Understanding Rejection Sensitive Dysphoria and its Connection to ADHD

Rejection Sensitive Dysphoria (RSD) is a phenomenon that can significantly impact the lives of individuals, particularly those with Attention Deficit Hyperactivity Disorder (ADHD). In this article, we will delve into the intricacies of RSD, explore its symptoms, causes, and discuss potential treatments.

What is Rejection Sensitive Dysphoria (RSD)?

Rejection sensitive dysphoria (RSD) is a condition characterized by extreme emotional reactivity and pain in response to experiences of rejection, exclusion, or criticism.

People with RSD have a strong tendency to overreact to even minor perceived slights. A passing comment or non-invite can prompt intense feelings of shame, inadequacy, and despair. Their emotional reactions feel out of proportion to the situation.

RSD is not an official psychiatric diagnosis, but many experts recognize it as a legitimate concern. The emotional dysregulation and impulsivity of ADHD appears to magnify painful reactions to rejection. RSD is considered a symptom cluster closely linked to ADHD’s neurobiology.

The ADHD-RSD Connection

Research reveals a strong, though complex association between rejection sensitive dysphoria (RSD) and ADHD:

• Up to 99% of adults with ADHD struggle with RSD symptoms ¹
• Certain ADHD-related brain differences may innately predispose people to RSD²
• ADHD symptoms like impulsivity, emotional dysregulation, and social struggles tend to exacerbate RSD³
• People with ADHD often experience frequent peer rejection, worsening rejection fears⁴
• Genetic factors linked to ADHD likely also play a role in RSD⁵

So while not all people with ADHD have RSD, the two conditions overlap and interact in important ways. Both inherited traits and environmental experiences appear to intersect - creating a heightened sensitivity to rejection.

If you have ADHD, be aware of your extra vulnerability to RSD. Work with your mental health provider to protect your self-esteem and handle difficult interpersonal situations adaptively. Though challenging, managing ADHD and RSD symptoms is possible with professional support.

Signs and Symptoms of RSD

Rejection sensitive dysphoria involves an array of emotional, psychological, and behavioral symptoms. Common signs include:

Emotional symptoms

• Intense reactions to perceived rejection or criticism, even minor slights
• Extreme emotional pain and shame when rejected or excluded
• Severe drops in self-esteem after criticism
• Difficulty self-soothing after a rejection
• Rapid mood swings based on how others treat you

Thinking patterns

• Obsessing and ruminating over being rejected
• Assuming others' neutral behavior is rejection
• Overanalyzing interactions for signs of dislike

Behavioral symptoms

• Withdrawing socially after feeling rejected
• Outbursts of anger or impulsivity
• Pleas for acceptance and people pleasing
• Over apologizing for perceived mistakes
• Avoiding situations where you may be rejected
• Self-medicating rejection pain with alcohol or drugs

Life impact

• Strained interpersonal relationships
• Disrupted work or school performance
• Curtailed social involvement due to avoidance
• Constant stress from hypervigilance around rejection

What Causes Rejection Sensitive Dysphoria?

The underlying origins of rejection sensitive dysphoria remain unclear, though researchers have some theories:

• Brain differences - Brain imaging shows RSD patients have atypical activity and structure in regions regulating emotions, like the amygdala and frontal cortex. These differences may predispose people to RSD.
• Genetics - RSD is closely tied to ADHD, which has genetic underpinnings. Certain gene variants affecting dopamine may contribute to emotional reactivity in RSD.
• ADHD factors - The social and emotional struggles common with ADHD, like peer rejection, may wire the brain to be hypervigilant about exclusion.
• Adverse experiences - Trauma and frequent criticism earlier in life may sensitize the threat response system.
• Temperament - Inherent sensitivity and emotional reactivity may interact with biological and environmental influences.
  

The development of RSD likely involves a complex interplay of inherited traits, brain changes, ADHD neurobiology, and life experiences. More research is needed to unravel the mysteries of RSD's origins and risk factors. But focusing on compassionate treatment in the present can help.

Getting an RSD Diagnosis

Since rejection sensitive dysphoria has no official diagnostic criteria, getting diagnosed can be challenging. There is no blood test or brain scan that can definitively detect RSD. Instead, mental health professionals make an RSD diagnosis based on a thorough evaluation of symptoms and life impairment.

To assess for RSD, a provider will likely:

• Ask questions about your emotional reactions to perceived rejection, exclusion, or criticism. Do you frequently feel humiliated, enraged, or crushed by minor slights?
• Explore your sensitivity levels in relationships, at school, or at work. Do you obsess or ruminate after perceived rejection?
• Assess functional impairment. Does emotional reactivity around rejection interfere with your academics, job performance, or relationships?
• Review your mental health history. A pre-existing ADHD diagnosis can support an RSD diagnosis.
• Have you complete questionnaires rating your level of rejection sensitivity.
• Speak to your loved ones to get examples of overreactions to exclusion.
• Rule out other conditions like borderline personality disorder.
  

While subjective and imperfect, these methods allow clinicians to identify extreme rejection sensitivity. More rigorous research is still needed to better define RSD diagnostically. But the suffering caused by RSD is real, and you deserve compassionate care.

Treatments for Rejection Sensitive Dysphoria

While no single treatment can "cure" rejection sensitive dysphoria, various therapies and medications can help manage symptoms.

Medications

Some medications that may help include:

• Stimulants like methylphenidate (Ritalin) or amphetamines (Adderall) - These ADHD medications can improve impulse control and emotional regulation.
• Alpha-2 receptor agonists like guanfacine (Intuniv) - This medication reduces norepinephrine activity, lowering emotional arousal.
• MAOIs such as phenelzine (Nardil) - These antidepressants have mood stabilizing effects that may aid with RSD's emotional volatility.

Therapy

Different forms of psychotherapy can provide coping techniques and skills training:

• Psychodynamic therapy can help uncover the deep-rooted causes of your Rejection Sensitive Dysphoria, offering insights and emotional regulation techniques for lasting relief and change
• Dialectical behavior therapy (DBT) focuses on distress tolerance and emotion regulation
• Mindfulness-based therapies promote non-judgmental awareness of emotions
• Cognitive behavioral therapy (CBT) helps identify and reframe negative thought patterns around rejection
• Interpersonal therapy improves communication and social skills

Other tips

• Join a support group to share struggles and solutions.
• Open up to trusted friends and family who can offer reality-checks.
• Identify personal triggers and establish self-soothing routines.
• Set healthy boundaries and communicate needs assertively.
  

While challenging, RSD becomes more manageable when met with compassion, professional support, and an arsenal of coping strategies.

The Takeaway on RSD

While not an officially recognized disorder, rejection sensitive dysphoria is an increasingly validated condition. RSD is characterized by extreme emotional sensitivity and painful reactions to perceived rejection.

RSD is strongly associated with ADHD - up to 99% of adults with ADHD struggle with RSD symptoms. The impulsivity, emotional dysregulation, and social difficulties typical of ADHD appear to exacerbate RSD.

RSD can devastate self-esteem, strain relationships, and impair functioning. However, various therapies and medications may help manage the intense emotional reactions. Support groups provide validation and coping strategies.

Further research is still needed to better understand the brain mechanisms and origins of RSD. But the suffering caused by RSD is very real. Seeking professional help and community support can make a profound difference.

If you identify with RSD’s hallmark sensitivity to rejection, you are not alone. Relief from RSD’s painful grip is possible. Reach out and take the first step today.

Frequently Asked Questions About Rejection Sensitive Dysphoria and ADHD

What are the symptoms of Rejection Sensitive Dysphoria (RSD)?

The symptoms of RSD can vary but generally involve extreme emotional sensitivity and emotional pain triggered by the perception of criticism or rejection. This can manifest as sudden mood swings, social withdrawal, or even aggressive behavior. It's essential to note that the emotional responses may seem disproportionate to the situation.

How is RSD related to ADHD?

ADHD, or Attention-Deficit/Hyperactivity Disorder, has been linked to Rejection Sensitive Dysphoria. While not everyone with ADHD experiences RSD, the two conditions often co-exist. The brain function and structure in individuals with ADHD, particularly in areas related to emotional regulation and impulse control, make them more susceptible to the symptoms of RSD.

Can RSD be treated?

Yes, treatment options for RSD include medication and psychotherapy, often in the psychodynamic model. At Relational Psych, for instance, we delve into long-term therapy work to uncover the root causes of your emotional sensitivity, typically tracing them back to childhood experiences.

What kinds of medication are used for RSD?

Various medications can be used to treat RSD, including stimulant medications and Monoamine Oxidase Inhibitors (MAOIs). These medications aim to regulate emotional responses and alleviate the symptoms. However, medication should always be prescribed by a healthcare provider based on an individual's specific diagnosis.

Can RSD lead to other mental health conditions?

Yes, if left untreated, RSD can contribute to other mental health conditions like depression and anxiety disorders. The emotional dysregulation and intense fear of rejection can significantly impact your self-esteem and overall mental health.

Is RSD hereditary?

While the research is still ongoing, there is evidence to suggest that both ADHD and RSD have a genetic component. It's not uncommon to find these conditions running in families, although environmental factors also play a significant role.

How can I get diagnosed for RSD and ADHD?

If you suspect you have RSD or ADHD, seeking a psychological assessment is crucial. At Relational Psych, we offer assessments that can help diagnose disorders like ADHD, providing a roadmap for treatment options, including in-depth therapy.

Are there any coping strategies for RSD?

Yes, coping strategies often involve psychotherapy where you can learn emotional regulation techniques. These strategies may include identifying triggers, improving communication skills, and developing healthier self-talk to bolster your self-esteem.

References

Scharf M, Oshri A, Eshkol V, Pilowsky T. Adolescents' ADHD symptoms and adjustment: the role of attachment and rejection sensitivity. Am J Orthopsychiatry. 2014;84(2):209-217. doi:10.1037/h0099391

Randazzo WT, Dockray S, Susman EJ. The stress response in adolescents with inattentive type ADHD symptoms. Child Psychiatry Hum Dev. 2008;39:27–38. doi:10.1007/s10578-007-0068-3

Babinski DE, Kujawa A, Kessel EM, Arfer KB, Klein DN. Sensitivity to peer feedback in young adolescents with symptoms of ADHD: examination of neurophysiological and self-report measures. J Abnorm Child Psychol. 2019;47(4):605-617. doi:10.1007/s10802-018-0470-2

Stenseng F, Belsky J, Skalicka V, Wichstrøm L. Peer rejection and attention deficit hyperactivity disorder symptoms: reciprocal relations through ages 4, 6, and 8. Child Dev. 2016;87(2):365-373. doi:10.1111/cdev.12471.