Episode 370: Unusual Response to ADHD Meds & Safer BDSM Practices

Hello, friends! I hope everyone is well.

In today’s enlightening episode, we delve into two insightful listener questions that touch on ADHD medications and the world of BDSM:

  1. The Nuances of ADHD Medications

    • A concerned friend notices that their peers, after starting ADHD medication, exhibit what seems to be exacerbated symptoms. We delve into the complexities of ADHD medication, understanding its effects, and the importance of individualized treatment.
    • Exploring the balance of neurotransmitters, the potential for overstimulation, and the common trial-and-error phase of medication adjustment.
    • The importance of observation, empathy, and open communication when approaching friends or loved ones about potential medication side effects.
  2. Journeying through BDSM Interests from Childhood to Adulthood

    • A listener shares their deep-seated interest in BDSM activities from an age as young as six, raising concerns about their adult relationships and personal safety.
    • We explore the broad scope of BDSM, its misconceptions, and the importance of self-awareness and education in safely navigating the BDSM community.
    • Touching upon the potential overlaps between Pathological Demand Avoidance (PDA) Autism and BDSM tendencies, and the significance of therapy in understanding oneself better.

As always, you can send me questions to duffthepsych@gmail.com and find the show notes for this episode at http://duffthepsych.com/episode370 


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Read more: Episode 370: Unusual Response to ADHD Meds & Safer BDSM Practices

Question 1:

Some of my friends have been diagnosed with ADHD and started taking medication. I was expecting this to reduce the symptoms of their ADHD but, at least in two cases, it seems their symptoms have potentially gotten worse? For example, one person used to enjoy watching films but now can no longer sit still/relax/focus long enough to watch a film.

I appreciate there’s a lot at play and you might not be able to explain it without knowing their entire situation but I wondered if this is a common phenomenon and what can cause it? I have wondered if it’s because they are going easier on themselves and being more open about their difficulties since their diagnosis – as opposed to actually experiencing worse symptoms. It would be good to know, because I worry that perhaps their care plan isn’t working for them if they are experiencing worse symptoms – but I also don’t want to interfere because I am certainly not a medical professional!


Thanks for reaching out with such an insightful question about ADHD and its medication. Your observations about your friends’ reactions to ADHD medication bring up a significant point about the complex nature of managing ADHD. There isn’t a one-size-fits-all approach.

It’s not uncommon for individuals to experience atypical reactions to medications, especially given the diverse nature of ADHD. The reasons for these varied reactions can be multifaceted. One fundamental reason is that individuals respond differently to medications. Not everyone will have the same reaction to a specific medication or dose. A parallel can be drawn with caffeine intake. While a few cups of coffee might enhance alertness for some, making them more productive, for others, too much caffeine can lead to agitation and a lack of focus.

Differentiating responses to medications within the same class is also common. As some people may respond well to Prozac but not Lexapro, the same variability exists with ADHD medications. It’s prevalent for trial and error to be a part of the medication journey.

Many ADHD medications are stimulants, which increase the availability of dopamine and norepinephrine. These neurotransmitters play vital roles in attention, focus, and impulse control. When balanced right, they can enhance focus and control impulsivity. However, because everyone’s brain chemistry is unique, increasing these neurotransmitters might lead to overstimulation in some individuals.

It’s also essential to consider the timing of medication intake. Some ADHD medications have a half-life of around 10 hours, leading to notable contrasts in behavior when on and off the medication. This can often result in rebound effects, where individuals experience a burst of symptoms as the medication wears off, which might give the appearance of worsened symptoms.

An important aspect to consider is that medications aim to provide control over one’s attention. Perhaps, in the past, activities like watching movies provided adequate stimulation to keep one focused. But with increased control over attention, these activities might seem mundane, leading to restlessness.

It’s crucial not to jump to conclusions based on observed behavior. It would be beneficial to observe other facets of their life and activities. Maybe it’s not about symptoms getting better or worse but about how their preferences and tendencies have evolved.

Another potential factor to consider is comorbid issues, which might be impacted by the medication. Mental health issues like anxiety or bipolar disorder, frequently comorbid with ADHD, might be exacerbated by stimulant medications.

It’s essential to approach this topic with sensitivity. While it might not be appropriate to directly question their medication’s effectiveness, opening a dialogue about their feelings and experiences can provide more clarity. They might share subjective experiences that have improved their quality of life due to the medication.

In conclusion, while the journey with ADHD medication might require adjustments and fine-tuning, it’s essential to remember that these medications aim to improve day-to-day quality of life. Moreover, coping strategies and therapeutic interventions play a significant role in managing ADHD. There are bountiful resources available online, and specialized therapists can provide coaching to ensure smoother life experiences for those living with ADHD.

Question 2:

Since I was younger (so young that I shouldn’t have even known about these things, yet somehow did), I’ve had an interest in BDSM related activities. I obviously didn’t know at a young age what they were, but from the age of 6 I’ve known about being certain aspects of it. It’s not something I ever witnessed anyone do (I have checked with family), and I didn’t have my own TV so never accidentally watched anything. So it feels like I was just born like this. It’s not lost on me that a 6 year old really shouldn’t know about such things, but there’s no way to get to the bottom of that, so I’ve had to just live with the possibilities of why that happened.

However, now as an adult, I am unable to have normal relationships without this being involved in some way. I’ve ended up in some quite dangerous situations due to this, I’ve been easily led by the wrong people. But it concerns me that I now don’t seem able to have a normal relationship without it. I’m also heavily compliant, so much so it’s no longer just a coping mechanism it’s an actual personality trait that I do without even thinking, whether I want to do something or not, I’ll do it to keep the peace. I have been like that since I was a child. My therapist believes I have PDA Autism and I am inclined to believe her because it makes sense for me and my life growing up, and now. But the compliance side mixed with the other side of me has also led me to some very dangerous situations.

I’m at a point in my life where I’d like to leave that side of me behind because it’s having a huge affect on my ability to be myself and stay safe, but I don’t know who I am without it and with the compliance I’m worried I will never know what I genuinely like for myself, or what is coming from this lifestyle that’s just been an inherent part of me for my entire life. Any advice about this would be so greatly appreciated. It’s not something I can just talk about with friends as nobody I know is like this (that I know of).


First and foremost, I commend you for bravely sharing your personal journey. Navigating one’s own interests, especially when they diverge from the societal norm, requires courage. Delving into the topic at hand, BDSM, which stands for bondage, dominance, sadism, and masochism, encompasses a broad spectrum of activities. It ranges from bondage, which involves tying up or restraining, to dominance, representing power dynamics, and even to sadism, where one derives pleasure from causing pain. It’s essential to understand that BDSM activities are vast and varied, and not everyone interested in this realm shares the same preferences.

Despite its expansive nature, the core principle of BDSM is ensuring activities are safe, consensual, and non-coerced. It’s not uncommon for certain BDSM activities to resonate on a non-sexual, meditative level for some, like rope bondage. As someone involved in the BDSM community, both as a participant and a therapist, I can provide insights based on both personal and professional experiences.

Your recount of recognizing BDSM-related interests from a young age is both intriguing and complex. Society often views BDSM as deviant or taboo, but it’s essential to acknowledge that there are non-sexual aspects within this realm. Children naturally exploring power dynamics in their play, such as one being the leader and another following, is not inherently inappropriate. The critical distinction lies in the context and understanding.

However, the real concern arises when one’s interest in BDSM potentially jeopardizes their safety. Unfortunately, there are individuals and groups that don’t practice BDSM ethically, leading some into dangerous situations. But this doesn’t mean one should abandon their interests entirely. Knowledge is power. Educating oneself about vetting partners, establishing consent, and negotiating scenes is paramount. Websites like Fetlife, books on BDSM, and community groups can be instrumental in this learning journey.

Another layer to your experience is the aspect of compliance, intertwined with a potential diagnosis of PDA Autism, or Pathological Demand Avoidance. This condition, often seen in those on the autism spectrum, involves avoiding situations or activities that cause discomfort. If such traits lead to dangerous situations within the BDSM community, it’s essential to address them. Therapy can be a pivotal tool in understanding one’s tendencies and ensuring safety.

In conclusion, while your journey with BDSM has had its challenges, there are avenues to explore this facet of your identity safely and confidently. Recognizing one’s tendencies, seeking education, and possibly therapy, can all contribute to a more fulfilling and secure experience in the realm of BDSM.

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