as far as I can tell) do any comparison with people with mental health problems, or with those with social anxiety. He didn’t look at children or those diagnosed in childhood. He just asked his patients to self-compare with others.
There were no attempts to test out whether this was specific to ADHD, nor universal in those with ADHD.
In 2016, the psychiatrist, William Dodson, gave this a name - rejection sensitivity dysphoria - and started writing about it. It resonated with influencers who created content talking about their RSD. It quickly multiplied. Articles were written about it on official sounding websites. Qualitative research was done, asking people who had heard about RSD whether they experienced it and what it was like.
By 2024, Dodson was saying that RSD was neurological and genetic, not related to trauma and wouldn’t respond to psychotherapy.
By 2026, bestselling author Alex Partridge wrote a whole book about his RSD, pinning it squarely to ADHD and saying that RSD ‘explained my entire life’. He gave a convincing sounding brain-based explanation about ‘glitches’ in how the ADHD brain processes dopamine and nor-epinephrine, and how these lead to rejection feeling far more brutal than for people without ADHD. There is no evidence of this that I have found.
And in this way a psychological and emotional reaction was framed as a neurobiological symptom. Millions started to think that perhaps they had ADHD, because they were sensitive to rejection and failure. RSD spread, and soon people started saying it was part of autism too.
Why does that matter? Because when people think something is due to how their brains work, they think that it is set in stone and won’t change. They think that medication is their only option, and that psychotherapy has nothing to offer. Emotional sensitivity is a really common psychological symptom, and it hasn’t been shown that it’s uniquely part of ADHD. RSD is an example of how neurodivergence is expanding to incorporate emotional reactions, and in the process turning psychology into neurology.
With RSD, the most basic scientific questions haven’t been answered, but you’d never know that from what you see online. There, it all seems so certain and clear.
It’s not.
