Rejection Sensitive Dysphoria: information and tips for coping

It happened again: you were in a group setting and something small happened. It could be a comment, a look, a laugh. Now you are reeling. Your heart may be racing, you may have a headache, or even feel sick to your stomach. You may be feeling extreme embarrassment or anger. The feeling is so intense, you can’t focus on anything else. You struggle to contain yourself and not make a scene. It may take you hours, or even days to stop playing it over in your mind.

You may be experiencing something known as Rejection Sensitive Dysphoria.

What is Rejection Sensitive Dysphoria?

Rejection Sensitive Dysphoria (RSD) is an experience that some people have when they feel really sensitive to being rejected, criticized, or disapproved of by others. It's like having super-strong emotions when they think someone doesn't like them or when they make a mistake. RSD is often connected to attention deficit hyperactivity disorder (ADHD), but it can also happen on its own.

If someone has RSD, they might feel really sad, anxious, or upset in situations where they think they're being rejected or failing, even if that's not really happening. They might worry a lot about being judged, criticized, or left out, so they try to stay away from situations that might make them feel that way.

Rejection Sensitive Dysphoria is not recognized as a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, it is often talked about when discussing ADHD and other mental health issues.

Here are some common signs and symptoms of Rejection Sensitive Dysphoria (RSD):

Emotional sensitivity: Individuals with RSD may have strong emotional reactions to situations that others might perceive as minor or insignificant.

Fear of rejection: There is a constant fear of being rejected, criticized, or disapproved of by others, leading to heightened anxiety in social interactions.

Low self-esteem: RSD can contribute to a negative self-image, where individuals feel inadequate, unworthy, or flawed due to the fear of rejection.

Perfectionism: There may be an intense drive to avoid making mistakes or being perceived as imperfect to prevent potential rejection.

Avoidance of social situations: People with RSD may actively avoid situations or relationships where they anticipate rejection or criticism, which can lead to isolation and social withdrawal

Why does recognizing RSD matter?

Rejection Sensitive Dysphoria matters because it can have a big impact on someone's feelings and their life.

RSD can make people feel really overwhelmed and upset, and that can get in the way of their everyday life, relationships, and personal growth. It can make it hard for people to interact with others and make friends because they're so scared of being rejected or criticized. This can cause social withdrawal and isolation, which can then lead to loneliness and depression.

RSD can make someone feel like they're not good enough or like there's something wrong with them. It can make them doubt themselves and have low self-confidence. It's often connected to ADHD and other mental health conditions, and it can make those conditions worse. So it's important to address and manage RSD along with other conditions.

If professionals understand and recognize RSD, they can provide the right kind of help and treatment. They can use techniques to challenge negative thoughts and help people develop ways to cope with RSD. When someone knows they have RSD, it can help them feel validated and understood. They can realize that their feelings are real and not strange or wrong. With this knowledge, they can take care of themselves, ask for support, and learn ways to manage the impact of RSD on their life.

How does Rejection Sensitive Dysphoria limit communication and connection with others

Because of their fear of rejection, individuals with RSD may try to avoid social situations altogether. They may feel safer isolating themselves or staying away from groups of people to prevent the possibility of being judged or criticized. This avoidance can limit opportunities for connection and interpersonal relationships.

RSD can make it difficult for someone to accurately interpret social cues and intentions. They might be overly sensitive to even minor signs of rejection or disapproval, which can lead to misunderstandings and strained interactions. This can make it challenging to establish and maintain meaningful connections with others.

How does Rejection Sensitive Dysphoria (RSD) limit personal development?

When someone has Rejection Sensitive Dysphoria, they may find it difficult to start tasks or activities. This is because they have a deep fear of making mistakes or being criticized, which can make them feel really anxious or scared. They worry that if they start something and don't do it perfectly, they might be rejected or judged by others.

Because of this fear, people with RSD might hesitate or avoid starting tasks altogether. They may worry so much about not meeting expectations or facing potential criticism that it becomes hard to take that first step. They might think things like, "What if I do it wrong? What if others think I'm not good enough?"

This fear of rejection can cause a lot of distress and make it challenging to initiate tasks or projects. It can create a sort of mental block or hesitation that keeps them from getting started. As a result, important tasks can be delayed or left unfinished, which can lead to added stress and feelings of inadequacy.

How Can I overcome Rejection Sensitive Dysphoria (RSD)?

Overcoming these limitations often involves building self-awareness, developing coping strategies, and seeking support. Working with a therapist or coach who understands RSD can help individuals learn to manage their fears, challenge negative thoughts, and improve their communication skills. By recognizing their value and finding ways to navigate social situations, individuals with RSD can gradually enhance their ability to connect with others and build meaningful relationships.

Everyone has their own unique challenges and it's important to be patient and understanding, both with ourselves and others, as we navigate these complexities. With the right support and strategies, people with RSD can work towards overcoming barriers and achieve their desired outcomes.

If you think you or someone you know might be dealing with Rejection Sensitive Dysphoria or similar emotional difficulties, it's a good idea to talk to a professional who can assess the situation and provide the right support. They can help figure out what's going on and offer guidance to make things better.

Rejection Sensitive Dysphoria (RSD) coping resource:

Why did we create this Rejection Sensitive Dysphoria resource?

Recognizing an RSD episode is the first step to getting through it successfully. If you know what RSD is, and what it looks like for you, then you are already on your way to getting better at dealing with these episodes!

If you are just learning about RSD and trying to figure out ways to cope, do not expect yourself to use this tool all at once. Think of it as a menu with options. You may want to work your way up to step 3. If it feels like too much in the beginning, that is OK. Just use the parts that seem helpful.

Rebecca at Shift Counseling, PC worked with a client who experiences RSD to develop this coping tool. She has given her full consent to share this, with hopes that it will help someone else.

When to use this resource:

Once you realize you are experiencing an RSD episode, try to take a step back, and not engage with the negative thoughts that are racing through your mind. Ideally, try to find a quiet place where you can focus for a few minutes, and use step one of this resource to manage intense distress in the moment. If you can’t get away at the time of the episode, you can still use this tool later to de-escalate any feelings that may still be lingering after the incident.

Step one: Calm the body.

Take one or two solid minutes of measured deep breathing. I generally recommend an “in for four, out for eight” pattern to calm the body down. You can use a metronome app to help you keep the rhythm for your measured breathing. I usually recommend a setting of about 55-60 beats per minute.

The best way to have this part resource ready is to practice your measured deep breathing and/or tapping when you are not upset, so it becomes an easy habit. Practice your measured deep breathing often. In time, you may eventually be able to use measured deep breathing to manage RSD in the moment, without needing to step away.

It is very important to get your body calmed down in order for your brain to work properly in order to process through the feelings that have come up during this episode. When we are in “fight or flight”, the logical parts of our brains are largely “offline” so we really are not processing information correctly. A brain that is in fight or flight mode is more likely to make assumptions and not appropriately read the cues of others. This is where things can go off the tracks if you suffer from RSD.

Step two: Remind yourself that you are loved and accepted by your support group:

Once you have gotten your body calmed down, take some time to remind yourself that you have people in your life that know the true you. These people have chosen to stick around for a long time, so you must not be that bad. Your list might only be one or two people, but this is OK.

It might even be helpful to have this list of supportive people written down somewhere, like in the “notes” section of your phone, so you can reference it when you are very upset. In the middle of an RSD episode, your brain will try to convince you that NO ONE loves or accepts you, and that is simply not true.

Step three: Start asking yourself OBJECTIVE questions about what happened

If you know you are someone who tends to spiral, limit yourself 10 minutes of processing the interaction with this checklist. Literally set a timer. You need to engage with what happened, but replaying it over and over is not productive . Setting limits from the outset will keep your engagement with this distressing encounter contained and productive.

If you feel like you cannot be objective on your own, use this part of the resource to process the experience with a supportive person.

What part of the interaction am I focused on? It helps to break things down and get specific about what bothered you. This can help you see the experience as being nuanced, instead of seeing it as “all good” or “all bad”

What did I do "wrong"? What is your brain telling you the problem is? After calming your body and reminding yourself that many people accept you, does it still seem like you have done something wrong?

What could I have done differently? If you could go back, what would you change?

Is this an opportunity for learning? You don’t really get a “do over”, but if you can learn something from this interaction, it might help you be more successful in connecting with others in the future.

Was this a neurodivergence- related miscommunication? Does it seem possible that you and the others involved in this interaction were just not fully understanding each other’s cues?

Am I making assumptions about others’ thoughts or intent? If the answer here is yes, then the good news is, you might be able to let this one go.

Have I been mistreated, or have I mistreated someone else? RSD episodes tend to have themes of either feeling mistreated by others, or fear of having wronged others.

If you truly feel you have been mistreated, then you have a decision to make here: Can you speak up to make things better in the future? If you feel like you can’t speak up, why? Do you want to continue letting this person or these people into your life if you can’t speak up?

This may not be an “all or nothing” situation. You may want to just take a step back and re-examine how much you share with someone who you don’t completely trust.

Do I owe someone an apology? After thinking through what happened, if you really feel that you may have wronged someone, you may want to make an apology. If an apology is not possible, then you have to let it go, knowing that you learned something from this and will do better in the future.

If you decide to apologize, do not dump your emotional “stuff” all over the other person and make it their problem. Keep your apology short and sweet.

Here’s an example: “I was thinking about our discussion earlier today, and it occurred to me that

something I said might have been out of line. I just want to let you know that I am sorry if I offended you.”

The person may respond, or they may not. Just because you apologize, it does not mean that they owe you forgiveness. They may not even have been upset by what happened. Also, some people are not used to being apologized to, so they might not know how to respond.

Do not allow yourself to obsess about their response or lack of response. Your apology is about your own accountability, not about expecting them to make you feel better about what happened. Do your part to clear the air so you can move on.

Would I be this upset if the tables were turned? In interacting with other people, we are constantly committing little social gaffes, which are often forgiven in the moment. You are likely showing others social grace and assuming the best in moments of small injury. If you are showing others grace, then you deserve grace as well.

End with words of kindness to yourself. Doing this kind of work is very hard, and you need to be gentle with yourself through the process.

Here are some are examples of Words of Kindness. Depending on what triggered your RSD, these may or may not apply.

* I am working hard to be kind to myself and others.

*This was likely just an RSD episode, and my worst assumptions are probably not true.

* I might not be “for” everyone, and that is OK.

* Even if I did “do something wrong”, I can learn from it.

*This was just my RSD talking, I know it can cause me to have outsized emotional reactions. I am learning to work through this and I am going to get better.

*I still deserve connection and acceptance, even if I am not perfect.

If you’d like to get more help with ADHD coaching, here is information about Suzy’s practice https://www.suzycarbrey.com

ADHD can be overwhelming, but with the right tools and strategies, you can achieve your goals. Here’s more information about executive function and ADHD coaching with Suzy Carbrey.

Suzy Carbrey is an executive function and ADHD coach who specializes in providing coaching services to adults, both with and without ADHD, seeking a neuro-informed approach to enhance their communication and executive functioning skills. Employing a language-based methodology, Suzy guides her clients towards the life they aspire to live.

Suzy's clientele consists of professionals, parents, and college students who want to improve in areas such as time management, organization, communication, and follow-through. Through her use of detail-oriented questions, she encourages clients to engage in thought-provoking discussions that foster personal growth.

By engaging in change-oriented conversations, Suzy ensures her clients feel deeply understood and empowered to exercise their agency and autonomy. This empowerment enables them to implement necessary changes aligned with their desired coaching outcomes.

Suzy has been certified as an ADHD Services Provider and received training in the Seeing My Time® executive functioning curriculum. While she is a certified speech-language pathologist, it is important to note that all services provided by Suzy Carbrey LLC strictly adhere to coaching principles and do not involve clinical evaluation or treatment services.

Reach out for a free discovery call at www.suzycarbrey.com