What Is Rejection Sensitive Dysphoria?

Rejection sensitive dysphoria is not a formal diagnosis, but rather one of the most common and disruptive manifestations of emotional dysregulation — a common but under-researched and oft-misunderstood symptom of ADHD, particularly in adults. Rejection sensitive dysphoria is a brain-based symptom that is likely an innate feature of ADHD. Though the experience of rejection sensitive dysphoria can be painful and even traumatic, RSD is not thought to be caused by trauma.

Dysphoria is the Greek word meaning unbearable; its use emphasizes the severe physical and emotional pain suffered by people with RSD when they encounter real or perceived rejection, criticism, or teasing. The emotional intensity of RSD is described by my patients as a wound. The response is well beyond all proportion to the nature of the event that triggered it.

One-third of my adult patients report that RSD was the most impairing aspect of their personal experience of ADHD, in part because they never found any effective ways to manage or cope with the pain.

What Triggers Rejection Sensitive Dysphoria?

Rejection sensitive dysphoria is characterized by intense mood shifts triggered by a distinct episode, typically one of the following:

• rejection (the real or perceived withdrawal of love, approval, or respect)
• teasing
• criticism, no matter how constructive
• persistent self-criticism or negative self-talk prompted by a real or perceived failure

The new mood sweeps in immediately and it matches the individual’s perception of the trigger. If these triggered emotions are internalized, the person can instantaneously appear as if they have a full Major Mood Disorder syndrome complete with suicidal thinking. If the feelings are externalized, they are commonly expressed as a rage at the person or situation that wounded them so severely. The moods return to normal very quickly so that a person with ADHD can have multiple episodes of mood dysregulation in a single day.

Many people with RSD say it’s always been a part of their lives, however some report growing significantly more sensitive in adolescence.

What Are the Outward Signs of Rejection Sensitive Dysphoria?

Individuals suffering from rejection sensitive dysphoria may exhibit the following behaviors:

• Sudden emotional outbursts following real or perceived criticism or rejection
• Withdrawal from social situations
• Negative self-talk and thoughts of self-harm
• Avoidance of social settings in which they might fail or be criticized
• Low self-esteem and poor self-perception
• Constant harsh and negative self-talk that leads them to become “their own worst enemy”
• Relationship problems, especially feeling constantly attacked and responding defensively

If you find RSD causing you major discomfort in your life, please organise your free initial consult to discuss your needs.