Rejection Sensitive Dysphoria

Try recalling how you feel about getting told no. Even if you know it’s reasonable, it hurts to get rejected. Everybody dislikes rejection. It is frustrating and upsetting when you cannot get what you want. Feeling upset when rejected is normal to some extent, but when it gets too intense and painful, there might be an underlying problem. Rejection Sensitive Dysphoria is a condition where an individual feels extremely overwhelmed and pained when rejected or criticised (Gillette, 2021).

You may think it’s typical to feel overwhelmed after rejection, and to some extent, it is. Except, people with Rejection Sensitive Dysphoria (RSD) feel intense and excruciating pain to even perceive rejection. They are extremely sensitive to both real and perceived rejection. People with RSD find it difficult to regulate their emotions when faced with rejection. They may feel as if they are being rejected or criticized, even when they are not.

However, RSD is not an official diagnosis and is not listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). This condition is commonly observed in people with Attention-Deficit Hyperactivity Disorder but is not exclusive to it. While not common, it is also observed in some personality disorders, but researchers have yet to determine a strong link. 

Signs and Symptoms: 

RSD is usually marked by intense emotional pain when faced with rejection, some other common symptoms include: 

• They are extremely self-conscious and get easily embarrassed. 
• They are extremely scared of disappointing others and are often “people pleasers” because of their fear of rejection. 
• They typically have low self-esteem and find it difficult to believe in their capabilities.
• Due to their fear of disapproval, people with RSD find taking on new projects or hobbies difficult and often miss life-changing opportunities.
• They find it almost impossible to contain their emotions when they feel as if they are being rejected. Perceived or real rejection is often followed by an intense emotional outburst such as crying fits or anger. 
• As they fear rejection or criticism, they turn to perfectionism. While trying to avoid rejection seems like a good coping mechanism, it affects their overall productivity and can lead to burnout. 
• Every person with RSD may not show outward emotional outbursts and can aim it inwards. This is usually mistaken for severe depression, bipolar or personality disorders because of the sudden shifts in mood

Causes of Rejection Sensitive Dysphoria 

While the exact causes of RSD continue to remain a mystery, some speculate that brain structure and childhood experiences may play a role. The amygdala and prefrontal cortex work together to control and manage our emotional responses. In other words, the amygdala and prefrontal cortex are in charge of regulating frustration and disappointment. As children get older, they learn how to control their emotions and react appropriately when faced with rejection and challenges. However, in some people, this regulation may not function properly, leading to intense emotional outbursts (Watson, 2023). 

Some believe that RSD could be linked to adverse childhood events, such as emotional neglect or abandonment. Children with overly critical or neglectful parents may impact their self-image and how they perceive the world (Higuera, 2021). Other traumatic events, such as bullying or abusive relationships, are also linked with fear of rejection and abandonment, increasing the chances of a person developing RSD. Due to its close connection to ADHD, some researchers suggest that genetics may also play a role. Individuals who have a close relative or parent with RSD are more vulnerable to RSD than others. 

Unfortunately, there is currently no specific cure for RSD yet. As it is usually seen in people with ADHD, treatment might involve managing the underlying condition first. While there is no specific cure for RSD, its symptoms can be managed through psychotherapy and medications. 

Cognitive Behavioural Therapy:

RSD is primarily caused due to distorted perception and hypersensitivity to rejection, making CBT the most effective therapy for dealing with RSD. CBT helps individuals identify and challenge negative thought patterns that lead to heightened sensitivity towards rejection. Through cognitive restructuring, individuals can learn to replace their irrational fear of rejection with more balanced and realistic thoughts.

CBT techniques, such as exposure therapy, can help improve tolerance towards perceived rejection. The primary goal of CBT is to develop coping skills and emotional regulation to enhance self-esteem, enabling individuals to respond more resiliently to rejection and reduce the emotional impact. Regular therapy can significantly improve an individual’s ability to manage RSD symptoms (Werner & Gross, 2010). 

Medications:

In most cases, RSD is mainly treated with medications that are commonly prescribed for ADHD and other similar conditions. Both ADHD and RSD are associated with problems in the same areas of the brain making such medications effective in controlling its symptoms. Considering that RSD is not an officially recognised medical condition, healthcare providers often off-label medications to manage its symptoms. This may appear suspicious at first, but rest assured, this process is legal and safe as it is used only when there is evidence proving it to be low risk with no harmful side effects.

Take Away

While it is a rare condition, RSD can significantly affect a person’s quality of life making it hard for them to function normally and maintain relationships. It is important to remember, that people with RSD are not overreacting or being dramatic but are not able to regulate their emotions making them hypersensitive to rejection. As mentioned before, RSD is not completely treatable, but with the help of medication and regular therapy can help manage symptoms and alleviate distress associated with it. If you feel that the symptoms mentioned here, resonated with you then please seek advice from a medical professional equipped to deal with neurodevelopmental and personality disorders as soon as possible. 

FAQs

1. Can I have RSD without ADHD? 

While RSD is usually related to and affects the same areas of the brain as ADHD, it can also occur in people without ADHD. People with RSD are extremely sensitive to rejection which could be caused due to past experiences with neglect, abandonment or extremely critical parents or partners. 

2. How does RSD actually feel? 

RSD is marked by intense pain when faced with rejection, this intense pain often feels like a physical wound as if they were stabbed in the chest or punched. People with RSD usually clutch their chest and hunch over in pain when they are faced with rejection. They may also burst into tears or throw an anger fit when criticised or rejected. 

3. How to talk to someone with RSD? 

When talking to someone with RSD it is important to be empathetic and create a non-judgemental space to make them feel safe and loved. Try to clearly express your thoughts to avoid misunderstandings and create a supportive environment so that they can express their feelings. 

4. Is RSD a mental disorder? 

RSD is not considered an official disorder and is not mentioned in DSM-5 TR. However, psychologists use it as a symptom that can be related and linked to other psychiatric disorders.