Introduction

Living with ADHD can be a challenge, and for many individuals, it comes with a symptom called rejection sensitive dysphoria (RSD). Rejection sensitive dysphoria is not a formal diagnosis, but rather a manifestation of emotional dysregulation that is commonly associated with ADHD. In this comprehensive article, we will explore the link between rejection sensitive dysphoria and ADHD, its symptoms, causes, diagnosis, and potential treatment options.

Understanding Rejection Sensitive Dysphoria

Rejection sensitive dysphoria is characterized by intense emotional pain and distress in response to real or perceived rejection, criticism, teasing, or failure. Although not officially recognized as a symptom of ADHD in the United States, emotional dysregulation, including RSD, is considered a fundamental feature of ADHD in the European Union. It is important to note that RSD is not caused by trauma, but rather an innate feature of ADHD.

The Experience of Rejection Sensitive Dysphoria

The emotional intensity experienced by individuals with rejection sensitive dysphoria is beyond what is considered typical. Rejection, criticism, or failure can trigger overwhelming emotions that are described as “awful,” “terrible,” or “devastating.” Patients often struggle to verbalize the quality of the emotional experience, but the pain is often compared to a physical wound. The response to these triggers is disproportionate to the event itself, leading to significant distress.

The Relationship Between Rejection Sensitive Dysphoria and ADHD

The exact relationship between rejection sensitive dysphoria and ADHD is still not fully understood. Research suggests that individuals with ADHD may be more prone to experiencing RSD due to differences in brain structure and function. The frontal lobe, responsible for attention, language, social skills, impulse control, and problem-solving, may work differently in individuals with ADHD. This can lead to misinterpretation of social cues and a heightened sensitivity to rejection or criticism.

Symptoms of Rejection Sensitive Dysphoria

While rejection sensitive dysphoria is not a formally recognized diagnosis, individuals with RSD often exhibit certain behavioral and emotional patterns. These symptoms can include sudden emotional outbursts following rejection or criticism, withdrawal from social situations, negative self-talk, low self-esteem, constant rumination, and relationship difficulties. It is important to note that these symptoms can vary in intensity and frequency among individuals.

How can RSD impact relationships?

Relationships can be challenging, as anyone who’s ever been in one can attest. RSD can create its own subset of challenges adding complexities to overcome for both partners, as it not only affects the person with RSD but how they interact and treat their partners. RSD does make individuals overly sensitive towards rejection whether real or perceived and this can lead to them responding in challenging ways.

Oftentimes people with RSD are hypervigilant in interpreting other’s responses and reactions towards them. They tend to overanalyze and scrutinize tiny fluctuations in conversations, speech patterns, facial expressions etc. and this can lead to them misinterpreting other’s feelings towards them casting a negative shadow over them. For example, people with RSD might perceive neutral or even positive comments as negative, which can cause them to inadvertently feel those negative emotions associated with rejection. They might then overreact emotionally to perceived slights, which can confuse or alienate others who don’t understand the intensity of their reactions. Are you starting to see the seriousness of RSD yet? Misunderstandings are common and the partner who is on the receiving end of backlash from those feelings can feel blindsided which in turn can cause them to become defensive and escalations will likely occur along with hurt feelings for both parties. If this sounds familiar, you are not alone!

But blowouts and fights aren’t the only thing that could arise from an individual feeling the effects of RSD. For some, fear of rejection might lead to social withdrawal or reluctance to initiate interactions, potentially resulting in social isolation. They might become quiet, closed off or distant. This can be just as confusing for the other partner as they might not understand what has happened or what they did and are only witnessing the fear response in utter confusion. Imagine complementing your partner but they perceived it as an insult or sarcastic, unbeknownst to you, and so they close themselves off and isolate.

One way to help resolve issues that arise in relationships due to RSD is to openly communicate with each other. It’s important that a safe place for open communication about feelings is created so that misunderstandings can be discussed and resolved. It’s also important so that strategies can be discussed to avoid those rejected feelings or so that clarification can take place before the feelings spiral.

How does RSD affect academia and the workplace?

RSD is not isolated to romantic or platonic relationships, it can also affect many areas of an individuals life. Two areas that are also greatly affected are at school and in the workplace. This especially holds true to those who value their education and those who care about their job. Oftentimes the more important the job or education is to the person the more likely RSD is to occur and the stronger the reaction to it. This can manifest in several different ways.

The fear of not meeting expectations or disappointing others can lead to procrastination. This is mainly due to anxiety about potential negative outcomes. This can be from past experiences that resulted in negative outcomes but it can also be from fantasized negative outcomes, or pessimistic views of the future. The likelihood of these negative outcomes is often perceived to be much greater than they actually are by the person experiencing the RSD.

The fear paralyzes them to the task and they will find themselves avoiding it, even resorting to other tasks that are usually difficult for them to complete. For example, I can usually tell when I’m avoiding a task that I need to do but am paralyzed from, when I find myself able to complete laundry from start to finish without the use of a body-double or my favorite show.

Sometimes this fear can have a degree of benefit especially when it takes on the form of perfectionism. Individuals might become perfectionistic in an attempt to avoid criticism. This can lead to very proficient work from the individual as they often find themselves engulfed in their perfectionism. However, this can ironically lead to heightened stress and performance anxiety if their stress level surpasses productive and reaches overwhelm. And anyone with ADHD will attest that there is a fine line between those two!

Oftentimes RSD will lead to an impaired level of concentration. The emotional turmoil caused by RSD can make it difficult to focus on tasks, as thoughts of potential rejection consume attention. The individual will find themselves fantasizing all the negative outcomes, consumed with potential negative futures and the fall out from their failure, to the point it can even become a self-fulfilling prophecy.

Causes of Rejection Sensitive Dysphoria

The exact causes of rejection sensitive dysphoria are not yet fully understood. However, research suggests that both genetic and environmental factors may play a role. The structure and function of the brain, particularly the amygdala and prefrontal cortex, which are involved in processing emotions and managing rejection, may contribute to the experience of RSD. Additionally, a history of ADHD in the family may increase the likelihood of developing RSD.

Diagnosing Rejection Sensitive Dysphoria

As rejection sensitive dysphoria is not an officially recognized diagnosis, it can be challenging to obtain a specific diagnosis for RSD. However, healthcare professionals familiar with ADHD and emotional dysregulation may be able to identify patterns of behavior associated with RSD. A comprehensive evaluation that considers the individual’s emotional experiences, responses to rejection, and overall ADHD symptoms can help in making an accurate diagnosis.

Treating Rejection Sensitive Dysphoria

While there is no specific cure for rejection sensitive dysphoria, various treatment options can help individuals manage their symptoms effectively. Medications commonly used to treat ADHD, such as alpha-2 receptor agonists and stimulant medications, may help regulate intense emotional responses associated with RSD. Additionally, psychotherapy approaches like cognitive behavioral therapy and talk therapy can provide valuable tools for emotional regulation and coping with rejection. To see the top 5 supplements that support individuals with ADHD click here.

Coping Strategies for Rejection Sensitive Dysphoria

As individuals with RSD go through life they often develop a variety of coping mechanisms to manage their sensitivities. But just like so many things with ADHD, there is a duality to their nature. It is up to the individual to weigh the pros and cons of the strategies to determine what will work best for them. Oftentimes the best solution depends on the individual situation as well as the individual themselves, there is no one right answer or fix all.

One strategy is for them to try to avoid situations that trigger their sensitivities. This takes a bit of self-awareness and evaluation as to learn and know your triggers. There are two potential downsides to this approach. The first is that some triggers may be unavoidable (good luck telling your professor that you can’t take final exams because it triggers your RSD) and because of that, this strategy is somewhat limiting. Also, this strategy can contribute to isolation as the individual may find many aspects of life contribute to their RSD. That being said this strategy can be used in conjunction with other strategies to mitigate is isolating and limiting properties.

In an effort to prevent rejection, individuals sometimes resort to people-pleasing. They may feel that if they can put in extra effort to please someone they can stave off ever having to feel rejected before-hand. This method can lead to them creating bonds with people as many who are on the receiving end will be appreciative of their efforts. But like every strategy this has potential negative consequences associated with it. First, some individuals may take advantage of those who have people pleasing tendencies, knowingly or unknowingly, by overutilizing the people pleaser’s efforts. Another downside is that those who people please oftentimes do so to their own detriment by ignoring their own needs and limitations. Both of these downsides can lead to burnout and resentment, which can lead the people pleaser to isolate as they attempt to regain homeostasis.

Another coping method used by some is overcompensation. Essentially the individual will try to overachieve and excel in various areas to prove their worth and avoid rejection. Similar to perfectionism they can find themselves adding additional stress and eventually overwhelm if they try to overcompensate in too many areas. They can find their schedule full with little time to unwind and decompress from all their efforts.

Lastly, a coping method that I personally would recommend as it has helped me, is the use of therapy. Cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) are two leading therapies that can benefit those dealing with RSD. It can help individuals manage their emotional responses as well as learn and develop healthier coping strategies that work for them.

Conclusion

Rejection sensitive dysphoria is a complex symptom that often accompanies ADHD. While it is not officially recognized as a diagnosis, the emotional distress it causes can significantly impact an individual’s daily life. By understanding the link between rejection sensitive dysphoria and ADHD, recognizing the symptoms, and exploring available treatment options, individuals with RSD can gain the support and tools necessary to navigate their emotional experiences effectively. Remember, seeking professional help and building a strong support network are essential steps towards managing rejection sensitive dysphoria and living a fulfilling life with ADHD.