About Rejection Sensitive Dysphoria (RSD)

Rejection Sensitive Dysphoria is becoming more commonly recognized, especially in the ADHD community. But not all doctors are familiar with RSD, as no official scientific research has been done on this condition. Recognizing the symptoms associated with Rejection Sensitive Dysphoria can better help you navigate your condition and obtain the right mental health professionals and supplements to help you cope. 

What is Rejection Sensitive Dysphoria?

No one enjoys rejection. But most of us can shake off a blow to our self-esteem with minimal damage to our egos. We can recover from rejection by deflecting jokes or talking through our injured emotions with friends. We can even use our frustrations to fuel our determination to grow, overcome, and defeat hampering criticism. Confidence, self-esteem, and close social bonds are all important attributes in working through feelings of rejection. 

Still, not everyone is able to cope with rejection the same way. In fact for some, the anticipation and fear of rejection can feel paralyzing to normal daily function.  

Rejection-sensitive dysphoria is an extreme response to a real or perceived rejection. It is characterized by extreme sensitivity and reactions to feeling rejected or criticized, regardless if there was the rationale to feel so. Also referred to as rejection sensitivity, it is far more than just being “overly sensitive”. 

How Does Rejection Sensitive Relate to ADHD?

Rejection sensitive dysphoria is a neurological symptom that is likely an inherent feature of attention deficit hyperactivity disorder (ADHD). Rejection sensitivity can affect anyone, although persons diagnosed with ADHD and autism are more likely to have RSD. The reason being that with ADHD, the brain has more difficulty regulating emotions in general. For people with ADHD, rejection sensitive dysphoria may emulate mood disorders with suicidal ideation. 

Though the experience of rejection sensitive dysphoria can feel extremely painful and even traumatic, RSD is not believed to be caused by trauma. However, trauma can make symptoms worse. 

Rejection Sensitive Dysphoria Symptoms

Though RSD can manifest in different ways, there are some common symptoms that are associated with this condition. 

• Extreme emotions triggered by feelings of rejection and criticism

• Frequent belief to have failed and disappointed people around you 

• Feelings that you are not able to meet your own high standards or other’s expectations

• Sporadic outbursts of rage and/or panic that don’t last but can feel overwhelming

• Feelings of humiliation and shame

• Anxiety and self-consciousness

• Often jittery, difficulty sleeping and crashing

• Feelings of hopelessness and depression

• Avoidance of partaking in social engagements for fear of rejection or criticism

• Accused of being “overly sensitive” or “unstable” by family and friends

If any of these symptoms resonate with you, it’s important to know that you are not alone. These symptoms are now recognized in the mental health world (especially when linked to ADHD and autism), though have often been misunderstood.

Rejection Sensitive Dysphoria Diagnosis 

Rejection sensitive dysphoria is a known mental health issue associated with ADHD. However, it’s important to know there is not an official diagnosis for RSD, and it is not currently included in the diagnostic criteria for ADHD, despite it being common or prevalent.

Why? There are three main factors:

1. RSD is not constant and emerges through triggered episodes. 

2. Persons with RSD are not always honest in sharing their experiences with outbursts or sensitive reactions during diagnosis because of extreme shame.

3. RSD cannot be measured, therefore it cannot be formally published in research. 

Understanding the traits associated with RSD will support you in identifying if you are subject to this condition and seek the necessary help.

Traits of Rejection Sensitive Dysphoria

Behaviors associated with rejection sensitivity can manifest in two distinct patterns: high-anger RSD and high-anxiety RSD. Because these behaviors are often tied to other mental health issues (more on this later), identifying these patterns can help diagnose your condition. It’s best to seek a professional diagnosis from a licensed mental health professional to prevent misdiagnosis.

High-anger RSD  

• Unprecedented outbursts of rage or anger 

• Aggressive responses toward others 

• Rage and hostile and impulsive tendencies

• Lashing out 

• Feelings of failure 

• Rumination 

• Resentment 

• Desire to retaliate or get revenge 

High-anxiety RSD

• Little-to-no self-esteem, high self-doubt, and highly self-conscious

• Intense feelings of hurt and humiliation

• Avoidance of people and situations to prevent the possibility of rejection

• Feelings of shame and disappointment, especially with loved ones

• Feelings of despair

Long-Term Effects of Rejection Sensitive Dysphoria

Symptoms associated with RSD can worsen over time if left untreated. Cycling through extreme emotions of anger, pain, and humiliation can develop into anxiety, panic, and depression. They can disrupt your ability to maintain relationships and lower your quality of life. 

How can RSD affect your life?

• Cause friction with your loved ones and lead to broken relationships

• Prevent you from entering new relationships or partnerships

• Prevent you from building new connections and friendships

• Lead you to constant unnecessary efforts to obtain approval from others

• Lead you to stop trying, assuming failure in all that you do

• Prevent you from engaging and partaking in social gatherings 

• Cause you to avoid social situations altogether and miss out on important life events

• Lead you to alienate friends and family and submit to self-isolation

• Prevent you from pursuing that next promotion or new job you want

Treatments for RSD

Dysphoria is Greek for “difficult to bear”, which explains if you feel like you cannot go this way any longer. There are treatments that will ease the symptoms associated with RSD.

Therapy/Counseling

Symptoms of rejection sensitive dysphoria are complex and mimic other mental health concerns, which doctors will want to evaluate and rule out. Such conditions may include:

• Emotional dysregulation

• Bipolar disorder

• Rapid-cycling bipolar

• Depression

• Borderline personality disorder

• Post-traumatic stress disorder (P.T.S.D)

• Social anxiety disorder (social phobia)

• Obsessive-compulsive disorder

• Body dysmorphia

There is one key factor that differentiates RSD from other conditions with similar symptoms. Symptoms of RSD tend to be fleeting and triggered by emotional cycles as opposed to an actual incident.

To help assess your symptoms, a mental health professional may inquire about your medical and family history. They may ask discovery questions to gauge your feelings and reactions to past or speculative situations.

Types of questions to expect in an RSD assessment:

• Are you easily embarrassed or tempered?

• Are you a people pleaser?

• Do you feel it impossible to live up to others’ expectations or even your own?

• Are you often seeking validation from others and feel deeply wounded if not received?

• Do you avoid social gatherings for fear of rejection?

• Do your friends and family label you as “overly sensitive” or emotionally unstable?

• Do you avoid projects or opportunities for fear of expected failure?

• Do you feel anxious and withdraw from people around you?

• Do you sometimes think about hurting yourself?

Online therapy platforms such as Talkspace can match you with a therapist that specializes in specific mental health disorders. 

Send your therapist text, voice, or video messages; or, schedule online sessions in real-time with your therapist. 

Medications

Guanfacine (Intuniv) and clonidine (Kapvay) are drugs that lower blood pressure and are effective in helping with RSD symptoms. The drugs are designed to interact with receptors in the brain, reducing hyperactivity and emotional responses. They can be prescribed by your doctor with various dosage options. 

Monoamine oxidase inhibitors (MAOIs) like tranylcypromine (Parnate) treat the inattention, impulsive behaviors, and emotional symptoms of ADHD. Parnate (tranylcypromine) has few side effects such as agitation, drowsiness, confusion, and low blood pressure. 

MAOIs are affordable and approved by the FDA for conditions related to mood and anxiety. Note you have to have to avoid certain foods, 

Supplements

Recoop makes supplements for balance and recovery before, during, and after taking stimulants. Medications for ADHD / ADD have uncomfortable side effects such as fatigue, abnormal feelings, insomnia, anxiety, and loss of appetite. Recoop’s “Wellness Set” supplements help to rebalance your system by restoring vitamins and combatting uneasiness, jitters, fatigue and crashing. 

Brillia pairs its supplements with lifestyle advice and behavioral change recommendations to treat both the conditions themselves as well as accompanying symptoms. 

Done is an online healthcare provider specializing in diagnosing and treating adults who have or think they might have ADHD. Done not only provides adults with medications to treat symptoms of ADHD, but they also pride themselves on taking a more holistic approach to ADHD prescriptions and treatments. 

Ahead specializes in diagnosing and treating adults with ADHD. They offer all qualifying patients online visits with mental health experts that can prescribe stimulant and non-stimulant medication that will be delivered directly to your door.

Lifestyle Changes

Implementing healthy lifestyle habits play a big role in regulating your mood.

Managing your sleep and meditation help to effectively control and respond to emotional experiences. Exercise and nutrition help to improve your quality of sleep and reduce feelings of anxiety and depression. 

Finally, managing stress in your life can make you less susceptible to emotional breakdowns and is critical to overall mental and physical health. 

It’s evident that intense sensitivity associated with rejection sensitive dysphoria is real and deeply painful to cope with. If you are suffering from RSD, then you are likely suffering from developing important relationships and life experiences. Seek the right help and treatment to help you manage your condition and gain mental stability for yourself.