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.

Prince Harry has made world wide news by promoting EMDR Therapy and giving an interview where he shows part of a psychology session using this therapy.

EMDR involves using various ways to get the mind to sweep back and forth and this promotes healing, especially in situations where a person has felt “stuck” with a problem. There is more than one technique to get the brain to do this and Prince Harry is shown using the tapping technique (with his arms crossed over his body) however there are other ways to use it such as following an object back and forth with your eyes, and using a special type of EMDR music on headphones.

In Prince Harry’s interview, he is shown using the Tapping method (which is easier to use if doing an online telehealth session). At Better Health Psychology, we use all types of EMDR and most people choose to use headphones as a much simpler method where you listen to a special type of music.

All types of EMDR methods are effective for treating a variety of conditions such as anxiety, trauma, PTSD, eating issues, addictions and stressful situations.

To see the interview with Prince Harry then click on this link.

To book a psychology session for EMDR treatment then click here.

For any questions, or to see more information then visit our website at www.betterhealthpsychology.com

Dependent personality disorder (DPD) is a type of anxious personality disorder. People with DPD often feel helpless, submissive or incapable of taking care of themselves. They may have trouble making simple decisions. But, with help, someone with a dependent personality can learn self-confidence and self-reliance.

OVERVIEW

What is dependent personality disorder (DPD)?

Mental health experts describe personality as a person’s way of thinking, feeling and behaving. A personality disorder affects the way people think or act, making them behave differently over time.

Dependent personality disorder (DPD) is one of 10 types of personality disorders. Dependent personality disorder usually starts during childhood or by the age of 29.

People with DPD have an overwhelming need to have others take care of them. Often, a person with DPD relies on people close to them for their emotional or physical needs. Others may describe them as needy or clingy.

People with DPD may believe they can’t take care of themselves. They may have trouble making everyday decisions, such as what to wear, without others’ reassurance.

Statistics show that roughly 10% of adults have a personality disorder. Less than 1% of adults meet the criteria for DPD. More women than men tend to have DPD.

SYMPTOMS AND CAUSES

What causes dependent personality disorder (DPD)?

Mental health experts haven’t figured out what causes DPD. They believe it results from a mix of genetics, environment and development. Experts have found DPD is more likely in people with particular life experiences, including:

• Abusive relationships: People who have a history of abusive relationships have a higher risk of a DPD diagnosis.

• Childhood trauma: Children who have experienced child abuse (including verbal abuse) or neglect may develop DPD. It may also affect people who experienced a life-threatening illness during childhood.

• Family history: Someone with a family member who has DPD or another anxiety disorder may be more likely to have a DPD diagnosis.

• Certain cultural and religious or family behaviours: Some people may develop DPD due to cultural or religious practices that emphasize reliance on authority. But passivity or politeness alone is not a sign of DPD.

What are the symptoms of dependent personality disorder (DPD)?

Someone with dependent personality disorder may have several symptoms, including:

• Avoidance of personal responsibility.

• Difficulty being alone.

• Fear of abandonment and a sense of helplessness when relationships end.

• Oversensitivity to criticism.

• Pessimism and lack of self-confidence.

• Trouble making everyday decisions.

DIAGNOSIS AND TESTS

How is dependent personality disorder (DPD) diagnosed?

Your healthcare provider does a physical exam to understand if another condition could be causing symptoms. A mental health provider makes the DPD diagnosis.

A mental health provider will talk with you about your past mental health history. Questions may include how you feel, any other mental health concerns and any substance use problems. The provider compares your answers to factors listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

For a diagnosis of DPD, a provider will look for five of the DSM-5 diagnostic criteria. These factors include:

• All-consuming, unrealistic fear of being abandoned.

• Anxious or helpless feelings when alone.

• Inability to manage life responsibilities without seeking help from others.

• Problems stating an opinion out of fear of loss of support or approval.

• Strong drive to get support from others, even choosing to do unenjoyable things to get it.

• Trouble making everyday decisions without input or reassurance from others.

• Trouble starting or completing projects because of a lack of self-confidence or ability to make decisions.

• Urge to seek a new relationship to provide support and approval when a close relationship ends.

MANAGEMENT AND TREATMENT

How can I manage or treat dependent personality disorder (DPD)?

A mental health provider can help you manage DPD. You may have psychotherapy (talk therapy) such as cognitive-behavioural therapy (CBT). This care teaches you new ways to handle difficult situations. Psychotherapy and CBT can take time before you start to feel better.

With psychotherapy and CBT, your provider guides you to improve your self-confidence. You’ll work to become more active and self-reliant. Your provider will also talk to you about finding more positive relationships. A positive, meaningful relationship can build self-confidence and help you overcome some of the symptoms of DPD.

PREVENTION

Can dependent personality disorder (DPD) be prevented?

You may not be able to prevent DPD. But treatment can help people at risk for developing the disorder find ways to avoid or handle difficult situations.

Some studies have shown that healthy relationships may help prevent the child from developing DPD later in life. If a child has even one strong relationship with a friend, parent or teacher, it can counter others’ harmful effects.

OUTLOOK / PROGNOSIS

What is the outlook for someone with dependent personality disorder (DPD)?

Someone with DPD can live an emotionally healthy life if they receive treatment from a mental health provider. Learning new ways to cope with difficult situations can make a difference in their overall outlook.

People who don’t get treatment may be at risk for depression and anxiety. Without treatment, a person may misuse substances and develop problems such as drug addiction or alcoholism. Without treatment, people are more likely to stay in unhealthy or abusive relationships. If you or someone you know is in a dangerous or abusive relationship, contact 1800 RESPECT on 1800 737 732    This service offers free, confidential support. Advocates are available 24 hours a day, 365 days a year.

This article was first published in November 2020 on my.clevelandclinic.org The contact number was updated in April 2021.

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When should I see a healthcare provider about dependent personality disorder (DPD)?

Your healthcare provider can help you decide if you need to see a mental health professional. Some reasons to talk about your mental health with your provider include:

• Frequent feelings of anxiety.

• Irritability or moodiness.

• Loss or change in appetite.

• Persistent negative thoughts about yourself.

• Trouble concentrating.

• Jumping from relationship to relationship.

Dependency is on a scale where some feel more or less dependent than others. We are all dependent to some extent, and more or less within certain times of our lives. It is considered Dependent PD when it fills the diagnostic criteria and this only applies to those that experience it at high levels. Even if your levels of dependence aren’t that high, it can be useful to seek help from a psychologist to understand the effects on your life and to learn how to become more independent in general.