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What is Rejection Sensitivity Dysphoria?

Attention Deficit Hyperactivity Disorder (ADHD) was once considered a childhood issue, however it is now acknowledged in approximately 50-65% of adult individuals (1,2).  The symptoms that are usually associated with ADHD are: being easily distracted, impulsive behavior, time blindness, and forgetfulness, however one of the most overlooked symptom is emotional dysregulation.  In fact approximately 70% of those with ADHD struggle with managing moods and feelings (3). Furthermore, research demonstrates adults with ADHD show higher perceived criticism that those without ADHD which  may contribute to poorer mental health (4, 5).

Has anyone accused you of being “too sensitive? Too dramatic? Or too emotional?” Perhaps you experience a deep pain when you believe you are being criticized or rejected? This intense response is called rejection sensitivity dysphoria (RSD).  Simply put, RSD is an increased sensitivity to rejection AND the rejection does not have to be real.  It can be imagined or feared. Another issue with having ADHD and RSD is that the memory of all past intense experiences of hurt and rejection are recalled as if it just happened.

First I am here to say the answer is NO. You are not a “drama queen” or “thin-skinned”, it is simply a matter of perceiving experiences more intensely than others.  Your feelings are still REAL and VALID.  Second, I hope this article offers you some comfort knowing you are not alone and struggling with overwhelming emotions can be very difficult.  Remember being sensitive and experiencing love are wonderful gifts and for me, ones I would like to see more often in society.  

It is important to note that RSD is not a medical diagnosis or a medical ailment.  Also, RSD is not exclusively associated with ADHD or any other condition, however it is commonly seen among people living with ADHD.  The literature suggests links with RSD and depression and bipolar disorder (6). 

What are Signs of RSD?

RSD symptoms may include:

  • Misinterpret others and situations
  • Perfectionism or people-pleasing characteristics
  • Experiencing rejection when none is truly present
  • Put up emotional walls
  • Exhibit extreme fear
  • Difficulty receiving feedback

These symptoms are common in some other mental health conditions such as:  Bipolar disorder, Borderline personality disorder, Post traumatic stress disorder (PTSD), Obsessive-compulsive disorder (OCD), Depression and Social Phobia. However, a big difference is that when experiencing RSD the episode is intense but doesn’t last very long.

How can I help?

If you have a friend or family member who has ADHD and experiences RSD, try these methods to support them:

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Listen to their experience

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Reassure them

Simply stating “I’m not rejecting you and I still love/like you.”

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Respect boundaries

Showing respect for their feelings and needs when they are feeling overwhelmed.

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Understanding

Your perception and their perception of the situation may be different.

References

  1. Fayyad J, Sampson NA, Hwang I, et al. The descriptive epidemiology of DSM-IV Adult ADHD in the   World Health Organization World Mental Health Surveys. Atten Defic Hyperact Disord 2017; 9: 47-65.
  2.   Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity       disorder: a meta-analysis of follow-up studies. Psychol Med 2006; 36: 159-165.  
  3.   Beheshti, A., Chavanon, M., and Christiansen, H. Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC Psychiatry 20, 120 (2020). https://doi.org/10.1186/   s12888-020-2442-7
  4.   Beaton DM, Sirois F, Milne E. Experiences of criticism in adults with ADHD: a qualitative study. PLoS One 2022; 17: e0263366.
  5.   Beaton DM, Sirois F, Milne E. Self-compassion and perceived criticism in adults with attention deficit       hyperactivity disorder (ADHD). Mindfulness 2020; 11: 2506-2518.
  6.     Shuling Gao, Mark Assink, Andrea Cipriani, Kangguang Lin,  Associations between rejection sensitivity and mental health outcomes: A meta-analytic review, Clinical Psychology Review,Volume 57, 2017, Pages 59-74, ISSN 0272-7358,  https://doi.org/10.1016/j.cpr.2017.08.007.
  7. Illustrations: Kate Jones (graphic designer)

Meet The Author

Laura Kobar, Clinical Therapist at Sea Glass Mental Health

LAURA KOBAR

MS, MC, LMHC, LPC

Meet The Author

Laura is a Clinical Counselor at Sea Glass Mental Health.  Laura specializes in ADHD, trauma, anxiety, depression, and DBT. She works with teen, couples, and adult populations.

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