What is Rejection Sensitive Dysphoria?

Nobody likes rejection — whether it comes from a crush, peers, family, or coworkers. It can hurt, yet it’s an unavoidable part of life.

Some people can shake off rejection easily. For others, this feeling can trigger an overwhelming emotional response.

In people especially overwhelmed, this is sometimes called rejection sensitive dysphoria or RSD. It’s characterized by extreme emotional sensitivity to being criticized or rejected, whether real or perceived.

This can affect anyone, though it has been suggested that people who have attention deficit hyperactivity disorder (ADHD) and autism are more susceptible.

What causes rejection sensitive dysphoria?

People living with rejection sensitive dysphoria are more sensitive to rejection and easily triggered by certain situations. However, the exact reason for this isn’t fully understood.

It’s not believed to be caused by a single factor, but rather multiple factors.

One possible explanation for RSD is a history of rejection or neglect early in life. This can come from having a parent who was overly critical or neglectful, which impacts how these individuals view themselves.

Because of this parental relationship, some people have lower self-esteem and an intense fear of rejection and abandonment in their own relationships.

Other situations can also cause sensitivity to rejection. For example, being teased or bullied by peers. Or, being criticized or rejected by a romantic partner.

It’s also believed that some people are genetically predisposed to rejection sensitive dysphoria. It can pass down through families. So if a parent or another close relative has RSD, you may develop it, too.

What’s the connection with ADHD and autism?

There appears to be a connection between rejection sensitive dysphoria and ADHD or autism.

This isn’t to suggest that people with these conditions will develop rejection sensitivity. Instead, having either condition is a risk factor.

People diagnosed with ADHD often experience difficulty paying attention, restlessness, and impulsiveness.

Doctors have also recognized emotional issues in some people with ADHD. This is characterized by an inability to control their emotional responses, or hypersensitivity.

Since these individuals experience more intense emotions, they may have a heightened response to any sense of rejection.

Rejection sensitive dysphoria also has a connection to autism.

This neurodevelopmental disorder affects the nervous system and triggers a variety of symptoms. Autistic children or adults may have difficulty communicating and socializing, and sometimes they have difficulty understanding the actions of others.

They might also deal with emotional dysregulation and hypersensitivity to physical and emotional stimuli. As a result, any real or perceived feelings of rejection or criticism can cause them to become overwhelmingly upset.

Symptoms of RSD

Symptoms of rejection sensitive dysphoria are complex so it can be challenging to identify.

RSD can sometimes resemble certain mental health conditions which include:

• depression
• social phobia
• bipolar disorder
• borderline personality disorder
• post- traumatic stress disorder

Typical symptoms of RSD (that may also occur in some of the above conditions) include:

• low self-esteem
• avoidance of social settings
• fear of failure
• high expectations for self
• frequent emotional outbursts after being hurt or rejected
• feelings of hopelessness
• approval-seeking behavior
• anger and aggression in uncomfortable situations
• anxiety

Although symptoms of RSD can mimic other conditions, one distinguishing factor is that symptoms of RSD tend to be brief and triggered by emotional cycles, rather than an actual event.

How to diagnose RSD

Figuring out if you have RSD can be challenging. Your doctor must first rule out if it’s a symptom of an underlying mental health condition.

Rejection sensitive dysphoria isn’t a recognized diagnosis under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) so a professional diagnosis may not always be possible.

To assess your symptoms, you’ll need to see either a counselor, psychologist, or other mental health professional.

Your doctor may inquire about your family history and symptoms. You’ll likely answer a series of questions regarding how you react and feel in certain situations.

Questions might include:

• Do you feel intense anger or aggression when someone hurts your feelings?
• Do you feel anger or rage when you’ve been rejected or criticized?
• Do you assume that no one likes you?
• Are you a people pleaser?
• Do people say that you’re overly sensitive?

Your doctor may also ask about any prior diagnosis of ADHD or autism spectrum disorder.

If you haven’t been diagnosed with these conditions but have symptoms, your doctor may recommend screening to better understand the underlying cause of your emotional reactions.

Treatment for RSD

Since this is associated with autism and ADHD, your doctor may recommend treating any underlying condition first.

There isn’t a cure for these conditions. But medication can help relieve associated symptoms such as hyperactivity and depression.

Cognitive behavioral therapy

Behavioral intervention can also help reduce hypersensitivity. This can make it easier to manage and cope with rejection and criticism. Therefore, your doctor will likely suggest psychotherapy.

This is a traditional method for helping people cope with rejection sensitivity dysphoria.

One type of effective psychotherapy is cognitive behavioral therapy (CBT). This is a type of talk therapy which teaches coping techniques.

You’ll learn how to handle stressful situations, resolve relationship conflicts, improve communication, and overcome emotional trauma or abuse.

Medications

Along with therapy, your doctor may prescribe medication to help symptoms.

There are no FDA approved medications for RSD, but some may be prescribed off- label or for other conditions.

Guanfacine is a common medication for RSD. It’s normally prescribed to lower blood pressure but it also interacts with receptors in the brain, reducing hyperactivity and emotional responses.

Lifestyle changes

Along with traditional therapies, you can do a few things on your own to help manage your emotional response to rejection and criticism.

For example, it may help to keep your emotions in perspective. Try to understand that what you feel or perceive to be rejection or criticism may not really exist.”

Understandably, it can be hard to control hurt feelings. But instead of having an outburst when you feel shunned, do your best to stay calm.

It also helps to reduce your overall stress level, which can help you feel more calm and at ease. This makes it easier to control your emotions.

You can also try:

• getting regular exercise
• eating a healthy balanced diet
• getting plenty of sleep

When to see a doctor

Everyone has good days and bad days, so having an occasional outburst or emotional response doesn’t necessarily mean that you need to see a doctor.

You should, however, make a doctor’s appointment if you have overwhelming feelings of hurt, anxiety, and rage anytime you feel rejected or criticized. Even if these feelings are brief.

If you don’t already have a mental health care provider, you can browse doctors in your area through the ishonest FindCare tool.

Learn more

Medical intervention is especially necessary when rejection sensitive dysphoria starts to have an impact on the quality of your life.

Rejection sensitivity can lead to problems in romantic relationships, and it can cause irrational jealousy with friends and family.

Fear of rejection also causes some people to stay in unhealthy relationships. It can also lead to other problems such as depression and anxiety.

The bottom line

Even though rejection sensitive dysphoria may be linked with ADHD and autism, it can affect anyone.

Symptoms may worsen if left untreated. So if you develop intense or overwhelming emotional reactions after rejection, hurt feelings, or criticism, reach out to a mental health professional.

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