Rejection Sensitive Dysphoria

Written By Noelle Benach, LCPC, CST

Getting turned down for a promotion. Never hearing back about that second date. Dead silence after you tell a (really good) joke. Ouch! Rejection is an inevitable part of life, and it can really sting. Most people are able to find a way to shake it off after the initial pain. However, for folks experiencing Rejection Sensitive Dysphoria (RSD), rejection and criticism can feel intensely excruciating and the effects can linger. In this blog post, we will explore RSD, its link to ADHD, and options for finding relief and support.

 
 

What is RSD?

Dysphoria is Greek for “difficult to bear”. RSD is characterized by intense emotional sensitivity in response to perceived rejection or criticism. RSD is is often linked to ADHD, potentially due to differences in brain structure. BIPOC folks, Gender-Nonconforming people, and those who have survived trauma may also be more vulnerable to RSD. While the supporting research is still in progress, it’s possible that RSD can be genetically inherited.

Growing up with a pattern of rejection or neglect in the family unit may also be a precursor for RSD. Witnessing a parent externalizing their symptoms of RSD can teach children that rejection is to be feared. Some people experience a damaging amount of rejection by peers in childhood. Into adolescence, a time where a sense of belonging in peer groups is developmentally important, rejection can be especially painful. Dating in adolescence and beyond can also be riddled with rejection for some folks.

People experiencing RSD symptoms may feel completely overwhelmed with emotion when they feel rejected or criticized. This can manifest as low self-esteem, self-criticism, social avoidance, emotional outbursts, a sense of hopelessness, people-pleasing, and/or anxiety. The experience can look and feel like mood disorders, even including suicidal ideation. Dr. Susan David reminds us, “discomfort is the price of admission to a meaningful life.” However, People with RSD may go to great lengths to avoid rejection and criticism. In their pursuit to avoid rejection folks with RSD may avoid taking healthy risks and thus live more insularly.

Are you resonating with this description? If so, I invite you to consider the questions below.

Some questions to ask yourself:

  • Do you feel intense emotions that are difficult to sit with when someone makes you feel criticized?

  • Do you assume that new people you meet will not like you?

  • Do you believe people in your life secretly don’t respect you?

  • Do you find yourself afraid to say “no” or turn down invitations?

  • Do you often find yourself doing things for other people that you don’t really want to do?

  • Have you received feedback that you’re too sensitive?

If you answer a clear “yes” to some of these questions, you might be experiencing symptoms related to RSD. Of course, these self-report questions are not a substitute for therapy.

RSD and ADHD

Not everyone with RSD has ADHD, and not everyone with ADHD has RSD, but there are some links between these two conditions. People who have ADHD may feel emotions more intensely than neurotypical people, and this can be tied to difficulty regulating emotions, which is also seen in RSD. Unfortunately, education systems in western culture have not traditionally been designed to accommodate people with ADHD. Many people in power often do not possess or demonstrate understanding of people who learn and think in ways that don’t follow the rules of the system. This can result in children with ADHD experiencing criticism from people who don’t understand them. Repeated rejection from teachers, peers, or family members grates on a child’s sense of self efficacy. When these kids grow into adults, they might go into overdrive to try to prove themselves. They may overachieve or people-please. When their supervisor praises them, they might wonder how long it will take to be “found out” and deeply struggle with imposter syndrome. If a friend takes a few hours to respond to a text, they might feel on edge and worry about what it means.

It’s inevitable to disappoint or annoy others from time to time. After all, all humans are complicated and annoying sometimes. However, receiving constructive or negative feedback from others can help strengthen relationships. People with ADHD and RSD might be hypersensitive to rejection and can catastrophize when they believe they’ve created a rupture, no matter how small. Some people experiencing these symptoms might not believe emotional closeness to be worth the agony they feel in response to criticism or rejection. They may give up and close themselves off, due to their fear of inevitable rejection.

 
 

Managing and Treating RSD

It’s important to know that RSD is not currently recognized in the DSM-V. It’s not a formal medical diagnosis. There isn’t any one prescribed treatment for this condition. Fortunately, though, if you are struggling with RSD symptoms, there are some things you can do that may help:

  • Learning more about RSD. Knowledge is power. The more you know about this condition, the better you can support yourself and set yourself up for success.

  • Validating yourself. RSD can be really hard, and it’s okay to name that. Practicing self-compassion may make it a bit easier to cope with the difficult parts of this experience.

  • Leaning on your people. Spend time with people who can hold space for your experience. If you have the emotional bandwidth, provide education about RSD to the people in your life so they can show up for you. It’s possible that not everyone will understand, and practicing good boundaries around those who don’t is an act of self-care.

  • Taking care of your physical body via movement, nutrition, and sleep can help with emotion regulation.

  • Exploring medication. Talking with a psychiatrist who has treated others for RSD may be beneficial. Certain medications have been suggested for treating RSD such as guanfacine, clonidine, or MAOIs such as tranylcypromine

  • Going to therapy. Finding a therapist who is knowledgeable about RSD and skilled in helping people manage its symptoms can be a supportive next step.

How Can Therapy Help with RSD?

Therapy can provide a space for clients with RSD to experience a safe connection without the risk of rejection. Any perceived criticism or rejection can be worked through in a way that promotes a greater sense of resilience, openness, and acceptance. Therapy can also provide an opportunity to practice new skills and role-play scenarios. Cognitive behavioral therapy (CBT) can be helpful in reframing old beliefs and encouraging more supportive thoughts and behaviors.

If you’re struggling with symptoms of RSD, know that you aren’t alone in this experience. Among other treatment options, therapy can be a powerful tool in finding relief from symptoms, getting unstuck, and experiencing more joy and genuine belonging in your life.

 

Additional Resources:

Consider the following articles, books and podcasts to learn more about Rejection Sensitive Dysphoria (RSD) and related content:

 
 

Meet The Author: Noelle Benach, LCPC, CST

Noelle Benach is a Licensed Clinical Professional Counselor and Board Approved Supervisor for LGPCs in the State of Maryland, as well as an AASECT Certified Sex Therapist. Noelle works with individuals, couples, and folks in non-monogamous relationships.

Noelle has trained in numerous therapeutic modalities including Stan Tatkin’s Psychobiological Approach to Couples Therapy (PACT) (Levels 1 and 2 Trained), Prepare/Enrich (Certified Facilitator and Trainer), the Gottman method (Levels 1 and 2 trained), and Brainspotting.

As a self-identified neurodivergent human, Noelle enjoys working with fellow “spicy-brained” folks.

When she’s not working, you’ll find Noelle enjoying time at one of Baltimore’s many coffee shops, restaurants, or farmer’s markets, spending time outside with her spouse and 2 dogs, or working on a house/craft project, likely while listening to a true crime or psychotherapy related podcast. Interested in learning more or working together? Click the link below:

 
Noelle Benach, LCPC, CST
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