• Sydni Rubio-Weiss

Rejection Sensitive Dysphoria (RSD)

Updated: Feb 9, 2021

RSD is a symptom of ADHD that is often overlooked. It's a form of severe emotional dysregulation that is very specific to the ADHD and ASD (Autism Spectrum Disorder) communities. Read on to find out what it is, where it comes from, what it's like for those who have it, and how to manage it.




What is Rejection Sensitive Dysphoria?


Before I get into RSD, I wanted to address its cousin: Emotional Dysregulation (ED). Emotional Dysregulation is defined as having an impulsive or extreme emotional response to something and being unable to regulate those emotions. People with ED become extremely (and perhaps, "irrationally") angry and sad about things that would cause a less intense reaction in a neurotypical. Emotional Dysregulation can be experienced by anybody, but you are more likely to experience ED if you have:

- ADHD

- Autism Spectrum Disorder (ASD)

- Bipolar Disorder

- Borderline Personality Disorder (BPD)

- Post-Traumatic Stress Disorder (PTSD)

-Depression

“People with RSD become very acutely aware of everything we're doing and saying in front of other people."

While Rejection Sensitive Dysphoria is an extreme emotional response to things, much like ED, it is also classified as being extremely emotionally sensitive to the possibility of things like:

- Rejection

- Disagreement

- Criticism

- Judgement

- Disappointing others or yourself


What does RSD feel like for those that have it?

We fear the idea of social interactions because we fear the above list. We are afraid that our coworkers, classmates, or group members are going to reject us, make fun of us behind our backs, or that we're going to say something stupid and embarrass ourselves. We're afraid of what other people's perceptions are of us and we react to it way too intensely. We have a similar feeling to that of social anxiety when it comes to the idea of having to engage in a social interaction. When we're actually present at the social interaction, these feelings are amplified and we become very acutely aware of everything we're doing and saying.


PEOPLE ARE NOT JUDGING EVERYTHING YOU SAY AND DO - but, that's easier to say than it is to accept when you have RSD. We're worried about our appearance, about how often we speak, about how we're standing, and about that joke we told that didn't get any laughs. We will lie awake every night until 1 am for 4 years thinking about that joke while the rest of the world moves on.


Why do we develop RSD and where does it come from?

You may have guessed this, but RSD develops in our childhood. By the age of 12, children with ADHD hear 20,000 more negative or critical messages than their peers without ADHD do [1]. These messages come from an adult in a place of authority, and some examples of these messages include things like:

- Why are you so messy all the time?

- Sit still and be quiet for once.

- Stop interrupting! You're being rude.

- You're so lazy!

- Your room looks a tornado went through it.

- Why don't you ever listen?

- Pay attention!

- You lost something else? Again?

- Why can you never remember anything?


Any of those sound familiar? When we were kids, we were criticized, punished, and yelled at for behaviors that were directly related to our ADHD. This is completely the cause of our RSD. I'm not saying that these behaviors should be ignored by teachers, parents, and other authority figures, but I am saying that there are much better ways to handle these situations.

“When we were kids, we were criticized, punished, and yelled at for behaviors that were directly related to our ADHD."

RSD can also come from how you interacted with other children when you were a kids. I personally struggled with bullies, specifically in middle school. Children with ADHD are rejected more by their peers than neurotypical children [2]. This is likely due to the other kids viewing the ADHD child as "the weird kid" or "the kid that talks too much". When you're avoided, made fun of, and/or bullied as a child, it HURTS. Even worse, we don't understand those kinds of things as children, but we remember it and it grows into things like social avoidance, social anxiety and RSD.


We turn into adolescents and adults that anticipate being rejected. This turns into us rejecting others before they have the chance to do this to us. This explains why many of us aren't liked by others (neurotypicals) as teenagers and adults


What parts of my life can RSD affect?

Spoiler alert: every aspect. It can affect work (or school if you're a college student). In these settings, you may be sensitive to feedback from your boss/manager/advisor/professor. They may be trying to give you constructive criticism on a project or assignment, and you take it very personally and create nonexistent tension between you and this person.

“People with RSD tend to take things very personally, which creates nonexistent tension between them."

It can also affect your relationships with family members or friends. People aren't going to agree with everything you say in your life, and some of those people that disagree with you may be someone close to you. When this happens, you take it very personally, creating friction between you and a loved one.


This one is huge: social media. Unlike interactions with someone at work or in your living room, interactions on social media are drawn out and made public. It's even worse when it's between you and someone you don't know, and even more when others agree with the person disagreeing with you, making you feel targeted and terrible about yourself.


Can I fix my RSD?

Yes, but it takes a lot of work. The first step: be mindful. What do I mean by this? Try this:


- For the next week or so... when something happens that provokes an emotional response in you, just take note of it. Practice becoming more aware of these emotional responses in this time frame without changing anything yet.


- Then, once you've become comfortable with recognizing these emotions, start to (kindly) judge them. How? WRITE IT DOWN.


Write down the facts first: what happened? Who said what? Where did this interaction occur? Next, write down how each part of the interaction made you feel. Then, you should be able to assess why you think certain aspects of the interaction made you feel a certain way. The assessment/judgement part is very important. Many times, whatever the other person said or did to upset you... they did not mean it in the way that you took it.


Writing down what happened is also useful so you're not throwing all of your drama onto someone that you love when they have their own things to stress out about. Take the time to reflect on your emotional responses alone before you talk about it with your friend, partner, roommate, parent, etc. You are responsible for yourself and your own RSD.


Other options for fixing/coping with RSD:

- Cognitive Behavioral Therapy

- Cognition-enhancing medications: Guanfacine and Clonidine (Non-stimulants)


Do you have any other ideas for coping with RSD? What works for you? Leave them in the comments! Check out the associated video here on YouTube.


References:

  1. Jellinek, Michael S. Don't Let ADHD Crush Children's Self-Esteem. May 2010. Clinical Psychiatry News. 12. https://cdn.mdedge.com/files/s3fs-public/issues/articles/70231_main_7.pdf

  2. Mrug, Sylvie et al. Peer Rejection and Friendships in Children with Attention-Deficit/Hyperactivity Disorder: Contributions to Long-Term Outcomes. 2012. Journal of Abnormal Child Psychology, 40: 1013-1026. https://link.springer.com/article/10.1007/s10802-012-9610-2

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