By EK Wills
When someone tells you they have always felt out of place, not accepted by their peers and insecure, the first thought is often judgement of character.
The narrative around this is lack of assimilation, lack of resilience and social anxiety.
But when a new formulation emerges in the form of Rejection Sensitive Dysphoria (RSD), a term not yet assimilated into the DSM-5 (Diagnostic Statistical Manual version 5 for mental health disorders), it becomes very difficult to quantify as there are no specific criteria.
For those of us who grew up before the awareness around neurodiversity, we attracted labels like ‘angry’ or ‘prickly’ and ‘sensitive’. Naturally, the criticism was internalised and the impact resonated throughout life from low self esteem to self consciousness, avoidance and self recrimination and anger. Mostly, you wonder what is wrong with you and why can’t you just be happy or successful.
Psycom has a good description of the types of experiences or feelings RSD can evoke, such as:
Intense feelings of anger when someone hurts your feelings
Intense feelings of sadness when you feel criticized or rejected
Being very critical of yourself
Feeling extremely anxious in social settings because you believe no one likes you
Avoiding new experiences and interactions with new people because you’re afraid of being rejected or criticized
Being described as too “sensitive” by others
Feeling physical pain in response to unpleasant emotions stemming from rejection or criticism
Emerging evidence shows us that this phenomenon occurs in ADHD (Attention Deficit Hyperactivity Disorder) and also in ASD (Austism Spectrum Disorder).
There has been a rapid increase in research recently. The EU had redefined adult ADHD by adding emotional self-regulation to the criteria — has substantiated that RSD cannot be ignored.
Gender difference modelling in ADHD tend to indicate more arousal states in women vs developmental deviation in men. Interestingly, RSD is sometimes referred to as 'hysteroid dysphoria' in Europe, adding to stigma, particularly for women, striving for equality in a world that does not accept emotion as a valid response to stress. Many people, particularly women, find this to be the prevalent issue which can then lead to a questioning of ADHD or ASD.
In my case, I was adamant I didn’t have ADHD because I was functioning, so believed I mustn’t have an ‘impairment’. Then a confluence of situations came together – high stress, Burnout, and a there was always a strong sense of Moral Injury. Finally, it became clear when the concept of RSD came into focus to explain those experiences. While I had life long coping strategies such as being terminally organised, when the cognitive load reached a peak, I could now recognise the symptoms as they relate to me. I took the self-report questionnaires for both ADHD and ASD - suffice to say there is evidence of neurodiversity without going into details as to what that is specifically for me.
I acknowledge that many people still struggle with the validity of the widespread diagnoses of neurodiverse states. From my perspective, I refute that I have a hammer so find nails everywhere, since I always methodically and thoroughly review the options. I also recognise the limitations in my life and the sense of not understanding myself and feeling misunderstood by others.
Thankfully there are treatment options for RSD and it doesn’t have to involve stimulants. First line medication treatment for ADHD is often a stimulant however this can result in anxiety for some. Alpha agonists such as clonidine and guanfacine are also ADHD treatments, approved in many countries, including Australia, but often second or third down the list of options. While there is currently no formal research regarding symptoms of RSD, many people gain relief from hyperarousal states with this medication. It also provides a way to then do the psychological work to develop skills to further alleviate this distress, much like the approach with other medications such as antidepressants for depression.
What do I do if I think this is me?
There are very good open resources available to research topics such as RSD on ADDitude or Embrace. They also have good suggestions to obtain further assistance.
As always, if not feeling safe, make sure to reach out to someone you trust.
