Rejection Sensitive Dysphoria

Shame: The Devil on My Shoulder

Rejection sensitive dysphoria causes feelings of guilt, shame, and rejection. This on top of your ADHD — and mixed in with the resulting anxiety or depression. I struggle with RSD, and I’m here to say you are not alone — and you are not weak.

ejection sensitive dysphoria and ADHD can cause feelings of guilt, shame, and rejection.
An illustration of a woman with the devil representing rejection sensitive dysphoria on one shoulder and the angel representing correct diagnosis of adhd and rejection sensitivity on the other

Rejection Sensitive Dysphoria (RSD) and ADHD

“Stop being so sensitive,” everyone told me when I was younger. “If you stop crying, they’ll stop teasing you.”

I was the kid who couldn’t handle red marks on my homework, who melted down at any sign of criticism. I’d dissolve into tears. I’d sometimes stomp away. I’d curl up into myself and feel worthless, miserable, and guilty. The shame was overwhelming. It led to self-harm in my teens and early 20s. I could not cope with the normal slings and arrows of daily life. Everything bad was my fault.

My psychiatrists thought I was depressed and put me on an SSRI. It didn’t help much, because I wasn’t depressed. Like so many women, I went through many diagnoses before my doctors finally hit on ADHD. I wasn’t manifesting depression or isolated anxiety issues. I was dealing with rejection sensitive dysphoria (RSD).

RSD is a condition that the psychiatric community at large, and the ADHD community, is just beginning to understand. ADHD expert William Dodson, M.D., calls it “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 important people in his or her life. RSD can also be triggered by failing to meet [your own] or others’ high expectations.”

As women, we know about high expectations, the failure to meet them, and the emotional backlash when we fall short. Add an actual, diagnosable psychiatric condition to that response, and you have a recipe for some serious psychological damage. It started with teasing from my peers in childhood over my reactions to not getting an A on every single paper; along with forgetting my homework or losing a book or doing any number of things girls with attention deficit disorder (ADHD or ADD) do regularly — missing social cues, flubbing personal interactions, blurting things out. I berated myself, and it didn’t help that others berated me too. I played those criticisms as a soundtrack of self-loathing.

[Self-Test: Could You Have Rejection Sensitive Dysphoria?]

Rejection Sensitive Dysphoria: Extreme Sensitivity to Criticism

It’s no surprise that a childhood like that, combined with RSD, left me with a hair-trigger response to criticism. I’m in my 30s now, and RSD is still the devil on my shoulder, the voice in my head, the soundtrack to my life. It affects every relationship in my life, from my parenting to my marriage to my friendships. I once took a much-anticipated trip to meet work friends in another state. I had fun for four hours before a comment had me convinced that these women hated me, that they thought I was an idiot.

I spent the rest of the trip in near tears. It took me months to recover. I’ve since realized that all of this was in my head, and my friends were, as they professed to be, my friends. They liked me.

I often feel like a terrible parent. The normal things that parents do — lose their temper, say — seem life-altering to me. I feel that I’m destroying my children’s lives. I may cry in apology in front of them. RSD means having to say you’re sorry more than anyone on the planet.

[Free Resource: Understanding Rejection Sensitive Dysphoria]

Rejection Sensitivity: Impact on Marriage and Parenting

RSD has a big impact on my marriage. I would encourage anyone who thinks he or she may be suffering from RSD to enter marriage counseling. It will help your spouse understand that when he or she asks you to take out the garbage, it may lead to an hour-long argument, complete with tears. Of course, you should have taken out the garbage long ago and why haven’t you done it sooner and what’s wrong with you, anyway? The person only said “Could you please take out the trash?” He’s baffled and upset that you’re flying into accusations.

RSD can imitate a mood disorder, including rapidly cycling bipolar disorder complete with suicidal ideation. Guanfacine or clonidine helps some patients, says Dodson. MAOIs can also be effective, but they come with a list of don’ts, including ADHD meds. Talk with your doctor.

Many people with ADHD experience some form of RSD. In women, it usually turns inward. So you’re not the only one feeling that guilt, shame, and rejection. I understand. I am right there fighting them with you.

RSD: Next Steps

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