What is Rejection Sensitive Dysphoria?

In this blog we will discuss what Rejection Sensitive Dysphoria is.

We will also discuss what are the signs of RSD, causes, how it is connected to ADHD, it’s impact on people’s lives, and treatment options available for Rejection Sensitive Dysphoria. 

What is Rejection Sensitive Dysphoria?

Rejection Sensitive Dysphoria refers to a condition where the individual experiences extreme emotional pain and sensitivity when they are faced with real or perceived rejection or criticism (MedicalNewsToday).

“Dysphoria” comes from a Greek word that means “hard to bear” thus, people with RSD are believed to find rejection hard to bear and they may become emotionally distressed and upset if they think someone has shunned or criticised them.

Rejection sensitive dysphoria is an overwehmling emotional experiece and it can increase the risk of mood disorders, suicide, and low self esteem whcih can impact the quality of life negatively. 

RSD is still a controversial new topic in the field of Psychology and it is not recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as any condition due to which there are no symptoms or diagnostic criteria as a result no standardised treatments are available. 

Researchers are unsure what causes this condition however most speculate that it is tied to ADHD and childhood experiences of neglect and abuse. Some suggest that it might relate to emotional dysregulation as well.

For people who have Rejection Sensitive Dysphoria, the experience of real or perceived rejection and criticism can be very severe, unbearable, and impairing. This condition can impact the lives of the person and their loved ones, and it can harm relationships. .

What are the signs of Rejection Sensitive Dysphoria?

According to writers at WebMD, some of the signs and psychological symptoms of Rejection Sensitive Dysphoria include:

  • 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
  • Sometimes think about hurting themselves

What causes Rejection Sensitive Dysphoria?

The exact reason as to what causes rejection sensitive dysphoria is not known however experts believe that it is a result of multiple factors such as:

  • History of rejection or neglect early in life- neglected and abused by caregivers, peers, and other important figures in their life leading to lower self-esteem and an intense fear of rejection and abandonment in adulthood. 
  • Genetic predisposition that causes a family history of people with RSD and this genetic disposition can make them more vulnerable to this condition in the face of trauma. 
  • Experts believe that people with ADHD respond to stimuli differently because of how their central nervous systems react and this could play a role in how they  perceive and respond to rejection.
  • Some also speculate that their sensitivity to rejection arises because of how ADHD warrants rejection in the face of stigma and ignorance. 

People might face criticisms and social rejection because of their behaviours and “abnormality” when they were younger. These experiences might make them more sensitive to rejection based on what they have learned and internalised from these experiences. 

How does Rejection Sensitive Dysphoria impact people?

For people who have Rejection Sensitive Dysphoria, the experience of real or perceived rejection and criticism can be very severe, unbearable, and impairing. 

Their emotional responses become internalised and this can lead to a full mood disrder episode and even increase the risk of suicide and other psychiatric symsotms and conditions. 

A person who internalises their perceived or real rejection in the sense that this rejection means it is their fault, they have done something wrong, or that it is because they are not good enough or lovable, it can lead to negative thoughts and feelings that result in conditions like depression. 

When an individual with RSD externalises the emotional reaction of rejection they can exhibit behaviours that are aggressive and violent towards the person or situation causing pain as a result of their criticism and rejection. 

Having rejection sensitive dysphoria can cause the individual to become hypervigilant about rejection and their behaviours could be directed towards doing anything that they can to avoid it- this can result in their avoiding relationships, social situations, and even professional prospects. 

Thy individual might become people pleasers and they might present themselves as something else so that they are admired and praised and socially accepted. This can go on to such an extent that their needs and wants are neglected leading a very unhappy life. 

They give up in the face of challenges because they feel like it is too painful to risk rejection and criticism so they might avoid being in relationships or any activities like dating, applying for jobs, or speaking up in public because they are afraid of being hurt. 

In some cases, they might develop perfectionist tendencies because they want to avoid being rejected and criticised, so they might develop a tendency to be overly controlled and perfect and this can cause immense stress and anxiety for them and the people around them.

What is the connection between Rejection Sensitive Dysphoria And ADHD?

It has to be mentioned and clarified that the current diagnostic criteria of ADHD according to the DSM5 does not include any emotional and mood dysregulation. 

However, it has been reported and observed in some people with ADHD along with a sensitivity and emotional distress related to rejection. 

There are some experts that believe that RSD and ADHD are linked and that having ADHD can be connected to a higher risk of experiencing rejection sensitivity. 

Experts believe that people with ADHD respond to stimuli differently because of how their central nervous systems react and this could play a role in how they  perceive and respond to rejection.

Some also speculate that their sensitivity to rejection arises because of how ADHD warrants rejection in the face of stigma and ignorance. 

People might face criticisms and social rejection because of their behaviours and “abnormality” when they were younger. These experiences might make them more sensitive to rejection based on what they have learned and internalised from these experiences. 

People with ADHD can struggle with impulsive reactions and behaviours which is why researchers speculate that people with ADHD may also cause people to respond inappropriately to rejection leading to more rejection and negative feelings. 

While some researchers believe that RSD could be connected to ADHD, others believe that RSD can exist exclusively apart from ADHD. 

However this has brought about criticisms since rejection cannot be measured due to which most researchers disregard it and believe it to be a manifestation of comorbid depression, bipolar disorder, borderline personality disorder, and social phobia.

What are the treatments available for Rejection Sensitive Dysphoria?

As of recent years, since RSD is not a separate diagnosable condition the treatment of RSD is similar to that of ADHD. Treatments include:

Therapy

In therapy the client and the therapist work on  developing coping skills for dealing with rejection in a relationship.

They also focus on working to minimise rumination, develop mindfulness, and regulate the negative emotions that arise in the case of RSD.

Effort is also made to help the individual manage their time, reduce the effect and urge to attend to impulses and develop more mindfulness as well as work on restructuring cognitive schemas by applying CBT techniques to deal with rejection related beliefs and thoughts. 

Medications

ADHD medications like methylphenidate (Ritalin) and dextroamphetamine-amphetamine (Adderall) might be used to treat ADHD symptoms including RSD and other treatments like Antidepressants can help to treat depression and low moods related to negative emotions observed in RSD. 

Support

Another form of treatment is academic and career support for people with adult ADHD and RSD and for children as well in order to develop coping skills, management, and emotional regulation.  Support can include from their family and friends or by being part of a group support.

Education

Another intervention is to educate the family and friends of the individual about RSD as well as the person who appears to have RSD to help them understand what it is and also how to process information.

By educating people around the person about RSD might help people choose their words and responses more carefully when interacting with the individual and also help the person become more mindful when encountering conversations. 

Conclusion

FAQ related to Rejection Sensitive Dysphoria

What does rejection sensitivity dysphoria feel like?

A person who internalises their perceived or real rejection in the sense that this rejection means it is their fault, they have done something wrong, or that it is because they are not good enough or lovable, it can lead to negative thoughts and feelings that result in conditions like depression. 

When an individual with RSD externalises the emotional reaction of rejection they can exhibit behaviours that are aggressive and violent towards the person or situation causing pain as a result of their criticism and rejection. 

Is RSD only in ADHD?

According to experts, it is speculated that “Rejection sensitive dysphoria” (RSD) appears to be only with ADHD.

Is RSD a mental disorder?

No it is not a mental disorder. RSD is still a controversial new topic in the field of Psychology and it is not recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as any condition due to which there are no symptoms or diagnostic criteria as a result no standardised treatments are available. 

Can RSD go away?

RSD does not go away on its own and there is no cure. However individuals can consider therapy, medical, and social support to learn how to regulate their emotions and replace negative cognitive schemas related to rejection and criticism. 

Is RSD nerve damage?

It is not known whether RSD is a result of nerve damage; however, Experts believe that people with ADHD respond to stimuli differently because of how their central nervous systems react and this could play a role in how they  perceive and respond to rejection.

Does ADHD cause RSD?

There is not enough research to clearly establish if there is a cause and effect relationship between ADHD and RSD however, There are some experts that believe that RSD and ADHD are linked and that having ADHD can be connected to a higher risk of experiencing rejection sensitivity. 

References

Higuera.V. What Is Rejection Sensitive Dysphoria? Healthline. Retrieved on 10th March 2022. https://www.healthline.com/health/mental-health/rejection-sensitive-dysphoria

Dodson.W. How ADHD Ignites Rejection Sensitive Dysphoria. Additude. Retrieved on 10th March 2022. https://www.additudemag.com/rejection-sensitive-dysphoria-and-adhd/

Watson.S. What Is Rejection Sensitive Dysphoria? WebMD. Retrieved on 10th March 2022. https://www.webmd.com/add-adhd/rejection-sensitive-dysphoria

Z.Villines. What to know about ADHD and rejection sensitive dysphoria. MedicalNewsToday. Retrieved on 10th March 2022. https://www.medicalnewstoday.com/articles/adhd-rejection-sensitive-dysphoria

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