Do you feel very strongly when someone rejects you? This could be Rejection Sensitive Dysphoria (RSD)!

Sometimes when someone rejects us, it's normal to feel a lot of sadness and pain in our hearts. But have you ever felt such overwhelming emotional pain, such a breakdown, even in the face of a minor rejection? Does an event that seems normal to others cause you great shock? If so, maybe there's a special name for what you're experiencing that doctors call it. Let's talk about it.

What is Rejection Sensitive Dysphoria (RSD)?

Simply put, RSD is a very intense, unbearable psychological pain that a person experiences when they are rejected. The word ``dysphoria`` comes from the Greek language. It means unbearable pain or discomfort.

RSD is not yet an officially recognized medical condition. However, doctors and specialists use the term to refer to some of the already recognized mental health conditions.

Normally, none of us like to be rejected. But the pain that a person with (RSD) feels is much stronger and harder to control. Also, people with (RSD) can sometimes misinterpret even vague, normal conversations as rejection. They may then have a hard time controlling their response to it.

What is the difference between Rejection Sensitivity (RSD) and Rejection Sensitivity (RSD)?

This (RSD) and ``rejection sensitivity`` are very similar. But there are some subtle differences. To fully understand this difference, we first need to understand what ``emotional dysregulation`` is.

What is this emotional dysregulation?

Think of it like a big network. Each part of it works together. Some parts store memories, others control emotions, and still others receive information from our senses. As we grow older, our brains learn to control these emotions, that is, to keep them at a level that we can tolerate. It's like turning the volume (`volume`) on a TV as much as we want.

So, emotional dysregulation is when our brains can't properly regulate our emotions. When that happens, it's like having to turn the volume down on the TV and it's so loud that it's almost deafening. That is, your emotions are so loud that you can't stand them. You may feel dizzy, overwhelmed, and even in pain.

This difficulty in controlling emotions can be seen with many mental conditions, especially those that affect the structure of the brain or the way it processes information. For example, it is common with personality disorders and mood disorders.

The relationship between emotional dysregulation and rejection sensitivity (RSD)

Both those with rejection sensitivity and those with RSD may have difficulty regulating their emotions. But the 'dysphoria' I mentioned earlier, which is severe pain , is only present in RSD.

A person with ``rejection sensitivity`` may experience the following:

• When you think someone will reject you, you feel intense anxiety or some other bad feeling.
• Even if it's not negative, that is, a general or vague response, it's still considered a rejection. That's how they behave.
• They overreact to the feeling of rejection. This means they express emotions like anger, rage, extreme sadness, and unbearable anxiety.

All of these things can happen to someone with (RSD). But, there's one more thing: People with (RSD) say they experience intense, unbearable emotional pain .

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

As mentioned earlier, the main symptom of RSD is intense emotional pain. This pain usually occurs when someone rejects or shows disapproval. However, it is difficult for people with RSD to describe what this pain feels like, because it is so intense and different from other emotional pains.

People with RSD may exhibit the following symptoms and behaviors:

• They feel embarrassed very easily, and feel insecure about themselves . Imagine, you called a friend and he couldn't pick up the phone. You might suddenly think, 'Oh, is he going to let me through? Am I a nuisance?'
• They show low self-confidence and low self-esteem . Thoughts like 'I can't do this' and 'I'm useless' may come up frequently.
• It is difficult to control emotions when someone feels rejected. This is especially true for children and young people with this condition. Some may suddenly show intense anger and rage . Others may suddenly start crying loudly . Imagine, even if the teacher at school scolds them for something small, some children will come home and close the door and cry for hours.
• Some people with RSD bottle up their emotions rather than expressing them. This can look like a sudden onset of severe depression. Sometimes, it can be mistaken for the sudden mood swings that people with bipolar disorder or borderline personality disorder experience.
• They often become ``people pleasers'' . They try incredibly hard not to be disliked by others. If a friend asks for a little help, they won't say 'no', no matter how difficult it is for them, because they are afraid that they will not like it.
• They avoid starting projects, tasks, and goals that are likely to fail. They are afraid of what others will think if they fail.
• As if to compensate for their fear of failure or rejection, they try to do everything to the best of their ability (`perfectionism`). They think that everything should be perfect. But the other side of this is that they feel constantly anxious. They may lose time to think about their health and rest.

Who does this (RSD) condition affect? ​​How common is it?

There is still limited research information on exactly who RSD affects and how common it is. However, it seems to be most common among people with ADHD (Attention Deficit Hyperactivity Disorder) . ADHD stands for Attention Deficit Hyperactivity Disorder. In addition, experts have linked it to other personality and mood disorders. However, more research is needed to determine exactly who RSD affects and how common it is.

What are the causes of (RSD)?

Experts aren't sure exactly what causes RSD, but they suspect that it's caused by problems with the structure of your brain . They also think it's caused by the same factors that cause ADHD.

Researchers know that social rejection—even if it’s vague and uncertain—works in our brains in the same way that it works when we feel pain. They also know that the way information is communicated within the brains of people with ADHD is different than the brains of people without ADHD. The parts of the brain that process and control information are less active in people with ADHD. This means that brain activity is less filtered.

This change in the way the brain controls information flow is why people with ADHD have difficulty processing information from their senses. It is also why they have difficulty coping with sudden loud noises, bright lights, or sudden changes in their environment. The brain of someone with ADHD may not be able to handle these painful sensations. This may be why rejection can be so painful for someone with RSD.

Genetic relationships

ADHD is a genetic condition. This means it can run in families. Similarly, RSD, which is closely related to ADHD, is also likely to have a genetic link.

Is (RSD) contagious?

No, RSD is not a contagious disease. You cannot catch it from anyone, nor can anyone catch it from you.

How to identify (RSD)?

(RSD) is not an officially recognized medical condition. And there is limited scientific research on it. Therefore, healthcare providers, including doctors, may not have much knowledge or experience about it.

Instead, doctors may suspect you have it based on your symptoms and whether you have other conditions, such as ADHD. Unfortunately, some doctors may not diagnose it, either because they are unaware of RSD or because they mistake it for another condition.

How is RSD treated? Is there a complete cure for it?

Although there is much that experts do not know about (RSD), there are ways to treat it. Treatments can vary. It is common to use several treatments at the same time.

Medications

Medications are the main way to treat (RSD). These medications are usually given for (ADHD) and related conditions. What happens is that when these conditions are treated, the medication affects the same parts of the brain that cause (RSD) symptoms. So when you treat one condition, it also affects the other. Some other conditions affect the same parts of the brain as (RSD), and the medications given for those conditions may help with this as well.

Because RSD is not an officially recognized medical condition, there are no specifically approved medications to treat it. Instead, doctors use a method called ``off-label prescribing.''

Off-label prescribing is when a doctor prescribes a drug for conditions other than those for which it is approved. This is legal and medically acceptable. It is also reasonable to do so if there is evidence that a drug has a low risk of serious side effects and is effective even when used off-label.

Medications like these can help treat RSD:

• Alpha-2 receptor agonists : These medications activate a special type of chemical receptor on brain cells (neurons). When medications like clonidine and guanfacine activate these receptors, those parts of the brain become more active. This makes it easier for the brain to control the flow of information within itself, reducing the effects of RSD.
• Stimulant medications : These medications increase the levels of certain neurotransmitters in your brain. Neurotransmitters are chemical messengers that the brain uses to communicate information and start or stop certain processes. When certain types of neurotransmitters are increased, activity in specific parts of the brain increases. Stimulant medications, such as amphetamine/dextroamphetamine (commonly known as Adderall®) and methylphenidate (better known as Ritalin®), activate the parts of the brain that control information transfer.
• Monoamine oxidase inhibitor (MAOI) medications : This class of medications is used to treat depression. However, experts know that medications like tranylcypromine (tranylcypromine) can also help with RSD. However, these medications should not be taken with other common medications for ADHD. Also, you need to be very careful about what you eat and drink. Some foods, such as aged cheese and aged meat, can react with MAOIs and cause dangerously high blood pressure.

Psychotherapy

Psychotherapy (sometimes called mental health counseling) can help people with RSD. Counseling cannot stop RSD from happening or change the symptoms. However, it can help a person understand their feelings and learn how to manage them. This helps them feel less overwhelmed and in control of their emotions.

What are the possible side effects or complications of treatment?

The side effects and complications that can occur with different treatments depend on several factors. It varies, especially depending on the treatment method. Therefore, your doctor is the best person to tell you what side effects or complications you may experience, and what you can do to limit their impact on you.

How can I take care of myself or manage symptoms on my own?

If you think you have (RSD), it's important to see a doctor to rule out a related condition, such as (ADHD). It's also a good idea to talk to a mental health counselor . Some people can learn to manage (RSD) on their own, but it can be difficult. (RSD) is caused by something to do with the way your brain works.

People with RSD often have other mental health conditions, such as anxiety and depression. In many cases, learning to live with the condition requires a combination of medication and mental health counseling. Your doctor can recommend treatment options and educate you about things that can help you manage RSD.

How soon will I feel better after treatment?

The time it takes to see a difference from treatment depends on the type of treatment you receive. Medication can help with symptoms, but mental health counseling is the best way to learn to live with RSD.

Because everyone's brain is different, and conditions like ADHD and RSD don't affect everyone the same way, the time it takes to see changes and recover can vary. Your doctor is the best person to talk to about this.

Can the formation of RSD be reduced or completely prevented?

Unfortunately, RSD occurs for reasons that experts still don't understand or predict. Therefore, there is currently no way to prevent it or reduce the risk of developing it.

What can I expect if I have (RSD)?

People with (RSD) often develop behavioral and mental health problems that stem from a fear of rejection. Children with both (ADHD) and (RSD) often experience problems such as low self-esteem, fear of failure, and severe social anxiety . These problems can affect schoolwork, social relationships, friendships, and more. Researchers have found that rejection sensitivity is also linked to a higher risk of developing a personality disorder.

Adults with RSD are more likely to experience anxiety, depression, and loneliness . People with RSD tend to avoid situations that are uncertain about outcomes, success, or achievement. This can lead to them missing out on career opportunities, friendships, or romantic relationships.

How long does (RSD) last?

There is limited research to show how long (RSD) lasts. In some people, (ADHD) may go away as their brains develop, meaning the condition may resolve on its own. For those who do not, (ADHD) can often be a permanent, lifelong condition.

However, diagnosis and treatment – ​​especially early in life – can help people adapt and manage it. Ultimately, people with RSD can learn to overcome its effects, or at least limit its impact on their lives.

What is the outlook for this situation?

(RSD) is not dangerous on its own. But it is associated with conditions that can be dangerous. The most important of these are anxiety and depression. These can increase the risk of self-harm or suicide.

When should you seek emergency treatment?

If you are having thoughts of harming yourself, including suicidal thoughts , or harming others, you should get help right away. And if you suspect that someone you know is in imminent danger of harming themselves, get them help right away.

To get help in situations like this, you can:

• If in Sri Lanka, call the National Mental Health Helpline at 1926 (this is open 24 hours a day).
• If there are crisis lines from mental health organizations and centers in your area, you can get help from them.
• Call your local emergency number, such as 119 (police emergency) or 1990 (ambulance service) . If you feel that you or someone you know is in immediate danger of harming themselves or committing suicide, call these numbers. Operators of these emergency lines can help and send first aid to people who are in immediate danger due to a severe mental health crisis.

How do I take care of myself? (More tips)

If you think you may have (RSD), it's important to talk to a healthcare professional who has expertise or experience in treating (ADHD) and related conditions. A doctor is the best person to diagnose (RSD), guide you through treatment options, and help you manage the condition.

Also remember these things:

• Medication makes a big difference. If medication is part of your treatment plan, it's important to make it a part of your daily routine. These medications can make it easier for you to understand and manage RSD and its effects.
• Find a counselor who you trust and meet with them regularly. Learning to change your thought processes and behavior patterns is essential to managing RSD. Counselors can help you think in new ways and develop strategies to reduce the impact of RSD on your life.
• Make self-care a priority. Stress and anxiety can make RSD worse. Finding ways to reduce your stress can help you cope with RSD.
• Be kind to yourself. Failure and rejection are things that everyone experiences at some point in their lives. Understanding and accepting them is part of managing (RSD). When you experience these feelings, finding ways to acknowledge and understand them in a healthy way can help you avoid quick reactions that you may later regret.

If I think my child has (RSD), how can I help him/her?

Children with ADHD are also at a higher risk of developing RSD. If your child is showing symptoms of either of these, you can do these things to help them:

• Talk to a doctor. Early diagnosis and treatment can make a big difference in the overall impact of RSD and related conditions.
• Understand that (RSD) is real and how it works. Research has shown that (ADHD) is a condition caused by specific changes in the brain of the affected person. These changes are often the cause of (RSD). This means that children with these conditions, no matter how much they want to and how hard they try, may not be able to control their behavior because of the way their brains work.
• Be patient. Children with ADHD face challenges (you can learn more about this in our article What Does It Mean to Be Neurodivergent?). Constantly blaming others can exacerbate the effects of ADHD, making it even worse for the child.
• Help your child develop resilience. Failures and rejections happen to everyone. Teaching children to learn from failures and get back up again will help your child cope with RSD and its effects.

So, what are the things we need to remember from all of this?

Rejection Sensitive Dysphoria (RSD) is a condition that affects your ability to control your emotional responses to rejection and failure. Although rejection is always unpleasant, people with RSD experience unbearable emotional distress. This can lead to long-term mental health problems, a fear of failure, and behavioral changes that can have a negative impact on them throughout their lives.

Although RSD is not an officially recognized medical condition, evidence and understanding of how it works is growing. Healthcare providers, including doctors, can treat it using treatments and approaches that help with similar or related conditions.

If you suspect you have (RSD), talk to a doctor who specializes in conditions like (ADHD). These professionals are the best people to help you understand the problem and learn to manage it. Remember, you are not alone, and help is available.

` Rejection Sensory Dysphoria, RSD, ADHD, Emotional Regulation, Mental Pain, Mental Health, Emotions