We all want to be rejected by someone in our lives, right? It could be in a romantic relationship, a friendship, or even at work. When that happens, it's normal to feel sad, angry, or disappointed. But we can usually control and manage those feelings for a while and get back to normal.
But imagine, what if a rejection causes you so much emotional pain that you can't even bear it, so much so that you can't even think about controlling those feelings? You may have what doctors call " rejection sensitive dysphoria" (RSD) . Research has shown that if you have Attention Deficit Hyperactivity Disorder (ADHD) , you are more likely to develop RSD.
What exactly is this RSD?
RSD is not an officially recognized condition with a list of symptoms. That is, it is not considered a separate medical condition. However, doctors and psychologists use the term to describe the exaggerated emotional responses to rejection that are often associated with officially recognized behavioral conditions like ADHD.
The word "dysphoria" comes from the Greek language. It means "severe pain or discomfort." People who experience RSD find it very difficult to cope with rejection. In fact, they find it difficult to describe the feeling in words. They often use words like "unbearable" and "devastating." Because of this, some people avoid social interactions out of fear of rejection.
What is the connection between this condition and ADHD?
Research is still unclear about who gets RSD and how it relates to ADHD, as rejection is difficult to measure. But experts believe that people with ADHD are more likely to show symptoms of RSD because of certain changes in their brain structure.
A person with ADHD has a slightly different frontal lobe of the brain, which controls things like attention, language, social skills, impulse control, judgment, and problem-solving. As a result, you may miss some social cues, have difficulty working with a group, or be unable to pay attention to details.
Because of this, when others say something about your behavior , or say something vague, you may misinterpret it as criticism, ridicule, or rejection .
This misunderstanding can cause you to feel overwhelming feelings of frustration, pain, sadness, and betrayal. You may have difficulty controlling these feelings as quickly as someone without ADHD.
RSD may also be associated with other mental illnesses and mood disorders, but more research is needed to fully understand this.
What are the common characteristics of RSD?
Although RSD is not an official disease, people with the condition may commonly exhibit the following symptoms. Let's see if these sound familiar to you.
| Characteristic | Description |
|---|---|
| Trying to please others (People-pleasing) | Trying to please others too much to avoid rejection. |
| Low self-esteem | Loss of self-confidence, constant self-doubt and shame. |
| Sudden emotional outbursts | Emotions that are even physically expressed, such as sudden outbursts of anger, tears, and unbearable sadness. |
| Negative self-talk | Always blaming yourself when something goes wrong or is rejected. |
| Social isolation | Avoiding social opportunities, work, and responsibilities due to fear of rejection. |
| Perfectionism | Trying to do everything perfectly to leave no room for criticism or failure. |
Sometimes, fear of disapproval or rejection from others can cause you to avoid certain tasks and responsibilities or withdraw from social interactions altogether. This can have a significant impact on your quality of life.
What causes RSD?
Experts still don't fully understand what causes this, but some believe the structure of your brain has something to do with it.
The amygdala and prefrontal cortex are the parts of the brain that process rejection, failure, emotion recognition, and negative messages. They are located in the front of the brain. Typically, as we age, these parts become better at controlling and organizing emotions.
But in people with certain mental or behavioral conditions, the brain can't properly regulate these signals. Instead, the brain interprets negative emotions as something that is too painful and overwhelming to handle. This is what experts call " emotional dysregulation ."
In addition to brain structure, some experts believe there may be a genetic influence, especially since ADHD, the condition most closely associated with RSD, is passed down from generation to generation.
How is this condition diagnosed and treated?
Because RSD is not an official medical condition and research on it is limited, your doctor or counselor may not know much about it, or may confuse it with another mental illness.
But if you've already been diagnosed with ADHD or another mental illness, your doctor may be able to recognize this rejection sensitivity behavior pattern.
There is no specific cure or treatment for RSD. However, some medications and therapies used for ADHD and other mental illnesses can help regulate these severe emotional responses.
Drug treatment
- Alpha-2 receptor agonists: Drugs like `guanfacine (Intuniv)` and `clonidine (Kapvay)` improve the brain's ability to receive and process emotional signals.
- Stimulant medications: Drugs like amphetamine (Adderall) and methylphenidate (Ritalin) stimulate the chemical messengers (neurotransmitters) that carry signals between brain cells. This helps the brain process the messages it receives better.
- Monoamine oxidase inhibitors (MAOIs): These are commonly prescribed for depression. They have also been found to help reduce sensitivity to rejection. However, these medications should not be taken with other ADHD medications or with certain foods (e.g., aged cheese, meat). Doing so can cause dangerously high blood pressure.
Most importantly: If you have any of these symptoms, be sure to talk to your doctor. Do not take any medication without your doctor's advice.
Therapy
In addition to medication, treatments such as Cognitive Behavioral Therapy (CBT) and talk therapy can be very helpful. These therapies help you gain insight into your own emotional responses.
This therapy also helps you develop good habits, such as listening to the other person, asking for clarification when things are unclear, and taking time to think instead of reacting immediately. Over time, you will be able to develop the tools and techniques you need to manage your emotions in different social situations.
Special Notice: If you or someone you know is having thoughts of harming themselves, please go to the nearest hospital Emergency Department (ETU) immediately. It is very important to seek medical advice.
Take-Home Message
- Rejection Sensitive Dysphoria (RSD) is an extreme, unbearably painful emotional response to rejection.
- Although this is not an officially recognized medical condition, it is common, especially among people with ADHD.
- It is believed that changes in brain function and genetic factors may be responsible for this.
- This condition can be managed with medication and, especially, treatments such as cognitive behavioral therapy (CBT).
- If you or someone you know has these symptoms, it is very important to seek advice from a qualified doctor rather than suffering alone.
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