Understanding the Struggle of Rejection Sensitive Dysphoria
Navigating adult relationships can be difficult for anyone but, for people like myself who have ADHD, it can be particularly challenging. Social skills are the verbal and non-verbal skills we use to understand, interact and communicate with others.
People with ADHD tend to have poorer social skills compared to our neurotypical peers. We can fail to pick up on simple social cues and can be easily distracted when we should be listening to another person. Perhaps the biggest social and professional struggle people with ADHD face in their lives is our over-sensitivity to rejection, which is known as rejection sensitive dysphoria.
I’ve written about rejection sensitive dysphoria before and will explore it in more depth in this article.
What Is Rejection Sensitive Dysphoria?
Rejection sensitive dysphoria (RSD) is characterized by extreme emotional sensitivity to being criticized or rejected, whether real or perceived. The word dysphoria is Greek for “difficult to bear”. RSD can affect anyone; however, studies suggest that people who have attention deficit hyperactivity disorder (ADHD) and/or autism are more susceptible to experiencing it.
People with ADHD often suffer from emotional issues, such as an inability to control emotional responses or hypersensitivity. Intense emotions might explain why we have such a heightened response to rejection. RSD can be explained as being overwhelmed by intense pain that feels like it will last forever. If it comes from the unexpected, such as from someone who you trusted, it feels like the ultimate betrayal.
No one likes rejection, but for people with ADHD, universal life experiences are much more severe compared to neurotypical individuals. Rejection for us is highly impairing and confronting.
Currently, RSD is not an actual recognized diagnosed part of ADHD under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, some experts have been arguing to have it included.
Symptoms of Rejection Sensitive Dysphoria
Symptoms of RSD can often resemble symptoms of other mental health conditions, such as depression, social phobia, bipolar disorder, borderline personality disorder and post-traumatic stress disorder.
Common symptoms of RSD may be:
- Experiencing a meltdown or mental breakdown
- Overreacting to social situations
- Feeling extremely hurt to even mild or creative criticism
- Increased or extreme anxiety
- Loss of self-esteem
- Avoiding social relationships
- Giving up on desires or goals
- Developing an eating disorder
- Struggling to maintain social relationships
- Avoiding challenging or competitive situations
- Social withdrawal and detachment
- Approval seeking behavior
- Suicidal thoughts
How Can RSD Affect a Person’s Life?
When RSD occurs, the person experiencing it will obsessively replay the event over and over in their head for hours on end. Often this process can interfere with a person’s work, other social relationships, and can keep them awake at night leading to insomnia. They may try to work out exactly what went wrong to try and avoid further rejection in the future, but it will usually only lead to further anxiety and distress.
Perhaps the worst aspect is that the rejection does not even need to be real or certain to create stress. As an example, I have had several job interviews where I was sure I had failed miserably, only to later get a phone call offering the position after days or even weeks of fretting. People with ADHD experiencing RSD often cannot trust if they are assessing certain social situations correctly or if things are as a bad as they may appear.
Sometimes the rejection is externalized, and it looks like a sudden instantaneous rage directed at the person or situation responsible for the rejection. More often it is internalized, and we blame ourselves for the millionth time.
You might ask questions like ‘what is wrong with me?’ Internalizing the rejection can lead to a major mood disorder, and in the most extreme situations, even suicidal thoughts or intentions.
More Research on RSD
One-third of adults with ADHD report that RSD is the most impairing aspect of their experience of ADHD, partly because they are never able to truly find any effective ways to manage or cope with the pain, which can affect their lives both personally and professionally.
People with ADHD who experience RSD are usually very ashamed of the over-reactions to simple rejection. Due to feelings of shame and fear at the thought of being considered mentally unstable, people with ADHD will often be reluctant to discuss their experiences.
Instead, they may hide their feelings to avoid any further embarrassment. The emotional reaction we have to rejection is real and most of the time uncontrollable. However, understanding how we process our feelings and emotional responses differently can help.
Treatment Options for Rejection Sensitive Dysphoria
Many people find some comfort in knowing that there is a name for their extreme feelings of rejection and that it is a largely unknown part of ADHD. RSD is genetic but childhood or adult trauma can make it worse.
If you find yourself experiencing overwhelming feelings of anxiety, hurt and rage caused by rejection or criticism, you should consider seeing a doctor. Like other mental disorders there are treatments that are available.
Behavioral intervention can also help reduce hypersensitivity which can make it easier to manage and deal with criticism and rejection. Psychotherapy is recommended, and cognitive behavioural therapy is considered an effective method of treating RSD.
Cognitive Behavioral Therapy
Cognitive behavioral therapy is a type of talk therapy that encourages coping techniques, including how to resolve relationship conflicts and handle stressful situations and social interactions. In combination with therapy, your doctor may also prescribe certain medications to help relieve symptoms.
Guanfacine is the most common type of medication used to treat RSD symptoms. Guanfacine was originally designed as a blood pressure medication but is also known to interact with certain receptors in the brain to bring down the intensity of emotional responses and hyperactivity, which assists in relieving RSD symptoms.
While living with RSD may be the most challenging aspect of ADHD, remember that help is available and never be afraid to reach out to your doctor or mental health professional.