Rejection Sensitivity Dysphoria

Human beings are social animals. We live in groups of people, where we form our social connections. Our emotional reactions be that of happiness or sadness. are based on our perceptions of these connections. We want to be ‘liked’ by other people at the other end of these social threads.

Perhaps it's in our genes, right from when we were cave dwellers, that these connexions, where we were liked, ensured us being part of that group, reducing the risk of physical danger to ourselves, or we would have been isolated and at a higher risk of dying.

We as a human being, spent a lot of time and energy in being liked. Be it in the clothes that we wear, to the language that we use, to how we look, to how we think.

This automatically leads to the distress we might feel if we face social rejection or are not liked. This can even feel like physical pain an emotional distress.

Rejection sensitivity Dysphoria (RSD) as concept is about being hypersensitive even to the possibility of rejection by others, causing low mood, mild in severity, however for quite some time.

This concept is being researched more so recently, on the background of people who have been diagnosed with ADHD.

Presentation

People with RSD cannot handle rejection well. They feel low and dysphoric.

People with RSD have an emotional overreaction to any negative feedback or criticism. This can worsen their emotional distress. Poor self-confidence and poor selfimage can the initial presentation. Feelings and fear of failure, disproportionate in severity can also be the presentation. Irritability and anger can also be seen. In some cases, over-compensation, or people pleasing behaviour is also seen.

The following have been reported

• High sensitivity about the possibility of rejection, ruminating about it.

• Be easily embarrassed, guilt and shame being predominant feelings.

• Avoiding social interaction to avoid feared rejection.

• Anger or aggression, to avoid rejection.

• Fear of not fitting in or being rejected from a group or a class.

• Self-esteem with significant external locus of control.

• Develop low self-esteem

• Have problems with relationships

There is some overlap with people suffering with social anxiety. However social anxiety is more about avoiding, due to increased anxiety, social interactions or specific situations which is connected with anxiety.

Comorbidity in ADHD

There are some views that ADHD increases the risk of people developing of RSD. Possible reasons postulated is the unusual activation of the nervous system in people with ADHD. Impulsivity seen in ADHD can sometimes have a negative impact on these social interactions, evoking a negative feedback. Delayed diagnosis of ADHD also points towards possible growing up childhood with more negative feedback but for ADHD, of reduced ability to learn how to manage negative feedback whilst growing up, lack of opportunity to learn skills required to manage negative feedback.

Relationships

It is in this aspect of our lives, where RSD has the biggest negative impact. Delayed diagnosis of ADHD adds morbidity of forming close social connexions. Developing RSD adds to the burden. Right from the start, at the educational environment of school and college, to later 1:1 and intimate relationships, ruminations about the rejection and the fear of rejection interfere with developing of close trustworthy connections. Overthinking about other’s actions and what it means, second guessing partner’s intentions, can reduce the probability of healthy relationships being formed.

Causes

A complex interaction between social, psychological and environmental factors might contribute and these come together to increase the risk of somebody developing RSD. Growing up in a household where perfectionism is expected, or the child is exposed to frequent negative feedback, criticism, which interferes with developing resilience can play a role.

Having undiagnosed ADHD, exposes the child to further negative feedback, with limited opportunity to learn how to cope and manage with such feedback. The morbidity interferes with learning the skills to manage such emotional upheaval while growing up. Being exposed to trauma, growing up in difficult or deprived childhood, abuse, or neglect, can also sensitise children and adults to rejection.

Treatment:

Research into the exact causes, and the treatment modality, for RSD is still in its infancy. For people with RAS with ADHD, optimal treatment of their ADHD is the primary step.

Guanfacine, as a treatment for ADHD has sown some promise. Clonidine has also been tried.

Therapeutic strategies can be tried, to help with automatic dysfunctional thoughts