Rejection Sensitive Dysphoria (RSD)

Individuals, children and adults alike, with ADHD are prone to sudden extreme mood changes as a result of perceived or actual rejection, teasing or criticism that is not relieved by reasoning. These episodes are intense, short lived and can occur multiple times in one day.

REJECTION SENSITIVE DYSPHORIA

To others they come across as too sensitive and emotionally reactive in situations where they feel slighted, embarrassed or humiliated.

For the person with Rejection Sensitive Dysphoria (RSD) the feeling is real, unbearably painful and prevents them from perceiving the incident or remark in context, often fleetingly distorting their view of the relationship. Triggers can be subtle and include a delayed text, vague feedback, or an unresponded greeting. 

It explains why a spouse may feel their partner has lost interest in them after a fight and require constant reassurance that they are loved. Children may react aggressively towards their parents if criticised, need constant reassurance if they have upset someone, hate doing orals for fear of being judged and have endless problems with teachers or friends that are ” being mean”.

Because it is so extreme, it results in the sufferer having perpetual feelings of vulnerability to others’ opinions of them and can cause them to be painfully shy or “people pleasers” unable to say no.

Advising someone who feels they are being bullied to stand up to their aggressor is counter intuitive as they fear the person or others may reject them further if they stand up and confront the perpetrator. After years of compromise to avoid feeling rejected they lose themselves and their trust in others and may adopt an approach of isolation, keeping only a few close friends as this is safer.

As a survival strategy, individuals with ADHD learn to hide their traits that make them different in order to navigate environments not built for their brains.

There is a recent view that RSD is in fact a trauma response to perceived exposure of a person with ADHD who has always felt different but made every effort to hide their inadequacies. RSD gets to their deep-seated fears about letting the world see who they really are and so is thought of as the panic of being found out.

It can also be felt in private if a person with RSD, for example, lets them self down by being disorganised and misses an important function or forgets a birthday as it exposes their deficit even if it’s just to themselves.  

Whatever the cause, RSD is real and potentially the most debilitating symptom of ADHD as it effects self-esteem, communication and relationships making the sufferer feel not only different but often socially isolated.