Rejection Sensitive Dysphoria

Rejection Sensitive Dysphoria
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Rejection sensitive dysphoria (RSD) is an intense emotional response caused by perpetual perceptions that we have disappointed others and because of our behavior they will withdraw their love, approval, or respect. RSD commonly occurs in connection to ADHD, causing extreme emotional pain. Often the emotional reaction is not in response to actual rejection, just a hypersensitive fear that a rejection has taken place.​

​Attention Deficit Hyperactive Disorder and RSD

Our neurons constantly communicate information, receiving inputs from external and internal stimuli. Our brains quickly interpret information, translating information into meaningful chunks to coordinate responses.

A helpful visual for understanding the flow of information is the top-down and bottom-up explanation of brain communication. This is an over-simplified explanation of a very complex process, involving multiple regions of the body and brain, nevertheless, the top-down and bottom-up explanation is helpful for understanding brain functioning.

Bottom-up processing refers to signaling from the back of the brain to the front and from the interior of the brain to the outer regions. These bottom up signals are the physical reactions to perceived stimuli. The arousal draws attention to important elements and is translated into emotion.

Top -down processing, also referred to as executive functions, sends signals from the pre-frontal cortex to the back and interior portions of the brain. These top-down signals modulate the arousal, regulating the reaction by integrating the arousal with goals and learning.

For most, these communication are well integrated and balanced, each providing essential information for survival and flourishing. However, for those suffering with ADHD, bottom-up signaling dominates the communication landscape, drowning out attempts to regulate heightened emotion. Emotions become an emotional black hole, sucking energy necessary for  considering harmful consequences and delaying gratification

In rejection sensitive dysphoria, intense arousal arises from perceptions of being rejected, teased, or criticized by important people in your life. The ADHD correlates to RSD prevent regulating these emotional arousals through top-down processing (Bedrossian, 2021).

The Need to Belong and RSD

Fears of rejection aren’t abnormal. Emotional sensitivities to others is a survival function. Historically, the tribe was essential to survival. We still depend heavily on society for survival. We naturally arouse when needs for belonging are stymied. The arousal is adaptive and functional, drawing attention to others we may have offended, hurt, or angered.

A balanced response would integrate the arousal with relationship and autonomous goals and we could respond accordingly. A maladaptive response is panic, fear, and avoidance. A quick reaction to heightened arousal may damage important relationships or sacrifice important autonomous aspirations. Rejection sensitive dysphoria can significantly disrupt life.

Andrea Bonlor PhD. explains, “people with RSD have such a strong emotional reaction to negative judgments, exclusion, or criticism from others that it sends them into a mental tailspin, leading to rumination and the pit-of-the-stomach malaise that won’t let them move forward with their day. They feel like failures, disproportionate to what has actually occurred” (2019).

What Does Rejection Sensitive Dysphoria Look Like?

A few symptoms of RSD are:

  • High sensitivity about the possibility of rejection
  • Guilt and Shame easily triggered
  • Isolating to avoid situations where rejection possible 
  • Aggressive protective behavior attacking those perceived to have rejected you
  • Frequently uncomfortable (embarrassed) due to self-judgements of insufficiency
  • A positive sense of self that is entirely dependent on what others think
  • Frequent and intense ruminating after an interaction, interpreting hidden meanings of rejection
  • Constant relationship drama because of the intensity of arousal

Rejection Sensitivity Dysphoria and Social Anxiety

RSD and Social Anxiety Disorder share many traits. RSD currently is not a formal diagnosis included DSM-V. There are a few notable differences between RSD and Social Anxiety Disorder. Those with social anxiety disorder tend to fret more over interactions with people they have not yet established a close relationship. Their excited subsides when with intimate partners. With RSD, close relationships magnify fearful reactions of rejection.

Social anxiety disorder may prevent a person from attending a party while RSD may lead to a quick departure from the party after a perceived slight or criticism. Bedrossian suggests that RSD symptoms dissipate rapidly, while many mental health conditions are constant companions (2021). 

Treatment for Rejection Sensitive Dysphoria

Many treatments are available. Because of the correlates to ADHD, treating ADHD symptoms can help with rejection sensitive dysphoria.

  • Many medications are available to calm emotional arousals, allowing top-down processes to perform their important functions.
  • Mindfulness practices also have a positive impact on improving regulation of emotion.
  • Supportive environments is a necessity for healing. We can’t grow when those around us are toxic. We need compassionate, loving others that validate and honor our individuality.
  •  Reframing skills to challenge critical unjustified thoughts.
  • Professional help from a skilled therapist.

Books on Rejection Sensitive Dysphoria 

A Few Words Final Words On Rejection Sensitive Dysphoria

We seek acceptance and security through others. However, these natural inclinations often go awry; sometimes in childhood, sometimes as adults. When sensitivities ignite fears that interfere with growth, we must seek help. Markedly, suffering from social disorders alone is terrifying, courageously do what you fear most, talk to someone that can hold your hand and lead you to recovery.

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Bedrossian, L. (2021). Understand and address complexities of rejection sensitive dysphoria in students with ADHD. Disability Compliance for Higher Education, 26(10), 4-4.

Dodson, W. (2021). [Self-Test] Could You Have Rejection Sensitive Dysphoria? Published 8-25-2021, accessed 12-14-2021

Bonlor, A. (2019) What Is Rejection Sensitive Dysphoria? Published 7-25-2019. Accessed 12-19-2021.

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