Understanding Rejection Sensitive Dysphoria

What is it? Do I have it? What can I do about it?

Rejection sensitive dysphoria (RSD) is a condition popularized by William Dodson, MD, that can cause persistent and often intense feelings of depression, anxiety, and low self-esteem in ADHD brains. Though not a formal diagnosis, it’s symptoms can be triggered by perceived criticism or rejection from the people around you, including family members and romantic partners, and can create overwhelmingly painful emotions.

What is Rejection Sensitive Dysphoria?

Rejection sensitive dysphoria (RSD) is an intense emotional and psychological reaction to perceived criticism or rejection. It can cause severe feelings of anxiety, depression, anger, and shame that may lead to avoidance behavior. Those with RSD are often overly sensitive in their reactions to criticism or perceived rejection, even if the person experiencing it was not actually criticized or rejected.

Many of the symptoms of rejection sensitive dysphoria are similar to those experienced by people who suffer from trauma, social anxiety, and panic disorders. And while RSD can feel traumatic and cause social anxiety and panic, it is a result of the hypersensitive nervous system of the ADHD, rather than the result of trauma.

It’s important to note that rejection sensitive dysphoria, as defined by William Dodson, MD, has not been well researched and therefore is not a diagnosis that is made by medical or psychological professionals. It has, however, been quickly adopted by the ADHD community because it so accurately describes a previously little-talked-about aspect of ADHD brains. This interest and identification have been combined with the substantial research that has been done on “rejection sensitivity” to help many who struggle with RSD and ADHD.

Who is Most Affected by RSD?

Rejection sensitive dysphoria was originally defined as a condition inherent in ADHD. Rejection sensitivity (the broader, more well-researched term), however, affects people with many other conditions, including autism spectrum disorder, eating disorders, and anxiety, as well as those with no other mental health condition. People of all ages and backgrounds are affected by RSD, though it is more common among adolescents and adults than among children.

Symptoms of Rejection Sensitive Dysphoria

Symptoms of RSD can manifest differently in each individual. Some common signs include

an intense fear of rejection
hypersensitivity to criticism, and humiliation
feelings of shame or inadequacy
difficulty regulating emotions
difficulty managing relationships, particularly relationship conflict
negative self-talk and thoughts of self-harm
avoidance of social settings
low self-esteem
rumination and perseveration about perceived rejection
shame about responses to perceived rejection

It is important to note that these symptoms may be associated with other mental health issues, so it’s important to seek professional help for a complete diagnosis.

Rejection Sensitive Dysphoria and Emotional Dysregulation

Rejection Sensitive Dysphoria is a type of emotional dysregulation common to ADHD brains. But emotional dysregulation and the large, overwhelmingly painful feelings and reactions that it causes can be triggered by other emotions and situations as well. Some of the most common situations and feelings that create dysregulated emotions in ADHD brains are:

Discovering Injustice
Anger
Failure- perceived, real, or forecasted
Overwhelm
Shame
Sadness
Regret

How To Manage Rejection Sensitive Dysphoria

One of the largest issues with rejection sensitive dysphoria (RSD) and all forms of emotional dysregulation is that we so often respond to these big, overwhelming feelings in ways that destroy our values, intentions, and goals. Then we get swept into a cycle of shame, regret, and self-punishment, making us feel worse.

Managing emotional dysregulation of all kinds, and RSD in particular, therefore, involves soothing yourself through difficult emotions while protecting your values, intentions, and goals. It also really helps when we build strong relationships, establish better conflict management strategies, become mindful of our rejection triggers, and work on how we talk ourselves through the often painful and overwhelming feelings.

Treatment and Therapy Options for RSD

There are several treatment options for rejection sensitive dysphoria and emotional dysregulation, and research shows that combining multiple approaches is often the most effective.

ADHD Informed Psychotherapy

ADHD-informed psychotherapy uses CBT, DBT, and coaching strategies to help ADHD brains address the regulatory, practical, and emotional aspects of living with an ADHD brain in a neurotypical world. ADHD-iPT helps people with ADHD brains develop ADHD-friendly ways of responding to big overwhelming emotions that help protect their values, intentions, and goals while using the power and wisdom of those emotions to build motivation and change. ADHD-iPT also helps develop systems and processes to craft an environment that works for ADHD brains rather than against them.

Medication

Some psychiatrists (William Dodson, in particular) are strong proponents of alpha-agonsist medications such as guanfacin and clonidine as treatment for RSD and ED. There are no research studies that examine its effectiveness for RSD or ED in patients with ADHD. Still, anecdotal reports suggest some portion of people with ADHD are helped by it and that the protection that these medications provide then helps them utilize their other therapeutic skills further.

Other Therapies and Treatments

Other treatment and therapy options for RSD include ADHD-informed psychotherapy, cognitive behavioral therapy (CBT), supportive therapy, exposure therapy, and dialectical behavior therapy (DBT). CBT helps you reframe your emotions and thoughts around rejection experiences by critiquing and deconstructing your beliefs about them. Exposure therapy gradually increases exposure to situations that may make you feel rejected or criticized so that you can learn to cope with those feelings. DBT focuses on building skills like distress tolerance, interpersonal effectiveness, emotion regulation, and mindfulness to help people manage their thoughts and behaviors. Additionally, supportive counseling can provide encouragement and offer a safe space to discuss challenging topics related to your experience with RSD.

Additional Supports

Regulatory strategies like improving sleep, exercise, meditation, and good, even nutrition all increase the regulatory capacity of ADHD brains, giving them greater resources to withstand rejection and other often-overwhelming feelings.

Do you struggle with rejection sensitive dysphoria? What have you found that helps?