Rejection Sensitive Dysphoria: What is it and how do we treat it?

I first mentioned Rejection Sensitive Dysphoria in my article where I listed 5 symptoms of ADHD that aren’t commonly known. I’d like to take this time to explain it again, but this time I’d also like to talk about how it can be treated.

 

Rejection Sensitive Dysphoria, or RSD for short, is 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 an important person in their life.

RSD can also be triggered by a feeling of falling short or a sense of failure. It can be triggered when you feel you’ve failed to meet your own high standards or the expectations of others.

 

Us ADHDers naturally experience emotions more intensely and for longer than the average person does. So when we sense that someone doesn’t like us, when someone makes fun of us, or when someone appears disappointed in us… It hits us really hard. Especially if it’s someone we admire or look up to in some way. Like a parent or a teacher.

 

For me, RSD made it difficult to make friends because I was terrified of being rejected or disliked. It made it hard to hold a job because I felt so afraid of disappointing my boss. The same went for teachers, my parents or any other adult in my life.

 

People who RSD are often perpetual people pleasers. They can’t handle the thought of upsetting anyone, so they do everything they can to make sure everyone around them is happy. Sometimes they do this to their own detriment.

 

Someone with RSD may be more likely to remain in an abusive relationship, because they are trying so desperately to please a person who is unpleasable. I spent five long years in a toxic relationship with someone who I now believe to be a covert narcissist, which I’m only now starting to truly recover from. I stayed so long because I really thought I could help the unhelpable.

 

So, how do we treat it?

 

Firstly, know that you are not alone. If you have ADHD, you likely have Rejection Sensitivity Dysphoria. Nearly 100% of people with ADHD have RSD, so that means you are definitely not alone in this. It’s not your fault and you are not damaged. This is just a part of your ADHD.

 

Unfortunately, psychotherapy typically doesn’t help with RSD because the emotions often hit suddenly and completely overwhelm the mind and senses. That doesn’t mean it’s not worth a try though.

 

But there are two possible medications that could help:

 

• Your doctor could prescribe the alpha agonists guanfacine and clonidine together. According to Additude Mag:
  
  “These were originally designed as blood pressure medications. The optimal dose varies from half a milligram up to seven milligrams for guanfacine, and from a tenth of a milligram to five tenths of a milligram for clonidine. Within that dosage range, about one in three people feel relief from RSD. When that happens, the change is life altering. The treatment can make an even greater difference than a stimulant does to treat ADHD.”
• Your doctor could instead prescribe monoamine oxidase inhibitors (MAOI) off-label.
  
  Traditionally, this has been the treatment of choice for RSD. Parnate (tranylcypromine) is said to work the best, and seems to have the fewest side effects.

 

RSD is no picnic. Believe me, I know how bad it can suck. But like I said, you’re not alone in this struggle, and there are options for treatment out there if you’re willing to try them.

 

I hope this can help anyone out there having a hard time with it.

 

Much love to you all and until next time,
Keep Calm and Grow On.