Are Your Anxiety And Depression Caused By Rejection Sensitive Dysphoria?
Updated July 03, 2020
Reviewer Christy B.
While many of us can be hurt when we feel rejected, for some people with ADHD this reaction develops into something more serious called rejection sensitive dysphoria. This article will guide you through some important information about the condition.
Rejection sensitive dysphoria (RSD) is when someone with ADHD experiences immense pain over a perceived rejection. Often this is often nothing more than a perception, and the person has not actually been rejected. Nevertheless, the feeling severely impacts their life and confidence. Put simply, RSD is the pain of having to deal with perceived rejections. Coping with a sense of rejection is much more difficult for those with RSD than for others.
Triggers of RSD
For some, any sense of failure is capable of triggering RSD, whether it comes in the form of a low grade, a blunder on the sports field, or telling a joke that did not go over well. Rejection can also take the form of being teased or criticized, resulting in diminished self-worth. Individuals with RSD often have very high standards for themselves, making such disappointments even more difficult to process.
There can be a wide range of symptoms, but some are especially common. Emotional confusion is usually present, and sadness. Although sadness has often been triggered by perceived rejection, the person will not necessarily recognize that as the cause. If you have ADHD and often feel sad but don't know why, try writing down some triggers to figure out if you might have RSD. Doing exercises like this with a professional can help even more.
Sensitivity to criticism is another symptom, including sometimes interpreting passive statements as criticisms. The person with RSD may sense that others disapprove of them, fearing a lack of love or respect. Because of the fear of rejection, a primary symptom may be a feeling of constant "edginess," or always feeling tense.
Internalization vs. Externalization
We can either internalize or externalize negative emotional responses, meaning attribute them to a fault in ourselves or in the environment. When emotional responses are internalized, the result can be intense. Because an individual may have been "fine and well" prior to an incident of perceived rejection, RSD is often misdiagnosed as bipolar disorder. Thus, it is crucial for physicians to be aware of rejection sensitivity in those with ADHD and how it can impact well-being.
When the emotional response is externalization, the person or situation that caused the perceived rejection may be attacked with forceful anger. It is therefore not surprising that approximately half of those who are assigned to court-mandated anger-management treatment are found to have undiagnosed ADHD.
Not only is bipolar disorder a common misdiagnosis for RSD, but the anticipation of rejection, even when there is no clear threat, may also be diagnosed as social phobia. Social phobia is the belief that when in public, you will inevitably humiliate yourself, so you come to avoid the outside world.
RSD and borderline personality disorder also share rejection sensitivity as a symptom. A person with borderline personality disorder has extreme sensitivity toward rejection or being cast aside. People with BPD may lash out at others in response to rejection. Individuals who have borderline personality disorder struggle with their self-esteem. Their self-worth is fragile, and they rely on the opinions of others to make them feel good about themselves. Similarly, a person with RSD has difficulty tolerating rejection, and in some cases, they could react aggressively. However, the individual with RSD will more likely socially isolate than attack the source of their rejection.
Sometimes, people misdiagnose RSD as hysteroid dysphoria, which is when people become generally depressed from feeling rejected and develop a dependence on sweets or other mood enhancers. This is a subtype of atypical depression that involves rejection sensitivity.
Importance of Emotional Well-Being With ADHD
While it is often overlooked, the emotional aspect of ADHD is crucial. ADDitude magazine explained, "Researchers have ignored the emotional component of ADHD because it can't be measured. Yet emotional disruptions are the most impairing aspects of the condition at any age."
Detrimental Ways of Coping
Those with RSD have three major ways of coping with their emotions. One is to become "people pleasers" in an attempt to avoid rejection. In this effort, they lose themselves and become "yes men," emulating whatever characteristics they believe someone else admires. The second coping strategy is to stop trying entirely. They believe that if they attempt to do something, they will fail, so they would rather avoid the rejection altogether. Of course, this is harmful to development and quality of life.
Lastly, some will become perfectionists, the rationale being that if they never fail, they can never be rejected. Of course, no one can entirely avoid failures, meaning that this population takes the falls even harder. Also, it stops them from being able to see value in the accomplishments they have made because they are always striving for more. Some with RSD use a combination of these coping devices.
How RSD Affects Relationships
Unfortunately, RSD can make relationships nearly impossible for some, as they constantly feel as if they have been insulted, hurt, or criticized, while the other person cannot understand why. After the person with RSD has felt hurt too many times, they may decide to cut the "abuser" out of their lives.
There is also the aforementioned tendency to be a "people pleaser," which results in a disingenuous persona that will cause problems down the line.
Being sensitive to rejection is intertwined with ADHD on a neurologic and genetic level, especially when compounded with any type of childhood trauma. This does not mean everyone with ADHD will develop RSD. However, for those who do suffer from RSD, it is often comforting to know that there is an official name, and they are not the only people experiencing those symptoms. That is why it is important to spread awareness of RSD, not to mention the fact that it enables many to seek treatment for a condition they might not have been aware of previously.
There are two medication options: alpha agonists (e.g.,guanfacine or clonidine) and monoamine oxidase inhibitors (MAOIs).
The prescription of alpha agonists guanfacine and clonidine have shown to be the simplest means of treatment. Both medications are more often used to control blood pressure, but they can also offer relief for approximately a third of people who suffer from RSD. Experts recommend somewhere between one-half to seven milligrams of guanfacine, with one-tenth of a milligram to five-tenths of a milligram of clonidine. Many have experienced better results with this approach than with stimulants for the treatment of ADHD.
The second option is the prescription of monoamine oxidase inhibitors (MAOI) off-label, which is considered by many clinicians to be the preferred treatment for RSD, as it shows significant results in a short period of time. It is reported that Parnate (tranylcypromine) offers the highest level of results with the least side effects, although some, such as low blood pressure, confusion, sedation, and agitation, may still occur.
MAOIs have also been around for a while, initially trialed for the treatment of ADHD in the 1960s. They are easily taken via once-a-day dosing and are not considered a controlled substance, meaning that there is no potential for the patient to abuse them. They are also available in the form of inexpensive yet high-quality generics, making them accessible to many. They are FDA approved.
One downside to MAOIs is that aged foods must be avoided, as well as first-line ADHD stimulant medications, all antidepressant medications, and many other medications. This can be challenging, and limits those for whom MAOIs are a possible treatment. However, successful medication can bring rapid progress in the lives of those with RSD.
All of the above are important points to bring up with a psychiatrist. Most important is to recognize that if you suffer from RSD, you are not alone in your struggles and help is available.
It is impossible to diagnose yourself officially. If you relate to some of the descriptions in this article, RSD is one of many possible diagnoses. It is important to seek professional help and receive a diagnosis if you can relate to the social anxiety, social phobia, ADHD, BPD, and/or RSD symptoms. You can receive a referral to a therapist from your doctor, look up a local practice, or inquire about services from a local hospital. One option is BetterHelp, which offers therapy online. Anywhere that you have a tablet, smart phone, or computer, as well as an Internet connection, you can receive therapy from a licensed therapist. Below are some reviews of BetterHelp counselors from people experiencing similar issues.
"I have really enjoyed working with Kim thus far. She has given me some excellent tools to manage and correct negative thought patterns in my daily life. I am so grateful for her patience, understanding, and just for her listening to me and helping me work through my thoughts."
"I worked with another counselor for over 6 months before working with Arielle Ballard. In one 30 minute session, I got more accomplished in terms of structuring goals, building coping mechanisms, and recognizing thought patterns, than I had in the 6 months working with the other counselor. I'm pleased with my progress and am very greatful to Arielle."
Frequently Asked Questions
What does rejection sensitive dysphoria feel like?
Rejection Sensitive Dysphoria (RSD) is a mental health condition of extreme emotional sensitivity which revolves around rejection or criticism. RSD is a severe emotional reaction to real or perceived rejection and is usually sparked by anxiety or emotional pain which is triggered when an individual perceives that he or she is being rejected or neglected. Rejection can be quite difficult and can affect people in diverse ways. Usually, many people feel sad, disappointed, or frustrated after experiencing rejection, and may take time for them to snap out of it. But for people with RSD, rejection can be very overwhelming to the extent of leading to rage and panic outbursts, feeling despair and hopeless, feeling ashamed and humiliated, or even forming beliefs that they have failed or disappointed those around them. It is important to note that RSD doesn’t only happen in an actual case of rejection. Sometimes, it is only an emotional response to actions or behavior which they perceive as rejection. In most cases, people with RSD may hide these intense feelings from people around them because they feel ashamed of their vulnerability. RSD is usually common with people who have mental health issues like sensory processing issues and Attention Deficit Hyperactivity Disorder ADHD.
Do I have rejection sensitive dysphoria?
In some cases, rejection sensitive dysphoria may be tied alongside a mental health condition like major depression, Post-Traumatic Stress Disorder (PTSD), ADD, ADHD, or Generalized Anxiety Disorder (GAD), so getting to know if you have RSD isn’t something you can guess off. You may need to talk to a psychologist, counselor, or other mental health professionals who would make some inquiries regarding your family history, assess your symptoms and ask you a series of questions as to how you feel and react in certain situations. Some of these questions may include:
- Do you feel angry when you experience rejection or are criticized?
- Do you sometimes feel that nobody likes you or wants to be your friend?
- Do you try to go out of your way to always please people?
- Do you feel intense aggression or anger when you feel someone has hurt your feelings?
- Do people tell you that you are overly sensitive?
What causes rejection sensitive dysphoria?
It is believed that rejection sensitive dysphoria isn’t exactly caused by a single factor, but multiple factors. Most possibly, RSD can be as a result of a history of neglect or rejection in the earlier years of one’s life, especially in situations where they have/had a parent who was overly neglectful and critical, and this impacts how these individuals view themselves in later years. For some, constant teases and bullying by peers, criticisms and rejection by a romantic partner, consistent queries from a tough boss regarding a particular executive function, a woman rejected by her husband after being diagnosed with breast cancer, and so on, are different scenerios that can cause RSD. Furthermore, It is also widely believed that RSD can be passed generically, i.e., if a parent or any other close relative has it, there is a high likelihood that one may develop it too.
Is rejection sensitive dysphoria in the DSM?
Rejection sensitivity dysphoria is not a diagnosis, but a symptom, so it is not listed in the DSM. Unfortunately, it also isn’t listed as an ADHD symptom either. Although research continues to show that it is a common experience, the criteria for ADHD exclusively remains focused on inattention and hyperactivity.
How do you fix rejection sensitive dysphoria?
Mental health requires proper medical advice, diagnosis, and treatment. Rejection sensitive dysphoria has been known to be misdiagnosed with ADD and ADHD. Medications that can be effective for RSD and ADHD treatments are:
- Guanfacine(Intuniv) and clonidine (Kapvay) are drugs that reduce blood pressure but are also effective to use for RSD symptoms.
- Monoamine oxidase inhibitors like tranylcypromine (Parnate) which treat the impulsive behaviors, attention deficit, and emotional symptoms of ADHD.
People living with ADHD may need to consult their doctor to help them find the best advice, diagnosis or treatment course for RSD. Although therapy can help with other symptoms of ADHD, it doesn’t exactly do much in treating RSD; the reason being that RSD episodes happen without warning. However, therapy can help you learn how to handle your emotions better and deal with rejection more healthily.
Another way to deal with RSD is to learn to manage the stress in your day to day life. This is because you are more likely to breakdown emotionally when you are stressed out. Make healthier decisions- eat right, sleep/ well exercise, and engage in other refreshing activities like meditation and yoga to help keep your mind calm.
How common is rejection sensitive dysphoria?
People with RSD often experience the feelings of rejection mostly with people they are close to, such as romantic partners, friends, or family members. This can be as a result of being deprived of love and care at different points in life, resulting in attention deficit. ADHD in children and teenagers could stem from being bullied or treated badly because their peers feel they do not belong in their class, hence, the withdrawal from social settings. Adults with ADHD may often act differently towards the people who have rejected them. Accumulation of the different emotions of ADHD ignites rejection sensitive dysphoria in both teenagers and adults. This indicates that rejection sensitive dysphoria is very common among different genres of humans.
Is RSD a mental illness?
Rejection Sensitive dysphoria can sometimes be confused with other mental illnesses or mental health conditions such as depression, post-traumatic stress disorder PTSD, bipolar disorder, ADHD, obsessive-compulsive disorder, and so on. However, one significant difference is the intensity that comes with rejection sensitive dysphoria episodes, albeit not long-lasting episodes. This means unlike some mental health challenges like bipolar disorder or post-traumatic stress disorder which are both continuous disorders that tend to last for a very long period, RSD is not necessarily a mental health challenge or illness due to how it occurs. In comparison, the symptoms of ADHD include forgetfulness, carelessness, restlessness, inability to focus, among others. In most cases, ADHD ignites feelings such as depression, frustration, impatience, etc., which can sometimes be linked to RSD. Instead, symptoms of RSD such as fear of failure, low self-esteem, feelings of rejection, and hopelessness, are offshoots of some emotional symptoms of ADHD. It is best to seek out medical advice and allow therapists to provide medical advice and diagnosis.
Do all people with ADHD have RSD?
Most people with Attention deficit hyperactivity disorder (ADHD) are often concerned and sensitive to people’s perceptions and thoughts about them, and this can be traced to rejection sensitive dysphoria (RSD). People feel hurt from time to time as a result of rejection but those living with ADHD and similar mental health issues often have these feelings of hurt develop into RSD. This painful reaction may also occur when high goals that were set have not been met. In children, ADHD ignites rejection sensitive dysphoria right from their early years, neglect, especially if they had an unavailable or abusive parent. For adults with ADHD, the feeling of rejection often stems from past or current life challenges and they may begin to feel like they are seen as a failure by friends and families, and this affects their mental health and wellbeing.
If you are struggling with symptoms of rejection sensitivity, help is right around the corner. Your journey can start today toward feelings safe and confident around others. Take the first step.