This guest post was done by the lovely Danielle, from The Spicy Therapist. I have written about RSD before, but this article blew me away!

Consider this your new epic guide to Rejection Sensitive Dysphoria!

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Are you a “people pleaser”?

Does failure terrify you?

Does “letting down” a loved one send you into an emotional tailspin? 

If you have ADHD and have answered yes to any of these questions, you might be one of the 1 in 3 that suffers from Rejection Sensitive Dysphoria (RSD).

Hi, I’m Danielle, I am a Marriage and Family Therapist and I also have ADHD.

Unfortunately, am also familiar with the emotional pain that accompanies RSD.

In fact, when I think about all of the things I find challenging about ADHD, managing my emotions definitively tops the list.

I can use planners to help me stay organized, put sticky notes all over my house to help my crappy memory, but there isn’t a handy device that can help me refocus after a fight with my husband.

Nothing but time and hard work will get me past a depressive episode.

I can’t help but feel like I have wasted A LOT of time in my head ruminating on negative emotions.

Luckily I can say I have experienced less RSD these past few years and I hope to help others do the same!

In this post I am going to cover:

• What Is RSD?
• How Does RSD Affect One’s Life?
• Why/ How Does RSD Develop?
• How To Make It “Better”.

rejection sensitive dysphoria sucks

Here’s what you need to know

What Is RSD?

Rejection Sensitive Dysphoria (RSD) describes an extreme sensitivity (emotional pain) to feelings of rejection, falling short, or, failing.

This emotional pain seems to be unique to those with ADHD.

According to William Dodson, who coined the term RSD, and who has specialized in ADHD treatment for 22 years, almost all of his clients have answered an enthusiastic “YES” to the following question:

“For your entire life have you always been much more sensitive than other people you know to rejection, teasing, criticism, or your own perception that you have failed or fallen short?”

“Dysphoria” comes from the ancient Greek word “dusphoría”, which means excessive pain. For someone that experiences RSD, any type of perceived rejection or loss of approval/respect/love is extremely painful emotionally.

The Part Of ADHD That No One Talks About

Another fascinating fact about RSD is that it is not very “well-known”. Many people suffering with RSD don’t know they have it and believe their emotional management issues are probably due to something else besides their ADHD.

Long ago diagnostic criteria did actually note emotional disturbance as a hallmark symptom associated with what is now known as ADHD. However, this was removed later as emotional issues are hard to measure and quantify for diagnostic purposes.

If you are interested to know more about the diagnostic history of ADHD, check out my other post: The Ultimate Guide To Emotions & ADHD

 Symptoms Include:

• *Constantly setting high, sometimes unrealistic, standards for oneself

• *Shy or socially anxious

• *Depression

• *Negative thoughts

• *Intense fear of failure

• *Anger/ Rage

• *Low self-esteem

• *Seeks the approval from family, friends, and/or partners

• *Often have feelings of hopelessness

• *Extremely critical of themselves

How Does RSD Affect One’s Life?

According to Dr. Dodson, people cope with RSD in three ways:

1. They become people pleasers.

According to Dodson, “They scan every person they meet to figure out what that person admires and praises. Then, that’s the false self they present.”

Often the individual “loses themselves”, forgetting what they actually wanted from their own lives.

2. They stop trying.

Dodson says, “If there is the slightest possibility that a person might try something new and fail or fall short in front of anyone else, it’s just too painful and too risky to even consider. So, these people just don’t. ”

“These are the very bright, capable people who become the slackers of the world and do absolutely nothing with their lives because making any effort is so anxiety-provoking.”

3. They become a perfectionist or an overachiever.

“They constantly work to be the best at what they do…They strive for perfection, which is never attainable, and are constantly driven to achieve more.” (Source)

RSD, Depression, and Misdiagnoses

The emotional pain can be so intense for some that it can trigger a depressive episode. Because of this, RSD has been the root of several misdiagnoses.

Rapid cycling from happy to extremely depressed can look like bipolar disorder. 

RSD & Violence

It has been speculated that RSD could be to blame behind violent outbursts.

This post by ADDitude claims, “50% of people who are assigned court-mandated anger-management treatment have previously unrecognized ADHD.”

Social Withdrawal

Sometimes the fear of rejection and ridicule can be so intense that it can cause social anxiety. The idea of being embarrassed in public is too much to bear. 

Relationships

It is normal for any relationship to experience friction from time to time. If you have RSD, normal relationship friction can suddenly turn into a major deal. Here are some scenarios:

A simple request from a significant other to load the dishwasher differently feels like a personal attack. You get defensive and blow up in anger at the perceived criticism. Then afterward you feel bad and get worried, afraid they will leave you.

A friend tells you her feelings were hurt when you forgot to call her back like you said you would. You apologize and deep down you feel awful. She accepts your apology and thinks everything is fine; you, however, start to slowly distance yourself from that friend not wanting to experience disappointing her again. 

For someone with RSD, knowing they displeased someone they love is very painful to deal with emotionally.

It is common for someone to with RSD to leave relationships quickly as it seems easier to “start again new” than to work on the issues present.

Discrediting Others

One of the ways people deal with the pain of RSD is by discrediting the individual that is the object of the perceived criticism.

Here are some examples: 

During her performance review, Cindy’s boss tells her several ways that he thinks she could improve in her job performance. Cindy is very offended and hurt as she feels criticized.

Afterward, instead of thinking objectively about his suggestions, Cindy begins to discredit her boss with thoughts like, “He is so stupid, he has never even worked closely with me before. He has no fricking clue what he is talking about!”

By discrediting her boss, Cindy is taking away his value. He is no longer an important authority figure that can hurt her feelings. He is now someone that is not worth listening to since he is stupid and his opinions are worthless.

This particular coping mechanism can create a lot of problems for people.

No one wants to work with or be in a relationship with someone you can’t give feedback to.

Everyone has shortcomings and constantly discrediting anyone with constructive criticism could mean missing out on valuable opportunities to grow and work on oneself.

Holding The Other Person “Hostage”

Those with RSD can unknowingly hold other people “hostage” with their emotions.

What I mean by that is, to avoid emotional outbursts, people may start to hold back their grievances. Unfortunately, not communicating is a surefire way to build up resentment in a relationship.

Self-Fulfilling Prophecies

Sometimes relationships end because the partner without RSD decides that they can’t deal with being in a relationship with someone so emotionally volatile.

Why/ How Does RSD Develop?

The hereditary nature of ADHD has long been in question in the scientific community.

There is speculation that a gene responsible for creating dopamine in the brain may have something to do with the development of ADHD but conclusive studies are hard to come by.

What we do know is that ADHD is a brain-based, biological disorder. Research and brain imaging proves there are many differences in the brains of individuals with ADHD when compared to a neurotypical brain.

So why do only 1 in 3 people with ADHD experience RSD?

Does it all boil down to genetics or is there more at play here?

No one has a solid answer to this as of yet but there are some guesses.

Negative Messages As A Child

According to Web MD, “ADHD researchers estimate that by age 12, children with ADHD get 20,000 more negative messages about themselves than other kids their age.”

20,000 more negative messages?! Wow! That will certainly take a toll on one’s self-esteem.

Persistent criticism can leave one feeling as if they are fundamentally flawed and different from everyone else.

Labeled As LAZY

Out of all the negative messages; the one I think almost all people with ADHD can identify with is being labeled as lazy.

Many people with ADHD are intelligent yet impulsiveness and poor attention to detail can lead to careless mistakes.

Typically this behavior is interpreted as laziness as the individual is obviously mentally capable.

Another reason people think those with ADHD are lazy is because of their ability to hyperfocus on things that interest them.

For example, parents see that their child can build Legos for 2 hours straight but then they see them struggle to get through 15 minutes of math homework. Not understanding the nature of ADHD, the parents conclude that the child is just lazy when it comes to doing their homework.

Lazy is an especially hurtful accusation as it insinuates that the actions of the individual are deliberate and malicious in nature.

A Matter of Perspective: Fixed Intelligence Vs Malleable Intelligence

If you follow a lot of parenting blogs, then you may already know one of the “hot topics” lately is praising children for their effort rather than their intelligence. 

See Liz’s article on growth mindset.

Scientific research has shown us that if you believe that intelligence is changeable, you actually learn better.

We know this, now – however, there was once a time when most people believed intelligence was fixed. Many of us, myself included, grew up in a time/culture where when we were children, we were praised for being “smart.”

So, how does that factor into RSD?

If negative messages received as a child is, in fact, a major factor in developing RSD, then there might be something to consider here.

In a culture of fixed intelligence, a struggling child that compares themselves to their classmates may believe that they are stupid and furthermore, there really isn’t a whole lot they can do about it.

This mindset is detrimental to learning and will eventually turn into poor grades, poor interactions at school, and ultimately more negative messages; igniting multiple episodes of RSD throughout their academic career.

My Story

I will never forget the shame and anxiety that I felt in my 3rd-grade math class. I was on the verge of tears all the time.

We had to memorize our multiplication tables and pass tests accordingly. Sounds normal, right? Not quite.

Tests results were taped to the wall for everyone to see and we had to physically move our seats according to our test results.

If you didn’t pass a test, then you were grouped together with all the other losers that did as bad as you and you couldn’t move out of Loserville until you pass your next test.

At the risk of sounding dramatic, it was traumatizing for me.

My ADHD makes memorizing things difficult, especially boring things like math! And the RSD that accompanies my ADHD made the public embarrassment of these math exercises almost unbearable.

Math became a really scary thing for me. I thought I sucked at it and I believed I couldn’t learn it. The worst part was math opened me up to embarrassment, therefore I wanted to avoid it at all cost.

I truly believe this early negative learning experience that ignited my RSD shaped my entire relationship with math. The years that followed, the poor grades, fights with my parents, teachers, etc. all of those experiences just brought about more RSD.

How To Make It “Better”

 

Psychotherapy or Meds?

Some experts feel as if psychotherapy is not especially helpful as episodes of RSD tend to have a sudden onset and can overwhelm the individual’s mind and senses for a certain period of time. These experts would say that medical intervention in the form of alpha agonists like clonidine is the best way to treat RSD.

I respectfully disagree with the statement above.

While psychotherapy may not calm the nerves of someone mid-RSD episode quite like clonidine would, what it will do is help the individual develop a healthier narrative around themselves and concepts like failure and rejection.

With a more balanced perspective they will reduce the frequency of RSD episodes.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy is thought to be one of the most effective forms of therapy for treating RSD. Cognitive behavioral therapy focuses on core beliefs that you hold about yourself (schemas), your thought patterns, and the behavior that steams from one’s thinking.

For Example:

James thinks he isn’t a “good person”, he thinks he is a failure at work and in his relationships. Over time, James started to expect things to be hard and difficult for him.

James is quick to give up on things and thinks there is “no point”. James therapist helped him identify these beliefs and examine the evidence for and against them. James learned that he has a “black and white” way of looking at things and has challenged himself to see the middle ground.

Remember when choosing a therapist, find someone you like. Successful therapy heavily depends on a positive relationship between client and therapist.

Adopt A New Outlook On Failure

Such an ominous word, failure. Just saying it gives me the heeby-jeebies.

Here’s the thing about failure:

If you are living your life and trying new things… you will fail. You will make mistakes. That’s good, that’s just what happens when you live your life!

I personally find making mistakes or “failing” much more tolerable than not living, never trying new things, and never taking any chances.

My “failures” and “mistakes” just validate the fact that I’m living my life and I’m trying and that is absolutely something to feel proud of.

Besides, I prefer to think of failure as just part of the process, not the end of the process. 

“Failing” might just be the struggle that comes with learning; maybe all you need to do is stick with it and not stop.

Perhaps “failing” is just a sign that you need to change directions with something.

Which brings me to my next point..

Changing directions is NOT the same as failing. 

Plans almost never go as planned.

As Oprah would say, “We can only do the next right thing”.

Considering that, give yourself the freedom to “figure it out as you go along” and don’t view yourself as a failure because things didn’t work out exactly like you thought.

Correcting Negative Thinking & Abusive Self-Talk

People that experience RSD usually suffer from low self-esteem and depressive episodes.

Both low self-esteem and depression are typically accompanied by lots of negative and distorted thinking.

Sometimes abusive self-talk is an extension of abuse endured in childhood. One can almost “adopt” the negative “script” that they were given as a child. It’s no longer grandma calling you a lazy slob, now it’s you.

How To Start Correcting Negative Thinking

First off, please know thoughts are just thoughts. They are not facts.Also, know that you have the power to change the way you think and to think more positively.

It is a process and it is work, but it’s not hard to do and if you are consistent you will notice a difference.

Step 1: Learn About Common Cognitive Distortions (Errors In Thinking)

There are specific errors in thinking that are common, meaning most people engage in all or some of them to some extent.

For example, the cognitive distortion of personalization is when you assume responsibility for something you have no control over. Ie. “My boyfriend didn’t get the job because I didn’t help him prepare for his interview.”

This post does a great job explaining common cognitive distortions. 

Here is liz’s post on cognitive distortions.

 

Step 2: Metacognition. Notice Your Negative Thoughts & Challenge Them! 

Metacognition is a beautiful thing, essentially it is thinking about what you are thinking about!

Really try to notice the things you say in your head. Pay special attention to negative thoughts that seem to pop up “automatically.” Question and challenge your thoughts regularly.

Step 3: Replace Negative Thoughts With Positive, More Balanced Thoughts 

Instead of “I suck. I’m never going to get this.” Try, “This is a challenge. Challenges are good for me.”

Instead of “I hate my job. I need to quit asap.” Try, “I am grateful to have a steady income. I am looking forward to finding a more fulfilling job in the future.”

The more you practice, the easier it will become. You might feel like you are “faking” it at first and that’s okay.

Try your best to notice how your feelings change once you adopt a more positive outlook, the more you actually notice and feel the benefits, the easier it will be to continue.

Meditation

Meditation makes metacognition easier by helping you increase awareness around your thoughts. Meditation allows “room” for you to “detach” from your thoughts. When you are “detached” you are able to objectively examine.

Pretend To Be Someone Else

If you have someone in your life that is super positive and supportive, sometimes pretending you are that person can help. Take on their voice in your head. What would they say to that negative thought?

Self-Care 

Deficits in sleep, nutrition, and exercise wreak havoc on one’s brain and subsequently one’s ability to manage emotions.

Unfortunately, most of us don’t implement self-care until we are already burned out. Self-care should be ongoing and should include activities that nurture your mind, body, and soul.

If you are interested in learning more about Self-Care check out my post: The Truth About Self-Care: What It Really Is, Why You Need It, & How To Get It.

And be sure to get your FREE Self-Care Planner.

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Liz here! I hope you enjoyed this guest post from Danielle, and you have a better understanding of RSD, what it looks like, and some of the options for living with it.

I deal with depression, anxiety, negative thought patterns, and core beliefs in my Feel Better Fast program.

Click here to check out the self-paced option!