What Are Some Common Signs And Symptoms Of Rejection Sensitive Dysphoria
On a personal note, Im a mom of two boys with ADHD, and I hadnt even heard of rejection sensitive dysphoria until I had my youngest son evaluated for it. Even with a degree in behavioral psychology and 12+ years of parenting behind me.
So, if youve made it to the What in the heck even is RSD? stage, then consider yourself well ahead of the pack. Many parents of kids with ADHD-RSD never even know their kids have it, let alone get the chance to try and learn more. Its just not as frequently evaluated or discussed as other conditions in typical psychological assessments. This makes learning about all of the different RSD symptoms a little more difficult than with other disorders. However, there are a handful of signs that appear to be fairly consistent.
Rejection Sensitive Dysphoria And Adhd
ADHD is characterized by a number of symptoms, one of them being a persons extreme sensitivity to what other people say or think about them. This can turn into rejection sensitive dysphoria in some cases, as those with ADHD cant avoid becoming distracted from the bigger picture and place too much focus on failure. RSD can be difficult to manage alongside ADHD, as the latter disorder already puts a strain on a persons ability to focus on whats most important.
Many of the common ADHD symptoms can dovetail with rejection sensitive dysphoria, which makes each condition more difficult to cope with. For example, many people with ADHD struggle with procrastination. RSD can amplify procrastination, as the ADHD sufferer may find themselves stalled with the need for self-imposed perfectionism. If they cant achieve perfection, they cant avoid a possible rejection, so they dont do anything at all.
Rejection Sensitive Dysphoria And Adhd: Are They The Same Condition
Attention Deficit Hyperactivity Disorder is a condition that affects children and adults throughout their lifespan in similar and unique ways. For some people with ADHD, these symptoms may be very internal with zoning out or daydreaming behaviors being the most prominent ones affecting school performance, work, or relationships.
Other people with ADHD, including both adults and children, may display more externalizing behaviors such as behavioral or emotional outbursts. With children with ADHD, the triggers to these outbursts may be more apparent, such as sensory overload, fatigue, or frustration, and other times it may be less so.
Rejection-sensitive dysphoria is a condition that affects a large percentage of those with ADHD and overlaps with ADHD symptoms. People with RSD are prone to emotional dysregulation with real or perceived criticism or rejection. They experience emotional pain that is hard to bounce back from as a result. The strong emotional reactions can disrupt a childs and their familys life and adults too, as it often leads to friction and upset with others.
So lets dive into what exactly rejection-sensitive dysphoria is and why havent you heard of this condition that might explain the behaviors you see in your child or teen.
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What Does Rejection Sensitive Dysphoria Feel Like
The excruciating pain of RSD is often beyond description. Patients describe the intensity of RSD as awful, terrible, catastrophic, or devastating, but they cannot verbalize the quality of the emotional experience.
No one likes to be rejected, criticized, or to be seen as a failure. It is unpleasant, so people avoid those situations if they can. RSD is distinguished by its extreme, unbearable intensity, which sets it apart from normal emotional responses familiar to people who are neurotypical.
This intense pain is often experienced as a physical wound the patient feels as if they were stabbed or punched in the chest. Commonly, people will hunch over, grimace, and clutch their chests when they describe their RSD experience.
Diagnosing Rejection Sensitive Dysphoria
While signs of RSD vary widely between those who experience them, nearly all symptoms are intensely negative, as well as being emotionally distressing. As a result of these painful feelings, both children and adults with RSD are at risk for developing other disorders, including depression, borderline personality disorder and anxiety.
Having one or two of these symptoms does not necessarily add up to RSD, and only a licensed psychologist or another similar healthcare professional can provide a legitimate psychological assessment. However, if your child has several of the signs, especially if they are intense or overwhelming, it may very well be worth finding a provider and scheduling time for a full evaluation.
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Why Am I So Sensitive Adhd
It is also possible that because of past experiences and growing up with all the negative labels that can be associated with ADHD, some people with ADHD may simply feel more sensitive to negative statements or complaints or even gentle suggestions from others than a person who did not grow up with ADHD.
How Is Rejection Sensitive Dysphoria Diagnosed
RSD isnt an officially recognized medical condition. Its also a condition for which theres limited scientific research available. As a result, healthcare providers may not know much about it or have a great deal of experience with it.
Instead, clinicians may suspect that you have it based on the symptoms you describe and whether you have other conditions like ADHD. Unfortunately, providers may not diagnose it because they arent familiar with RSD, or they mistake it for another condition.
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Episode 1: Adhd And Rejection Sensitive Dysphoria
Listen to this episode from ADHD for Smart Ass Women with Tracy Otsuka on Spotify. In this podcast, Tracy talks about ADHD and Rejection Sensitive Dysphoria or RSD. Because Tracy doesn’t struggle with RSD she wasn’t that interested in learning about it but once she realized it was the number one requested topic among the women in her Facebook group, she started doing her research.
*Tracy mentions using guanfacine and clonidine. This is an error. According to Dr. William Dodson he has had success with prescribing guanfacine OR clonidine and a stimulant. “If the first medication does not work, it should be stopped, and the other one tried. They should not be used at the same time, just one or the other.”
In this podcast, Tracy talks about ADHD and Rejection Sensitive Dysphoria or RSD. Because Tracy doesnt struggle with RSD she wasnt that interested in learning about it but once she realized it was the number one requested topic among the women in her , she started doing her research.
Discover why emotion is not mentioned in the DSM, despite the fact that all experts believe that it is an integral part of ADHD.
What do so many of us with ADHD complain about?
- Overwhelmed by the pain or energy of others
- Others with ADHD may be unaware of others feelings and may seem to be insensitive
Tracy clarifies that if emotion isnt mentioned, that means that RSD is also not recognized in the DSM.
Q3: Are you your own harshest critic?
How Do You Take Care Of Rejection From Someone You Like
Here’s How to Deal With Rejection in a Healthy Way, According to Psychologists
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Handling Rejections And Intense Emotions Effectively
There are different approaches for an adult with ADHD to handle their emotions well. And these are not limited to Rejection Sensitive Dysphoria. The Cognitive-Behavioral Approach, Mindfulness Meditation, and other forms of mindfulness can help people monitor their emotions better. The advice is to establish an everyday schedule that helps foster self-awareness and regulate the emotional misery they feel daily.
Rejection Sensitive Dysphoria might be a vicious cycle unless intervened upon. Having the right coping skills and receiving the right treatment plan can be life-changing. The ability to strengthen one’s mental state can help lift burdens of emotional pain. With the right support group and medical attention, and even participating in peer-reviewed studies, managing ADHD can be âlighterâ for those who are willing to get up from the intense emotional cycles. Those that don’t neglect early signs of this condition can find solutions in their lives. Those with a higher risk factor of this rejection sensitivity can still manage their symptoms if they undergo psychotherapy ð©ââï¸ or take FDA-approved medications upon the advice of a mental health professional.
People Have Said That You Take Things Too Personally
This is something that many ADHDers have been told lots of times. We appear emotionally reactive to others who â instead of getting curious about our experience â tend to dismiss us.
I personally know a woman who, throughout her childhood and adolescence, was told she takes things too personally. This made her feel very bad about herself, and she spent years feeling ashamed of this “embarrassing flaw.” But then in her early 30s, she learned about RSD and realized this is simply the way her brain is wired. She has since been able to forgive herself and has started to work on letting things go.
Oh, and her name is me. If you identify with my story, you, too, could have RSD.
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How You Can Help Your Child Cope With Rejection
There are ways you can help your child learn to put rejection into perspective and move past it. Here are some things you can do:
Help your child see different explanations. If your childs friend is playing with someone else and cant come over, your child may see it as rejection. Help your child understand that sometimes things just happen. Maybe another kid called first. It doesnt mean your child has lost a friend.
Michael Jordan was cut from the high school basketball team. J.K. Rowling was rejected by 12 publishers for her first book, Harry Potter and the Sorcerers Stone. You can also share your own experiences of being rejected and what you did to get over it.
Teach resilience. Help your child come up with a plan to move forward. For example, If your child isnt chosen for baseball, find another activity to focus on. If your child still wants to pursue baseball, develop a practice schedule.
If your childs friend cancels plans, brainstorm who else could come over. These kinds of coping strategies will make your child stronger and more resilient when faced with setbacks in the future.
Seek help. If your child is feeling down for longer than what you think is a reasonable amount of time, or if your child just seems off, talk to your doctor. Keep in mind that kids with ADHD are more prone to mental health issues. If you see signs of anxiety or depression in your child, there are treatment options.
Why Am I So Delicate Adhd
It is also imaginable that because of previous studies and growing up with all the unfavourable labels that may be related to ADHD, some other folks with ADHD would possibly simply really feel extradelicate to unfavorable statements or court cases and even gentle tips from others than a person who didn’t grow up with ADHD.
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How Soon After Treatment Will I Feel Better
The time it takes to notice a difference from treatment depends on the treatments you receive. Medications can help with the symptoms, but mental health therapy offers the best chance of learning to live with RSD.
Because no two peoples brains are alike, and conditions like ADHD and RSD affect people differently, the time it takes to notice changes and improvements can also vary. Your healthcare provider is the best person to tell you more about when you should expect to notice changes and what else you can do to help yourself manage this condition.
Is Rejection Sensitive Dysphoria A New Concept
Rejection sensitive dysphoria and emotional dysregulation are old concepts associated with ADHD that are gaining new exposure in research and clinical settings. Dr. Paul Wender, who spent four decades conducting the pioneering studies on ADHD beginning in the 1960s, was the first to recognize emotional dysregulation as a persistent, prevalent, and highly impairing component of what we now call ADHD.
The most recent contribution to this new thinking about the mood regulation component of ADHD comes from Dr. Fred Reimherr, one of the founding fathers of ADHD who established the current childhood criteria for ADHD along with Wender more than 50 years ago . His recent replication7 of his study of the validity of each diagnostic criterion has led him to now conceptualize ADHD as being divided into only two subtypes: the well-known inattentive type and an emotional dysregulation type.
This is a huge change in thinking. A feature of ADHD that was ignored for 50 years now is rapidly becoming one of the defining features of the syndrome in both the European Union and North America.
In 2019, Faraone published Emotional dysregulation in attention deficit hyperactivity disorder implications for clinical recognition and interventions in the Journal of Child Psychology and Psychiatry.8 It states that there is solid theoretical rational for emotional impulsivity and deficient emotional self-regulation as core symptoms of ADHD.
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Why Isn’t Rsd An Official Diagnosis Yet
For a disorder or issue to become a formal clinical diagnosis, not only must there be research, a group of mental health professionals must agree that it should be included in the Diagnostic and Statistical Manual . The DSM is a clinical reference guide that professionals use to make a formal diagnosis and is updated very infrequently.
Is Rejection Sensitive Dysphoria A Symptom Of Adhd
Rejection sensitive dysphoria is not included in the DSM-V for attention deficit hyperactivity disorder it is not a formal symptom of ADHD in the United States, however emotional dysregulation is one of the six fundamental features used to diagnose ADHD in the European Union.
Its widely understood that the diagnostic criteria for ADHD in the DSM-V only fit well with elementary school age children and have never been validated in a group of people over the age of 16.1 They are based on only observational or behavioral criteria that can be seen and counted. The traditional diagnostic criteria intentionally avoid symptoms associated with emotion, thinking styles, relationships, sleeping, etc. because these features are hard to quantify. For clinicians who work with later adolescents and adults, the DSM-V criteria are almost useless because they ignore so much which is vital to understanding how people with an ADHD nervous system experience their lives.
Still, there are at least three reasons why emotional dysregulation or RSD may never be included in the diagnostic criteria for ADHD, no matter how prevalent:
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The Third Pillar Of Adhd: Rejection Sensitive Dysphoria
Dont feel like reading? Listen to my podcast episode on Rejection Sensitive Dysphoria instead.
Ive hinted at this third pillar for some time now. I know you may be tired of me calling out ADHDers as sensitive in more scientific terms than you can imagine. Rejection sensitive dysphoria is a big one, though, that requires specific attention both because of how overlooked it is as a symptom of ADHD, and the immense pain it causes ADHDers and their loved ones.
Nobody likes rejection, right? Breakups, job interviews, bullying you will never find a person that says, Oh man I LOVE rejection. When someone lets me know that they hate who I am and what I do, Im like, I FEEL SO ALIVE. But just like ADHD amplifies our emotions and our senses, it also makes us experience this already-unpleasant sensation in a unique way. Almost 100% of people with ADHD suffer from rejection sensitive dysphoria , yet very few people have found the words to accurately describe it. RSD is an extreme emotional reaction to the perception of rejection, failure, or criticism regardless of the circumstantial reality.
Everyone Ive talked to has articulated RSD as something intense and debilitating either physical or emotional pain that makes them feel small and vulnerable.
- mindfulness and grounding exercises
- creating a safety plan or crisis card with resources for suicidality or emotional escalation
- DBT distress tolerance skills to wait out the feeling
Criticism Literally Ruins Your Day
Criticism is a normal part of life! And when it’s delivered constructively, criticism can help us grow and improve as students, professionals, or just as plain ol’ humans.
If you have RSD, you might know – deep down – thatâs true, but your brain doesn’t always cooperate. If you’re receiving any feedback with just a hint of negativity â even teeny-tiny, ever-so-kindly-delivered criticism â and you’re immediately thrown into a spiral of shame, despair, or anger… youâve likely been experiencing RSD.
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How Does Rejection Sensitive Dysphoria Relate To Those With Adhd
Rejection sensitive dysphoria is comorbid with ADHD, which means that it occurs at a high rate in individuals with a diagnosis of ADHD.
The brains of individuals with ADHD are more prone to dysregulation and thus their behavior can reflect that. With emotional dysregulation, behaviors such as excitability, rapid, exaggerated mood changes, easily upset or tearfulness, rage, or being quick to anger. A lack of impulse control, cognitive flexibility, and behavioral inhibition are all common to ADHD and manifest in many ways including sensitivity to criticism.
In the case of RSD, a person with ADHD not only lacks behavioral control but may perceive the slightest suggestion as a direct character attack and become emotional as a result. Their impulsive sensitivity can be a barrier in relationships.