Definition
Rejection sensitive dysphoria (otherwise known as RSD) is a term that is meant to describe the overwhelming emotional response experienced by a person that feels rejected. This is not a clinical term, and it is not currently in the diagnostic and statistical manual used by providers of psychotherapy. It does capture a common dynamic that is worth discussing, though.
Rejection sensitivity is a common component of many psychological experiences including anxiety, ADHD, and borderline personality adaptation. Everyone has some amount of rejection sensitivity, but for those impacted in this way it feels much more intense.
How does it feel to experience RSD?
RSD is often experienced as overwhelming guilt or shame. Some people are so overwhelmed by it, that they have learned to suppress or numb the feelings themselves. Rejection sensitivity often comes with an intense feeling of guilt or shame. If you are having an episode of RSD, you may find yourself obsessing over how an interaction went, or you may find yourself looking for your go-to methods of checking out (distraction, drugs, alcohol, video games, sex, shopping, etc.) so you don’t have to feel those bad feelings.
How does it look on the outside when someone is having an RSD episode?
This is tricky as it can vary from person to person. Generally, you’ll either see anger and aggression or shutting down. You may see defensive reactions. You may see blame shifting, lashing out, outbursts. You may see that person withdraw. They may instigate an argument. The person may or may not know that a sense of rejection is behind their behavior.
Why does RSD happen?
RSD usually means that person’s self-esteem is dependent on how others respond to them. This can result in swinging wildly from one mood to another based on how people are responding to that person. Self-esteem that is dependent on others can develop for a variety of reasons. If you make a lot of mistakes and experience other people frustrated with you on a regular basis, that can cause self-esteem to be fragile. This can result in seeking approval from others and signs that they are not rejecting you to feel okay – to feel safe. Usually, if you make a lot of mistakes involving the same person, they will become aggravated and you will experience their negative emotions directed at you.
Add in the hypersensitivity and reactive nature of the ADHD brain, and you have a recipe for disaster. If you are sensitive to negative emotions, and if you struggle to modulate your emotional reactions because of brain functioning, and you attract a lot of negative emotions directed at you, then it’s only natural to have some challenges in self-esteem and to seek approval, because you learn that disapproval is very painful and causes you to be in a situation of threat.
How do you treat RSD?
There is no medication that is approved to treat rejection sensitivity. Some psychiatrists may prescribe medications that are thought to address some of the mechanical processes involved. Guanfacine and clonidine, both used to treat blood pressure, may be prescribed to help with symptoms of RSD. These medications may tone down the intensity of the reaction, but therapy and healthy lifestyle choices are the best way to actually change the thought patterns that cause RSD episodes.
When I work with couples, we look into whether RSD is a factor in the relationship and work together to develop a plan to help both parties cope with it, while the individual experiencing RSD addresses those struggles in a 1:1 setting.
What can I do as the person having the RSD episodes?
You can help yourself and your relationship by learning to recognize signs that you are having an RSD reaction. You can also work with someone to help you understand the thoughts behind those reactions and work on learning new habits. You can also learn and practice active coping skills like stress management, emotion regulation, and exercise if you mostly rely on passive coping skills like avoidance, complaining and distraction.
You may feel out of control but you can learn to feel more in control of yourself and your reactions. It just takes time and it takes baby steps. Until you have some level of mastery over this dynamic, it can help reduce damage to your relationship to approach your loved one once you are calm again to apologize for whatever behaviors that may have caused harm or concern. This also takes practice. We want to try to get past the desire to hide from what we did when we were upset, as hiding from it tends to hurt the relationship much more in the long run. None of us enjoy thinking about our unhelpful behaviors but we will need to learn to repair the relationship after an episode to buy time to do the work of change.
What can I do as the supporter of the person having an RSD episode?
Learn to recognize when it’s happening. Learn to wait to try to address what is happening until the episode is over. Once a brain is in the threat response, that person cannot reason or make the same logical choices they would make if they were calm. Do your best to not escalate the situation. That may mean walking away if they are agitated, or giving them space if they cope by pulling away. Once they seem back to their usual self, you can ask when would be a good time to talk about what happened between you. This is going to take a tricky balance between accepting their current state, and advocating for your own needs. A person that copes by withdrawing is going to want to avoid a conversation about it. The two of you will need to find compromise.
Hope
RSD is not a life sentence. It is painful for the person experiencing it, and painful for anyone that is on the receiving end of their momentary destructiveness. But it can be changed. It is a hard change, but it can be done. It’s hard, because it usually requires dealing with the guilt or shame that most of us would rather run away from and feel anger instead. You can’t fix RSD if you aren’t willing to learn how to feel the emotions under the anger. The anger is a smokescreen meant to protect the ego from yet another social punishment. It makes sense that we would have such clever ways to protect ourselves! Unfortunately RSD usually protects us while hurting our loved ones, and hurting our relationships. Coaching or therapy can help you navigate this tricky dynamic in a way that is respectful of the needs of both parties.