Rejection-Sensitive Dysphoria & ADHD

The Emotional State of My ADHD

“Emotional disruptions are the most impairing aspect of the [ADHD] condition at any age.”

This is an excerpt from an ADDitude Magazine article called Emotion Commotion by William Dodson, M.D. You can find the online version of the article here. I struggled to keep my self from tearing up while reading this article. I really did feel like I was reading about myself. And I was reading about the part of myself that I don’t really like to talk about—that part that I am somewhat ashamed of. Before reading this article I would tell you that I am an insanely sensitive person. Someone who starts crying or becomes angry whenever I am reminded of rejection. But after reading this article I believe I can look at myself differently. And maybe others can feel the same way about themselves.

Sensitivity

THOUGHT YOU WERE just an overly sensitive person? Someone who was just born with a fragile emotional state? That may not, necessarily, be the case.

Dodson says almost all ADHDers answer yes to this question: “‘Have you always been more sensitive than others to rejection, teasing, criticism, or your own perception that you have failed or fallen short?'”

I FOR ONE can answer yes to this question. I am extremely sensitive to rejection, teasing, and criticism. And honestly, if I think I’ve failed or “fallen short” in some way, it literally can ruin my whole day, week, and/or month.

DOES THIS SOUND LIKE YOU or someone you know? Well Dodson says “this is the definition of a condition called rejection-sensitive dysphoria,” otherwise known as RSD. And the RSD condition is all too familiar to individuals with ADHD.

The Difference Between RSD and Depression

THOUGH BEING REJECTION-SENSITIVE can mean a lot of tears and feelings of depression, it does not mean that RSD is the same thing as depression. In fact, Dodson explains, that it is “the ADHD nervous system’s instantaneous response to the trigger of rejection.”

SO WHILE DEPRESSION is (as I often describe it) much like always being sad—even when there’s nothing to be sad about—RSD is difficult in another way.

As I understand it, ADHDers are hyper-active and this in turn allows the mind to always be on the look-out for emotional danger, or emotionally risky situations. In the ADDitude Magazine article Dodson says ADHDers always feel tense, and are unable to relax.

On Dodson’s website he further explains how RSD affects individuals with ADHD:

It is the constant vulnerability to being “wounded” by anyone at any moment that continues to throw them into a tailspin without warning[,] and then disrupt[s] their lives for days with obsessive worry[ing] about “what did I do to make them hate me so much?”  It does not even have to be real rejection or criticism . . .  Perceived criticism and withdrawal of love and respect is just as devastating as the real thing.

ADHDers WITH RSD are always on their guard, scanning their environments, attempting to ready themselves for the next big hurt. This causes us to become emotionally injured. And even when we think, or perceive, that someone/something is hurting us, we can still feel the emotional pain as a result.

The Pain

THE EMOTIONAL PAIN, whether real or perceived, that is felt by those with RSD in response to a trigger is “catastrophic,” says Dodson. In ADDitude Magazine he explains that “‘dysphoria’ means ‘difficult to bear,’ and most people with ADHD report that they ‘can hardly stand it.’ They are not wimps; disapproval hurts them much more than it hurts neuro-typical people.”

SO, YOU ARE NOT A CRYBABY. You are not wuss. You are not a sissy. And you are not any of the other terrible things people use to identify sensitivity. The pain you feel from rejection is literally stronger and more intense than the pain felt by those without RSD.

HOW DO WE REACT TO THAT PAIN? Dodson says, that internalizing that pain can mean short-term feelings of depression. While externalizing that pain can mean short-term expressions of rage.

WHAT DOES THAT PAIN DO TO US? In his article Dodson notes that overtime many ADHDers try to become “people pleaser[s],” which helps them better avoid rejection. On the other hand, some people become afraid. Afraid of trying anything new. Afraid of putting themselves into situations in which pain is a possible outcome. This fear of pain is based in the fear of possible rejection. “Taking a chance is too big of an emotional risk” Therefore, “their lives remain stunted and limited.”

SO WHAT DO WE DO ABOUT IT? Overcoming RSD is the hardest part. As always, I would recommend you speak to a qualified professional about RSD and how it relates to your ADHD. But I would also recommend awareness. I myself am trying to be more aware that RSD is condition that I do not have to ashamed of. This type of thinking and positive self-talk, I believe, will help me to overcome the RSD part of my ADHD life. The more experience I gain in working with the feelings and phobias associated with RSD, the closer I will be to overcoming RSD altogether.