I Have Rejection Sensitivity Dysphoria, And This Is What That Means

I’m Not Overly Sensitive Or Dramatic, I Have Rejection Sensitivity Dysphoria

Rafa Elias/Getty
Rafa Elias/Getty

I have adult ADHD. I was diagnosed later in life, and with the diagnosis, things suddenly made sense: why I was always running late, why I couldn’t remember to pack basic necessities in a diaper bag, why my car was such a wreck all the time. Why I often “spaced out” during conversations and had so much trouble remembering names, remembering dates. Why my wedding thank-you notes were still sitting in my closet five years later.

But it also explained something else. Since the time I was a small child, I’ve been what people call “sensitive.” The criticism has been lobbed at me since I was in kindergarten. I was the kid who always cried whenever kids teased me. I sulked and got angry at the slightest criticism. Actual constructive criticism about my parenting can send me into a downward spiral of despair that can last days.

That’s because my adult ADHD comes with a hefty side of what’s called rejection sensitivity dysphoria, a little-understood condition that is, according to ADDitude Magazine, “an extreme emotional sensitivity and emotional pain triggered by the perception — not necessarily the reality — that a person has been rejected, teased, or criticized by important people in their life.” It can also be caused by “sense of failure, or falling short” — by a person “failing to meet either their own high standards or others’ expectations.”

Basically, it means that when I feel like I’m criticized or I’ve failed in some way, I totally freak out.

Obviously, this causes some major strife in my everyday life. It can mimic a major mood disorder; I sometimes wonder if I actually have bipolar disorder or just a bad case of RSD. But the condition is so new, and so poorly understood by the majority of psychiatrists, that it’s impossible to tell.

And also unfortunately, there isn’t much they can do about it.

There are treatments available, none of which I’ve tried. You can take a cocktail of blood pressure medications, which works in about 30% of people. Or you can try MAOI drugs, which are inconvenient to take (you have to avoid things like cured meats, cough syrups, and all other antidepressants). These used to be the first-line treatment for ADHD, according to ADDitude, but come with lots of side effects.

So, I spend a good bit of time freaking out.

It means that my marriage can be, as thrivetalk.com says, plagued by insecurity. My husband has learned to tread lightly when he comments on anything, which makes honest discussions about things that need to change, or his own emotional needs, difficult if not impossible. Since this isn’t a healthy way to run a relationship, real conversations often end in anger, tears, and recriminations. He complains that nothing is ever my fault, that I refuse to take responsibility for my actions or see how they affect other people. This isn’t a totally unfair assessment. It’s just so excruciatingly painful for me that I can hardly bear to face it.

This doesn’t mean I don’t try to improve my parenting. I do. It doesn’t mean I don’t do my best, that I don’t take criticism to heart. It means that when I hear it, I also hear, You are a bad person. I hear You are not worth it. I hear You are a horrible mother/person/friend/sister/daughter/wife . I’ve been hearing it since I was a child, and it’s taken a hell of a toll on my self-esteem.

It’s difficult to make friends. I have massive social anxiety, and when I do manage to trust people, it can be difficult to keep them trusting them. I often misinterpret innocent remarks, and internalize criticism that isn’t there. I think people dislike me when they don’t. It’s hard to go through the world that way. It’s hard to let people in.

RSD isn’t unknown in children either, according to ADDitude Magazine’s RSD self-test. If your child with ADHD shows symptoms of hypersensitivity to criticism, you may want to talk to your doctor about RSD. Be prepared to show up with articles, because they likely won’t know much about it. You may want to ask for a referral for a child psychologist, though RSD may be new to them as well.

RSD is still poorly understood. But it’s likely that many people with ADHD — especially those with anger management issues — are actually suffering from RSD rather than rage problems. If your child is diagnosed with rapid-cycling bipolar disorder, it’s worth exploring RSD with your medical team as well. 

RSD is not well understood and less often accurately treated. But it’s out there. It’s real. And it can cause a hell of a lot of suffering for those of us who are tormented by it. ADHD can carry enough stigma. Throw emotional issues on top of it and you’ve got a stew that’s ripe for societal rejection and shaming.

But it shouldn’t be. It’s like any other mental health condition: a disruption in brain chemicals, a problem with the way you process chemicals, not an issue with your personality or disposition or basic humanity. And if you think you have RSD, get help. It’s out there, if you look hard enough, push hard enough. Even if you can’t get medication (or wish to avoid it),  talk therapy may help. You can try to get some of your life back. I’m working on it. It’s hard. But I’m getting there.