Understanding Rejection Sensitive Dysphoria: Symptoms, Causes, and Management

Most of us may not take rejection well initially, but lately, we will pull ourselves together, and move on, right?. What if the rejection, causes severe emotional pain, and intensely heightened negative emotions that are challenging to manage? This condition is called Rejection Sensitive  Dysphoria (DSD). Let’s discuss this condition in detail. 

What is Rejection Sensitive Dysphoria (RSD)? 

As its name says, Rejection Sensitive Dysphoria (RSD) refers to intense emotional distress triggered by rejection. While most people dislike rejection, those experiencing RSD feel even stronger negative emotions that can be more challenging to handle. They tend to perceive ambiguous interactions as rejection and struggle to regulate their responses. RSD lacks an officially recognized set of symptoms and is not classified as a formal medical diagnosis. However, healthcare professionals frequently use the term to describe heightened reactions associated with recognized behavioural conditions such as ADHD. 

Read More: How To Deal with Rejection? Insights from Expert

The connection between ADHD and RSD: 

ADHD and RSD share overlapping symptoms, individuals with ADHD have experienced emotional sensitivity and strong emotional reactions. RSD includes intense emotional responses to rejection. Next, is the Co-occurrence nature of both disorders, Research indicates that as many as  98% of adults with ADHD experience clinically significant levels of RSD. There are some believe that RSD is a symptom of ADHD but there is no adequate research to prove it. It is also confused with mood disorders, mood disorders do not have any specific trigger, while RSD is triggered by rejections, criticism, and teasing. For mood disorder, episodes last at least 2  weeks, but episodes for RSD rarely last for 2 hours. 

Read More: 9 Signs of Highly Sensitive People

Symptoms of RSD 

As we discussed earlier RSD does not have officially recognized symptoms, but experts provide insights about how individuals with RSD may react when triggered by rejection.  

• They are prone to feeling embarrassed or self-conscious easily. 
• They may pursue perfectionism and push themselves to the extreme, to cope with their fear of rejection. However, it often ends in heightened anxiety and difficulty in prioritizing self-care or relaxation. 
• Managing emotions becomes challenging while facing rejection, it is notable in children and teenagers.  
• Some may respond with sudden bursts of anger or rage, while others may break down in tears. 
• They exhibit signs of low self-esteem and difficulty in self-belief. 
• They may internalize their emotions rather than express them outwardly, leading to sudden episodes of severe depression.  
• They often strive to please others and are deeply concerned with avoiding disapproval.
• They may avoid the projects or setting goals where failure is possible. 
• They may be involved in negative self-talk. 
• They may find difficulty in managing relationships. 

Causes of RSD: 

The exact cause behind the RSD is still known, but experts theorize that the following factors,

1. Brain Structure 

Brain regions such as the amygdala and prefrontal cortex play roles in processing emotions, dealing with rejection and failure and interpreting negative information. During childhood, adolescence, and young adulthood, these areas can lead to emotional outbursts and frustration. For example, they could not handle losing their toys. As they grow older, the amygdala and prefrontal cortex improve their ability to interpret signals, allowing individuals to regulate emotions, maintain composure, and effectively interact with the environment. But for some, the brain may struggle to regulate emotions effectively. This can result in experiencing negative emotions as extremely painful and difficult to manage or control, a phenomenon known as “emotional dysregulation”. 

2. Relation with ADHD 

As we already discussed ADHD connections with RSD, experts say that the brains of individuals with ADHD do not regulate internal communication in the same manner as those without ADHD. Specifically, responsible for filtering and managing effective regulation of brain activity. This often leads to heightened sensitivity to loud background noises, bright lights, and sudden environmental changes. Moreover, the ADHD brain’s challenges in managing pain-like responses may explain why experiences of rejection are particularly distressing and painful for those with RSD.

Read More: How ADHD can Impact your Relationship and How you can (still) Work it out

3. Personal experience 

Another cause for RSD might be experiencing early-life rejection or neglect, possibly stemming from a parent who was overly critical or neglectful. This early experience can shape an individual’s self-perceptions, leading to lower self-esteem and a heightened fear of rejection and abandonment in their interpersonal relationships. Also, personal experiences include being teased or bullied by peers, or facing criticism or rejection from a romantic partner. 

4. Genetic Factor 

Genetic factors are also considered as one of the causes of RSD, we know ADHD is connected with RSD. ADHD often runs in families due to its genetic component, and similarly, RSD also appears to have a genetic link.

How to Overcome Rejection Sensitive Dysphoria:

1. Mindfulness: Engaging in mindfulness during episodes of rejection sensitivity dysphoria has been observed to reduce the intensity of perceived rejection. This approach has shown beneficial effects in managing conditions marked by heightened sensitivity to rejection, such as social anxiety and borderline personality disorder. 
2. Psychotherapy: Psychotherapy is beneficial for individuals experiencing RSD. While therapy does not prevent RSD episodes or directly change symptoms, it teaches techniques for processing and coping with overwhelming emotions. This can empower individuals with RSD to better manage their emotional responses and feel more in control. 
3. Medication: The medications usually prescribed treat ADHD and related conditions because they impact the same brain regions responsible for RSD symptoms. Addressing these conditions can therefore have a dual benefit. Although RSD is not formally recognized as a medical diagnosis, treatments for similar conditions affecting these brain areas can often to effective. In practice, healthcare professionals may use “off-labeling prescribing” for managing RSD symptoms. 
4. Seek Social Support: Seek support from friends, family, and therapists who understand RSD. To help in processing emotions and also to vent out the emotions by sharing their thoughts. This can prevent you from having low self-esteem and negative self-talk.
5. Building Coping Skills: Developing coping strategies such as assertive thinking and problem-solving skills can improve the ability to manage and respond to rejection. 
6. Self-Awareness: Having insight and awareness about RSD and how it affects your life can empower you to recognize triggers and follow effective strategies.

In summary, RSD is a condition that arises from rejection, causing significant emotional distress. And it presents as a challenge, particularly for ADHD and related conditions. It does not have an officially recognized set of symptoms and diagnostic criteria. There is no specific medication for this condition but practitioners use off-labeling prescriptions to handle the symptoms. Psychotherapy, psychoeducation, practising mindfulness, and learning coping strategies may help to manage its symptoms. Don’t hesitate to seek support from healthcare professionals, please feel free to access them for understanding and coping with RSD. 

FAQs: 

1. Is Rejection Sensitive Dysphoria recognized as a formal diagnosis? 

RSD is not currently recognized as a distinct medical diagnosis in the Diagnostic and  Statistical Manual of Mental Disorders (DSM-5). It is widely recognized by mental health experts. 

2. What should I do if I think I have RSD? 

If you suspect you may have symptoms of RSD and have difficulty coping with emotions triggered by rejection, it is advisable to seek help from mental health professionals near your location. They can provide comprehensive assessment and recommend appropriate options to cope with it. 

3. What are the causes of RSD? 

The exact cause of RSD is not fully understood, but experts believe that brain structure,  genetic factors, and personal experiences may be considered as the factors for causing  RSD. 

4. What are common triggers for RSD? 

Rejection (whether actual or perceived as the withdrawal of love, approval, or respect),  teasing, constructive criticism, persistent, self-criticism, or negative self-talk arising from perceived failure are some common triggers for RSD.