What is Rejection Sensitivity Dysphoria?
RSD shows as an extreme emotional reaction to the fear of rejection and failure. Unlike typical feelings of disappointment or sadness that people might experience, those with RSD feel an overwhelming wave of emotion. In some people it can be debilitating.
Dr. Shyamal Mashru is a consultant psychiatrist, specialising in Adult ADHD, anxiety, depression, OCD and trauma. He explains, “RSD is described as a complex and intense emotional response that occurs when someone perceives or actually experiences rejection or criticism.” This condition can lead to significant distress, affecting personal and professional relationships and often leads to avoidance of social situations where rejection could occur.
For adults with ADHD, RSD can complicate already challenging interactions by intensifying their emotional responses. This can lead to rapid mood swings and may show as internalised symptoms (e.g. depression and anxiety) or externalised symptoms like anger and hostility to other people. The fear of rejection becomes so extensive that it can prevent individuals from engaging in new opportunities or maintaining existing relationships.
According to Dr. Mashru, “Patients describe Rejection Sensitivity Dysphoria almost as a physical pain that can destroy them for a long period. It comes on suddenly and they can’t control it.”
The intensity of RSD responses can severely disrupt lives, particularly when the person feels that their emotional reactions are disproportionate and uncontrollable.
Treatment for Rejection Sensitivity Dysphoria
Managing RSD involves a combination of understanding the condition, psychological strategies and possibly medication. Dr. Mashru explains that some treatments, such as alpha agonists, show promise in moderating the emotional responses associated with RSD, but they are not officially licensed for this purpose in all countries. These medications are thought to help dampen the intensity of emotional reactions, providing a “protective armour” against the pain of perceived rejection. “Patients often describe a more tempered emotional response when on these medications, though it is essential to note that this is not a universal solution and is still under research,” he notes.
Due to the intense emotional fluctuations associated with RSD, it can be misdiagnosed as other conditions e.g. bipolar disorder or borderline personality disorder. Dr. Mashru emphasises the importance of accurate diagnosis, noting that many people with RSD experience relief when their condition is correctly identified and treated. This relief often stems more from improved emotional regulation and self-understanding than from any direct improvement in attention or hyperactivity symptoms.
Despite its profound impact, RSD is not currently recognised in the diagnostic criteria for ADHD. This omission can lead to oversight in treatment plans and lack of support for those affected. Dr. Mashru advocates for its inclusion, “Incorporating RSD into diagnostic frameworks would validate the experiences of many experiencing symptoms associated with the condition, and guide clinicians in developing more comprehensive treatment approaches.” He calls for a holistic approach to ADHD treatment, where emotional symptoms are treated with as much importance as other aspects of the disorder. This approach would recognise the deep-seated emotional turmoil that RSD can create and provide strategies for individuals to manage their symptoms.
He continues, “The second form of treatment, which I think is actually where you should go to first with this type of experience, is talking therapy.” Counselling, including cognitive-behavioural techniques and mindfulness can help people recognise and regulate their emotional responses, providing them with tools to manage their sensitivity to rejection.
Rejection Sensitivity Dysphoria is a significant challenge for many adults with ADHD, but recognising and addressing it can lead to substantial improvements in quality of life. With appropriate therapy and support, those affected by RSD can learn to navigate their sensitivities better, leading to more stable and fulfilling relationships and a better understanding of themselves. As research continues, it is hoped that more tailored treatments will become available to help those affected by this intense aspect of ADHD.
