What is Rejection Sensitive Dysphoria (RSD) ?

Rejection sensitive dysphoria (RSD) is extreme emotional sensitivity and pain triggered by the perception that a person has been rejected or criticized by important people in their life. It may also be triggered by a sense of falling short—failing to meet their own high standards or others' expectations.

RSD is common in people who have Attention deficit hyperactivity disorder (ADHD), which makes it harder to focus, pay attention, and sit still. Most people who have ADHD are also very sensitive to what other people think or say about them. Up to 99% of teens and adults with ADHD are more sensitive than usual to rejection. And nearly 1 in 3 say it's the hardest part of living with ADHD.

It is common in ADHD and ADD but it can also occur in people who do not have either of these. Rejection sensitive dysphoria is not a medical diagnosis, but more a way of describing certain symptoms. "Dysphoria" comes from a Greek word that means “hard to bear." People who have RSD don’t handle rejection well. They get very upset if they think someone has shunned or criticized them, even if that’s not the case.

How Can RSD Affect Your Life?

People who have the condition sometimes work hard to make everyone like and admire them. Or they might stop trying and stay out of any situation where they might get hurt. This social withdrawal can look like social phobia, which is a serious fear of being embarrassed in public.

RSD can affect relationships with family, friends, or a romantic partner. The belief that you're being rejected can turn into a self-fulfilling prophecy. When you act differently toward the person you think has rejected you, they may begin to do so for real.

What Are the Signs?

People with RSD may:

• Be easily embarrassed

• Get very angry or have an emotional outburst when they feel like someone has hurt or rejected them

• Set high standards for themselves they often can't meet

• Have low self-esteem

• Feel anxious, especially in social settings

• Have problems with relationships

• Stay away from social situations and withdraw from other people

• Feel like a failure because they haven't lived up to other people's expectations

• Sometimes think about hurting themselves

Some of these symptoms are also common in other mental health conditions. RSD can be confused with:

• Bipolar disorder

• Borderline personality disorder

• Posttraumatic stress disorder (PTSD)

• Obsessive-compulsive disorder (OCD)

• Depression

• Social phobia

One difference is that RSD episodes are intense but don't last very long.

Because RSD can look like other mental health disorders, it's important to get the right diagnosis. If you have ADHD and you've had any of these symptoms, see a psychologist, counselor, or other mental health provider for help.

What Causes RSD?

Doctors believe gene changes that are passed down through families cause RSD. Serious trauma, like abuse or neglect, can make the symptoms worse.

When you have ADHD, your nervous system overreacts to things from the outside world. Any sense of rejection can set off your stress response and cause an emotional reaction that's much more extreme than usual. Sometimes the criticism or rejection is imagined, but not always. ADHD researchers estimate that by age 12, children with ADHD get 20,000 more negative messages about themselves than other kids their age. All that criticism can take a real toll on their self-esteem.

How Is RSD Treated?

Two types of medicine work well to ease symptoms:

• Guanfacine (Intuniv) and clonidine (Kapvay) are drugs that lower blood pressure, but they also help with RSD symptoms.

• Monoamine oxidase inhibitors like tranylcypromine (Parnate) treat the inattention, impulsive behaviors, and emotional symptoms of ADHD.

A therapist can help you learn how to get a handle on your emotions and deal with rejection in a more positive way.

Another way to deal with RSD is to manage the stress in your life. You're more likely to have an emotional breakdown when you're stressed out. Eat right, sleep well, and do things like yoga or meditation to keep your mind calm.

SOURCES:

ADDitude: "How ADHD Ignites Rejection Sensitive Dysphoria," "Parental Criticism May Worsen ADHD Symptoms."

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD): "Redefining ADHD for the Rest of Us."

Depression Alliance: "Rejection Sensitive Dysphoria: What Is It and How to Deal With It."

National Institute of Mental Health: "Attention Deficit Hyperactivity Disorder."

© 2020 WebMD, LLC. All rights reserved.