What is Rejection Sensitive Dysphoria?
Rejection sensitive dysphoria or RSD is a neurologic and genetic condition very common to persons with ADHD. Those who have RSD experience extreme emotional sensitivity and emotional pain. These feeling can be triggered by the perception — not necessarily the reality — that they have been rejected, teased, failed, disrespected, or criticized by people in their life.
For people with RSD, these emotional experiences are much more intense and last longer than for neurotypical individuals. The emotional pain can hit suddenly and last for days. The dysphoria completely overwhelms their thinking, feelings, and senses. Often, it is hard for people to describe their feelings of pain. They say it’s intense, awful, terrible, overwhelming. The feelings are unbearable and highly impairing. And even though many who experience RSD say they are aware of the extreme nature of their emotional reaction, it can be nearly impossible to stop the negative emotional downward spiral. To others, RSD can look like depression, or a mood disorder complete with suicidal ideation.
In order to avoid this huge emotional pain, two things tend to happen. First, people with RSD might become people pleasers or perfectionists. The hope is that by pleasing others, they won’t suffer the feelings of rejection. Secondly, they may stop trying altogether. The possibility of failing or not meeting someone else’s expectations is just too risky. For instance, people with RSD might not apply for job advancements, meet new people, or challenge themselves with higher learning.
So what can someone with ADHD do if they are experiencing an RSD response?
Following are some behavioral and medical suggestions that may help to minimize the spiral of pain and negativity.
Don’t try and repress the feelings. It may seem logical that to get rid of negative thoughts we must suppress or push the thought out of our minds. Unfortunately, many studies have shown that doesn’t work. Trying to push thoughts out of our mind only makes them come back stronger. It’s like trying to forget about that last piece of chocolate cake sitting untouched on the kitchen counter!
Try distracting yourself. A natural tendency is also to try and distract yourself, think about something else, leaving you in peace. This can help at times, however the key is to focus on one thing rather than letting your mind wander. Apparently for the human brain, mindless wandering is associated with unhappiness. So it’s better to focus on something specific, like lyrics to a song, a game or completing a task or project.
Don’t add more stress. Another way to avoid negative persistent thoughts is to create stress in other areas of our lives. The hope is that this will leave little mental energy for the thoughts that are troubling us. Unfortunately, when tested scientifically, this turns out to be a bad approach. In fact, for whatever reason, stress makes unwanted thoughts come back stronger. So remember when you are experiencing RSD don’t make matters worse by adding more stress to your life.
Postpone the feeling until later. Even though trying to suppress a negative thought makes it come back stronger, postponing it and thinking about it later can work. For instance, postponing the negative emotion or thought and then designating 15-30 minutes as “RSD time” might work. Allowing time for all the bad feelings may ease your mind for the rest of the time.
Do the opposite of what makes sense. What if, instead of trying to get rid of the emotional RSD feeling, you actually concentrated on it? Some research suggests this can work. This is based on the same principle as “exposure therapy.” Where, for example, someone who is afraid of spiders is slowly exposed to spiders, until the fear begins to fade. This may not be for the faint-hearted, but research suggests it can be useful to get rid of negative and obsessive thoughts.
Accept the feelings. Along similar lines, trying to accept unwanted thoughts and emotions rather than doing battle with them can be beneficial. Struggling with emotions is like struggling in quicksand. Instead, try allowing the thoughts and emotions to come and pass by without feeling like you need to make them go away.
Be mindful. With mindfulness you don’t judge your thoughts. Instead let them come and go as they will, then nudge your attention back to feeling at peace. The key is to be curious and notice in a detached way what’s happening in your mind but not get involved with it. Please note that this way of thinking doesn’t come naturally but can improve with practice.
Try remembering the positive. In the midst of the negative emotional RSD spiral it can seem as though the last thing possible is to remember your positive traits. However, considering the alternative, remembering our strengths may be worth a try. And if you are having trouble remembering these nuggets, try asking someone you trust to remind you.
Write it out. Rather than telling yourself to simply snap out of it, try expressive writing. Writing about your deepest thoughts and feelings does seem to have health and psychological benefits. Expressing yourself through writing may help to get rid of negative thoughts and help you move through the emotional pain.
Use your creativity. Writing is only one way to express yourself. If you have a creative talent, and many persons with ADHD do, try tapping into this resource. Use your creativity to express yourself and the emotional overwhelm in this way.
Boost your dopamine naturally. Dopamine is a neurotransmitter that helps us do things. It’s the main reason why we can or can’t focus when we have ADHD. It’s something your brain naturally produces. And, aside from being the ultimate motivator, dopamine has other fringe benefits such as:
- Helping you lose weight
- Making you feel more alive
- Improving your memory
- Stopping self-destructive behavior including certain addictions
- Counteracting depression
- Letting you resist impulsive behavior
Medication management of ADHD aims at increasing the availability of dopamine in our brains. However, there are ways to boost dopamine naturally that might be helpful in reducing the RSD experience. Briefly these include:
- Human contact
- Pet therapy
- Music you enjoy
- Taking a cold show
- Eating foods that support the production of dopamine such as: meats, nuts, fruits, avocados, butter, broccoli, salmon, dark chocolate, blueberries, eggs, and almonds.
Medication. Currently there are two possible medication options for RSD. One is already used in the treatment of ADHD. It is guanfacine, or clonidine. Although not everyone experiences relief from their RSD on this medication, a large majority say it helps.
The second medication is one not typically used in the treatment of ADHD. The class of medications is called monoamine oxidase inhibitors (MAOIs). Taking an MAOIs requires strict dietary restrictions and may include side effects such as sedation, confusion and agitation.
NOTE: Always consult your prescriber about adding or changing medication for the treatment of any ADHD or related conditions.
RSD is a debilitating condition common to persons with ADHD. Appreciating this, even if some of the above strategies may not completely prevent the experience, when combined with appropriate medical intervention, they just might provide a much welcome relief for many.