Medical homelessness of ADHD and Rejection Sensitivity Dysphoria. Part 5 of ADHD and Fibromyalgia
Updated: Aug 11
Similar to fibromyalgia, those with ADHD often have a sense of homelessness. Eighty percent of homeless have ADHD. It is a considerable contributor to homelessness. The VA looked at honorably discharged veterans and found 83% of homeless veterans had previously unrecognized ADHD. They had functioned well under the structure and routine of the military but struggled when they got to civilian life, where they had to create their structure in life. PTSD occurs more frequently in veterans as well.
Pain and anxiety are like alarms where the threshold is lower than those with neurotypical pain. PTSD, posttraumatic stress disorder, is on the high end of the anxiety spectrum. Many veterans used to be athletes and loved to be active. They loved the physically active military training but struggled with routine time independently.
As many veterans also have comorbid ADHD with fibromyalgia have insomnia. In medicine, it is better to treat the cause. In ADHD, the treatment of insomnia is to take a stimulant to help turn off the brain. The stimulant medication is fine-tuned. Dr. Dobson says to try taking a nap on the stimulant. Many had never taken a nap before being treated for their ADHD due to feeling overwhelmed and having difficulty relaxing. What they find is that they sleep great on their ADHD stimulant. 90-95% of patients with ADHD and insomnia sleep better when the stimulant is added and fine-tuned. There is a hyperaroused nervous system. There is also contentment with completing the tasks they previously struggled to follow through on and finish.
Someone with ADHD as a single person living in an apartment may not take the medication on the weekend, but when they get married, have a house, start a family will struggle. And as life gets more complicated, they will struggle with ADHD symptoms. Treatment of ADHD allows them to complete those formerly tedious tasks. As life gets more complex, like when fibro symptoms become more manifest, ADHD symptoms can flare up.
With pregnancy, there may be more stress. They may stop an addiction like nicotine and marijuana and substitute food to cope. This substitution can lead to excessive weight gain, leading to hypertension and diabetes during pregnancy.
It is clear treating ADHD is very important. Dr. Barkley, a clinical psychologist with decades of experience researching and caring for patients with ADHD, showed that untreated ADHD leads to 13 years shorter lifespan. Mortality for those under age 40is related to accidents, overdoses, and suicide. Over 40 premature deaths are related to maladaptive behaviors like smoking, alcohol abuse, and obesity, shortening their lives by heart disease, cancer, and diabetes.
How did Dr. Dobson get interested in ADHD? He always liked people with ADHD. They are so much fun and interesting. They know the jokes. They also do so well when treated. You can turn their life around in an afternoon by treating ADHD. The medication is effective an hour after starting it. Weeks are not needed to treat as with other psychiatric conditions like depression.
He started a clinic for kids with ADHD and learning disabilities during his residency. He then went to Georgetown University and started a similar clinic there. After his time in Georgetown, he worked with drug and alcohol addicts. More than half had untreated ADHD. When their ADHD was treated, it made a huge difference. He finds it a fun way to work.
Many people untreated with ADHD have struggled for so long. There needs to be primary care stepping up to help with the struggling. Psychiatrists do not have the capacity in their schedules to treat, and many have not had much training.
The title of my book emphasizes real pain and a real struggle with fibromyalgia. ADHD has a cognitive piece where the nervous system works on interest and not the importance that motivates the rest of the world is nothing but a nag to those with ADHD. The second thing is sleep disturbance which they often try to self-medicate. The third is the emotional component. American researchers have paralyzed the field of the emotional impact of ADHD. The Europeans have been more involved in this research. Virtually 100 % of people will endorse that they have been much more sensitive to rejection, criticism, teasing, or their perception of falling short for their entire life. Nearly all adults report that has always been me. This description comes from an old psychology textbook called rejection sensitivity dysphoria. It means that people are hardwired to be particularly vulnerable to withdrawal of love, approval, and respect. People with ADHD are much more devastating when they perceive someone rejects them or they reject themselves. It has only been discussed in lay literature, but it got more feedback on REDDIT on ADHD than any others. ADDitude magazine editor Jessica McCabe didn't find research to support a series, but there were more requests for a unit on it than others that she had it. On youtube, there are more than 100 videos on it. It is triggered by the loss of love, approval or disrespect. The pain is indescribable. The original researchers pestered the research subjects, but they could not find the words to describe it, but they could hardly stand it. Dysphoria is greek for unbearable emotional pain. It can feel like they got punched in the chest.
This dysphoria overlaps well with fibro because it is so disruptive and overwhelming. I tried to develop a cover for the book cover, Conquering Your Fibromyalgia, and came up with different ideas, but one was the idea of chains that bound someone being broken free. Having fibro is like being bound, blindfolded, and tortured by an unknown person for unknown reasons without any recourse for rescue. Rejection sensitivity dysphoria captures the emotional aspect of fibromyalgia and the pain.