Rejection Sensitive Dysphoria: What You Should Know About ‘Emotional Sunburn’

By The Fix staff 10/20/21

A lifetime of criticism can make people with ADD or ADHD particularly sensitive to perceived criticism.

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Almost everyone is familiar with the sensation of sunburn. After a day of splashing and fun at the beach, you’re overexposed. Your skin is red and any tiny touch can feel overwhelming.

Now, let’s consider the idea of emotional sunburn. This is how some professionals characterize Rejection Sensitive Dysphoria (RSD), a condition that often appears in people with ADD and ADHD. After years of being criticized and critiqued for their behaviors, people with these conditions often feel raw and vulnerable. Because of that, they can react strongly to any real or perceived criticism, critique or failure.

What is RSD?

Usually, RSD is characterized as an outsized reaction to an incident, says Mandy Schneider, alumni coordinator at Sunshine Coast Health Centre, a non 12-step drug and alcohol rehabilitation center in British Columbia. Someone with RSD might show emotional outbursts, which are sometimes confused with rapid-cycling bipolar disorder or other mental health conditions.

RSD can manifest in two ways. Some people become angry. These people are prone to outbursts, and may become aggressive to themselves or others. In other cases, RSD manifests as anxiety. People with this form of RSD are likely to become withdrawn and isolated. They may become perfectionists in hopes of avoiding failure.

RSD might present as aggression toward others, but the condition is even more dangerous when it is internalized. In the most severe form, this can lead to suicidal ideation.

ADD/ADHD and RSD: The Connection

Understanding the connection between ADD, ADHD and RSD can help people get the treatment that they need. Some estimates say that children with ADD or ADHD receive 20,000 more negative interactions during their school years than their neuro-typical peers. Constantly being told to sit down, calm down, and work differently can grate on people, particularly if they have not been diagnosed and thus don’t have a clear understanding of the root cause of their behaviors.

Overtime, these people can become particularly vulnerable to having outside emotional reactions when they experience criticism. This compounds the emotional dysregulation that is a feature of ADD and ADHD in children and adults. Up to 70% of adults with ADD or ADHD have trouble controlling their emotions. RSD is an even more pronounced and severe form of this.

Treatment of RSD

RSD is not a well-known condition, so it can be difficult to get a diagnosis. Still, many people feel relief when they are diagnosed, in part because they learn that there is an explanation for their behaviors.

Once RSD is diagnosed, providers can use medication to help alleviate the symptoms. A class of medications known as alpha agonists can provide relief to about one-third of people with RSD. MAOI inhibitors can also help control the symptoms of ADD/ADHD and RSD. Some people find that controlling the symptoms of their ADD or ADHD can make them less prone to mistakes. That might reduce the frequency of criticism that can lead to outbursts.

Medications alone can’t fully control the condition, however. Cognitive behavioral therapy might allow people to better understand their triggers, and equip them with healthier coping mechanisms when they feel an RSD episode coming on. However, CBT and other therapies are considered less effective for RSD than they are for other mental health conditions, in part because of how quickly an episode of RSD can be triggered. Although therapy may be helpful, mindfulness can also help people with RSD control their emotional reactions.

Spotting and Treating ADD/ADHD and RSD in Adults

In order to get treatment for RSD, you’ll need to identify the condition as the cause of your emotional dysregulation. Getting a diagnosis of ADD or ADHD can be an important first step. Although ADD and ADHD are more common in children, an estimated 2-5% of American adults also have the conditions. Although diagnosis of ADD/ADHD in adults is on the rise, it remains relatively rare. Oftentimes, a patient must raise the issue with their provider in order to get a diagnosis.

In adults, the symptoms of ADD/ADHD can include:

  • Impulsiveness
  • Forgetfulness
  • Restlessness
  • Extreme emotions

Adults who have RSD might:

  • Become “people pleasers” to reduce the risk of criticism
  • Focus on perfection to lessen the chances of failure
  • Experience emotional reactions as physical symptoms
  • Have intense emotional reactions
  • Be their own worst critic

If the symptoms above look familiar to you, you should talk with your doctor about whether you might have ADD, ADHD or RSD. It’s never too late to get a diagnosis for these conditions, and start on the path to better mental, emotional and physical health.

Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.

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