rejection sensitivity dysphoria
What is it?
Rejection Sensitivity Dysphoria (RSD) is an overwhelming emotional sensation that someone experiences in response to an actual or perceived rejection or criticism. It is a serious issue that can result in low mood and self-esteem and is not just a simple case of a person being overly sensitive.
A person with RSD may experience a negative feeling, such as rejection, from an innocent comment, or they may see a mild disagreement as being very severe. They may have a different view on what constitutes ‘constructive criticism’.
A person will sometimes internalize this overwhelming emotional sensation, causing a low mood and withdrawal from the situation. At other times, they might externalize their feelings, which could take the form of sudden anger or rage, the classic ‘fight or flight’.
RSD can be difficult for the person and their loved ones, and it can harm relationships. It can become a self-fulfilling prophecy, causing rejection, particularly if a person reacts with anger or impulsive behaviour toward a perceived slight.
ADHD & RSD
While the diagnostic criteria for ADHD do not currently include problems with emotion and mood regulation, people with ADHD can experience these issues. This is because rejection is difficult, if not impossible, to measure and therefore cannot be included in a scientific diagnostic process. Experts also see the traits potentially occurring in other conditions, such as depression, bipolar disorder, borderline personality disorder, and social phobia.
There are, however, factors associated with ADHD that increase the risk of experiencing rejection. These include:
- Stimuli that can trigger the central nervous system differently in people with ADHD, potentially changing how they perceive and respond to rejection.
- ADHD itself may also lead to rejection. Other people may view ADHD’ers with RSD differently and be critical if they do not conform to “social norms.” This criticism can make a person more sensitive to future experiences of rejection.
- The impulsive behaviours of ADHD may also cause people to respond inappropriately to rejection. In turn, this can cause them to experience more rejection.
- Difficulty in regulating emotions may explain the problems that some kids with ADHD experience when socializing. Studies also report that peer rejection and victimization frequently occur among children with ADHD and may exacerbate the symptoms of RSD.
Experts continue to work on identifying the potential role of emotional dysregulation in ADHD and how it may explain the difficulty in processing emotions, such as rejection, however, emotional dysregulation is not unique to ADHD, and not all research supports the idea that ADHD increases the risk of rejection sensitivity.
Symptoms of RSD
The symptoms of RSD can vary among individuals, but they can include:
- Frequently or obsessively thinking about negative experiences, especially experiences of perceived or actual rejection.
- Perceiving rejection when it is not actually occurring.
- Viewing small rejections as catastrophic.
- a chronic fear of rejection
- Misperceiving constructive criticism, requests for more information, or neutral feedback as rejection.
- Perfectionism or people-pleasing tendencies.
Treatments
At present, the treatment options for RSD are similar to those for ADHD. Just as when treating ADHD, people with RSD can benefit from combining different treatment methods. Treatment for both RSD and ADHD can involve:
- Therapy and coaching: In therapy, a person can work on developing coping skills or dealing with rejection-related problems in a relationship. They can also learn how to minimize rumination, which is a common theme among people with RSD. Therapy can also help with other ADHD symptoms by supporting better time management and reducing negative impulses.
- ADHD medications: ADHD medications are highly effective in managing the core symptoms of ADHD and can also help with RSD.
- Antidepressants: Antidepressants can help with some RSD symptoms, especially rumination or feelings of sadness.
Other ways people can try to cope
People living with RSD can try to develop skills and strategies for processing emotions in therapy or support groups. Some strategies that might help include:
- Education: If a person knows that they have RSD, this can help them put their feelings into context. Learning more about the condition might help them understand how to process information.
- Delayed responses: There is no need to respond to rejection or other negative experiences right away. People with ADHD sometimes behave impulsively. Pausing to think about how best to respond may help reduce potential conflicts.
- Talking about rejection sensitivity: A person can make their friends, family, and other loved ones aware of their RSD. This knowledge may help people choose their words and responses more carefully when interacting with the individual.
RSD & Me
I recently had my first coaching session with a counsellor who, like me, has both ADHD and Asperger’s and was diagnosed as an adult. She picked up very quickly on some of my descriptions of situations that had caused me issues in the past, and how I perceived them, and she immediately homed in on RSD as something that I should be looking into and for me it was a revelation. I have always been my own harshest critic and it turns out there is a reason why.
If I look at the individual RSD symptoms, I can relate to most, if not all of them very strongly:
Frequently or obsessively thinking about negative experiences, especially experiences of perceived or actual rejection – I have an array of memories that are incredibly vivid that I can mentally step back into, and replay comments made to me that had a negative impact. Some go back as far as my early teens; some are much more recent. When I am experiencing anything that feels negative, I will end up replaying one of these memories in a way that reinforces the current problem.
Perceiving rejection when it is not actually occurring and viewing small rejections as catastrophic. This is pretty much a daily occurrence, usually very low level but with a huge cumulative effect. A simple ‘no’ or ‘rain-check’ type response is near on impossible for me to take at face value and is overanalysed to the extreme.
A chronic fear of rejection. An underlying sense of not belonging, or good old imposter syndrome and the fear of being found out means that I have rarely sought promotion at work. I have never once asked for a pay rise as I’ve felt that doing so might open a can of worms that leads to my faults being laid bare and my being shown the door instead! I’ve never applied to join a team, society, or a club. I have let friendships lapse over what I thought was rejection in some form. Madness, I know, but it’s in my wiring and without knowing what caused it I’ve been captive to it all my life.
Misperceiving constructive criticism, requests for more information, or neutral feedback as rejection. I find this trait less straightforward to analyse in myself. There is definitely a link between these interactions and rejection, but I also think it is heavily influenced by the inattentive elements of my ADHD. All three situations identify to me as more work-related ones that can require me to revisit a piece of work, and before I started on ADHD medication I dreaded this. I just didn’t have the ability to reconnect my focus to the specific thread that I needed to get back to in order to understand the critique or elaborate on a subject. Once I had finished something, that was it, it was history. This is changing rapidly for me, medication has allowed me to harness my focus in a way that I have never imagined, let alone experienced before and I am developing an ability to put a task down and then return to it later and pick up exactly where I left off. This probably sounds normal to any neurotypical people reading this, but believe me, for me it is a game-changer!
Perfectionism or people-pleasing tendencies. Perfectionism was only relevant for me when the subject matter grabbed me and I could harness my focus for long enough to try, but I don’t really remember ever achieving it, but as with many things in the last few months, it’s changing with the help of the (legally prescribed) stimulants!
I find the people-pleasing trait a hard one to identify in myself. I do exhibit it at times, but I don’t think I do it regularly, preferring instead to stay under the radar. I certainly think it’s one of those areas where the Asperger’s Syndrome and the social awkwardness that is a big part of that condition comes in to play and runs interference for the ADHD, minimising the trait.
Conclusion
Up to now this part of my psyche has been wrapped up in what I have previously described as the environmental factors that I have always thought to be at the heart of what I now know to be my combined ADHD and Asperger’s. As I have got older and more worn down by perceived rejection I have been mentally ‘circling the drain’, at times letting a fear of it overwhelm me in ways that have led to it becoming a self-fulfilling prophecy. The result is that I basically have tended to reject others before they get a chance to reject me, though in a passive sense, just withdrawing from the relationship.
I understand, given the inability to measure it, why RSD is not part of the formal diagnostic criteria for ADHD and other neurodiverse conditions, but now that I am aware of it and how it has driven so many of my thoughts and behaviours over the years, I wish it was. It needs to be linked into conditions so it can be ruled out, rather than being left off to one side to be stumbled on. It seems to be a major component of ADHD that can be managed if it is identified and getting to grips with understanding it and how to alleviate the traits looks as if it is going to be a big step forward in my own journey.
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