What you need to know about Rejection Sensitive Dysphoria RSD & ADHD

A Quick Guide

Rejection is never fun for anyone, but for those with Rejection Sensitive Dysphoria RSD in ADHD, it can cause an intense emotional reaction. It appears that individuals with Attention Deficit Hyperactivity Disorder are possibly more vulnerable to RSD. Though researchers are still unclear as to why this happens. This article explores the relationship between RSD and ADHD. RSD is a controversial subject in psychiatry, and there is still much to learn about it. Some mental health providers might not treat RSD because they don’t believe it to be a legitimate condition.

What Is Rejection Sensitive Dysphoria?

RSD is a condition that occurs when a person experiences severe emotional sensitivity and suffering in response to shame, rejection, or criticism, whether it is real or imagined. It’s still unclear how RSD and ADHD are related, according to researchers. 

Rejection-sensitive dysphoria is a prevalent but understudied and frequently misinterpreted symptom of ADHD, especially in adults. It is not a recognized diagnosis, but instead one of the most distressing symptoms of Emotional Dysregulation. Rejection-sensitive dysphoria is a brain-based symptom that is most likely an intrinsic component of ADHD. Despite the fact that experiencing it can be uncomfortable and even devastating. RSD is regarded not to be caused by trauma.

Literal Meaning

The Greek word dysphoria, which translates to “unbearable,” highlights the extreme physical and emotional suffering experienced by persons with RSD when they meet genuine or imaginary rejection, criticism, or taunting. Some people have used the analogy of a wound to express the emotional severity of RSD. The reaction is completely out of proportion to the nature of the incident that set it off. These common everyday experiences are substantially more difficult for people with RSD than they are for neurotypical people. They are excruciating, constricting, and severely limiting.

Internalized & Externalized emotional responses

This emotional response can resemble a full, serious mood disorder complete with suicidal ideation when it is internalized, which happens frequently for people with RSD. Rapid cycling mood disorder is sometimes misinterpreted as RSD because of the abrupt transition from feeling completely fine to extremely depressed that occurs as a result of RSD.

Whenever this emotional response is externalized, it appears as a powerful, instant rage directed against the person or event generating the pain.

While all other parts of interpersonal interaction appear normal, it can take time for doctors to realize that these symptoms are brought on by the abrupt emotional swings related to ADHD and rejection sensitivity. In fact, RSD is a typical sign of ADHD, especially in adults.

Common ways of coping

Due to the fact that they were never able to find any efficient coping mechanisms for the pain, one-third of the adult patients stated that RSD was the most debilitating component of their personal experience with ADHD. There are two basic strategies that people with ADHD use to deal with this enormous emotional elephant.

1. They start trying to please everyone

When they meet someone, they immediately scan them to see what they value and appreciate. They then exhibit this phony self to other people. More often than not they frequently lose sight of what they genuinely intended from their own lives when this objective takes such control of their life. They are too preoccupied with trying to avoid making other people angry.

2. They give up trying

It becomes too unpleasant or risky to make the effort if there is even the tiniest chance that one might attempt something unfamiliar and fail or come up short in front of everyone else. These intelligent, capable individuals avoid any anxiety-inducing activities and eventually give up things like dating, applying for a new job, or expressing themselves in public.

Some people overachieve and discover ways to adapt to their RSD symptoms. They continually strive for idealistic perfection and aspire to be the best at what they do. They can be driven by a desire to be faultless. While they live excellent lives, at what cost?

Symptoms of Rejection Sensitive Dysphoria

RSD symptoms might vary from person to person, however, they can include:

• An ongoing worry of being rejected.
• Imagining rejection while it is not happening.
• Interpreting even minor criticisms negatively.
• Mistaking requests for clarification, more information, or neutral feedback for rejection.
• Perfectionism or a desire to please others.
• Thinking about unpleasant events, especially those involving real or imagined rejection, repeatedly or compulsively.

Read: Understanding The Connection Between ADHD And Anxiety

Who is more prone to Rejection Sensitive Dysphoria?

There isn’t much information on exactly who develops RSD and how prevalent it is. However, those with ADHD appear to experience the condition the most frequently. It has also been connected by experts to other personality and mood disorders. But more research is needed to determine the prevalence of this problem and who is affected by it.

What’s the difference between rejection sensitivity and rejection-sensitive dysphoria?

Even while RSD and rejection sensitivity are closely related, there are some minor variations. It helps to first be familiar with the condition known as Emotional Dysregulation in order to comprehend the differences.

What is Emotional Dysregulation?

The connections between the various parts of the human brain are intricate. These sections perform a variety of tasks, with some handling memory, emotions, sensory input, etc. As you become older, your brain develops the ability to control those impulses and maintain manageable amounts. This is similar to how a TV’s volume control works when it maintains sound levels that are comfortable for you.

When your brain struggles to control the signals associated with your emotions. It is said to be suffering from Emotional Dysregulation. It’s like if the TV volume control is set to an annoying or excruciatingly high volume without the option to control it. Emotional dysregulation is essentially when your feelings are too strong for you to control. That may leave you feeling overpowered, uneasy, or even in pain. Numerous illnesses, especially those that alter the structure or information-processing mechanisms of your brain, might cause Emotional Dysregulation. It frequently occurs with personality disorders, mood disorders, and other conditions.

Emotional dysregulation and rejection sensitivity

Both RSD and rejection sensitivity have Emotional Dysregulation. As opposed to dysphoria. People who are sensitive to rejection may do any of the following:

• Experience intense anxiety or other negative feelings before receiving a rejection.
• Have a hard time interpreting negative interactions (such as neutral or ambiguous responses) as anything else other than rejection and respond accordingly.

Rejection-related overreactions can cause people to act out of negative emotions like hatred, pain, great sadness, worry, etc. All of these things are feasible with RSD, but there is one additional element. RSD people experience an intense if not completely overwhelming, level of emotional suffering.

Is Rejection Sensitive Dysphoria a symptom of ADHD?

Although it is not a recognized symptom of Attention Deficit Hyperactivity Disorder ADHD or ADD in the United States, Rejection Sensitive Dysphoria is one of the six key characteristics used to diagnose ADHD in the European Union. However, it is not included in the DSM-V for Attention Deficit Hyperactivity Disorder ADHD or ADD. It is commonly known that the DSM-diagnostic V’s criteria for ADHD have never been tested in a population of individuals older than the age of 16 and that they only apply to children in elementary school (ages 6 to 12).

They simply take into account visible and countable observational or behavioral factors. Because these characteristics are difficult to quantify, the standard diagnostic criteria purposefully overlook symptoms linked to emotion, thinking patterns, relationships, sleeping, etc. The DSM-V criteria are nearly useless for clinicians who work with older teens and adults. Because they overlook so many important factors that are crucial to understanding how those with an ADHD nervous system view their lives.

Emotional Dysregulation in ADHD

The concepts of RSD and Emotional Dysregulation are relatively new. And both patients and their families immediately embraced this new understanding of the emotional component of ADHD since it so closely mirrored their own experiences. However, the response from many clinicians and medical professionals was extremely unfriendly. Many professionals were unaware of the emotional aspect of ADHD, which had always existed but was purposefully ignored. They felt that the idea lacked any actual or historical foundation. Additionally, just a small amount of research had been published just a few years back. And the majority of those studies originated in the European Union, where the term Emotional Dysregulation ED, was used rather than RSD.

These barriers are being swiftly removed in order to recognize RSD/ED as a significant and defining feature of adult ADHD and to use medications to provide some help from the discomfort and disturbances caused by this aspect of ADHD. In a relatively brief period of time, the amount of research available has rapidly increased. RSD/ED is now officially recognized as “a thing” in the EU, where the definition of adult ADHD was changed to include emotional self-regulation as a crucial component of the diagnostic criteria.

Despite this, there are at minimum three factors why Emotional Dysregulation or RSD may never meet the diagnostic standards for ADHD:

• RSD/ED do not always exist. The episodes are brought on by triggers.
• People with RSD/ED typically suppress their overreactions out of embarrassment and to avoid being viewed as mentally or emotionally unstable.
• Even though RSD/ED is present, it cannot be assessed, which makes it impossible to publish studies on it.

As a result, Emotional Dysregulation was purposefully left out of the diagnostic criteria for ADHD and was essentially ignored for a long time.

Developments over the last decade

Researchers have created a number of fresh perspectives on ADHD across the lifecycle in the last ten years. The European Union released its 10-year update of the Consensus Guidelines on Adult ADHD by the end of 2019, which redefined teenage and adult ADHD and listed difficulties with emotional regulation as one of just six key characteristics of ADHD symptoms:

• Attention deficit and hyperfocus
• Behavioral self-regulation
• Emotional dysregulation
• Excessive daydreaming
• Hyperactivity
• Impulsivity

The fundamentals are similar, even if the EU has opted to use the more inclusive term Emotional Dysregulation ED rather than RSD. What is meant by Emotional Dysregulation is:

• The sort of Emotional Dysregulation associated with ADHD has been described as lacking the ability to control emotional symptoms including irritation, annoyance, and anger as well as a low tolerance for frustration, temper outbursts, emotional impulsivity, and mood instability.  
• The Emotional Dysregulation that occurs in ADHD is distinct from episodic symptoms such as severe continuous irritation that takes place in the context of changed mood states, like an episode of acute sadness or mania. 
• When a person has ADHD, their emotional symptoms frequently reflect brief, exaggerated shifts that are frequently in response to everyday occurrences and quickly return to normal after a few hours.

Outlook

For those who have RSD, rejection can be very agonizing. Despite the lack of conclusive studies, analysts argue that RSD is more prevalent among those who have ADHD, potentially as a result of difficulties processing and regulating emotions. A person should consult a therapist, psychiatrist, or primary care physician about the next steps if they believe they have RSD, ADHD, or another disorder that affects their mental health. 

We hope you found this article useful for understanding more about Rejection Sensitive Dysphoria RSD, Rejection Sensitivity, Emotional Dysregulation, and how all that relates to ADHD.

Learn more about the treatment of Rejection Sensitive Dysphoria In ADHD.