Your underwear proclaims “champion”. Your brain says loser.

I’ve been quieter than usual. Currently wrapping up a Master’s in clinical psychology and writing my doctoral dissertation proposal for the fall. I wanted to drop a major spoiler. I intend to write my dissertation on ABT and RSD.

Whoa, Tommy! That’s six too many capital letter packed together there. Let’s break that down.

The ADHD Baseline Trauma hypothesis

My ADHD Baseline Trauma hypothesis (ABT) (Underhill, 2025a) is what all of us with ADHD experience in the early part of our lives… well, all of the several hundred of us I’ve spoken to. ADHD Baseline Trauma is a concept I had peer-reviewed and published last year in the International Journal of Psychosexual Therapy. By the time we are twelve years old, we have experienced upwards of 20,000 “you suck” statements from trusted adults. No matter how resilient we were as kiddos, eventually we succumb and believe “we suck”.

Let’s break that down.

• Over the span of twelve years, 20,000 is “only” eight statements per day.
• “You suck” statements include all the snide comments we are accustomed to hearing: “you’re always late”, “why can’t you sit still?”, “don’t you ever stop talking?”, “would you please stop daydreaming”, “you pass all the tests but don’t turn in your homework!” And we can’t forget, “If you only tried harder you could do great things!” (I got this last one when I had the highest grade in my AP Biology class… while being the youngest in the class!)
• We hear these statements from trusted adults like parents, relatives, family friends, and teachers so they must be true.

That last point can be quite the zinger. Because of who we hear these statements from, we not only believe them, we incorporate them into our personal identities. “I will never succeed”, “I’m not good enough”, “I’m too much”, “no one values me”. Our adolescent ADHDers will often do almost anything to break this internal narrative (Underhill, 2026).

Now on to RSD

This acronym stands for Rejection Sensitivity Dysphoria. Dysphoria is the key word here. For everyone who has not experienced RSD, it is significantly more intense than a fleeting feeling of self doubt or feeling alone. Dysphoria is a state of intense emotional and physical distress. Dysphoria can be intensely physically painful.

Here is where the name falls short. Rejection encompasses the real, perceived, or anticipated expectation of not being wanted, letting someone down, or generally not measuring up to our overall-exaggeration of someone else’s expectations. Rejection includes much more than rejection—consider it to be the hint of the perception of the anticipation of the possibility of failure, or even letting someone down. Consider as well echoes of past experiences of not being enough for someone or being told “no” to a request for something and hearing “my needs are not important. Rejection doesn’t need to be feeling rejected, just not measuring up or feeling important.

Let’s not forget that not-so-funny face our partner makes when we try to be funny. Or the blank look our boss wears he calls RBF. Facial expressions. Tone of voice. Body posture. Word choice. We ADHDers are just waiting for everything and everyone around us to confirm how utterly worthless we know we truly are.

Avoiding RSD can lead to withholding the truth about finances or infidelity. Keep in mind the ADHDer really has only two temporal positions: now and not now. Not getting in trouble now is a success that’s worth pushing the RSD pain into the not now, ahem, future.

ADHD, RSD, and the DSM

The DSM is a great catalogue of maladies described by people, many of which have never experienced them. Yes, it’s a whole lotta outsiders looking in. As a demonstration, we will consider ADHD.

The DSM defines ADHD by a set of anecdotal requirements we must have had prior to age twelve. There is some discussion in the literature that the age could be raised to 18, however it’s not real at the moment. Adult ADHD is not even a consideration yet. Feels like we are living in the dark ages.

ADHD is not characterized as a neurodevelopmental condition resulting in failures of executive function including time blindness, rejection sensitivity, procrastination, perfectionism, anxiety, bipolar disorder, stress management, working memory problems, imposter syndrome, and the “now”/“not now” conundrum (Underhill, 2025a; Underhill, 2025b).

Instead, the literature describes too many causations and correlations proposed in the wrong direction. You know, like sugar increases the risk of ADHD (Yu et al., 2016) or too much dopamine is the root of ADHD. Other studies also indicate that a diet rich in fat can lead to ADHD-like behavioral symptoms and disrupt REM sleep in individuals without ADHD (Jiseung, 2023). All this blurs the line when trying to understand what ADHD is and does.

Sources

• Jiseung, K., Mincheol, P., Chang-Myung, O., & Tae, K. (2023). High-fat diet-induced dopaminergic dysregulation induces REM sleep fragmentation and ADHD-like behaviors. Psychiatry Research, 327, 115412. doi:10.1016/j.psychres.2023.115412
• Underhill, T. (2026). The importance of sex-informed therapy for female Adolescent ADHDers. International Journal of Psychosexual Therapists.doi:10.64207/wjvvmp84
• Underhill, T. (2025a). ADHD Baseline Trauma in Romantic Relationships. International Journal of Psychosexual Therapists, 1(1). doi:10.64207/x41fc649
• Underhill, T. (2025b). Minimizing the impact of executive function in relationships with ADHD. In C. Jacobson (Ed.), Bridging Theory and Practice in Psychosexual Therapy: Global Insights into Cultural and Clinical Dynamics. Cambridge Scholars Publishing.
• Yu, C. J., Du, J.C., Chiou, H.C., Feng, C.C., Chung, M.Y., Yang, W., Chen, Y.S., Chien, L.C., Hwang, B., & Chen, M.L. (2016). Sugar-Sweetened Beverage Consumption Is Adversely Associated with Childhood Attention Deficit/Hyperactivity Disorder. International journal of environmental research and public health, 13(7), 678. doi:10.3390/ijerph13070678