The Mystical Rejection Sensitivity Dysphoria In ADHD/Autism

— Researched and written by Dr. Sandip Roy.

People with attention deficit disorder (ADHD) and autism spectrum disorders (ASD) often feel rejection sensitivity dysphoria — a strong unhappiness when rejected by people.

When others seem to dismiss their opinions, advice, or ideas, they can behave in unusually strong ways.

That explains it briefly. Let’s take a deeper dive into the mystery of rejection-sensitive dysphoria (RSD).

What is Rejection Sensitive Dysphoria (RSD)

Rejection-sensitive dysphoria (RSD) refers to a condition causing feelings of intense emotional and physical pain in response to real or perceived rejection.

People with RSD often experience an intense fear of rejection and a heightened sensitivity to perceived rejection. They may also avoid social situations or withdraw from relationships to avoid the possibility of rejection.

They have a high emotional sensitivity to negative judgments, feedback, or criticism beyond what most people feel. Children with RSD tend to have high emotional sensitivity, low self-esteem, and social withdrawal.

Rejection Sensitivity Dysphoria In ADHD Autism

RSD is not an officially recognized diagnosis and is not in the DSM-V (the diagnostic manual for mental health disorders), nor recognized in the psychiatric or psychological communities.

Moreover, RSD can present with signs similar to other mental health conditions and can also worsen the symptoms of anxiety and depression, which makes it difficult to identify. But it is receiving more attention in recent years.

Rejection is more frequent and more painful for neurodivergent people.

So, some think that RSD is an acquired symptom, more likely to develop over time, rather than being present from birth.

[Neuro-atypical or neuro-divergent refers to people whose brains function in a way different from the majority of people.]

How RSD People Interpret Situations

People with Rejection Sensitivity Dysphoria (RSD):

People with RSD are also more likely to interpret vague interactions as rude turn-downs, curt dismissals, cold indifference, exclusion and ostracism, abandonment, neglect, or estrangement.

  • Interpret positive comments as less positive or neutral, neutral opinions as negative, and benign or mildly negative social cues as catastrophic.
  • Feel intense emotional and even physical pain when they feel rejected, like feeling hurt and tearful, angry, embarrassed, and pain in the chest.
  • Avoid social situations or withdraw from relationships to avoid the possibility of rejection, often leading to social isolation and loneliness.

Their interpretations of these as rejection may make it difficult to control their reactions and emotions.

  • A person with RSD may interpret a friend’s late text as a sign that the friend is mad at them, even though the friend is simply busy.
  • An RSD person may take a critical comment from a coworker personally, even though the coworker was not intending to be hurtful.
  • RSD can make one assume that their partner is going to leave them when they are busy with their deeply personal issues, even when there is no evidence that the partner is disloyal.
  • They may interpret their partner not answering a text message immediately as a sign of outright rejection or a future plan to break up.

The negative feelings of Rejection-Sensitive Dysphoria RSD can be more intense and difficult to control compared to those associated with Rejection Sensitivity (RS).

Dysphoria in RSD

“Dysphoria” is a state of generalized low mood, joylessness, apathy, dissatisfaction, or frustration. The word comes from the Greek dys (pain) and pherein (to carry), meaning “pain that is hard to bear.”

Dysphoria in Rejection-Sensitive Dysphoria (RSD) isn’t just unhappiness; rather, it refers to the severe emotional pain experienced by sensitive people when they sense failure, rejection, or loss of love, approval, or respect.

The dysphoria in RSD typically gets triggered by an upsetting event, but the affected person’s reaction is so intense that it makes them greatly distressed.

Dysphoria can also result from feelings of being deprived of love or respect. The “sad” or “angry” reaction that ensues can be far more severe than what is often considered typical in such cases.

Symptoms of Rejection-Sensitive Dysphoria (RSD)

When you experience rejection, your brain perceives it as a threat and activates the stress response. This response triggers the release of cortisol and other stress hormones, leading to physical symptoms like increased heart rate, sweating, and muscle tension.

Some of the common psychological symptoms of RSD include:

  • Emotional pain
  • Fear of rejection
  • Rage
  • Anger
  • Outbursts

Rejection-Sensitive Dysphoria (RSD) Triggers

RSD symptoms can be triggered by criticism, rejection, and failure. People with RSD may often experience emotional outbursts out of proportion to the situation. Sometimes, they react even when they perceive, not experience, a rejection-like situation.

Some common triggers that can lead to RSD symptoms include:

  • Criticism
  • Rejection
  • Failure
  • Feeling ignored or overlooked or unloved or disrespected

Rejection-Sensitive Dysphoria (RSD) In ADHD

Rejection Sensitive Dysphoria (RSD) is common in people with Attention Deficit Hyperactivity Disorder (ADHD).

Some neuro-atypicals, like those with ADHD and autism, are more likely to have RSD. Some estimates suggest that 1 out of 3 people with ADHD experience RSD-like symptoms. However, we need rigorous research to confirm these figures.

“There are a number of possible reasons those of us with ADHD experience emotions more intensely than others. We often struggle with emotional lability, emotional impulsivity, emotional dysregulation, and negative intent attribution.”

Jillian Enright
RSD-Features-in-ADHD

ADHD is a neuro-atypical condition characterized by difficulty paying attention, hyperactivity, and impulsiveness. There are three main types of ADHD:

  1. Predominantly Inattentive (difficulty paying attention, disorganized, distracted, and forgetful)
  2. Predominantly Hyperactive-Impulsive (excessive activity, fidgeting, and difficulty sitting still)
  3. Combined (combines the symptoms of both the above).

Emotional Impulsivity and RSD

Emotional impulsivity and lability, and emotional permanence, are common in ADHD’ers, which makes them more likely to experience RSD.

This means that they are more likely to make fast but distorted judgments about others’ behaviors.

They can misconstrue neutral behavior as negative, positive behavior as neutral, and negative intent as hostile.

People with ADHD are impulsive not just in their actions, but also in their thoughts and feelings. This makes them more prone to jump to conclusions and misinterpret the intentions of others.

This can lead to a fear of rejection, even when there is no evidence of rejection.

This makes it a struggle for those affected to manage their emotions. It often leads to impulsive behavior and mood swings.

RSD is a specific type of emotional dysregulation often experienced by those with ADHD.

Rejection Sensitive Dysphoria (RSD) & ADHD: Understanding the Connection

Hyperactivity and RSD

ADHD brains are wired differently than those without ADHD. Experts think people with ADHD have more dopamine receptors in their brains, and less dopamine to attach to them.

Those who have the Predominantly Hyperactive-Impulsive type of ADHD could be more vulnerable to developing RSD.

Hyperactivity makes it difficult for these individuals to sit still and focus. This can lead them to high levels of inappropriate activity and to facing more reprimands and warnings.

Being hyperactive can make them more prone to criticism, leading them to become more sensitive and develop RSD.

Research finds that children diagnosed with ADHD are more often rejected by their peers. As many as 52% of 7–9 year olds with ADHD fall in the rejected category.

Children with ADHD are also more vulnerable to bullying and victimization.

An extreme emotional response to being turned down or criticized can have a major effect on an ADHD person’s mental health and overall welfare.

RSD and Other Mental Health Conditions

Rejection Sensitive Dysphoria (RSD) is not exclusive to ADHD people. It may also affect other neuro-atypicals.

RSD in Autism

There may be a connection between Rejection Sensitivity Dysphoria (RSD) and Autism Spectrum Disorder (ASD).

Autistic individuals, facing social communication difficulties, may experience intense emotional pain from perceived rejection, complicating coping mechanisms.

Those with ASD might show a greater susceptibility to rejection sensitivity due to their social interaction challenges.

This study found that children with ASD are vulnerable to the effects of social exclusion, but they have difficulty understanding and responding to social cues in aversive social situations.

  • Researchers McPartland & Crowley in the above study found that children with ASD had a decreased P300 in EEG in response to social exclusion. This suggested they were not engaging their attentional resources as much.
  • One possible reason was that they were simply not paying attention to their social exclusion. This could be because they were unable to understand the social cues used to express rejection.
  • Another possibility was that the children were paying attention to social exclusion, but they were not able to process it in the same way as typically developing children. This could be because they had different social-cognitive skills or different emotional responses to social rejection.

RSD in Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) is a condition involving intense emotional instability, frequent mood swings, impulsive behaviors, and turbulent relationships.

Rejection sensitivity (RS) is one of the core features of BPD or borderline personality disorder (Cavicchioli & Maffei, 2020). 

It correlates with lower self-esteem and more severe BPD symptoms, even in remitted patients. It often results in heightened feelings of exclusion, even during social inclusion.

According to the Cognitive-Affective Personality System (CAPS) model, personality disorders, including Borderline Personality Disorder (BPD), stem from maladaptive thought patterns, emotions, and behaviors.

So, overly sensitive to rejection might be one of these harmful thought patterns contributing to BPD.

Although Rejection-Sensitive Dysphoria (RSD) is more commonly associated with ADHD, its presence in BPD often creates a destructive cycle.

The fear of rejection may lead to self-protective behaviors such as withdrawal or confrontation, that ironically can result in the very rejection they aimed to avoid, thereby intensifying the RS.

RSD and Bipolar Disorder

Bipolar disorder is a condition involving severe mood swings from manic highs to depressive lows.

While Rejection Sensitive Dysphoria (RSD) is not a mood disorder, it can co-occur with bipolar disorder in some individuals.

Some experts propose that RSD might be a symptom of bipolar disorder, rather than a separate condition.

Emotional Impact of RSD

Rejection-sensitive dysphoria (RSD) can have a significant emotional impact on individuals with ADHD. interactions.

Effects on Self-Esteem

RSD can cause individuals with ADHD to experience low self-esteem, negative self-talk, and rumination. They may constantly worry about being rejected or criticized, leading to a fear of failure.

This fear can make them hesitant to take risks or try new things, which can further impact their self-esteem.

Depression and Anxiety

RSD can also lead to depression and anxiety. The constant fear of rejection or criticism can cause individuals with ADHD to experience distress, loneliness, and social withdrawal.

They may feel isolated and disconnected from others, which can exacerbate their symptoms of depression and anxiety.

Social Anxiety and Withdrawal

RSD can also cause individuals with ADHD to experience social anxiety and withdrawal. They may avoid social situations or interactions, fearing rejection or criticism.

This avoidance can lead to feelings of isolation and loneliness, further impacting their mental health and well-being.

Rejection Sensitive Dysphoria (RSD) and Relationships

Having Rejection Sensitive Dysphoria (RSD) can make it difficult to maintain relationships, particularly in a meaningful way.

It can alter one’s understanding of and response to social signals, resulting in unnecessary feelings of being turned away and having a negative effect on relationships.

Challenges in Romantic Relationships

People with RSD may find it difficult to maintain healthy romantic relationships.

They often feel rejected or unloved by their partner, even when they express their affection.

This can lead to misunderstandings and conflicts, as their partner may not understand the root cause of their excessive reactions.

Moreover, RSD can make it hard to trust others and form attachments.

They may fear rejection so much that they avoid getting close to others altogether. This can be especially challenging in romantic relationships, where intimacy and vulnerability are essential.

Perceived Rejection in Social Interactions

RSD can also impact your interactions with friends and acquaintances.

You may perceive rejection in social situations where none exists, leading to feelings of isolation and loneliness. This can make it challenging to form new relationships and maintain existing ones.

We must note that perceived rejection is not the same as actual rejection.

Social cues can be challenging to interpret, so, it’s easy to misread someone’s intentions. If you are perceiving an oncoming rejection, communicate with the other person and clarify their intentions.

Impact on Family Relationships

RSD can also impact your relationships with family members.

One may feel rejected or criticized by their loved ones, even when they have good intentions. This can lead to conflicts and strain their relationships with their family.

Open communication with your family members i the key here. Ask them about their intentions and express your feelings and fears.

Share with them how RSD affects you and how they can support you. This can help you maintain healthy relationships with your family members.

Diagnosis and Treatment of RSD

If you suspect you or someone you know has Rejection Sensitive Dysphoria (RSD), do not label yourself or them.

You may suggest they seek a professional diagnosis from a mental health professional

Diagnosing RSD

Diagnosis of RSD can be challenging as it is not currently a formal diagnosis.

However, a mental health professional can assess symptoms and provide a diagnosis based on criteria such as extreme emotional sensitivity and emotional pain triggered by real or perceived rejection, criticism, or failure.

Medication Options

While no specific medication is approved for RSD, some medications used to treat ADHD have been found to help manage symptoms of RSD.

All medications should always be prescribed and monitored by a licensed healthcare professional.

Therapy and Counseling

Talk therapy, such as cognitive-behavioral therapy (CBT), can be an effective treatment option for RSD.

CBT can help individuals with RSD learn to identify and challenge negative thought patterns and develop coping strategies to manage emotional pain and reactions to rejection.

Some other helpful types of therapy could be interpersonal therapy, acceptance and commitment therapy, and dialectical behavior therapy for managing RSD symptoms.

How To Overcome RSD: Coping Strategies

Living with Rejection Sensitive Dysphoria (RSD) can be challenging, but there are strategies you can use to help cope with the symptoms.

Building Resilience

Building resilience means developing the ability to bounce back from rejection and setbacks.

Here are some ways to build resilience:

  • Practice mindfulness and meditation to help manage stress and anxiety.
  • Focus on your strengths and accomplishments to boost your self-esteem.
  • Seek supportive relationships with friends, family, or a therapist.
  • Learn from rejection and setbacks by reflecting on what you can do differently next time.

Lifestyle Changes and Self-Care

Making lifestyle changes and practicing self-care can also help manage RSD symptoms. Here are some tips:

  • Get regular exercise to help manage stress and improve mood.
  • Eat a healthy diet that includes plenty of fruits, vegetables, and whole grains.
  • Get enough sleep each night to help manage stress and improve mood.
  • Avoid drugs and alcohol, which can worsen RSD symptoms.
  • Take breaks and engage in activities you enjoy to help manage stress.

Coping Techniques

There are some science-backed coping techniques to manage RSD symptoms. Here are some examples:

  • Practice self-compassion and self-kindness.
  • Set realistic goals and break them down into manageable steps.
  • Use positive self-talk to challenge negative thoughts and beliefs.
  • Seek support from others by talking about your experiences and feelings.
  • Use relaxation techniques like deep breathing or progressive muscle relaxation.

Coping with RSD takes time and effort, but with the right strategies and support, you can manage its symptoms and live a fulfilling life.

Neurological Aspects of RSD

Research suggests that people with RSD may have increased activity in the amygdala, the part of the brain responsible for processing emotions like fear and anxiety.

This increased activity may contribute to the heightened emotional response that people with RSD experience when faced with rejection.

FAQs

  1. Can rejection-sensitive dysphoria occur without ADHD?

    Rejection-sensitive dysphoria is often associated with attention deficit hyperactivity disorder (ADHD), but it can occur independently of ADHD. However, individuals with ADHD are more likely to experience RSD due to the challenges they face with executive functioning, social skills, and emotional regulation.

  2. Is rejection-sensitive dysphoria considered an anxiety disorder?

    Rejection-sensitive dysphoria is not considered an anxiety disorder, but it is often associated with anxiety and other mood disorders. While RSD is not an official diagnosis, it is a real and distressing experience for many individuals, and seeking treatment can help improve their overall quality of life.

  3. What are the common symptoms of rejection-sensitive dysphoria?

    Rejection-sensitive dysphoria (RSD) is when individuals experience intense emotional pain and distress in response to perceived rejection or criticism. Some common symptoms of RSD include feelings of worthlessness, low self-esteem, anxiety, and depression. Individuals with RSD may also experience physical symptoms such as headaches, stomachaches, and muscle tension.

  4. How is rejection-sensitive dysphoria treated?

    Treatment for rejection-sensitive dysphoria typically involves a combination of medication and therapy. Medications such as antidepressants and mood stabilizers can help manage symptoms of anxiety and depression, while therapy can help individuals develop coping strategies and improve their self-esteem. Cognitive-behavioral therapy (CBT) is particularly effective in treating RSD.

Final Words

Rejection Sensitive Dysphoria (RSD) can make you see things differently in life. However, having a neuro-atypical outlook is not necessarily a negative thing.

Neuro-divergent people, like those with autism spectrum disorder, ADHD, dyslexia, dyspraxia, and Tourette syndrome, often have unique strengths and talents.

For example, ADHD people are often very creative and resourceful.

RSD cannot be cured but can be managed. Look for guidance from those who specialize in cognitive-behavior therapy (CBT) and mindfulness-based stress reduction (MBSR) meditation.

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