Rejection sensitivity dysphoria or Reasonable Response to Rejection
TL:DR? Skip to the end or click here for info about the next Spicy Spaces workshop on RSD – May 15, 11am
A few days ago I was taking part in an online meeting. Not a dull work meeting, but a get-together of people I really like, who share my interest in new music. I love these meetings. We laugh, a lot. We share the great music we’ve found, we make up stupid band names. It’s a lot of fun, and I feel very safe with these people. But as it came to the end of the meeting, I experienced the most overwhelming feeling of doom, a deep, dark foreboding. I was panicked, going over everything I’d said, reviewing every time I might have interrupted, or not given someone the response they were looking for, wondering if I’d dismissed something someone had said. I was suddenly deep in the abyss that is Rejection Sensitivity Dysphoria. I wanted to disappear. There was no way I could face that group again.
For ADHD people, this kind of experience will be all too familiar. Rejection Sensitivity Dysphoria or RSD for short, it is not a formal psychiatric term, but according to Dr. William Dodson who coined it, RSD is so common that almost 100% of ADHDers experience it.
The reality is that RSD is a horrifically painful and truly miserable experience that can make you believe even your closest friends hate you. These deeply distressing feelings of worthlessness and self-criticism are triggered by the perception that you have been fundamentally rejected – by your partner, your friends, your work colleagues. It can happen with anyone you interact with. It is incredibly disabling, has been the cause of many broken relationships, and can often lead to suicidal ideation.
“Some rejection hits like a physical punch. The air leaves my lungs because of the hurt. Other times I feel this all-consuming humiliation. Or a fierce frustration and anger at myself. If I’m blindsided, I feel like a sad, confused little girl, thunderstruck in my bewilderment. I’ve even lashed out like an injured animal, cornered by the pain and wanting to dish it back out.”
But what actually is RSD?
The short answer is, we don’t really know, but there are two main theories that aim to explain what is going on with RSD.
The biological view
The frontal lobe of the brain, which controls our ability to pay attention, our language, social skills and impulse controls, our judgment and problem-solving skills, works slightly differently in ADHD brains. This may be why ADHDers can miss, or not pay attention to, certain social cues or details. It may be why team collaboration is generally not a strength ADHD people generally have. This frontal lobe difference could trigger overwhelming feelings of confusion, failure, betrayal, pain, and sadness, making it more difficult for ADHDers to regulate and control emotion as quickly as non- ADHDers might.
So RSD happens because of differences in the brain. But as a description, this feels a bit empty. It doesn’t describe the enormity and impact these intensely negative and self-destructive emotions can have on the lives of ADHD people. And it puts the onus on the individual to “fix” themselves without considering the context in which they are trying to exist.
The trauma theory of RSD however, speaks to the relational aspects of RSD. In this view, RSD is fundamentally and inevitably connected to our social nature, to our intersubjectivity and how we affect one another.
The trauma view
A study on social functioning challenges in ADHD by Carpenter et al states that around 60% of ADHD children experience rejection by their peers, that ADHD kids are disliked within minutes of meeting new children, and because of these rejections, are denied opportunities to practice social skills, leading to further rejection.
“Am I sensitive to rejection because I am genetically predisposed to be, or am I predisposed to be because people with ADHD get rejected constantly from birth?”
If we consider that, in all likelihood, every ADHD child has experienced a steady and relentless stream of tiny rejections by the time they finish school, for no real reason other than they are perceived as “different”, or “weird”, we can see quite easily how RSD might take hold.
The downward spiral of rejection
When we ADHDers notice the negative reactions of others, even though we often don’t know why they are happening, we aim to change ourselves to be more acceptable, more likeable. Girls in particular, try everything to fit in, often by covering up or “masking” their true selves. They try to “act” like their peers. This is, in reality, inauthentic behaviour, which others pick up on, feeling the ADHD person is in some way untrustworthy or disingenuous. Conversely ADHD people pick up on these feelings, that they are not trusted, not believed, somehow doing things wrong. This perceived rejection is compounded by feelings of being unheard, unseen or misunderstood.
Image of the insidious treadmill of RSD from Neuroclastic.com
This constant sense that you are bothering people, that they are in some way dissatisfied with you, can lead to the coping mechanisms of hypersensitivity and hypervigilance. ADHDers can become intensely aware of people’s responses, which in turn can lead to internalised ableism - the belief that we SHOULD be able to fit in, be “normal”, and be accepted. So we must try harder, be nicer, be friendlier, be more, and also less, all at the same time.
In the act of trying to be something they are not, to protect themselves and keep safe “inside the tribe”, ADHD people become even less acceptable to others, who sense their lack of self-honesty, their false self, and respond, once again, with rejection. This vicious cycle underpins the experience of RSD.
RSD as a CPTSD response
Neurodivergent people are a minority group, making up around 15% of the population. As with other minority groups, they suffer the minority stresses of prejudice, discrimination, stigma and rejection. This discrimination is all the harder for being unspoken or undefined, like being excluded by peers for no stated reason, or being called weird. Not knowing why people reject you can chip steadily away at a person’s self-worth, until they feel that every interaction, every relationship, has the potential to cause pain.
For me, RSD is an understandable trauma response, “rooted in fear about our ability to survive, which depends on our ability to fit in and get by”. (Jess Meadows, Medium, 2020). It shares many symptoms with CPTSD, a response to sustained, repeated trauma, such as long-term bullying, domestic abuse or repeated exposure to verbal or emotional abuse.
Viewing RSD as a response to harm done to ADHDers, by the application of social norms that other and exclude them, enables us to consider how we, as a society, might change things, in a way that the biological view does not. And if we view RSD as a trauma response, we are far better placed to help, therapeutically, than when presented with biological difference. So knowing what we know, how can we help people struggling with RSD?
Shared symptoms of RSD and CPTSD from Jesse Martin article
Taking off the mask
As individual therapists, we may not feel it is within the scope of our role to try to change a society that so persistently discriminates against difference. But we can help people suffering from the trauma of that discrimination to find their real self, under the mask that has been both their protector and their downfall.
Authenticity, being the real, unmasked you, however difficult to demonstrate in a neurotypical world, is essential. It enables others to see the real person and not the false self that ADHD people are driven to create if they are to survive the judgement, rejection and dismissal that results in RSD. But not masking may be very difficult, particularly in those who are late to recognise their neurodivergence. It takes confidence. It takes self-understanding, and most importantly, it takes understanding from others.
If therapists can provide a safe place, that allows RSD sufferers to reflect on their trauma, to test out and integrate experiences, then they can start take down the mask and be their real ADHD selves. They can start to live in the present without the anticipation of a future skewed against them by experiences of the past. They can start to heal from the pain and loneliness of being shunned for just being themselves.
Author Note: The above view of RSD is my own, informed by my own experiences of struggling with RSD, or struggling with being persecuted for being different, whichever way you want to look at it.
Come and share your thoughts on RSD & how we can best help RSD sufferers
Free2BMe are running a Spicy Spaces session, a conversational workshop focusing on RSD, on Weds 15 May at 11am.
We’ll take a deep dive into the subject, considering how people respond to rejection by becoming people pleasers, or by giving up and retreating from life. We’ll also share possible therapeutic approaches, considering what has worked for us and what hasn’t, so that we can learn from one another.
If you are interested in RSD, or just want to know more about how you might support ADHD people, then do join us. It would be great to meet you.