Experiencing rejection is a universal part of life. You will encounter it at some point, whether it arises in friendships, romantic relationships, or the workplace.
While these situations can lead to uncomfortable emotional and physical sensations, most people can manage and cope with these feelings.
However, for some individuals, rejection triggers an intense emotional and physical pain that is challenging to handle, a condition known as rejection-sensitive dysphoria (RSD).
RSD may lead to heightened emotional outbursts, negative self-talk, rumination, and withdrawal from social situations.
Typically, we think of ADHD in terms of inattention, impulsivity, and hyperactivity, but RSD is also prevalent among ADHD individuals and those with other neurodivergent conditions.
If you identify with the traits of RSD, a virtual ADHD rejection-sensitive dysphoria coach may provide valuable support.
Read on to discover more about RSD, its connection to ADHD and other neurodivergent conditions, and effective strategies for managing RSD.
What Is Rejection-Sensitive Dysphoria?
Rejection-sensitive dysphoria (RSD), referred to as hysteroid dysphoria in Europe, is not an officially recognized diagnosis, but it often occurs alongside other conditions.
It is characterized by a brain-based symptom primarily linked to neurodivergent conditions, such as ADHD. RSD manifests as a heightened emotional response to rejection or criticism, stemming from emotional dysregulation.
The term “dysphoria” originates from ancient Greek, meaning strong or unbearable. This indicates that rejection can evoke severe emotional reactions and physical pain. Interestingly, these emotional and physical responses can occur not only in direct response to real rejection but also to imagined scenarios of reaction. Even ambiguous remarks, like a simple “OK” in reply to an email, can lead someone with RSD to worry that they did something wrong.
While everyone feels negative emotions in response to rejection, those with RSD experience feelings in an exaggerated manner that can be difficult to control. The emotional response tends to be disproportionate to the situation, and RSD can disrupt a person's work or school life, relationships, and overall well-being.
Individuals struggling with RSD often grapple with feelings of inadequacy, low self-esteem, depression, and anxiety. In an attempt to avoid rejection and its associated traits, you may engage in behaviours such as people-pleasing and perfectionism.
Rejection-Sensitive Dysphoria vs. Sensitivity to Rejection
Your brain comprises various regions that serve distinct functions. As you mature, your brain gains the ability to integrate signals from these regions to manage your emotions effectively.
However, for individuals experiencing emotional dysregulation, this integration does not occur, leading to overwhelming emotions you cannot manage.
Both rejection-sensitive dysphoria and sensitivity to rejection involve emotional dysregulation, but there is a fundamental difference between the two.
Dysphoria specifically refers to intense emotions of RSD and is not present in individuals who simply exhibit sensitivity to rejection. While both those with RSD and those with sensitivity to rejection may respond anxiously or overreact to rejection, only those with RSD will experience the severe emotional discomfort with rejection.
History of Rejection-Sensitive Dysphoria and Its Associated Emotional Dysregulation
RSD is closely related to emotional dysregulation, a concept that dates back decades.
Dr. Paul Wender emerged as a pioneering figure in the study of emotional dysregulation and its relationship to ADHD in the 1960s and beyond.
He was among the first to recognize that emotional dysregulation is a pervasive and impairing symptom of ADHD. Initially, he referred to this phenomenon as atypical depression due to societal misunderstandings at the time.
Subsequently, society came to realize that Dr. Wender was referring to RSD in ADHD individuals. Once neglected, emotional dysregulation and RSD are now gaining recognition as important features of ADHD.
In the 1990s, researchers further elaborated on the subject, with Dr. William W. Dodson coining the term "rejection-sensitive dysphoria" at Milton E. Hershey Medical Center.
He utilized this term to illustrate how some of his patients experienced extreme mental and emotional distress due to mere perceptions of rejection. Currently, many ADHD and other neurodivergent individuals identify with these intense responses to rejection.
What Triggers Rejection-Sensitive Dysphoria?
The intense emotional and physical responses associated with RSD are often triggered by events such as:
Abandonment by a loved one
Teasing
Criticism
Real or perceived rejection or disapproval
Self-criticism, perfectionism, or negative self-talk
These triggers can lead to various symptoms, manifesting either externally or internally. When internalized, the response may resemble a sudden bout of depression, which can include suicidal thoughts. Conversely, when emotions are externalized, they may result in outbursts of anger or rage.
What Causes Rejection-Sensitive Dysphoria?
Experts have yet to determine the exact cause of RSD.
Some theories suggest that it relates to brain areas that process rejection, failure, and criticism, primarily the amygdala and prefrontal cortex. The amygdala governs emotional responses, while the prefrontal cortex controls higher cognitive functions.
As you mature, your brain ideally develops in a manner that helps you manage your emotional responses more effectively.
However, for some individuals, the emotional centers may override cognitive functions, leading to overwhelming painful emotions. The resulting emotional dysregulation, characterized by the inability to manage negative emotions, is closely tied to RSD.
Researchers also believe genetics may play a role in the development of RSD. Individuals with familial histories of mental health conditions or neurodivergent traits may be more susceptible. Further research is necessary to explore the relationship between genetics and RSD.
Signs of Rejection-Sensitive Dysphoria
Experiences of RSD can differ greatly among individuals. However, the hallmark of RSD is intense emotional pain resulting from real or perceived rejection or criticism.
Those affected might find it challenging to articulate their experiences, as RSD feels distinct from other types of emotional pain. Individuals often describe RSD as akin to having an open wound.
Some common signs of rejection-sensitive dysphoria include:
Becoming easily embarrassed when criticized in public
Low self-esteem
Persistent fears of rejection
Physical discomfort, such as a heavy chest or tight stomach
Trouble controlling emotions in response to rejection (real or perceived)
Rumination and perseveration
Defensive reactions to rejection, including anger or aggression
Relationship challenges
A sudden onset of depression or anxiety following rejection
Neglect of self-care and potential burnout
Negative self-talk and thoughts of self-harm
These RSD symptoms often create a negative feedback loop. Individuals may resort to behaviors to limit rejection, which can include people-pleasing or striving for perfection to avoid criticism.
Unfortunately, rejection can still occur regardless of these efforts since no one can achieve perfection consistently. Consequently, individuals experiencing RSD might react negatively to being rejected, subsequently engaging in these behaviours again.
What Is ADHD, or Neurodivergence?
ADHD is a neurodevelopmental and neurodivergent condition, diagnosed through a comprehensive ADHD assessment.
“Neuro” pertains to the nervous system, while “divergent” signifies a deviation from "typical" brain functioning.
Consequently, ADHD individuals brains develop differently, and you may process information differently, including through the symptoms of inattention, impulsivity, and hyperactivity, which can benefit from ADHD coaching.
ADHD is also associated with emotion-based traits such as "ADHD waiting mode," where an individual feels overwhelmed while waiting for something.
There are numerous other forms of neurodivergence, including conditions like anxiety, Tourette syndrome, depression, learning disabilities, and autism.
Is Rejection-Sensitive Dysphoria a Symptom of ADHD?
RSD is not officially recognized in the DSM-5 as a symptom of ADHD. Several challenges complicate the acknowledgement of RSD in the context of ADHD.
Firstly, the DSM-5 criteria are primarily tailored to elementary school-aged children, leaving a gap in understanding for those over the age of 16 (Pliszka, 2007).
Moreover, the criteria often overlook emotional aspects, cognitive styles, relationships, and sleeping issues while concentrating on behavioral symptoms.
Over the past decade, ADHD emotional dysregulation and RSD have become more widely studied. Despite a growing body of knowledge, RSD still lacks recognition in the DSM-5. This may be due to RSD not being universally present in individuals with ADHD and the challenges involved in measuring it.
Nevertheless, though RSD is not recognized, in 2019, emotional dysregulation, which shares many characteristics with RSD, was acknowledged by the European Union as one of the six facets of ADHD. Studies indicate that 35 to 70% of people with ADHD experience emotional dysregulation.
Consequently, ADHD individuals may respond to emotions differently than neurotypical individuals, with even minor criticism triggering severe emotional reactions.
Despite the strides in research and understanding, further advocacy is needed to formally recognize emotional dysregulation and RSD as core facets of ADHD in the DSM-5.
Can Rejection-Sensitive Dysphoria Occur with Other Neurodivergence?
Just as with ADHD, research on the relationship between rejection-sensitive dysphoria and other forms of neurodivergence is limited.
However, there is some recognition that RSD may be prevalent among individuals with various neurodivergent conditions, including autism, learning disabilities, depression, anxiety, and complex PTSD (CPTSD).
Further investigation is needed to uncover the reasons behind this association.
Can You be diagnosed with Rejection-Sensitive Dysphoria?
RSD is not officially recognized as a standalone condition, nor can it be diagnosed using the DSM-5.
Clinicians may suspect RSD based on your symptoms in conjunction with the presence of neurodivergent conditions.
They will evaluate your responses to rejection and assess past or present experiences of harsh criticism.
The symptoms of mood disorders and other mental health conditions often overlap with those of RSD, complicating the identification of RSD.
Support for Rejection-Sensitive Dysphoria
While there is no cure for RSD, it can be managed effectively. Management strategies can vary based on individual needs and may include a blend of medications, coaching, and lifestyle adjustments.
Medications
Medications play a vital role in managing the symptoms of RSD. Currently, there are no specific medications approved for RSD treatment. Instead, healthcare providers may prescribe medications approved for related conditions, such as anxiety, depression, or ADHD.
Off-label prescribing can also occur, where medications are used for purposes other than their original approval. For instance, centrally acting alpha-agonists, like clonidine (Kapvay) and guanfacine (Intuniv), initially developed for treating high blood pressure, are potential options for managing RSD due to their effects on ADHD. Other medications, including stimulants and anti-anxiety medications, may also be prescribed by a doctor off-label for RSD.
Counselling
Counselling is another valuable approach to treating RSD, helping you process and manage emotions connected to RSD while developing coping strategies for episodes. Therapists can assist you in identifying specific triggers and understanding effective emotional management techniques.
Counselling may also address identity aspects subject to societal criticism, such as sexual orientation, recognizing that societal rejection can trigger RSD symptoms. This approach will incorporate neurodiversity-affirming practices that focus on accommodation rather than attempting to "fix" the individual.
Therapy may take the form of a number of therapy modalities, including those that target attachment style, such as International Family Systems and Dialectical Behavioral Therapy. You can prepare for your initial therapy session by using our how-to guide.
Lifestyle changes
Lastly, lifestyle modifications through life coaching can help manage RSD. Techniques for stress management, mindfulness meditation, breathing exercises, restless sleep, and proper nourishment can be instrumental. Here are some suggestions gathered from neurodivergent individuals:
Reinforce your strengths: Acknowledge your positive traits and celebrate your accomplishments. Reward yourself for achievements to build confidence.
Use positive affirmations: Employ affirmations and mantras to counteract negative thoughts associated with RSD.
Validate your emotions and practice self-compassion: Let yourself feel your emotions and practice self-compassion, recognizing your feelings are valid.
Shift focus: Each day, recognize one good thing and one bad thing. Try to concentrate on the positive while acknowledging and holding space for the negative.
Supportive People: Reach out to people in your life that uplift you and help build your confidence to counteract negative feelings.
Distractions: Engage in activities or use items that bring comfort, such as a fidget spinner or calming music.
Book a Free Consultation With Blue Sky Learning
Are you a neurodivergent individual experiencing RSD and seeking the support of a virtual rejection-sensitive dysphoria coach or therapist?
Blue Sky Learning is here to assist you, with a dedicated team of coaches and therapists providing free consultations to determine whether they are the right fit for you.
Book a free 20-minute consultation with a member of the Blue Sky Learning team by emailing hello@blueskylearning.ca or following the link below.
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