<body><div><p>Key points</p><ul><li>People with RSD feel emotional pain in reaction to a perceived slight or rejection.</li><li>People with RSD are highly self-critical, extremely anxious in social situations, and have low self-esteem. </li><li>It's not survival of the fittest that wins the evolutionary race but survival of the fondest.</li><li>Differences in the brain structure of individuals with ADHD may be less effective in regulating emotions.</li></ul><p>Rejection sensitive dysphoria (also known as rejection sensitivity disorder) is the non-diagnosis that is right on the tip of everyone's tongue these days—but you won't find it in the DSM-5. </p><p>Here's why.</p><h2>What Is Rejection Sensitive Dysphoria?</h2><p>Rejection sensitive dysphoria, or RSD, is an emotional dysregulation where individuals experience severe and persistent emotional pain in reaction to a <i>perceived</i> slight or rejection.</p><p>Of course, no one likes to be criticized or rejected, and we would all secretly love to be lauded for every almost brilliant thought that flows from our lips, but that's just not realistic. </p><p>What is a realistic feeling if someone says or does something to make you feel overlooked or slighted?</p><ul><li>"Wow. That sucks."</li><li>"I wonder if they're having a really bad day."</li><li>"Did I do something to offend them?"</li></ul><p>But for someone with RSD, the perception of being rejected or excluded can feel catastrophic. People with RSD tend to be highly self-critical, are extremely anxious in social situations, and have low self-esteem. They internalize everything that <i>they think</i> someone else is thinking or feeling about them.</p><figure><img src="https://img.particlenews.com/image.php?type=thumbnail_580x000&amp;url=2ZYwRt_0vjJDRI800" alt="https://img.particlenews.com/image.php?url=2ZYwRt_0vjJDRI800" width="320" height="213" ><figcaption>Is it possible everyone really is out to get you?</figcaption></figure><h2>Rejection Sensitivity and the Social Brain</h2><p>Humans, like most animals, are social creatures, dependent on each other for survival. Often, it's not survival of the fittest that wins the evolutionary race but rather survival of the fondest: who has the most friends or peers to help them along the way. </p><p>And there is a substantial amount of evidence to show that our brain is wired this way for success.</p><p>Wanna know what makes someone's brain circuits light up with happiness? Tinder matches. </p><p>Why? Because if your peers like you, you feel safer and happier. Poor social connection with your peers is found to contribute to depression and anxiety. </p><p>To be clear, we all feel bad when we don't feel like we fit in or belong. But some of us, especially those with ADHD, tend to feel a lot worse.</p><p>There is evidence that differences in the brain structure of individuals with ADHD may be less effective in regulating emotions of rejection. Specifically, abnormalities in the orbital and ventromedial prefrontal and limbic areas can influence emotionality and motivation to interact with your peers.</p><p>This creates a cycle of not being able to control your emotional response when it comes to other people's (supposed) perception of you, which then makes you less likely to interact with your peers. Less interaction with your peers reinforces your cognitive distortions that no one likes you. Isolation fuels your symptoms of depression and anxiety, and the natural human response is...avoidance of other people. </p><p>It's an impossible cycle for many people to break free from.</p><h2>Do I Have Rejection Sensitive Dysphoria?</h2><p>There are a few tools out there to help determine whether you might have RSD. Keep in mind that this is not a diagnostic tool but rather a way to give you an idea of whether some of the symptoms listed here apply to you.</p><h2>How to Treat RSD</h2><p>Interestingly, the same medicines that are used to treat ADHD may help manage symptoms of RSD. Stimulant medications such as Adderal or Vyvanse have been effective in lessening the symptoms of RSD, as have alpha-2 receptor agonists. </p><p>The latter group of medications lowers heart rate and blood pressure, reduces hyperactivity and impulsivity, and has mild sedative effects—all of which are helpful in treating anxiety.</p><h2>Why RSD Isn't a "Real" Diagnosis</h2><p>There are four generally accepted criteria for a syndrome or condition to become an official diagnosis, as per inclusion in the DSM. Here are some other obstacles:</p><ol><li>Lack of research: Currently, information on RSD relies on anecdotal evidence from large amounts of people and small-scale empirical studies. We need more information to be certain this is an empirically validated diagnosis.</li><li>We don't have enough information to parse apart whether RSD is a genetic condition, an issue of the environment someone is raised in, or—most likely—a combination of the two. Psychoanalysts, in particular, point to the possibility that RSD could be explained by attachment theory and, therefore, not limited to individuals who have ADHD.</li><li>Adding to the confusion of how and where to categorize RSD is the issue of the large overlap that other mental health impairments have with RSD. Depression, anxiety, and other conditions that result in general emotional dysregulation blur the lines of where this ADHD-related dysphoria begins and ends. </li></ol><p>Let's be clear: There are many diagnoses that are currently included in the DSM-5 but were not initially included. Post-traumatic stress disorder was not added to the DSM until the 1980s, long after we were well aware that our soldiers were returning from war as different people than they were before. Borderline personality disorder was previously referred to as borderline psychosis until the DSM-3, and obsessive-compulsive disorder used to be called obsessive-compulsive neurosis.</p><p>And none of these were diagnoses until science caught up with society.</p><p>References</p><p>Hsu DT, Jarcho JM. "Next up for psychiatry: rejection sensitivity and the social brain". Neuropsychopharmacology. 2021 Jan;46(1):239-240. doi: 10.1038/s41386-020-00802-9. PMID: 32792681; PMCID: PMC7424132.</p><p>Rubia K. Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation. Front Hum Neurosci. 2018 Mar 29;12:100. doi: 10.3389/fnhum.2018.00100. PMID: 29651240; PMCID: PMC5884954.</p></div></body>

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Is Rejection Sensitive Disorder Real or Really In Your Head?

People with RSD feel emotional pain in reaction to a perceived slight or rejection. People with RSD are highly self-critical, extremely anxious in social situations, and have low self-esteem. It's not survival of the fittest that wins the evolutionary race but survival of the fondest. Differences in the brain structure...

Is Rejection Sensitive Disorder Real or Really In Your Head?

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