The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
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It is entirely possible you do have ADHD. Based on what you've described, the clinical suspicion is at a degree that warrants formal assessment, and pursuing one is a move I would happily encourage.
That being said, I wince at anyone invoking "rejection sensitivity dysphoria," which in this context strikes me as a rather useless pseudo-diagnostic label that pathologizes being a Sensitive Young Man.
RSD appears in neither the DSM-5 nor the ICD-11, has no validated measurement instrument, and the term traces back mostly to one enthusiastic clinician in the 90s rather than any systematic research program. The construct it gestures at (emotional dysregulation in ADHD) is real enough, and the DSM-5-TR now acknowledges overreactive emotionality as an associated feature. That is very different from being a core feature, or being helpful in terms of narrowing down the differentials. Feeling terrible when a girl leaves you on delivered is not a neurological syndrome. Young man, that's the human condition, plus youth.
I used to be one, you know. Which is to say young. I'm still a man. In terms of sensitivity? Mostly I've just become increasingly willing to tell people to go fuck themselves, or more politely, to stand up for myself when I'm clearly in the right. There was a time when being left on read would have felt like the end of the world to me. These days I shrug and move on, or at worst wince slightly and forget about it by the next week. This will happen to you too, and it will manifest as external confidence. People can tell when you've got it, and they act accordingly. Time and reps, mostly. No pill need popping for that particular problem.
At best, marked rejection sensitivity might point toward a comorbid anxiety disorder, which is worth mentioning to whoever assesses you, since the comorbidity rates between ADHD and anxiety disorders run somewhere around 25-50% depending on the sample. But as a diagnostic marker for ADHD specifically, it offers little.
Now, I am a psychiatry trainee, and I do have ADHD. And my life has interesting parallels:
My dad, despite being a good doctor, was loathe to acknowledge that his son(s) have mental health issues. I'd blame it on him being from a different generation. When I was older and telling him about my problems again, he mentioned episodes around my age that sounded awfully like depression to me, except he hadn't had the vocabulary at the time, and more importantly, he had managed to push through and flourish anyway. In his eyes, a son who was clearly intelligent, academically and professionally successful, couldn't possibly be mentally ill, let alone chronically. He flinched away from the notion. In his cosmology, that's the realm of the insane and the delusional, and if you're objectively succeeding, everything must be fine upstairs.
I wish that were true.
On that note, I'd be careful bandying accusations of narcissism about. Not because you're necessarily wrong, but because I remember being around your age and being quite mad at my dad, and the heat of the moment is a poor time to hand out cluster B diagnoses to family members. Hold that belief lighter than currently feels natural. You can always revisit it when you're older and know better. That would the kind of statement that would have annoyed me when I was younger, but it's true nonetheless.
Pragmatically speaking: stimulants work on just about everyone. This has been known since we gave dextroamphetamine to entirely normal prepubertal boys in 1978 and watched their motor activity drop and cognitive performance improve, a finding replicated in normal adult men. That makes "I took Adderall and functioned better" a poor confirmation of the diagnosis, in the same sense that telling someone who perks up after a cup of coffee that they're "caffeine deficient" is a suboptimal diagnostic framework. Scott's essay on Adderall covers the gatekeeping problem well: attention is a normally distributed trait, the diagnostic cutoff is somewhat arbitrary, and most psychiatrists and possibly the majority of patients knows it.
Even more pragmatically:
ADHD is associated with a life expectancy reduction that is more alarming than I originally remembered. This paper found an apparent reduction of about 6.8 years for men and 8.6 for women, and Barkley's earlier estimates are thereabouts too. The mortality rate runs roughly double the general population's, pushed up by accidents, substance use, and the general downstream consequences of poor impulse control and executive dysfunction.
And treatment works! A Swedish registry study of around 150k patients found medication initiation associated with a 19% reduction in all-cause mortality over two years, concentrated in deaths from unnatural causes. The usual observational-study caveats about confounding apply, and the follow-up window is short, but the direction of the evidence is consistent across studies of injuries and hospitalizations too.
That's why I don't much care about gatekeeping this diagnosis as zealously as some do. The failure mode of slightly over-prescribing a well-tolerated medication with fifty years of safety data is considerably less bad than the failure mode of leaving a disorder with those base rates untreated because your dad is a dum-dum. I care about results uber alles, and I care even more about the fact my disease is comparatively mild. The medication changed my life for the better.
I wholeheartedly appreciate you taking the time to write such a conscientious response with your experience and the statistics you've included! I don't have much to add, but one thing I will tell you is that the suspicion of narcissism has been present for a while. It was certainly not triggered by this alone, though this sure as hell adds insult to the injury. Without getting too personal, I began picking the suspicion up after spending time reading literature, observing healthy family dynamics in movies, having dinner at my pals' houses, etc. and recognizing that something was off about my family. Obviously I ought not to take them as the gospel, but have researched what medical professionals had to say as NPD and have delineated the concrete exchanges I've had with my father to Claude. I provided some examples of the behaviors exhibited by my father a few Wellness Wednesday threads ago, which I've linked in my response to another person replying to my post.
You're welcome! Don't worry, your dad could well be a narcissist, and if he's an asshat, you have the right not to contact him regardless of a formal or informal diagnosis.
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