Rejection Sensitive Dysphoria

Q: Bipolar Meltdown? Or Rejection Sensitivity Meltdown?

If your child is prone to extreme outbursts, it’s important to understand whether the source is ADHD-fueled rejection sensitivity or co-morbid bipolar disorder — the latter means you might be dealing with unprovoked rages called “affective storms.” Treatment options include medication and behavioral management interventions.

Rejection Sensitive Dysphoria
Rejection Sensitive Dysphoria

Q: Could my child’s extreme, sudden outbursts be a sign of the rejection sensitive dysphoria commonly associated with ADHD or a sign of bipolar disorder? How can I manage these meltdowns?

A: Unfortunately, meltdowns — whatever their root cause — usually have to run their course. That said, as a psychiatrist, I would first evaluate whether these temper tantrums are, indeed, temper tantrums. Do they have a secondary gain? Are they manipulative? Are they done by the child to get his way? As soon as he gets his way, does the temper tantrum go away? (Once the tantrum has achieved its goal?) Is there a noticeable trigger for the meltdown? If you answered yes to these questions, the tantrums might be a sign of rejection sensitive dysphoria (RSD), a common symptom of attention deficit disorder (ADHD or ADD) wherein a patient feels extremely strong emotions and reacts equally extremely to real or perceived criticism or rejection.

Children with bipolar disorder, on the other hand, have what are known as “affective storms,” which are uncontrolled rages that follow a minor (or no) provocation. If you’ve ever seen one, you’ll never forget it. These are way, way beyond temper tantrums.

If I were fairly sure that the temper tantrums were not manipulative — a child trying to get his way on pretty much any conflict with the parent — I would hope the child is in that lucky 60% of people who respond to medication for bipolar disorder. If he is in the 40% that do not respond, I would try behavioral management, which would give the child ways to correct his distortion and respond in a healthier fashion.

The following information is from William Dodson, M.D.’s webinar titled “All the Feels: An ADHD Guide to Emotional Dysregulation and Rejection Sensitive Dysphoria.” That webinar is available for free replay here.