How to Deal with Fear of Rejection (Rejection Sensitive Dysphoria)?

rejection sensitive dysphoria
Medically reviewed by Dr. Mavra Farrukh

Overview

Rejection-sensitive dysphoria is a dark secret. It lurks in almost everyone with ADHD, unknown and unspoken. Some people who have discussed it describe it as the worst part of ADHD. Rejection-sensitive dysphoria is known as the overreaction to real or perceived rejection.

ADHD makes it more difficult to concentrate, pay attention, and maintain stillness. Most ADHD sufferers are also sensitive to what others think or say about them. This is frequently referred to as rejection-sensitive dysphoria (RSD), which is a term used to describe particular symptoms connected to ADHD but is not a medical diagnosis.

There’s no treatment for RSD, only coping. Coping is challenging but doable. It mitigates the worst pain rather than taking it away, but it’s better than nothing. I’m sharing some strategies in this article to cope with rejection-sensitive dysphoria that you might find helpful.

What is Rejection-Sensitive Dysphoria ADHD?

.The word “dysphoria,” which means “hard to bear,” is Greek. RSD sufferers struggle to accept rejection. Even if it’s false, people become upset if they believe someone has ostracised or ridiculed them.

It means that whenever someone is horrible to you, be it, someone you love saying something hurtful in an argument or a Twitter troll baiting you for kicks, you react in a way that most people would find disproportionate. Even extreme. But why do we respond like this? Because it hurts. And no one knows why. People with ADHD often get told they’re “too sensitive.” That they “blow up too easily.” They’re always overreacting. That they’re getting upset over nothing is valid for an average person. But our neurotypical friends don’t realize we are reacting like that because it reflects how we feel. And we can’t control how we feel. Saying that we’re too sensitive or overreacting isn’t helpful. It doesn’t take away how we feel. It doesn’t make it better. All it does is show us that ordinary people don’t understand. It can feel like the world has ended. 

Up to 99% of adolescents and adults with ADHD are more vulnerable to rejection than usual. And about one-third of those with ADHD say it’s the most challenging aspect of having the disorder.

Consult one of our Doctors Online if you Suffer from Rejection-Sensitive Dysphoria.

What’s the Difference Between Rejection Sensitivity and Rejection-Sensitive Dysphoria?

Rejection sensitivity is a common human trait where a person is more attuned to perceiving rejection or criticism from others. It can lead to feelings of hurt or distress, but it does not necessarily interfere with a person’s daily life.

Rejection Sensitive Dysphoria (RSD), on the other hand, is a more intense emotional response to perceived rejection or criticism from others. It is a symptom of various conditions, including Attention Deficit Hyperactivity Disorder (ADHD), Borderline Personality Disorder (BPD), and Social Anxiety Disorder (SAD). Those with RSD may experience severe emotional anguish, anxiety, and a sense of worthlessness or inadequacy in response to perceived rejection or criticism. It can have a detrimental effect on a person’s mental health and capacity to function daily.

What is the Difference Between Social Anxiety and Rejection-Sensitive Dysphoria?

There are some parallels between Social Anxiety Disorder (SAD) and Rejection Sensitive Dysphoria (RSD), but they are two distinct disorders.

A social anxiety disorder, a mental health condition, is characterized by intense worry and fear in social situations. They may worry excessively about being judged, embarrassed, or humiliated and avoid social problems altogether. SAD can lead to physical symptoms such as sweating, shaking, and rapid heartbeat.

On the other side, Rejection Sensitive Dysphoria (RSD) is a symptom that is frequently linked to disorders like Borderline Personality Disorder (BPD) and Attention Deficit Hyperactivity Disorder (ADHD). It entails a strong emotional reaction to what is seen to be rejection or criticism from others. Even when rejection is unintentional, people with RSD may experience an overwhelming sense of worthlessness, shame, and emotional suffering.

While both SAD and RSD can involve a fear of rejection and may lead to avoidance of social situations, the critical difference is that SAD is primarily characterized by anxiety and fear, while RSD involves an intense emotional response to rejection or criticism. SAD is considered a standalone mental health disorder, while RSD is a symptom commonly associated with other mental health conditions.

What Causes RSD (Fear of Rejection)?

The exact cause of Rejection Sensitive Dysphoria (RSD) is not fully understood. Still, doctors believe it is a symptom of various mental health conditions, including Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD).

People with ADHD who experience RSD may have difficulty regulating their emotions, leading to an intense emotional response to perceived rejection or criticism from others. This can be compounded by problems with executive functioning, making it harder for them to manage their emotions and reactions to stress.

Similarly, people with BPD who experience RSD may have a heightened sensitivity to rejection and criticism due to their difficulties with emotion regulation, self-image, and interpersonal relationships. They may also have a history of childhood trauma or neglect that can contribute to the development of RSD.

By the age of 12, ADHD experts predict that compared to other children their age, children with ADHD get 20,000 more self-deprecating messages. The amount of criticism they receive might damage their self-esteem.

Consult one of our Doctors Online if you Fear Rejection and Feel Overwhelmed.

Symptoms of Rejection Sensitive Dysphoria(Fear of Rejection)

Rejection Sensitive Dysphoria (RSD) symptoms may vary depending on the individual and the underlying condition causing it. However, some common symptoms of RSD include:

Emotional symptoms

Emotional symptoms of Rejection Sensitive Dysphoria (RSD) are specific to this condition and are typically characterized by an intense emotional response to perceived rejection or criticism. Here are some common emotional symptoms of RSD and their explanations:

Intense emotional response

Individuals with RSD may experience extreme emotional reactions to perceived rejection or criticism from others, even if it is not intended or directed at them. This can include feelings of worthlessness, shame, emotional pain, mood swings and difficulty regulating emotions.

Self-doubt and fear of failure

Individuals with RSD may battle self-doubt and failure anxiety, which can cause them to avoid situations or activities that might make them feel rejected or judged. They might also talk to themselves negatively or have a wrong view.

Impulsivity

In some cases, individuals with RSD may engage in impulsive behaviors, such as lashing out at others or engaging in risky behaviors, to cope with their emotional distress.

Low self-esteem

The intense emotional response associated with RSD can also contribute to low self-esteem and a negative self-image.

Difficulty with relationships

Due to their hypersensitivity to perceived rejection or criticism from others, people with RSD may struggle in social situations. As a result, one may become socially isolated and reluctant to develop close relationships.

Suicidal ideation

Severe circumstances may cause RSD sufferers to have suicidal thoughts or engage in self-harming behaviors as a coping mechanism for their mental suffering. It’s imperative to seek expert assistance if you or someone you know exhibits RSD symptoms.

Behavioral symptoms

Behavioral symptoms of Rejection Sensitive Dysphoria (RSD) are observable actions or behaviors that can indicate the presence of this condition. Here are some common behavioral symptoms of RSD and their explanations:

Avoidance

People with RSD may avoid situations or people they perceive as potentially triggering rejection or criticism. This may lead to social isolation and a reluctance to participate in activities they enjoy.

Consult one of our Doctors Online to Find the Cause of RSD.

Defensive behavior

When faced with perceived rejection or criticism, individuals with RSD may become defensive and engage in arguments or confrontations with others. This can lead to interpersonal conflict and difficulty maintaining relationships.

Impulsive behavior

Individuals with RSD may sometimes use impulsive behaviors to cope with their emotional distress. This can include substance abuse, binge eating, or risky sexual behaviors.

Self-harm

In severe cases, individuals with RSD may engage in self-harming behaviors, such as cutting or burning themselves, to cope with their emotional pain.

People pleasing

To avoid rejection or criticism, individuals with RSD may engage in people-pleasing behaviors, such as always saying yes to requests or constantly seeking approval from others.

Perfectionism

Individuals with RSD may also exhibit perfectionistic tendencies, as they may feel that anything less than perfection will lead to rejection or criticism from others.

Cognitive symptoms

Cognitive symptoms of Rejection Sensitive Dysphoria (RSD) refer to changes or disruptions in an individual’s thought processes that can indicate the presence of this condition. Here are some common cognitive symptoms of RSD and their explanations:

Catastrophizing

People with RSD may catastrophize situations, meaning they imagine the worst possible outcome of a case, often involving rejection or criticism. This can lead to anxiety, stress, and avoidance behaviors.

Negative self-talk

Individuals with RSD may engage in negative self-talk, criticizing themselves or engaging in self-blame for perceived rejection or criticism. This may contribute to low self-esteem and a negative self-image.

All-or-nothing thinking

Individuals with RSD may think all-or-nothing, seeing situations as either entirely positive or negative. This can contribute to difficulty with emotional regulation and may lead to impulsive behavior.

Hypervigilance

People with RSD may be hypervigilant, constantly scanning their environment for signs of potential rejection or criticism. This can lead to anxiety and avoidance behaviors.

Fear of abandonment

Individuals with RSD may have an intense fear of abandonment, which can lead to difficulty with interpersonal relationships and social isolation.

Perceived criticism

People with RSD may perceive criticism as not intended, leading to emotional distress and avoidance behaviors.

How Can RSD Affect Your Life?

Often someone with this problem puts a lot of effort into winning over others’ admiration and likeness. They could also give up and avoid any situations where they might get wounded. This social disengagement may resemble social phobia, a severe dread of shame in front of others.

RSD may impact relationships with family, friends, or a romantic partner. It’s possible for your perception that you’re being rejected to become a self-fulfilling prophecy. If you behave differently towards the person you believe has left you, they might start to do so.

How to Diagnose Rejection Sensitive Dysphoria?

There are no criteria for Rejection Sensitive Dysphoria (RSD) because it is not a recognized diagnostic in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). RSD may be diagnosed alongside other mental health issues like ADHD or borderline personality disorder, though, as these conditions are frequently linked to RSD.

To diagnose RSD, a mental health professional will typically take a medical history and assessment to gather information about an individual’s symptoms and family history. They may also use standardized questionnaires or rating scales to assess the severity of an individual’s symptoms.

Some common signs and symptoms that a mental health professional may look for when diagnosing RSD include intense emotional reactions to perceived rejection or criticism, fear of social situations, avoidance behaviors, and impulsivity.

It is important to note that a diagnosis of RSD is unnecessary to receive treatment for the symptoms associated with this condition. A mental health professional can work with individuals experiencing symptoms of RSD to develop coping strategies and provide support, regardless of whether or not they meet the criteria for a specific diagnosis.

Seek Professional Help from our Doctors if You are Experiencing Symptoms of RSD.

How is RSD(Fear of Rejection) Treated?

Because the Diagnostic and Statistical Manual of Mental Disorders does not recognize it as a mental condition, Rejection Sensitive Dysphoria (RSD) lacks a defined therapy (DSM-5). Yet, the right treatment strategies and dietary changes can effectively manage many RSD-related symptoms. Some patients may even benefit from rejection therapy, especially after a traumatic event. 

Medication

Medications can be prescribed to manage associated conditions that may contribute to the development of RSD.

For example, RSD is often associated with Attention-Deficit/Hyperactivity Disorder (ADHD), and medications used to treat ADHD, such as stimulants or non-stimulant drugs, can help manage symptoms of RSD.

Additionally, if RSD is associated with depression or anxiety, medications used to treat these conditions, such as antidepressants or anti-anxiety medications, can also help manage symptoms of RSD.

Psychotherapy

(CBT) cognitive-behavioral therapy or dialectical behavior therapy (DBT) can be effective in treating Rejection Sensitive Dysphoria (RSD). Psychotherapy can help individuals with RSD to develop coping strategies, improve emotional regulation, and reduce the impact of rejection or criticism.

CBT therapy aims to recognize and alter unfavorable thought and behavior patterns. CBT can assist people with RSD in overcoming self-defeating attitudes about their capacity for handling rejection and developing more flexible coping mechanisms.

DBT aims to help patients improve their capacity for emotional control, distress tolerance, and interpersonal efficacy. For those with RSD who suffer from strong emotions, impulsivity, and issues in social situations, DBT can be especially beneficial.

In addition to CBT and DBT, other types of therapy, such as talk therapy or psychodynamic therapy, can also help address the underlying causes of RSD and develop effective coping strategies.

It is important to note that psychotherapy is a process and may take time to produce significant results. Additionally, therapy should be individualized to meet each individual’s unique needs and circumstances with RSD. Working with a qualified mental health professional can help individuals with RSD find the most effective therapy type.

Lifestyle changes

Lifestyle changes can be effective in treating Rejection Sensitive Dysphoria (RSD) by promoting overall physical and mental well-being, which can, in turn, reduce the severity of symptoms associated with RSD. Some lifestyle changes that may help manage RSD include:

Regular exercise

Exercise effectively reduces symptoms of depression and anxiety commonly associated with RSD. Additionally, exercise can help to promote overall physical health and well-being.

Healthy eating

Consuming a nutritious, well-balanced diet supports general physical health, which can help improve emotional regulation.

Stress management techniques

Stress might make RSD symptoms worse. Stress-reduction techniques, including deep breathing, progressive muscle relaxation, and mindfulness meditation, can ease anxiety and boost emotional well-being.

Healthy sleep habits

Getting enough restful sleep cannot be overstated for physical and mental health. Creating sound sleep habits, such as going to bed and waking up at the same daily, can help promote restful sleep.

Self-care

By engaging in relaxing and self-care activities like taking a warm bath, reading a book, or spending time in nature, stress can be lessened, and emotional well-being can be improved.

Support groups

These groups can effectively treat Rejection Sensitive Dysphoria (RSD) by providing individuals with a sense of community and connection with others experiencing similar struggles. Support groups can help individuals with RSD feel less alone and isolated and provide a space for sharing experiences and learning from others.

Mental health professionals can facilitate support groups or can be peer-led. Some support groups may focus specifically on RSD, while others may be broader in scope and address related conditions, such as anxiety or depression.

In a support group setting, individuals with RSD can share their experiences and feelings in a non-judgmental and supportive environment. They can also learn from others who have found effective coping strategies for managing their symptoms of RSD.

These groups can also provide a sense of accountability and motivation. Individuals with RSD can hold each other accountable for making positive changes, such as seeking treatment or lifestyle changes.

Consult one of our Doctors Online to Manage and Treat Rejection Sensitive Dysphoria.

FAQs About Rejection Sensitivity Dysphoria Answered by Your Doctors Online Team.

What does rejection sensitivity dysphoria feel like?

Rejection Sensitivity Dysphoria (RSD) is a heightened emotional response to perceived rejection or criticism from others. It can cause an intense fear of rejection, feelings of worthlessness, shame, and anxiety. Those with RSD may experience avoidance behaviors and social withdrawal. They may also have a heightened sensitivity to any perceived criticism, leading to a strong emotional reaction that is difficult to control.

Can you have RSD without ADHD?

While Rejection Sensitivity Dysphoria (RSD) is often associated with ADHD, it is possible to experience RSD without having ADHD. RSD can occur in individuals with other neurodiverse conditions or those without neurodiversity. The experience of RSD can be similar regardless of the underlying condition, with symptoms such as emotional sensitivity, fear of rejection, feelings of worthlessness, shame, and anxiety.

What triggers RSD?

The triggers for Rejection Sensitivity Dysphoria (RSD) can vary from person to person. Common triggers include perceived rejection or criticism from others, social situations, interpersonal relationships, work or school performance, and personal setbacks or failures. Even minor or unintentional comments or actions can trigger intense emotional responses in individuals with RSD. Additionally, past experiences of rejection or trauma can also contribute to the development of RSD. Understanding individual triggers can help develop coping strategies and seek appropriate treatment for RSD.

How long do RSD episodes last?

The duration of Rejection Sensitivity Dysphoria (RSD) episodes varies and depends on the trigger’s severity. In some cases, the emotional response may be short-lived and resolved quickly. However, in other cases, RSD episodes can last hours or even days, causing significant distress and disruption to daily life.

How do you comfort someone with RSD?

Comforting someone with Rejection Sensitivity Dysphoria (RSD) involves understanding and validating their feelings while providing safety and support. Listening attentively and acknowledging the person’s emotions without judgment or criticism is essential. Offering practical solutions or problem-solving strategies can also be helpful. Additionally, reassurance and encouragement can help alleviate feelings of worthlessness and self-doubt. Overall, showing empathy and support while respecting the individual’s boundaries and needs can be beneficial in comforting someone with RSD.

Why do I handle rejection so badly?

There can be various reasons why a person may mishandle rejection. Rejection Sensitivity Dysphoria (RSD) is one potential explanation that can cause intense emotional responses to perceived rejection or criticism. Additionally, past experiences of rejection or trauma can contribute to a fear of rejection and difficulty handling rejection. Low self-esteem or lacking confidence in one’s abilities can make rejection painful. Cultural or societal pressures prioritizing success and achievement can also contribute to feelings of failure and inadequacy after experiencing rejection. Understanding the underlying causes of difficulty handling rejection can help develop coping strategies and seek appropriate treatment.

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