What is Rejection Sensitive Dysphoria (RSD)?
Recently on the blog, I talked about emotional dysregulation in ADHD. A related, common experience of folx with ADHD is Rejection Sensitive Dysphoria (RSD). I will go into the details about what exactly RSD later in this post, but it is important to know that RSD is not a diagnosis in and of itself. Rather, it is currently considered a specific type of emotional dysregulation. While emotional dysregulation isn't currently recognized as a criterion for ADHD in the DSM (Diagnostic and Statistical Manual of Mental Disorders) in the United States, it is acknowledged as such in European countries, indicating a disparity in the way we view these conditions across the globe.
What is Rejection Sensitive Dysphoria?
RSD is characterized as emotional dysregulation triggered by situations involving rejection, teasing, criticism, or negative self-talk. These situations can range from explicit instances of rejection, like being let go from a job, to more subtle perceived rejections, where an innocent interaction might be interpreted as a form of rejection. While RSD primarily manifests as emotional dysregulation, some individuals also experience physical symptoms. Moreover, RSD typically presents rapidly and intensely, often with specific triggers.
While not an exhaustive list, here are some things that folx who experience RSD have reported as behaviors related to RSD (adapted from Dodson, 2023):
Quick emotional shift (for example, a sharp increase in anxiety or frustration) following perceived criticism or rejection
Withdrawing from or avoiding social situations
Self-criticism and negative self-talk
Low self-esteem
Rumination regarding the rejection
Often feeling as if they are being attacked and responding defensively
Do all individuals with ADHD experience RSD? No, it's not a universal experience. Furthermore, RSD isn't exclusive to ADHD; other neurodivergent individuals may experience RSD as well. For example, research into the link between Autism and RSD is relatively new and more information is needed in this area. Nonetheless, it's plausible that many Autistic individuals identify with RSD.
How is RSD different than other reactions to rejection or criticism?
Rejection is undoubtedly challenging for everyone. RSD is different in that the way it shows up is decidedly more quick and intense than what one may consider a “typical” reaction to rejection. (I use quotes around typical because to be fair - what is normal or typical? It’s all relative.) Folx that experience the emotional dysregulation of RSD describe it with words such as “devastating” or “catastrophic.” These descriptions aren't limited to specific types of rejection but instead are consistently used to convey the depth of experience associated with RSD. In my opinion, this suggests that RSD deserves its own recognition and category.
How is RSD approached in therapy?
While I can't speak for all therapists, I've found that acknowledging the existence of RSD is an essential step in helping individuals cope with it. This recognition is more powerful than it may initially seem. People with ADHD already contend with stigma and invalidation regarding their experiences, such as being labeled as lazy or inconsistent. In the U.S., where I practice, emotional dysregulation isn't formally recognized in the criteria for ADHD. In my view, this lack of recognition can lead to a lack of understanding regarding the impact of RSD in individuals with ADHD, and ironically, it may contribute to the persistence of RSD. Hence, acknowledging the existence of RSD and its effects can be a transformative and healing process in its own right.
Regrettably, the dearth of research on working with adult ADHDers makes it challenging to offer "official" treatment recommendations for RSD. Therefore, I tend to place a strong emphasis on the client's perspective when assisting someone with RSD. What does their unique experience with RSD entail? What has helped them in the past, and what hasn't? Then we can build a plan to manage RSD based on their individual needs and experiences.
Want to learn more? Check out the article by Dr. Dodson (referenced above, linked here) and an excellent blog post from Embrace Autism (linked here).