Rejection Sensitive Dysphoria

Have you always been significantly more sensitive than other people to rejection, criticism, or failure?

What is Rejection Sensitive Dysphoria?

Rejection Sensitive Dysphoria (RSD) is a disabling and disruptive feature of Attention Deficit Hyperactivity Disorder (ADHD). Although Rejection Sensitive Dysphoria is very painful and even traumatic, it is not the result of trauma. It’s the sudden severe emotional sensitivity and pain triggered by the perception of not belonging that can last for hours, days or even longer.

RSD comes in triggered uncontrollable episodes and is much more powerful and impactful than the normal sense of rejection. Someone with ADHD will believe they’ve been rejected in the absence of actual evidence. They’ll dwell on the apparently rejecting event even when others involved have long forgotten. A neurotypical person would be barely affected by the same interaction, if at all.

This cognitive, somatic and emotional response to failure is devastating and deeply troubling. An episode is physically painful as if being hit or stabbed, and the resulting injury can’t be soothed. One is left feeling sad, unlovable, unlikeable, unwanted and inadequate. Repetitive negative thoughts cycle around and around, and the body is left feeling sore and tender.

95% of all people with ADHD experience RSD, and for 30% it’s the most impairing part of this neurological disorder due to symptoms of emotional dysregulation, hyperarousal and hypersensitivity. Dysphoria is a Greek word meaning ‘hard to bear’. The internal response to rejection is bearable, but it certainly doesn’t feel like it while experiencing an episode. Both external and internal stimuli strongly entice people with ADHD.

The working memory impairments of ADHD allow emotions to become too strong and overwhelm the brain with a single strong emotion. The ADHD nervous system is interest-based. Because of its compelling significance to someone with ADHD, rejection is one experience that activates a state of hyperfocus. This leads to preoccupation with what transpired at the moment of rejection, the assumed lasting implications and the impact on one’s sense of worth.

Many people with ADHD have difficulty regulating their behaviour – they’re impulsive. Impulsivity is the inability to evaluate the consequences of our actions beforehand. Impulsivity in ADHD leads to: saying inappropriate things, butting into conversations, intruding on others, engaging in risky behaviours and wanting things immediately. Being impulsive breeds self-doubt and we end up second-guessing and judging ourselves and remunerating on this. When these traits are combined with some of the traits of restlessness and hyperactivity, such as feeling edgy, a sense of rejection (including self-rejection) is unfortunately always around the corner.

Nearly everyone with ADHD has difficulty with:

Some of the consequences of living with Rejection Sensitive Dysphoria include:

What helps Rejection Sensitive Dysphoria?

If you have ADHD, you may know that your moods can shift through finding a new interest or occupation that seizes your interest and therefore distracts you from your internal responses. Managing stress and reminding yourself the pain of rejection will eventually pass helps. Having strategies in place to manage your emotions in situations that set them off can minimise the impact. Seeking to fully understand the other person’s true intentions, the real meaning behind their words and actions, along with their perspective, can remove some of the sting of rejection sensitivity. Consider creating an RSD plan. Teach the people in your life about your emotional patterns and train them to de-escalate compassionately when you’re triggered.

Does talk therapy help Rejection Sensitive Dysphoria?

The knowledge that Rejection Sensitive Dysphoria is a shared experience, rather than an aspect of a deficient personality, is often the catalyst for accepting support and seeking treatment. Conventionally, it is believed biological treatment (e.g. medication) is the best treatment for the symptoms of ADHD because without it psychological therapies are often ineffective.

Counselling and therapy can contribute to a multimodal approach to the treatment of emotional challenges. They facilitate self-understanding, support in holding the pain, and foster new strategies for emotional self-control. Psychological support can help you deal with many of the ‘secondary symptoms’ of ADHD, such as overwhelm, worry, depression, hopelessness and low self-esteem.

A counsellor can help you understand triggers and identify high-risk situations. As with almost any challenge, fruitful solutions begin with good understanding. Psychotherapy could help you re-evaluate your beliefs about your self-worth and reframe painful situations where habitual distorting, deleting and generalising thinking has taken over. Counselling is a safe and caring space where you will experience belonging and kindness. Encouragement and recognition transform positively feelings of failure and inadequacy.

Finding ways to handle your emotions as they arise starts with developing greater awareness of when you’re in their hold. In counselling, you will build resiliance and learn to manage your strong emotions. Your counsellor will also help you manage your fear and low self-esteem. You will learn to feel into and listen to your body. Body mindfulness can support you in identifying negative feelings and releasing them by initially naming them and then transforming them by exploring their non-conceptual energetic quality.

Counselling, Psychotherapy, Somatic therapy, Neuro-linguistic Programming (NLP), Cognitive Behavioural techniques, and Dialectical Behaviour Therapy can help you live with emotional dysregulation.