Rejection Sensitive Dysphoria

TL;DR: You might not have social anxiety. You might not have anxiety at all. You might have RSD.

First up on our journey through mental health symptoms is Rejection Sensitive Dysphoria (RSD). This symptom was first brought to my attention in the Facebook group that I joined following my ADHD diagnosis. It’s very common in those with ADHD and Autism Spectrum Disorders (ASD). However, it is also a symptom of other disorders (though some say it may just mimic those disorders).

Associated Disorders

Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder, Borderline Personality Disorder, Social Anxiety, Depression, Bipolar Disorder, and Post Traumatic Stress Disorder.

What Does the Research Tell Us?

First of all, dysphoria is a word associated with feeling unwell. But it’s more than just feeling a little nervous or hoping someone doesn’t hate you. Dysphoria is a profound feeling of being unwell. There are other types of dysphoria (perhaps you’re most familiar with gender dysphoria?) that can affect your well-being in a number of areas. Rejection sensitive dysphoria means that you are profoundly affected by the real or perceived rejection to the point that it is impacting your day-to-day life. This experience might come from walking into a room and hearing people laughing – if you think that they are talking about you and you are suddenly shy and afraid to approach, this is RSD. If you send a text message and don’t immediately receive a response and your mind begins to spiral into all the horrible things this person might think of you, that’s RSD. Or, in a very real sense, if you attend an interview for a job and it goes very poorly and you are told that you will not be receiving an offer, if you spiral into a sense of rejection and recount all of the reasons why you are deserving of that rejection, this is RSD also.

RSD often accompanies ADHD because of emotional dysregulation. Those with ADHD and ASD are more likely to experience stronger emotions than their neuro-typical counterparts simply because they lack the ability to control those emotions. Without getting too technical, the part of the brain that is responsible for impulse control is also responsible for emotional regulation and because it is impaired in those with ADHD and ASD, they are more likely to experience RSD and other strong emotions (such as angry outbursts).

For other disorders that experience RSD, it is less likely to do with their brain chemistry and wiring and more likely to do with trauma. Those with Borderline Personality Disorder (which is characteristically Rejection Sensitive) typically have suffered trauma. Of those individuals diagnosed with Borderline Personality Disorder 91% have reported physical abuse and 92% have reported [general] neglect in childhood. Those with mood disorders such as depression experience rejection sensitivity and are actually more likely to experience this sensitivity as pain. In fact, in RSD is an indicator of regression of symptoms, especially in depression.

Rejection Sensitivity Dysphoria may manifest in avoidance. If you are afraid you might stumble over your words and find yourself laughed at, you’re more like to avoid social situations and phone calls. It may manifest in anger, where if something doesn’t come out absolutely perfect then you rip it up, throw it out, or break it. You might feel ashamed of your mistakes and try to cover them up or find yourself blowing them more out of proportion than anyone seems them as. Or when your boss calls you to their office, you might be afraid that you’ve done something wrong and you’re about to be fired even if there is no apparent reason for that fear. People pleasing. Lack of trying. Overachieving. These are all manifestations of RSD.

So What Can I Do About It?

First and foremost: I am not a therapist, psychologist, or psychiatrist. The following are experiences I’ve had with RSD and other skills from the internet (maybe a few nuggets sprinkled in from my own therapist). The best way to find how to cope with your own symptoms? Go to therapy.

Work on emotional regulation. This takes some conscious effort. A lot of conscious effort. Remember when you were a kid and they would tell you to stop and count to ten? That’s a good place to start. The second you feel that sense of rejection stepping in, stop and count to ten. Take a few deep breaths, and then flip the script. Take the rejection thought of “They’re not texting me back because I’m a bother and they hate me” and turn it into “They’re just busy and they will text me back when they have a moment.” Or if it’s real rejection you’re dealing with walk through the parts of what went wrong and think about how you could improve them in the future (I recommend doing this with a close friend or your therapist).

Write it down. Journaling can be very therapeutic in general. If you’re the type of person that can’t keep a physical journal (you’re afraid of someone finding it, you constantly lose it, or whatever reason), like me, you can send yourself an email or type it into your notes app. The more you write down your thoughts on the issue, the easier they are to process.

Reduce stress. This is not my personal favorite, but it does come up in a lot of the resources I was reviewing. The least helpful suggestion that those with mental health issues come across is “Just reduce your stress! Try yoga! Go for a walk!” It’s important to know that reducing your stress load WILL help your overall mental well-being, but how you go about it may be different for you. I have a high-stress job, so it’s unlikely I’m going to reduce stress there, but I’ve learned to leave it at the door. If I take work home with me, it’s going to boil over into other parts of my life. Compartmentalize the stress so the less stressful parts of your life can be less stressful when you’re in them.

ADDitude has a great online quiz for you to determine if you have RSD as a symptom.

What about you? Do you feel you have this symptom and what are some of your coping strategies? What other symptoms would you like to see covered in the future?