Rejection Sensitivity Dysphoria
People with Rejection Sensitivity Dysphoria (RSD) experience severe emotional pain because of a failure (perceived or real) or feeling rejected. RSD is linked to ADHD and there is speculation that it occurs due to differences in brain structure and functional connectivity. As a reminder, the brains of people with ADHD do not regulate internal communication in the same way. The area that filters and regulates signals is less active, therefore, there is less of a filter. This can also mean that there is a difficulty processing information from the senses and it may not regulate pain or pain-like activity in the same way.
The frontal lobe, specifically the prefrontal cortex, is related to language, social skills, impulse control, judgement, and problem solving. ADHD might cause someone to be less aware of certain social cues or details and they may “lack insight” into how that can affect others and/or interpret unclear conversations as a form of rejection. Feelings of rejection can trigger feelings of confusion, failure, betrayal, pain, and sadness.
People with RSD can interpret vague interactions as rejection and have difficulty controlling their reactions. Brain imaging has shown that social rejection, even if it is vague and uncertain, causes similar brain activation to when a person is in physical pain. RSD is an intense feeling of emotional pain which can be difficult to describe in addition to aspects of rejection sensitivity. Emotional dysregulation occurs with both Rejection Sensitivity and RSD, however, dysphoria is only present in RSD. People with RSD have difficulty with regulating rejection-related emotions and behaviors and experience those feelings more intensely. People experience feelings of rejection stronger, find them harder to manage, or both.
People with RSD can be triggered by rejection, disapproval, judgement, exclusion, and criticism. It can be easy for them to feel embarrassed or self-conscious, have low self-esteem, trouble believing in themself, and trouble containing emotions when feeling rejected. Sometimes those feelings are displayed externally with anger, tears and sadness. Feelings can turn inward which can lead to a snap onset into a depressive episode. This onset can be mistaken for the emotional shifts in Bipolar Disorder or Borderline Personality Disorder.
People with RSD are typically people pleasers and can find it difficult and/or draining to manage relationships. The fear of rejection may lead them to putting up emotional walls and for them to distance themselves or not fully engage in relationships. They can avoid starting projects or not taking job opportunities where there is a chance of failure and try to compensate for their fear by striving for perfection. Going all out and striving for perfection can lead to intense feelings of anxiety and sometimes mean that the person does not maintain appropriate self-care. They may also struggle with receiving feedback, due to it being perceived as failure or rejection.
It can be help for a person with RSD to identify their triggers, engage in radical acceptance, learn and utilize self-compassion, find tools to better regulate their nervous system, journal, and find ways to “catch the stories” that their brain creates and shut them down to reduce the intensity and frequency of these feelings. A therapist can assist with this and additionally, it may help to speak to a prescriber about medication.