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RSD in ADHD: Symphtoms of Rejection Sensitive Dysphoria

Julia Ovcharenko, CEO of Numo
January 4, 2024

Hello, again! 

Over the past few weeks, we’ve been highlighting how ADHD bounces off other disorders and conditions, or, as a fancy person would say, we’ve been talking about ADHD comorbidities.

Ironic, isn’t it? While ADHD can often make it difficult to make friends and maintain relationships, this diagnosis picks up “friends” as if it were nothing. 

So, today we’ll be putting a spotlight on yet another “fwend” of ADHD, that being Rejection Sensitive Dysphoria, and uncover what it means to live with it.

In today’s article, you will learn:

  • A quick refresher on what ADHD is, its symptoms, and misconceptions
  • An introduction to Rejection Sensitive Dysphoria (RSD), a lesser-known but significant aspect of ADHD.
  • The intersection of ADHD and RSD.
  • The challenges faced by individuals who struggle with RSD ADHD.
  • How RSD can exacerbate ADHD symptoms, impacting emotional regulation, self-perception, and interpersonal relationships.
  • The potentially severe consequences if RSD and ADHD go unrecognized and untreated.
  • Diagnosis and treatment for RSD.
  • Few useful tips on how to manage ADHD and RSD both.

Okay, are you ready?

Let’s dig in.

What is ADHD?

While this particular article won’t be spending too much time on ADHD and its symptoms, it’s still worth doing a quick refresher for the new kids on the block (Welcome, by the way, 👋😀)

ADHD is Attention-Deficit/Hyperactivity Disorder, a neurodevelopmental condition often diagnosed in childhood but can persist into adulthood. It's not a phase, a character flaw, or the result of poor parenting. It's a legitimate brain-based condition. 

ADHD Core Symptoms

Three primary symptoms commonly characterize ADHD:

  • Inattention: The person might find focusing, sustaining attention, or completing tasks challenging. They might seem forgetful, easily distracted, or often lose things. Daydreaming frequently and appearing not to listen when spoken to are also common signs.
  • Hyperactivity: This is where the "HD" in ADHD comes from - Hyperactivity and Disruptiveness. Individuals with ADHD might seem "on the go" or driven by an "internal motor." They might talk excessively, have difficulty sitting still, or always move around, even in situations where it's inappropriate.
  • Impulsivity: People with ADHD may show impulsive behaviors. They might act hastily without considering the consequences, interrupt others frequently, or struggle with self-control.

To a greater or lesser degree, all ADHDers will exhibit these symptoms. But, the severity of symptoms will differ across age and gender. So, make sure to check out 👈that 👈 article to learn more about them. 

Prevalence of ADHD

While numbers can fluctuate, studies suggest that about 5% of adults worldwide have ADHD. Remember, ADHD isn't just a childhood phase. Childhood is when symptoms are first observed, but it doesn’t mean they stop once you age up to a magic number. 

Misconceptions about ADHD

ADHD is a thing that people just can’t help but misunderstand. The legitimate and very real changes to the brain are mistaken for character flaws and things that are well within a person’s control. 

So, let's debunk a few myths circling ADHD:

  • It's not just a 'childhood disorder': Many ADHDers continue to experience symptoms as they age.
  • It's not a result of bad parenting: ADHD is a neurological condition, not a consequence of poor upbringing.
  • People with ADHD can 'snap out of it' if they try hard enough: ADHD is not a choice or a result of laziness. It requires appropriate treatment and management; sometimes, that is not enough. 

Understanding these misconceptions gives us a valuable foundation as we explore Rejection Sensitive Dysphoria (RSD).

Similar to ADHD, RSD has symptoms that are easily mistaken for bad character or emotional immaturity. Yet, that cannot be farther from the truth. 

[What is RSD?]Understanding Rejection Sensitive Dysphoria (RSD)

Imagine standing in a crowded room, narrating a joke you thought was hilarious. The punchline lands, but instead of laughs - awkward silence. Your heart sinks, your stomach clenches, and embarrassment creeps up your neck. This hypersensitivity to the perceived judgment, an overreaction to an otherwise mild situation, is the essence of RSD, a common but under-recognized companion of ADHD.

RSD Symptoms

RSD doesn’t have symptoms, per se. It would be better  to say there are certain noticeable behaviors they can exhibit, either during a crisis regularly:

  • Negative-self talk and low self-esteem.
  • Withdrawal from social situations out of fear of rejection.
  • Emotional outbursts following real or perceived rejection
  • Trouble maintaining and creating new relationships because of constant anxiety about being rejected. 

[Specifics of RSD]RSD vs. Social Anxiety vs. Mood Disorder

So you might be thinking: “Hey, this RSD thing sounds a lot like social anxiety because of the avoidance of social gatherings. But it also kinda looks like mood disorder because of the sudden emotional outburst.”

You would be correct, my imaginary friend, that will cease to exist after this paragraph. 🤗Indeed, these three conditions tend to be quite similar, but the devil is in the details, per usual. 

Thus, let’s look at what these differences entail. 

RSD vs. Mood Disorders

While mood disorders involve untriggered, gradual mood changes that last for weeks or months, RSD involves intense but short-lived emotional pain triggered by a specific event. The moods in RSD are normal in every way except their intensity.

In other words, once the outburst passes, the emotions of the one living with RSD return to normalcy2. Unlike certain manifestations of a mood disorder, RSD emotions have cause and effect. It’s only that the “effect” tends to be disproportionate to the cause that might not even exist.

Now, let’s look at social anxiety, shall we? 

RSD vs. Social Anxiety

Social Anxiety is a fear of social situations. People with social anxiety often fear being humiliated, embarrassed, or judged by others. This fear can be so intense that it interferes with their daily life. They might avoid social situations entirely to prevent feeling this anxiety.

In RSD, avoidance is due to the intense emotional pain of rejection or criticism. The Pain of RSD feels excruciating and hard to put into words. It's not just the usual discomfort we all feel when criticized or rejected. It's an intense, unbearable pain that feels like a physical wound. People with RSD often describe it as feeling like they've been stabbed or punched in the chest.

Another key difference is the intensity and duration of the emotional response. In RSD, the emotional response is immediate and intense, but it usually doesn't last long. In Social Anxiety, the fear and anxiety can build up over time leading to a social event and lingering afterward.

[RSD and ADHD]RSD ADHD: Exploring the Intersection

Now that we have cleared the waters on what RSD is and what RSD is not let’s look at how it pairs with ADHD. 

While RSD isn't exclusive to ADHD, these often go hand in hand. Why is that, you ask? 

It could be due to the emotional impulsivity that is inherent in ADHD. People with ADHD tend to react more quickly and intensely to emotional triggers, and rejection, or even mere anticipation, is big.

The Interplay

ADHD and RSD often co-occur, creating a complex dance of psychological and emotional challenges. ADHD, with its attention deficit and impulsivity, fuels the triggers for RSD. And RSD, with its intense emotional response to perceived rejection, magnifies the challenges of ADHD. It's a perpetual feedback loop that can be mentally and emotionally exhausting.

Why This Happens

The exact reason why RSD and ADHD often coexist is not fully understood. However, it's theorized that emotional dysregulation in ADHD plays a role. Those with ADHD often struggle to manage their emotions effectively, which makes them more vulnerable to the overwhelming feelings of rejection that characterize RSD.

Amplified Challenges

Individuals dealing with both ADHD and RSD face amplified challenges. Imagine struggling to focus on a task because of ADHD and then feeling intense shame and distress if you make a mistake or don't meet expectations. Or, envision the strain of always being on high alert, anticipating potential rejection in social situations. It's a tough path to tread.

Understanding these conditions separately is crucial. But understanding how they interact gives us deeper insight into the lived experience of those grappling with both.

The Impact of RSD on Individuals with ADHD

Impact of RSD on ADHDers

If ADHD and RSD were Marvel characters, they'd be the kind that feeds off each other's powers, amplifying their effects.

Amplification of ADHD and RSD Symptoms

RSD can intensify ADHD symptoms. For example, the dread of rejection might make an individual even more hesitant to engage in activities where their inattentiveness or hyperactivity might be noticed and criticized. This fear could result in avoidance behaviors, leading to missed opportunities and unfulfilled potential.

Effects on Emotional Regulation

RSD directly affects emotional regulation. People with RSD experience strong emotional responses to situations they interpret as rejection or criticism. This emotional turmoil can make it even more challenging for someone with ADHD, who may already struggle with emotional control due to the disorder's nature.

Effects on Self-Perception and Relationships

Moreover, RSD can dramatically affect self-perception and interpersonal relationships. You might develop low self-esteem or feel unworthy if you constantly fear rejection or criticism. It can also strain relationships, as those with RSD might misinterpret innocuous comments as criticism, leading to conflicts or withdrawal from social interactions.

Potential Severe Consequences

If RSD and ADHD go unrecognized and untreated, they can contribute to more serious mental health conditions like anxiety disorders, depression, and chronic underachievement. If not addressed, it can gather momentum, becoming more substantial and damaging over time.

However, recognizing the signs of RSD can pave the way toward understanding, empathy, and targeted intervention.

[Symptoms of RSD]Recognizing RSD in Yourself or Others

Knowledge is power, and understanding the telltale signs of RSD can make a significant difference. Here are some symptoms to watch out for in adults and children:

RSD Symptoms in Adults

  • Intense emotional sensitivity to perceived rejection, criticism, or perceived failure.
  • Fear of rejection leads to avoidance of situations where rejection could occur.
  • Low self-esteem or feelings of unworthiness.
  • Social anxiety or discomfort in social situations due to fear of embarrassment or humiliation.
  • Sudden mood changes in response to perceived criticism or rejection.

RSD Symptoms in Children

  • Excessive emotional sensitivity to situations that might not seem significant to others.
  • Anger or frustration in response to perceived rejection or failure.
  • Avoidance of trying new things due to fear of failing or being rejected.
  • Clinginess or over-dependence on approval from peers or adults.
  • Challenges in making or maintaining friendships due to their heightened sensitivity to perceived slights.

Recognizing these signs in oneself or others can be the first step towards seeking professional help, enabling targeted and effective treatment strategies.

[RSD Diagnosis & Treatment]Professional Diagnosis and Treatment

Like a good detective story, diagnosing ADHD and RSD involves clues, careful observation, and professional insight. 

ADHD RSD: How is It Diagnosed?

Professional diagnosis is crucial for both ADHD and RSD. ADHD is typically diagnosed based on behaviors that include inattention, hyperactivity, and impulsivity. As for RSD, it's a bit tricky. Since RSD isn't officially recognized as a separate disorder in the DSM-51, it's usually identified through detailed patient histories and the elimination of other conditions that might cause similar symptoms.

Treatment Methods for ADHD and RSD

Once diagnosed, treatment often involves a combination of medication, therapy, and lifestyle changes.

Medication can help manage the core symptoms of ADHD, such as hyperactivity, impulsivity, and inattention. In some cases, it might also help manage the extreme emotional sensitivity of RSD.

Therapy, especially cognitive-behavioral therapy (CBT), can be effective in helping individuals recognize and change negative thought patterns that fuel RSD and ADHD. It can also provide strategies to manage stress and improve social interactions.

However, the clinical efficiency of therapy for treating RSD is still up in the air. Dr. Dodson, a psychiatrist who specializes in ADHD treatment, believes that behavioral therapy doesn’t offer relief from impairments caused by RSD

Nonetheless, considering how ADHD and RSD feed off each other, a therapy might still be a viable way to reign in ADHD symptoms and thus potentially reduce the occurrence of RSD episodes. 

[Coping Strategies for RSD]Coping Strategies and Lifestyle Changes

ADHD and RSD might seem intimidating, but if equipped with the right strategies and lifestyle changes, it's a battle you can hold your ground in. Here are some suggestions:

Cognitive-Behavioral Techniques

CBT techniques can help individuals with ADHD and RSD manage their symptoms effectively. These techniques often involve identifying negative thought patterns and replacing them with healthier, more balanced ones. This can help manage the fear of rejection and criticism central to RSD.

Mindfulness

Mindfulness is another powerful tool. By practicing being present and accepting experiences without judgment, individuals can learn to observe their emotions without becoming overwhelmed.

Exercise

Physical exercise is beneficial not just for our bodies but also for our minds. Regular exercise can help reduce symptoms of ADHD by improving concentration, reducing impulsive behavior, and enhancing mood.

Healthy Diet and Routine

A healthy diet and routine can also support overall well-being and symptom management. Balanced meals can help maintain energy levels and mood stability, while a predictable routine can help manage the impulsivity and inattention associated with ADHD.

Supportive Social Environments

Surrounding oneself with understanding and supportive individuals can make a world of difference. They can provide reassurance during moments of self-doubt and encourage positive self-perception.

Moreover, a properly chosen support group can enrich you in a way that traditional, peer-reviewed treatments cannot.

DISCLAIMER: I am not peddling alternative medicine, healing crystals, or detox teas. Science is meticulous, meaning researchers can only make claims if they are 100% certain that the findings and treatments can be reproduced independently. 

But that doesn’t mean there aren’t non-scientifically backed solutions that cannot help. 🧐

We touched on this topic when we wrote about ADHD and Body Doubling. While there isn’t enough research to claim that it’s an effective way to treat its symptoms, the ADHDers who tried it have vouched for its effectiveness.

In the same way, folks with ADHD and RSD have probably figured out their unique coping mechanisms to reign those two puppies in. So, you may gain insights not available elsewhere by getting to know a few fellow sufferers. 

And where can one find this group of fellow ADHDers, you may ask? Well, luck to you, because I have just the answer. 

[Numo.so: App for ADHD & RSD]Numo.so: A Community to Be Sad and Happy, Together!

You know how it’s sad when you’re the only one who got a bad mark on the test, but it’s suddenly less sad if your friend is in the gutter, too?

(For the most part) that was the concept behind creating Numo, our smol ADHD companion app. 

While we understand the value of creating a great companion app to help with ADHD needs (and, trust me, there are plenty of that, as well), we wanted to go a bit further and create this hub of peers where you can get advice and support you can’t get anywhere else.

And, hence, Numo. 😀

But enough talk! What can you find inside this app of ours? 

  • ADHD Planner: This isn't an ordinary planner; it's a task-conquering tool. With every completed task, you're taking a victory stride in your day-to-day journey!
  • Noise Generator: Our noise generator can be your haven when the world's volume just isn't right. This tool can help you find the optimal soundscape that enhances your focus, a valuable asset for those wrestling with ADHD.
  • Squads and Tribes: Community is powerful, especially when navigating the challenges of ADHD and RSD. Here, you can connect with others who truly 'get it,' sharing experiences, posing questions, and celebrating victories big and small. Plus, the diverse perspectives can provide unique coping strategies that you might not find elsewhere.
  • Knowledge Repository: Our repository is chock-full of wisdom, advice, and tips about managing ADHD and RSD. The journey becomes less daunting when armed with knowledge.

So, we’d be lucky to have you 🤗Come along if you like!

[Conclusion]Conclusion: What Have We Learned About RSD?

If you've made it this far, pat yourself on the back. You've taken an important step in understanding not only ADHD but also the elusive creature that is RSD. But this is just the beginning.

And since this has been a long trek, let’s do a quick refresher on things we’ve learned today:

  • We've uncovered the realities of ADHD, shedding light on its symptom, impacts, and common societal misconceptions.
  • We also discussed Rejection Sensitive Dysphoria (RSD), a lesser-known but significant facet of ADHD that often goes unnoticed or misunderstood. 
  • And we did explain how it is different from social anxiety and mood disorder.
  • We've dived into the impacts of RSD on individuals with ADHD, discussing its effect on emotional regulation, self-perception, and relationships, along with potentially severe consequences if left untreated.
  • We've presented a comprehensive list of telltale signs or symptoms of RSD in adults and children, highlighting the importance of recognizing these signs.
  • We've given you an overview of the professional diagnosis and treatment methods for RSD and ADHD.
  • And finally, we've offered advice on coping strategies and lifestyle changes, encouraging you not to let stigma or fear prevent you from seeking help, and reminding you of the various tools and communities available to support you.

Okay, so we've gone through a lot here. But remember, life with ADHD and RSD isn't a lonely road. There's a whole tribe out there who gets it. And guess what? They're rooting for you, and so are we.

So reach out, connect, and know it's okay to lean on others. With knowledge, understanding, and the right resources, there's no obstacle too great. We believe in you. 

References
1 Journal of the American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder
2 Attention Deficit Hyperactivity Disorders. Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: a controlled study


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