Rejection Sensitive Dysphoria?

Written by Eileen Hopkins

My road to counselling and psychotherapy has been interesting. Having worked in a caring profession, nursing for over 30 years, I was always at my happiest when interacting with my patients & I have always been a people person.

Attention deficit hyperactivity disorder (ADHD) makes it harder to focus, pay attention, and sit still. Most people who have ADHD are also very sensitive to what other people think or say about them. This is sometimes called rejection-sensitive dysphoria (RSD), which is a way of describing certain symptoms associated with ADHD. RSD is characterized by extreme emotional sensitivity to being criticized or rejected, whether real or perceived rejection.

“Dysphoria” comes from a Greek word that means “hard to bear.” People who have RSD don’t handle rejection well. They get very upset if they think someone has shunned or criticized them, even if that’s not the case. Up to 99% of teens and adults with ADHD are more sensitive than usual to rejection. And nearly 1 in 3 say it’s the hardest part of living with ADHD.

The almost debilitating fear of rejection that sometimes accompanies ADHD is often an overlooked part of adult ADHD according to William W. Dobson, a specialist in RSD. Rejection is not enjoyable for anyone. But for people with a condition called rejection sensitive dysphoria (RSD), getting turned down, criticized, or rebuffed can trigger an overwhelming emotional response.

Research findings

While researchers are still unsure of the cause, it seems that people with ADHD may be more susceptible to RSD.

In a 2019 study, children aged 10–15 years with ADHD presented high levels of sensitivity when they received feedback as part of a virtual game. Youths with elevated ADHD symptoms exhibited higher sensitivity to peer rejection.

Researchers have noted that difficulty regulating emotions may explain the problems that some children with ADHD experience when socializing. They found that hyperactivity was associated with reacting aggressively to rejection in affected children. Other studies also report that peer rejection and victimization frequently occur among children with ADHD and may worsen the symptoms of RSD.

Rejection sensitive dysphoria: a hidden condition

The emotional pain the person experiences is real & extreme, says Dr Dodson, & not easily dismissed.

“The pain is so primitive & overwhelming that people struggle to find any words to describe it,” he writes. “They talk about its intensity (awful, terrible, catastrophic) & cannot find words to convey the quality of the emotional pain.”

In reaction, these individuals often become people pleasers or withdraw & abandon their own goals out of fear of failure.

How Can RSD Affect Your Life?

People who have the condition sometimes work hard to make everyone like and admire them. Or they might stop trying and stay out of any situation where they might get hurt. This social withdrawal can look like social phobia, which is a serious fear of being embarrassed in public.

RSD can affect relationships with family, friends, or a romantic partner. The belief that you’re being rejected can turn into a self-fulfilling prophecy. When you act differently toward the person you think has rejected you, they may begin to do so for real.

What Are the Signs of RSD?

People with RSD may:

  • Be easily embarrassed
  • Get very angry or have an emotional outburst when they feel like someone has hurt or rejected them
  • Set high standards for themselves they often can’t meet
  • Have low self-esteem
  • Feel anxious, especially in social settings
  • Have problems with relationships
  • Stay away from social situations and withdraw from other people
  • Feel like a failure because they haven’t lived up to other people’s expectations

What Causes RSD?

Doctors believe gene changes that are passed down through families cause RSD. Serious trauma – like abuse or neglect — can make the symptoms worse.

When you have ADHD, your nervous system overreacts to things from the outside world. Any sense of rejection can set off your stress response and cause an emotional reaction that’s much more extreme than usual.

Sometimes the criticism or rejection is imagined, but not always. ADHD researchers estimate that by age 12, children with ADHD get 20,000 more negative messages about themselves than other kids their age. All that criticism can take a real toll on their self-esteem.

How Is RSD medically treated?

There are medications such as Guanfacine & clonidine that lower blood pressure, but they also help with RSD symptoms. Also Monoamine oxidase inhibitors like tranylcypromine treat the inattention, impulsive behaviours, and emotional symptoms of ADHD.

Therapy can help with other symptoms of ADHD & RSD. RSD episodes happen suddenly and without warning. A therapist can help you learn how to get a handle on your emotions and deal with rejection in a more positive way.

How to care for yourself if you have RSD?

There are many ways to deal with RSD. The most important thing is to manage the stress in your life. You’re more likely to have an emotional breakdown when you’re stressed out.

  • Eat right, sleep well, try yoga or meditation to keep your mind calm
  • Explain to a few trusted friends what this is like for you
  • Combat rejection by reinforcing strengths
  • Quit taking it personally!
  • Remember that all emotions are valid
  • Emphasize connection with friends & family

Most importantly, don’t give up because you matter.

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