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Emotionality & RSD
Understanding and navigating the world of Rejection Sensitive Dysphoria
What Is
Rejection Sensitive Dysphoria?
Rejection Sensitive Dysphoria (RSD) is intense, overwhelming emotional pain related to real or perceived rejection or criticism from others. It may also be caused by a sense of falling short of others’ expectations or not measuring up to one’s own high standards. People with RSD don’t handle rejection or criticism well. In fact, those with RSD may even experience actual physical pain from feelings of rejection or failure.
RSD is linked to emotional dysregulation, which is often a symptom of ADHD in adults. Emotional dysregulation occurs when your brain can’t properly regulate the signals related to your emotions, and you end up being overwhelmed and unable to manage your emotions, including the negative feelings related to rejection.
RSD that is not managed or treated can result in a fear of failure and rejection, as well as behavior changes that can negatively impact one’s ability to lead a happy, fulfilling life.
While the pain experienced with RSD can be traumatic, it is not caused by trauma. It’s also important to remember that it is not a sign of weakness – it’s simply a condition that’s linked to ADHD, and experts believe it is the result of differences in brain structure and function.
What are the signs of RSD?
Since RSD isn’t an official medical condition and there’s limited research on it, your doctor, counselor, or licensed therapist might not know much about it or they may mistake it for another condition, such as bipolar disorder or social anxiety disorder.
Signs that someone may have RSD:
- The have sudden emotional outbursts (e.g. anger, rage, crying) following real or perceived criticism or rejection
- They engage in negative self-talk, low self-esteem and poor self-perception
- They avoid social settings, projects, or tasks where they might fail or be criticized
- They are intensely focused on avoiding the disapproval of others (i.e. “people-pleasers”)
- They exhibit perfectionism or excessively high standards
- They easily feel embarrassed or self-conscious
- They may suddenly become quiet, moody, or show signs of depression or anxiety
- They have a persistent fear of being rejected or criticized
- They often feel frozen or unable to start something due to fears over not being good enough
- They find it emotionally draining to manage relationships, and may feel like they are constantly being attacked
Treatment
How can RSD be treated?
There hasn’t been a lot of research into RSD, and it is not an officially recognized medical condition. However, it can be treated, usually with a combination of medication and therapy. The medications used to treat RSD are typically used to treat ADHD and related conditions, as well.
The following medication types are often used to treat RSD:
- Alpha-2 Receptor Agonists (e.g. Clonidine and Guanfacine): These medications make it easier for your brain to regulate internal communication, reducing the effects of RSD.
- Stimulant medications (e.g. Adderall® and Ritalin®): These medications make the areas of the brain that regulate communication more active, thus reducing RSD symptoms.
- Monoamine Oxidase Inhibitor (MAOI) medications (e.g. Tranylcypromine): These medications, which are sometimes used to treat depression, can also help with RSD. However, these medications must be used with caution. You can’t take them at the same time as other common medications for ADHD; you also can’t eat certain foods (such as aged or strong cheeses, aged meats, etc.) because they can interact with MAOIs and cause dangerously high blood pressure.
Psychotherapy is often used in conjunction with medication to treat people with RSD. Therapy doesn’t prevent RSD from happening or make the symptoms go away – it simply helps those with RSD to better process and manage feelings of rejection so they’re less overwhelming, and as a result, they feel more in control of their emotions.
Consulting
Tailored RSD Solutions
Struggling with RSD? Develop a personalized strategy with expert one-on-one consulting. Reach out to learn more and take control of your RSD management.
Can I manage the symptoms of RSD on my own?
It’s very difficult to manage RSD on your own – that’s because RSD is due to differing brain structure and function compared to a neurotypical person. Successful treatment typically requires both medication and therapy.
Identify your triggers - The mood changes that occur with RSD always have a trigger. By recognizing the situations, events, and people that act as these triggers, you can anticipate the resulting mood changes and prepare yourself to respond more effectively.
Practice self-compassion & self-acceptance - Be kinder to yourself; affirmations and positive self-talk can help defuse the negative emotions that come with RSD. Accepting the feelings and sensations that occur without judgment or resistance can also help you move forward.
Keep a journal - Writing down how you feel can help you deal better with feelings of rejection, as well as provide insight into why you feel the way you do.
Use emotional regulation techniques - RSD episodes are stressful; emotional regulations techniques can help calm you down and manage your emotions more effectively. Such techniques include deep breathing exercises, Progressive Muscle Relaxation (PMR), guided meditation, visualization, and sensory grounding techniques.
While behavioral strategies can help ease RSD symptoms, the disorder is usually best managed with medication and psychotherapy. Your healthcare provider can help you decide on which approach – or combination of approaches – will work best for you.
Resources
Where can I find help?
There are several resources here on my website that can help you navigate RSD in your life. Looking for personal support? Reach out to book a one-on-one consultation with me.
- At the ADHD 2023 Conference, Dr. William Dodson and I gave a presentation on Rejection Sensitive Dysphoria, looking at it from both a clinician’s point of view, and the point of view of an adult living with ADHD and RSD.
- I wrote a blog post detailing my journey as an RSD lived experience researcher, including how I came to team up with Dr. Dodson
- Based off of the presentation, I put together the RSD Support Guide that outlines the steps to finding help and creating a plan to manage your RSD.
- In a November 2023 interview with Melissa Reskoff, Dr. Dodson and I discussed unique insights into the world of Rejection Sensitive Dysphoria from both a clinician’s and a patient’s point of view.
Here are some other RSD resources that may be helpful:
- ADDitude also offers an hour-long webinar featuring Dr. Dodson that discusses emotional dysregulation and RSD. You can view the webinar and download the accompanying slide presentation.
- The online magazine ADDitude has a free PDF available that explains RSD, its signs, and treatment.
- Also courtesy of the ADDitude website is a webinar where Dr. Sharon Saline explores various treatment options and practical techniques for managing RSD in real time using cognitive behavior therapy, positive psychology, and mindfulness. You can access the video replay, listen to the podcast episode, and download the slide presentation.
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