As I drive home from work, the wind beats comforting patterns across my shaved head and I sing boldly along to the music pouring out of the speaker. I admire the beauty of the landscape and think of how lucky I am to live in such a beautiful place. My heart beats in anticipation of the moment I will see my love.

I open the door to the home we share and take a few steps into the living room where he lays upon the couch playing a video game. I say nothing and neither does he. He is sucked into the world of Zelda.

As a chandelier falls and shatters, so does my once good mood. I am crushed, devastated, broken. My soul tears and bleeds. Thoughts race so quickly I can barely register them.

Of course he doesn’t love you. See? He never did. You’re just an annoyance. Why else wouldn’t he greet you? He clearly doesn’t love you. He’s mad at you. You fucked up and now he’s mad and it’s all over. This will be the end of everything…

I collapse into myself unable to utter words to break the silence.

Having finished a battle, he looks up to see me standing frozen in the entry way. He smiles and greets me, but it’s too late. In my mind, I have done something terrible and unforgiveable and he will never love me again.

Many tears and hugs and reassurances later, I’m back to being chipper and happy about life.

This is just one small moment in my life with Rejection Sensitive Dysphoria. Just one of the many instances that occur daily.

What is Rejection Sensitive Dysphoria?

Rejection Sensitive Dysphoria (RSD) is an extreme emotional sensitivity and pain triggered by perceived or real rejection, teasing, or criticism by people important to the person. This condition is common in ADHD, and, as of now, considered unique to ADHD. RSD can also be triggered by a sense of failure or a feeling of falling short of one’s own expectations or the expectations of others.

We often hear the word dysphoria in relation to gender. We hear about people who have body dysphoria or social dysphoria. In these uses as well as in RSD, dysphoria means a profound state of unease or dissatisfaction, derived from the Greek word dusphoros meaning “hard to bear.” When dysphoria is used without specification, it can be a psychological term for the intense state of unease or dissatisfaction that often accompanies depression or anxiety. When used in relation to trans experiences of gender, dysphoria specifically refers to the unease and dissatisfaction experienced in relation to gender. With RSD, the sense of profound unease and dissatisfaction is in relation to rejection.

Rather than being weak, people with RSD experience emotional responses that are neurologically and physically more painful than those experienced by people without the condition.

So, what does RSD look like?

This depends on how the person processes these emotions. For those who internalize the emotional response, it can manifest as intense major depression, including suicidal ideation. In fact, the rapid mood shifts that occur with RSD are often mistaken for rapid cycling bipolar disorder.

For those who externalize the reaction, it can manifest as an intense and instantaneous rage at the person or situation responsible for causing the pain. In fact, 50% of people who are assigned court-mandated anger-management have ADHD that had previously gone unrecognized.

Further, regardless of whether a person internalizes or externalizes the emotional response, people with RSD can come to anticipate rejection and avoid situations in which they may be rejected. This can seem like social anxiety or a social phobia. Social phobia is an intense, anticipatory fear that one will embarrass or humiliate themselves in public which is different from the social avoidance with RSD as this avoidance derives from fear of rejection by others rather than fear of embarrassment or humiliation.

The emotions experienced in response to failure or rejection is often catastrophic for those of us who must live with RSD. Perceived criticism or withdrawal of love or respect is just as devastating as if it had actually happened.

These experiences can lead ADHD people to cope in two ways. We either become people pleasers or we stop trying, or both. For those who become people pleasers, we often craft ourselves to be liked by those we care about, even to the extent of forgetting who we really are or what we really want in life. We will do anything to make sure that others are not feeling negative emotions towards us. For those who stop trying, any possibility of failure is too painful and risky to chance and thus they don’t. For instance, the pain of being rejected while applying for jobs may lead a person to simply stop applying entirely.

The pain of RSD can also drive people to become perfectionists who constantly work to be above criticism or reproach. These people may seem to have it all together from the outside, but are often suffering significantly internally.

How can I deal with this?

The first step in dealing with RSD is understanding. Just knowing that there is a name for these experiences and that you’re not alone can be huge. Remember, it’s not your fault and you are not damaged, this is just a part of how ADHD brains are wired.

Unfortunately, therapy has not proven particularly helpful because of how suddenly the emotions hit and how completely overwhelming they are.

There are a couple of medications that have proven useful in managing the emotional difficulties of RSD. The medications were originally designed as blood pressure medication but have been found to be useful in the treatment of ADHD. These medications are guanfacine and clonidine together or MAOIs. If you are interested in learning more about these medications in relation to RSD, you can read more here. As always, talk with your doctor about any medications you are interested in taking.

If you’re not interested in medication, or aren’t able to utilize these options, there are still things you can do to help manage the emotions of RSD which are as follows:

  • Managing stress– while this is much easier said than done, try to limit the sources of stress in your life
  • Avoid over-commitment
  • Get enough sleep– getting enough rest can help us be more positive and less reactive
  • Exercise regularly– exercise can alleviate stress which can in turn help with RSD
  • Self-care– make sure to take time to allow yourself to recharge. Play a game, read a book, or whatever else is enjoyable or relaxing for you.
  • Treat comorbid anxiety and depression– if you have anxiety or depression as well as ADHD, make sure to seek treatment for these conditions as, untreated, they are likely to make emotional control worse
  • Avoid situations likely to spark strong emotions– of course, we can’t avoid everything in life that may invoke strong emotions, but it’s important to weigh the importance or benefit of a situation vs the emotional toll it will take. Sometimes, things just aren’t worth the emotional burden.
  • Create a plan– plan ahead for how to respond to situations that you know will evoke strong feelings. Think about how you can respond to things the other person might do as well as figuring out what your desired outcome is.
  • Take a break– if you’re about to blow up at someone, walk away. If you are in a situation with someone you care about, try to let them know that you need a few minutes alone to calm down.
  • Train others to talk you down– identify situations where you are likely to experience intense emotions and train your friends and family on ways they can help pull you out of the emotional spiral.
  • Remind yourself that this will pass– no matter how strong the emotion is, it will eventually fade. Try to remind yourself of this in the moment.
  • Separate feeling from acting– often, our emotions dictate our behavior, but it doesn’t have to be this way. Mindfulness training can help you learn to separate emotion from action to give yourself time to choose how to react.
  • Educate others-explain your emotional patterns to those you are close to. This can help them understand and diffuse difficult situations.
  • Once you are calm, explain what you really meant– if something came out differently than you intended or you said things you didn’t mean, explain what you really meant. Don’t deny what was perceived but rather explain your intention while acknowledging the effects your words or actions had.

Life with RSD can be really hard at times, but it is possible to learn to manage the intense emotions so that you can lead a better life.

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