Rejection Sensitive Dysphoria

My last post on Adult ADHD briefly outlined some of the main traits and symptoms of Attention Deficit Hyperactivity Disorder. It was very much uncharted territory for me as I’d never even considered the possibility that many of my struggles may be secondary to or exacerbated by ADHD. Since writing that blog, it has been agreed by two independent GPs that I meet the criteria to be referred for an official clinical diagnosis. Anyone undergoing the diagnostic journey will tell you that it is a lengthy one, with wait lists of around 3 years. So, as I wait patiently (not something that I or many ADHD-ers are good at), I will continue to blog about my experiences in case they help other people going through something similar. I am by no means an expert, but I can write about the things that affect me the most; starting with Rejection Sensitive Dysphoria (RSD).

RSD is extreme emotional sensitivity and pain triggered by the perception that a person has been rejected or criticised by important people in their life. It may also be triggered by a sense of falling short—failing to meet their own high standards or others’ expectations.

Dysphoria is Greek for “difficult to bear.” It’s not that people with ADHD are wimps, or weak; it’s that the emotional response hurts them much more than it does people without the condition. No one likes to be rejected, criticised or to fail, but for people with RSD, these universal life experiences are much more severe than for neurotypical individuals. They are unbearable, restricting, and highly impairing.

For me, RSD presents as an inability to deal with any form of conflict or confrontation, actual or perceived. I will try to fix a situation even if it’s not my fault, and I feel an overwhelming sense of guilt if someone else is unhappy. I remember repeatedly being told as a child “Oh Kate, don’t take everything to heart”… but I did, and I do – I just didn’t know that it had a name. If something goes wrong, I automatically think it’s my fault and that other people are angry towards me (even if they are not), and I spend my life either trying to keep people happy to avoid the guilt, or to fix things to eradicate the guilt, even if these ‘fixes’ put me at a personal disadvantage. I even experience RSD anxiety when I receive neutral feedback – in my head it is very black and white; if it’s not 100% positive, I’ve failed and people think badly of me.

Growing up, my RSD wasn’t limited to what other people thought about me; I had huge expectations of myself and sought validation through achievement. I did a bunch of competitive sports – none of which I was more than mediocre at, and none of which I was forced to do by anyone else. To be honest, I didn’t really enjoy a lot of them and I put so much pressure on myself to do well that when I didn’t, I hated the failure I perceived myself to be. My parents even gave me the option to give them up at various times, but I felt the NEED to keep going… but could not explain why.

I think the strangest effect my RSD has is its manifestation as a fear of answering the phone or listening to voicemails. It sounds utterly ridiculous, but I am so afraid that the person on the other end of the phone is going to be displeased with me, that I avoid the situation whenever possible (not a great strategy for a business owner!). Having an amazing admin assistant has helped a lot with this, as it alleviates a lot of the pressure.

When an emotional response to RSD is internalised, it can often be misdiagnosed as a rapid cycling mood disorder with the sudden change from feeling perfectly fine to feeling intensely sad. Many people with RSD incorrectly end up on antidepressants or anti-anxiety drugs, which can mask the symptoms of RSD but don’t actually get to the route cause. 

There are several suggested coping mechanisms for RSD:

1. They become people pleasers. They scan every person they meet to figure out what that person admires and praises. Then they present that false self to others. Often this becomes such a dominating goal that they forget what they actually wanted from their own lives. They are too busy making sure other people aren’t displeased with them. This is me.

2. They stop trying. If there is the slightest possibility that a person might try something new and fail or fall short in front of anyone else, it becomes too painful or too risky to make the effort. These bright, capable people avoid any activities that are anxiety-provoking and end up giving up things like dating, applying for jobs, or speaking up in public (both socially and professionally). This is also me when not answering the phone. Anticipating rejection and making life changes to avoid it can sometimes be misdiagnosed as social phobia. 

3. They use the pain of RSD to find adaptations and overachieve. They constantly work to be the best at what they do and strive for idealised perfection. Sometimes they are driven to be above reproach. This is also me; if I always go above & beyond, then I can’t be criticised. But this just means that when I am criticised, I fall twice as hard because it feels like no matter how hard I try, I still fail.

Doctors believe there is a genetic component to RSD and almost 100% of ADHD patients display RSD symptoms. Although trauma cannot cause RSD persay, serious trauma — like abuse or neglect — can make the symptoms worse. When you have ADHD, your nervous system overreacts to things from the outside world. Any sense of rejection can set off your stress response and cause an emotional reaction that’s much more extreme than usual. Sometimes the criticism or rejection is imagined, but not always. ADHD researchers estimate that by age 12, children with ADHD get 20,000 more negative messages about themselves than other kids their age. All that criticism can take a real toll on their self-esteem. This would go a long to explaining why even the smallest negative (or perceived negative) comment would have the most devastating emotional impact on me and why I have never had a good level of self esteem. Even whilst writing these blogs I have “ah ha!” moments where memories of ‘not fitting in’ or feeling like I was different suddenly make sense. I was always told I was too sensitive, too emotional, or took things too much to heart, but learning that it may have been undiagnosed ADHD/RSD helps me understand that it wasn’t actually all my fault. And I hope that my ramblings help other people out there too.

One Comment Add yours

  1. Chris Humphrey says:

    Me and Mum were, and still are, incredibly proud of all your achievements…..and of your self-perceived failures!!


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