Meet The Podcast Hosts!

The Divergent Conversations Podcast is hosted by Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals and entrepreneurs, as well as features other well-known leaders in the mental health, neurodivergent, and neurodivergent-affirming community. Listeners know, like, and trust the content and professionals on this podcast, so when they hear a recommendation on the podcast, they take action.


Episode 29: Unmasking Rejection: Answering Questions About RSD

Dec 25, 2023
Divergent Conversations Podcast

Show Notes:

Rejection sensitive dysphoria (RSD) impacts many aspects of your life and can be a driving force in how you manage relationships and internally process the world around you, so there are many nuances for it.

In this episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, answer some of the questions from listeners about RSD, including everything from self-shaming to the connection with other diagnoses.

Top 3 reasons to listen to the entire episode:

  1. Understand what masked RSD looks like and the impact it has on shame and finding connection.
  2. Identify what connections and impact RSD might have on conditions like PMDD, as well as how the experience of rejection can be viewed differently between ADHD and Autistic individuals.
  3. Learn some strategies to help deal with the experience of RSD to create a better environment around you and pay attention to your core needs.

When it comes to RSD, everything goes back to connection. It’s both the thing that humans need and also something that can seem so difficult to attain and maintain. If you are struggling with complex and shifting intrusive narratives or internalized emotions that can last for years, try to focus on your core needs at the moment and check in with yourself so that you can offer yourself the opportunity to think more objectively and take action that is more likely to benefit you.

Resources plus Exclusive Coupon Code


A Thanks to Our Sponsor, Tula Consulting!

✨ Tula Consulting:

We would love to thank Tula Consulting for sponsoring this episode.

Workplace communication can be messy. Considering the lens of neurodiversity can be helpful for understanding this. Maybe you found yourself frustratedly typing "per my last email" in an office communication, perplexed about how a colleague or client doesn't seem to understand your very clearly written email.

Consider this. Visual information processing isn't everyone's strength. Perhaps a quick call could make a world of difference. Or how about including a video or voice message with your email? And this technology exists! Simple steps like these can make your work environment more accessible and bring out the best in everyone.

Tula Consulting is on a mission to help organizations build more neuro-inclusive products and work environments. Tula does this by bringing curious minds to solve curious problems. Find out more by visiting



PATRICK CASALE: All right, so we are back with RSD part three, which will probably lead into an eventual RSD part four. But last week, we did not get to all of your questions, we kind of diverged, and we want to get to more of them today, especially, the ones that we think we have a lot to talk about. So, I think we want to start off with what can highly masked RSD look like?

MEGAN NEFF: Love that question, first off. So, last month when I was, like, deep in RSD mode, making the workbook, I created a grid, which… this is my like pattern finding, so I just want to tease out it's not like in the clinical research. But I made a grid of overlain RSD responses on top of kind of like the fight, flight, fawn, freeze, and talked about different responses. And we talked about this a little bit in our first episode. But like the fawn and the freeze response, I would say are masked RSD responses. And so this could show up as like perpetual people-pleasing, right? And perfectionism, those two. The myth being if I never make a mistake, or if I never make someone upset with me, then I would never have to experience this really painful thing.

And so a lot of masked RSD looks like really high-performing, high-achieving kind of busybodies ways of being in the world. And then I think when the RSD doesn't really get triggered, because none of us are perfect, and even if we're people pleasers, we're going to have miscommunications with people. I think that experience gets very internalized. So, instead of perhaps an emotional or angry outburst, what you're going to see is things like perhaps substance use, or a lot of negative self-talk, and rumination, and retreating, in some cases, self-harm, and other really like that…. And taking the pain internal. Like, also talked about as internalization, you're going to see a lot more of that. So, the people around you might not actually even know you're having an RSD trigger.

PATRICK CASALE: Yeah. And you know, those are the moments, right? Where we could use the language for a lot of self-destructive behavior going on behind the scenes to be able to keep up appearances, to be able to apply that social lubricant, like you've mentioned before, of this is how I fit into these spaces, this is how I show up, this is how I can people please, this is how I can socialize. And then that burnout just really takes over, right? Because there's going to be intensified depression, there's going to be intensified burnout, there's going to be intensified anxiety going on behind the scenes. And you, kind of, like, starting each day from a negative energy reserve and trying to get it back at that point in time where you're like, I'm operating at like negative percentage, and I'm going to put myself into the situation again, and again, and again.

MEGAN NEFF: Absolutely. And then we've also got to consider shame dynamics, which also perpetuate all those things you just mentioned of people with internalized RSD would have a lot of shame dynamics going on, which perpetuates a lot of like negative coping.

And here's the thing about shame, so shame theory is really interesting, actually. But one of the tricky things about shame is that sometimes there's this belief we fall into or trap. Like, if I can self-shame enough, I can protect from other shame, right? So, self shame it's the shame we give ourself. Other shame is the shame we experience from others.

So, people with very internalized RSD who are, you know, people pleasing, perfectionistic, tend to have really harsh inner critics that are very shame-based and have a really hard time diffusing and unhooking from these inner critics partly because the inner critic feels really protective. Because if that inner critic is, "I'm going to shame you, so you don't experience shame from another person." It's playing a protective role.

Now, we would argue it's not actually protecting or helping the person, right? But it feels like it's incredibly protective. Most of my life I've had a very, very harsh inner critic. And yeah, I couldn't unhook from it until the last few years because I was like, "No, this is protecting me." So, self shame protecting from other shame.

PATRICK CASALE: Yeah, shame is one of those emotional experiences that is probably one of the most painful things that happens to a human being, I think, that that shame spiral is so incredibly painful, destructive, torturous, hellacious. I mean, the criticism that ramps up the internal dialogue. I tend to go into more of like a shutdown space when I'm feeling really shameful. I noticed that comes up a lot when I feel like I can't do something that I feel like I should be able to easily do like screw something in in a way that looks even, or not cause a hole in the wall, or having to call a handy person after that because I've created said issue. That happens a lot. Then there's the social shame component where that really happens with the RSD triggers for me, where it really does create this almost like existential dread component to where you are really questioning everything and anything and almost losing sight of your sense of self in those moments too.

MEGAN NEFF: Oh, I think we absolutely lose sight of ourselves in shame spirals. Yeah, so that's kind of, I guess, clinical or lexiconic, if that's the word, definition of shame, just in case people aren't aware. So, guilt is the experience of like, I've done something bad and guilt is actually a good experience. Right? It's helpful feedback. For one, we're not living consistently with our values.

Shame, on the other hand, is I am bad, right? It's like I am the bad object, I am bad. And so that experience of I am bad. It's interesting, as we're talking about shame I'm like, how are we three episodes into RSD and we haven't talked about shame yet? Or even how did I write a workbook on RSD and not to talk about shame? Because I think, really what we're talking about it is when the shame is activated relationally because I think that is what happens with the RSD trigger is it's, I let this person down, or I like hard feedback, I am bad, right? And it's such a quick narrative we drop into, I am a bad person, which is the shame narrative.

PATRICK CASALE: For sure. So much of our sense of self, self-worth is connected too. And that narrative of I am bad, or I am unworthy, or I am not good enough, or all of the things that start surfacing, oh, man, I've seen so many, just situations where shame has created this spiraling sensation that has created an immense amount of destruction in people's lives in terms of both therapeutically and personally, and from my own perspective for myself. So, it is one of those emotions that is just really, really painful.

MEGAN NEFF: Yeah, absolutely.

PATRICK CASALE: I mean, we're talking about associations right now and we're talking about shame, we're talking about guilt, we're talking about sense of self that all gets triggered. We start to also see, and I just want to use a trigger warning, but we do start to see an intensified sense of suicidal ideation with a lot of this, too.

MEGAN NEFF: Yeah. Oh, I mean, yeah, shame and suicidality absolutely walk hand in hand. So, when you're doing a suicide assessment, there's questions you ask, and how a person answers some of those questions are indicative of how much risk they're in. And one of those questions that tells us this person is in a really high-risk bucket is do you believe or feel that the people in your life would be better off if you weren't here? And shame seduces us into that really painful narrative, shame and many other things, depression, but…

PATRICK CASALE: Yeah, I personally think that shame is one of the most damaging and destructive things that we experience. So, heaviness aside, techniques and strategies to work through that shameful experience when it's coming over you because there are ways to not let it engulf you and drown you in a way where, you know, it can be that devastating and destructive too.

MEGAN NEFF: Yeah, I mean, Brene Brown is really the queen when it comes to shame, right? Like, I love the idea that vulnerability is the anecdote or the cure to shame. And I think that's part of why when we have internalized RSD we're so prone to some of the like negative coping, because we're less likely to reach out and be like, "Hey, I'm having this experience right now." We probably feel shame about the experience, right? Like shame about being too sensitive, shame about our shame. So, reaching out becomes incredibly difficult. But if we can find someone, whether it's a therapist, or a friend, or a partner who gets it and where we can give that shame some breathing room, and by breathing room not like room to expand, but like room to dissipate, right? Where it doesn't live inside so intensely, that is one of the most powerful things we can do to disrupt a shame spiral is to connect, which again, like we're talking about relational shame, right? So, like belonging has been threatened. It makes sense that connection would be the anecdote to that.

PATRICK CASALE: And it also makes sense that it would be the last thing that you would reach for when you're feeling like, "Oh, I'm really feeling this massive amount of shame or rejection. I know I need connection, but I can't reach out for it, because that makes me feel too vulnerable, that makes me feel unsafe. I don't feel worthy of connection." Whatever the internal dialogue is, it makes it that much harder a lot of the time.

MEGAN NEFF: Yeah. Well, it's interesting, I'm thinking about the matrix and I'll, like, find a way to make a one page infographic of this that I'm referring to, and we can attach it, because the other parts of the matrix are fight, flee. And I'm just seeing how all of these reactions, all of these stress reactions to RSD move us away from what we need, they move us away from connection. So, if we're fleeing, obviously, that's going to move us away from connection in the in the fight. That's where I would say projection comes online, and where the shame is so intolerable to feel it gets projected onto other people, and then we lead with anger. That's a way of pushing people away.

So, whether it's like we're retreating in our pain internally, we're fleeing, or we're projecting all of these move us away from what we need, which is connection. And so, I think that's a lot of work living and working with RSD is figure out like, these are going to be my, like, automatic stress state responses. How do I override that to actually address a coordinate here and move toward that?

PATRICK CASALE: Yeah, I think that's a great point. And if we can anchor into the idea that foundationally at the root of this is the desire and necessity to have connection yet the fearfulness or inability to feel like you can access it, and just constantly trying to anchor in, and remember, like, connection is at the root of this, right? Like, as humans, relational beings, regardless of we're introverted, extroverted, does not matter, we still need connection in some capacity. That's something that we absolutely need and it's a major… What am I going to say? It's majorly a part of our makeup. And when we don't have access, or we feel like it's not possible, or we don't have those people in our lives we can turn to, then this can really start to spiral out of control, I think, and this is where we see this really get to that negatively impactful place, and that really destructive place too. I'm not finding my words appropriately right now, but I just want to emphasize the importance of connection.

MEGAN NEFF: I feel like I was tracking. I didn't notice that. I feel like I could linger in this conversation if this feels poignant and important. I'm also aware we talked about trying to get through questions in this episode.

PATRICK CASALE: Oh, yeah. We did [CROSSTALK 00:14:08]-

MEGAN NEFF: Should we move on to the next one?

PATRICK CASALE: Let's put in that one question because I think that the topic of shame, in general, could be an entire series.

MEGAN NEFF: Let's do an episode on neurodivergent shame because shame is very much part of the experience. It's often tied to, like, of course, past relational experiences we've had, internalized ableism, and then a lot of us have co-occurring trauma and trauma and shame are also very, like part of what's traumatizing about trauma is the shattering of self that often happens in trauma. So, yeah, let's do a shame episode or episodes, because it's a big topic.

PATRICK CASALE: Yeah, so for everyone listening, if shame is important, it feels like it's a part of your experience, which I assume for most of you it is, including ourselves, we will do more episodes on shame and specifically focused on that topic.

But we do have other questions that we want to get to, if we want to make it an Answer Your Questions episode. So, one question was RSD linkage to PMDD. So, you wanted to take that one?

MEGAN NEFF: Yeah, I mean, I think we should do an episode on PMDD, and just like neurodivergence and hormones at some point. Anyways, but PMDD is essentially, oh my gosh, what does it technically stand for?

PATRICK CASALE: Post-menopausal dysphoric disorder?

MEGAN NEFF: Good job. Yeah, I've been referring it to PMDD so long. I was like, I'm not going to get those letters right. Thank you. So, it's kind of-

PATRICK CASALE: [CROSSTALK 00:15:47] also dysphoric disorder.

MEGAN NEFF: I mean, it's like PMS on steroids, essentially.

PATRICK CASALE: Yeah, it's called that.

MEGAN NEFF: So, basically, yeah, PMS on steroids, the clinical definition, PMS on steroids.

PATRICK CASALE: Going into the DSM 6 soon, premenstrual dysphoric disorder?

MEGAN NEFF: Yeah. And it's very connected to like how hormones are shifting as part of this cycle. And both autistic and ADHD people who have a estrogen cycle, would that be the way to say it? That experience a cycle are much more vulnerable to do both PMS and PMDD.

And one of the things about PMDD… PMDD can be really intense. Like, I've definitely seen cases where someone baseline mood is actually pretty okay but will experience like, acute suicidality in that like week or that period. Like, it can be that intense. It's not that intense for everyone, but for some people, it is that intense of a mood shift.

So, absolutely, like, I describe it as like just paper thin, like in the sense of like everything's getting in, in that period. So, emotions are going to be heightened. So, of course, RSD, if someone has a baseline RSD, that's also going to be heightened because RSD is connected to emotion regulation. So, with PMDD, emotional regulation becomes a lot harder. And we tend to feel things more intensely.

So, yeah, I hadn't actually thought about that, but I love that of that thought experiment of what RSD looks like in that window of time. And I think that's actually really helpful to know. Because it's not going to make it go away, but being able to say like I know RSD triggers are going to be big this week, I'm probably going to perceive rejection where it's not, I'm going to feel it deeply. It doesn't mean it's true. Like, being able to do that self-talk. Like, I don't know whether I have PMDD. But I definitely have like hormonal shifts. I'll tell myself typically that week, "Don't trust your mind. You're not allowed to think about the future, you're not allowed to evaluate relationships." Like, I have like hard rules about what my mind is allowed to do that week.

And it's not like a harsh rule. It's like a kind, like, parental figure come in and be like, "You know what? Your mind's not up to any good this week." So, there's some things we're just not going to think about because it's not going to be helpful. Here's what we're going to do instead.

PATRICK CASALE: I love that.

MEGAN NEFF: Yeah, but yeah. Sorry, go ahead.

PATRICK CASALE: No, that's great. I mean, man, you can make worksheets, or like affirmations, or guidelines for people around like that sort of structuring in terms of, I'm not going to trust my mind this week. Like, these are the things that you know to be true, these are the things that we're not going to put any energy into. Like, that makes so much sense. Okay, add another episode to the list of neurodivergence and hormones.

So, moving on through the questions, these are leading to episodes which we love. So, thank you for submitting these. Okay. Do stimulants cure RSD? That's a pretty basic response and we're going to say no to that. There are stimulant medications, right? Megan talked about the psychopharmacological perspective in episode one of things that do help in some capacities. But if we're going to just make a blanket statement that say stimulants do not just cure or help RSD in that capacity. Okay, we did highly masked RSD. What else did we say we were going to talk about?

MEGAN NEFF: I think autistic versus ADHD, and that was a question that came in. So, you'll hear autistic people and ADHD people talk about RSD. Like, there's a lot of resources out for both. Now, I actually didn't realize this till I started doing the deep dive about… as soon as questions come up, like is RSD specific to ADHD?

So, first of all, I see a lot of like monopolizing of experiences. Like, I see a lot of autistic people who are like only autistic people have sensory sensitivities, which isn't true. So, I just want to caveat that. Like, anyone can be high on the rejection sensitivity spectrum, right? This is a spectrum of humanity.

RSD as a term, as a concept, as something we talk about is specific to the ADHD literature, in the sense that it's come out of ADHD literature, you know, the projections are like, I don't know how scientific this is, but according to Dr. Dotson, like 99% of ADHDers experience this. Like it's a very core component of ADHD.

Other people might be very high in the rejection sensitivity spectrum for different reasons. You know, attachment style, trauma, autistic. Like being misperceived, internalized ableism.

Is it RSD if a person's autistic and not ADHD? I don't know. Like, I don't know if we would apply that term. We could say there might be really high in the rejection sensitivity. I have noticed when working with autistic-only populations, it's like hit or miss. Like, maybe they have it, maybe they don't. But I also see people where it's like, I don't really care what people think about me. Like, that's also present.

So, autistic people do experience victimization, and like social bullying, and marginalization, they're neuro minority. So, I think there's a lot of reasons why autistic people would also be high on rejection sensitivity. And then we know a lot of autistic people who are also ADHD. So, I think I didn't provide clarity, I just explained how muddy the waters is.

PATRICK CASALE: That's okay. Sometimes that is the answer, though, how muddy the waters are, because… And I'm also thinking as you're talking, right? Like, we know so many people are undiagnosed either autistic or ADHD, and how much gets missed. So, I'm just wondering just how many people out there who identify as ADHD, who are also autistic, but unknown, or undiagnosed, and vice versa, and how so much of that also plays a role into the prevalence of RSD showing up as well?

MEGAN NEFF: Absolutely, absolutely. Yeah. I will say, oh, this was after you left, you had to dip out for a meeting, when we interviewed Amanda for Ask An Autistic I asked about this. And at first, it was kind of like, yeah, maybe some RSD. And then we talked about like, okay, what happens when… and because we're both on social media, why I asked explicitly about that, she's like, "Yeah, these narratives come on and then, you know, I've usually worked through it in like five or 10 minutes."

And I was like, "Five or 10 minutes?" Like, I still get intrusive thoughts about experiences, or even like, this is embarrassing to admit, like comments that I got two years ago, where like, if I embarrassed myself, or did something I'm not proud of, I still get intrusive memories about that like 20 years later. That's a pretty different experience than being able to move through something fairly quickly. And I know Amanda's just one autistic person.

But that was a really interesting moment in our conversation, when, like, yes, painful, yes, hard. But the ability to have the tools to work through it without it like bouncing back for me, I work through it, but it keeps bouncing back. And then I have to work through it again. And that's part of that intrusive kind of overtaking.

PATRICK CASALE: That's a great point because that actually makes me remember what I was saying for my group practice. So, shout out to Dr. Bennett Harris who's going to rub that in my face that I named him on this podcast. But saying like, these things linger for years sometimes, right? And that's something we haven't addressed yet, is the length of time. I know you've addressed it in your workbook, but we haven't addressed on air that this can bounce back, like you just mentioned for years. And it can be something where you can look at it when you're in a healthy like cognitive space where you're like, "Okay, this comment, I've worked through it." But then maybe something thematic, or something similar comes into play, and it hits you, or it impacts you in a way that you didn't expect. And all of a sudden you're right back to that comment from two and a half years ago.

MEGAN NEFF: Yeah, yeah absolutely. Yeah, I'm glad we're talking about that because that's a part of RSD that like, A, it's just confusing and B, it's really stressful to just like be going throughout your day and like all of a sudden intrusive, like, embarrassing or shameful memory pops up and you're like back in it. Like, yeah.

Okay, this is kind of a silly example. But we were filming an episode, and we were talking about how we need to do RSD, and we were like speaking of RSD, we just got our first like one star review. And in the moment I was like, you know, like talking through like, okay, that makes sense.

But then that comment kept popping in my head throughout the day. And sometimes when I think about this podcast, like that just pops back up. And it feels so silly. And then the secondary narrative of like, "Megan Anna, why do you care about this?" Right?

So, it's not just the interest of memory, there's often a second narrative that comes on up like, why are you still holding on to this? Especially, if it's something like that or like, I feel like that's petty. And I should be able to just release it, then there's a second narrative of like, why are you still thinking about this? Why can't you release it? Why can't you get over it?

PATRICK CASALE: Let's talk about the secondary narrative, because I think that's so important that you just named that. One, I'm sorry for bringing that up on air, won't ever do that again.

MEGAN NEFF: No, I'm glad you did. It's a good live example. And it's like, yeah.

PATRICK CASALE: I think we're onto that ship forever. I cannot tell you how often I check All Things Private Practice and Divergent Conversations Apple Podcast reviews. Why am I doing this to myself? Like, why am I going on there knowing that there could, eventually, be a one star review? Like, I should be able to let that go and then that will destroy me for days. I don't know why. That's self-inflicted, it's not healthy.

The secondary narrative, that process, right? Of, okay, this experience, this reaction is creating this sensation, it's creating RSD, it's creating distress, then the secondary narrative that's trying to rationalize said reaction that is exhausting to bounce back and forth between narrative one and two over and over and over and over and over again.

MEGAN NEFF: Yes, and one thing I've observed, because the neurodivergent brain as well, so divergent is that we often have, like, overlapping narratives. I'm doing this with my hands of like, we'll have an experience, and then we'll have a narrative about it, and then we'll have a narrative about the narrative.

And so one thing I've noticed, and I've started to be more careful with this, so I don't do too much CBT, I do have more of a mindfulness approach to like, let's start noticing your thoughts. What I've noticed, and I think, especially, with neurodivergent people, sometimes once they started noticing their thoughts, they got worse.

So, like, there's an experience of this. So, the next week came back and like so much worse. So, it's like, okay, let's unpack what's happening here. And it was the secondary narratives. It's now that I'm observing my thoughts, I'm having so much judgments, and evaluations, and feelings about those thoughts. And so then you have to teach how to become mindful of the secondary narrative, right?


MEGAN NEFF: Yeah, yeah. RSD about the RSD. And invalidation, right? Like, I think we're really good at invalidating ourselves in those narratives. Yeah, yeah.

PATRICK CASALE: I'm going to try not to diverge too much, because we said we were going to stay on course, which we should always know it's never going to happen. I'm thinking about like, secondary narratives, and how often I have to verbally process them out loud. Like, I will talk myself through the secondary narratives a lot of the time, and how often my wife looks at me in the house. And she's like, "Who the fuck are you talking to?" And I'm like, "I am talking through like my internalized experience and my thoughts that are happening right now and processing them out loud to try to pick them apart to decide what feels rational versus irrational and what feels like there's a linkage to." And she's like, "Is this happening in your brain all the time?" And I was like, "This is happening in my brain all the time."

MEGAN NEFF: Yeah, yeah, absolutely. It's weird to me that it's not happening for everyone inside their brain all the time. Like-

PATRICK CASALE: Like, this isn't taking up all this mental real estate 24/7 for you? People were like, "What?" She looked at me like, "How do you sleep?" And I'm like, "Well, you know the answer to that, not well." Oh, my God.

MEGAN NEFF: Yeah, we have busy minds. And so I think learning how to work with our mind it becomes really important.

PATRICK CASALE: Sometimes that is that mindfulness. Like, for me when I hear the word mindfulness, right? And I'm really going to diverge is I hate that word.

MEGAN NEFF: I do too. I do too.

PATRICK CASALE: Because I associate it with like being still-

MEGAN NEFF: Meditation.


MEGAN NEFF: Come to your mind.

PATRICK CASALE: Exactly. Yeah, that's not going to happen.


PATRICK CASALE: But I would much rather apply mindfulness in the way that you do, which I think you said was like, I cannot remember the term that you [CROSSTALK 00:29:38]-

MEGAN NEFF: Oh, mindfulness on the go. And I searched it up after that. And there actually is a book that was written a long time ago with that same term. So, I did not come up with the term. I mean…

PATRICK CASALE: But I like what you mentioned, right? Like, you're being mindful about the temperature of your smoothie in the morning, or your water, or you're being mindful about the fact that your mind is diverging into a million different directions. And instead of like saying, "Oh my God, my mind is diverging into a million different directions. I need to shut it down. There's something wrong, I can't do it." I'd rather say my mind is diverging into a million different directions. And I'm just being mindful of that.

MEGAN NEFF: Yeah, yeah. So, when I think about mindfulness, like I like the imagery of tagging. Like, I feel like a lot of what I'm doing is tagging, like, oh, that's what that is, that's what that is. So, it's like naming, tagging, and…

PATRICK CASALE: List making.

MEGAN NEFF: Yeah, what did you say?


MEGAN NEFF: List making. Well, no, I think I would think of list making as more like you're in the content. And when I think about mindful tagging, it's more of an observational process. That's a really subtle distinction. And that's part of it.

So, I like the imagery of like, observing mind, evaluative mind, and what mindfulness, like it's not an activity, it's a way of being, it's a way of being with self. So, whenever we're in observing mind, like that observer who's not judging, not evaluating, but like tagging, like you're having this experience, this is the script that's happening, you're in observing mind. And you can do that while being busy. Like, you can do that. You don't have to sit and listen to a 10-minute meditation and try to empty your mind.

For me, when I tried to do those exercises, then all of the evaluation scripts like I can't do this, this is so hard for me, my body physically feels uncomfortable.

PATRICK CASALE: Yep. And that can even lend itself and I'm going to get us back on track in a second. But that can even lend itself to being dismissed in the medical and mental health care system where medical professionals are like, "Have you tried mindfulness for sleep?" And you're like, "The fuck? Yes, of course, I have tried mindfulness for sleep. I am neurodivergent. Do you understand how that mean? How the brain works?" Yes, I have tried it.

Have I ever tried to like tag and be mindful of a million different thoughts simultaneously while looping them all together? Like, that's every night of my experience? Of course, I've tried that. Yeah, anyway, I don't want to diverge that way. So, you wanted to also get to the topic of…

MEGAN NEFF: Oh, yes, yeah.

PATRICK CASALE: … slash [CROSSTALK 00:32:20]…

MEGAN NEFF: So, we got a couple of questions about like, how do you tease out RSD from trauma, from attachment stuff? Which is great question. So, first, I think whenever we get the, like, tease out questions, I want to first ask, like, for what cause? Or for what purpose are we teasing this out? If it's like, I don't know what the diagnosis is, if you're a clinician, that's going to be a very different conversation. And if it's like, this is a known neurodivergent person.

So, I mean, it's physiologically the same things happening, right? Like, the sympathetic nervous system or shut down mode, like it's been activated, a stress state has been activated. We're responding to something relational like, so teasing out like what are the triggers? So, in the context of trauma, and well, that also gets complicated over time about PTSD with a specific trauma, we're talking about complex trauma? But like, what are the triggers around it?

Same thing with attachment. But honestly, I have a hard time teasing out like, what is anxious attachment and what is RSD, because if criticism, or feedback, or someone being disappointed in you, that's going to be an attachment injury. So, in attachment theory, we talked about attachment injuries, and that's going to activate stuff. So, yeah, again, muddy waters.

When it's the neurodivergent person who also has trauma, also has insecure attachment, that point it's like a soup, right? Like all of these things are intersecting. And which means, also, like on one hand that could feel disempowering, but on the other hand, it means like, as we heal from trauma, as we move toward more secure attachment, everything's going to get better, right? The whole system's going to get better. Okay, I feel like I've talked or rambled. Let's stop for now.

PATRICK CASALE: When you say it's, you know, muddy waters and like a soup, I think that's, again, I know so many of you want clarity on this. And I think sometimes there's not a lot of clarity to be given, because so many [CROSSTALK 00:34:44]-

MEGAN NEFF: …things intersect. And these are constructs, right? Like attachment theory. Like, these are constructs we've put on top of experiences.


MEGAN NEFF: But they're limited.


MEGAN NEFF: Now, it's totally up to you.

PATRICK CASALE: No, that's fine. We're both having thoughts at the same time. But the one takeaway when we're talking about attachment trauma, if we're trying to like differentiate, if we're trying to… okay, if we want to put RSD over here versus what's anxious versus what's avoidant versus what's complex PTSD? Gets really murky. But what is at the foundational level of all of these things? It's something we've talked about several times already in the last two hours, connection. Attachment trauma is about connection. RSD, ultimately, is about connection, complex PTSD, there's going to be layers of unsafe or unhealthy connection. And I think that so often we're missing this mark of like, we want so badly to understand what's happening to us or our own experiences, right? But at the end of the day, foundationally, at our core, it comes back to connection, and our desire to have it, and our inability sometimes to receive it, or maintain it. And I think that that impacts everything that we're talking about.

MEGAN NEFF: I love that of like, get back to the basics. And I think, especially, with autistic people, I can see this of like, we want to know precisely what's happening, right? So, like, what's the RSD? What's the trauma? What's this?

I don't know how helpful that conversation is, but I do know that what's helpful is getting down to the core need. Like, okay, this is a painful moment, what do I need in this moment? And getting back to that like? And yeah, typically, a lot of these things are connection, belonging, these are the things that are being threatened, and this is what I need right now. So, getting back to the basics in those moments, I think, is ultimately, typically, going to be more helpful than like, is this attachment is this? It's like it's all the things, right? It's all the things intersecting in a difficult moment.

PATRICK CASALE: Exactly. And what usefulness does it serve if we're just throwing label on top of label on top of label, because like, there's such a bad negative stereotype with avoidant attachment as there is, and then you throw, you know, the label of autism or neurodivergence, and people are going to have their own experiences around this.

And I think, if we just circle back to connectivity, and just the ability to have relationships, and what are we missing? What are we feeling like we're really having painful experiences around? The attachment label doesn't matter as much. Like, it just gets so complicated and convoluted then, or trying to, like, parse apart, you know, things that are really deeply connected and interwoven too, and it's really hard sometimes to get a sense of like, where does this go? And where do I place this?

MEGAN NEFF: Yeah, yeah, absolutely. And I think, partly, like, we have to get into how is the label being used? You know, I take a very constructivistic approach to language in general. Like, I prefer language that is most helpful. So, for some person, like talking about like, oh, my attachment system is activated right now. If that's the most helpful for you attuning to yourself, and validating your experience, use that language, right? If it's more helpful to be like, "Oh, my RSD is activated right now." Use that language, use that frame.

But how these labels are being used, I realized, like for myself, I often use these labels in that mindful tagging way that we were just talking about of like, "Oh, this is happening for me right now." But I'm very aware that those labels could be used and have a very different experience for someone, right? It could be like, a shame base. Like, this thing is activated right now and I'm so like, mad about it and mad at myself. Or it could be used as a distancing, right? Distancing from the core wound, distancing from the core need by saying, "Oh, that's RSD." And then, like, just leaving it at that. It could be a way to emotionally distance from the pain.

So, as much as the label is important, I think, more so like, how is that label being used? What's the internal experience of it?

PATRICK CASALE: I just lost your sound for a second.


PATRICK CASALE: You're back, okay. I heard how is this label being used? How is this label being experienced? Is that it?

MEGAN NEFF: Yes. And then I was done. So, I just feel like I ended the sentence.

PATRICK CASALE: Maybe that was it. But yeah, I agree 100%. And I think if we can kind of incorporate some of those techniques, and strategies, and just ways of thinking about this it could be a little bit less painful. And it's given me a lot of ideas right now, which is not where I want my brain to be going, and to diverging into all these ideas because I've got to get into other meetings. But I have so many ideas for episodes based off of these last couple of conversations.

And again, I just want to highlight how helpful these Ask The Audience sessions can be, because, one, we want your feedback. Those of you who are listening, we appreciate all of you. That feedback has been very helpful, constructive, positive, and we do not take it for granted. And we want to answer these questions because we know a lot of this experience is feeling confused, feeling overwhelmed, feeling [INDISCERNIBLE 00:40:26], feeling disconnected, feeling alone, and we want to help maybe make this a little bit more of a human experience for all of you involved. Megan's just [INDISCERNIBLE 00:40:42].

MEGAN NEFF: I'm feeling like that was the conclusion, episodes are out every Friday.

PATRICK CASALE: Yeah, episodes are out every Friday on all major platforms and YouTube. And goodbye.

MEGAN NEFF: It's like a compulsion now, Patrick. I like have to make it awkward at the end.

PATRICK CASALE: I mean, you're doing a good job.

MEGAN NEFF: I honestly I'm not trying. It's just like, okay, that was the summary. You look at me. I don't know what to add. I feel like if I add anything I'll have ruined yourself your beautiful summary. My voice is now going out.


MEGAN NEFF: Goodbyes are rough.

PATRICK CASALE: All right, goodbyes are rough. Goodbye.

Join Patrick & Dr. Neff's Newsletters

Get more valuable resources and stay up to date on offers.

We will not spam you and you and unsubscribe at any time.

Join the Neurodivergent Insights Newsletter by Dr. Megan Anna Neff.

Learn More

Join the All Things Private Practice Newsletter by Patrick Casale.

Learn More