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When fear of rejection is more than it appears

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Rejection sensitive dysphoria, an aspect of ADHD, is being explored and treated in new ways.

Having struggled with ADHD for most of my life, I’m always interested in new research about it. A recent article in ADDitude explains an emotional reaction called Rejection Sensitive Dysphoria that’s unique to those with ADHD:

Rejection sensitive dysphoria (RSD) is 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 their life. RSD may also be triggered by a sense of failure, or falling short – failing to meet either their own high standards or others’ expectations.

No doubt we’re all familiar with the term “dysphoria” right now, but I was surprised to find that I didn’t even know what it meant. I thought it meant “confusion” or something similar (it’s literally Greek to me) … but it actually means “difficult to bear.”

Contrary to what ADHD kids hear regularly growing up, they’re not weak or wimpy — their emotional response is disproportionately greater than what others feel, and the emotional pain is correspondingly more intense.

Dr. William Dodson is an ADHD expert, and has written extensively about the emotional effects of ADHD. He explains that there are two directions this emotional pain can take: internal or external.

The kids (and adults) who manage to contain the pain and turn it inward can trigger full-0n depressive episodes. Dr. Dodson notes that, “The sudden change from feeling perfectly fine to feeling depressed that results from RSD is often misdiagnosed as rapid cycling bipolar disorder.” This also might help explain why ADHD individuals also suffer from borderline personality disorder (characterized by extreme and unstable emotional reactions) at a higher rate than the general population.

When the emotional response is externalized, it looks like rage. Not just some yelling, either — I’m talking full-on, wall-punching, vein-throbbing, Hulk-smashing RAGEY rage. Dr. Dodson even claims that 50 percent of people with court-mandated anger-management therapy have previously undiagnosed ADHD.

Those who suffer from this cope with the extreme emotional reactions in two ways: they either try to please everyone, or they give up trying to please anyone. Obviously, both of these coping mechanisms are detrimental and eventually paralyzing — there’s no possible way to please everyone all the time, and trying can create such a sense of failure that giving up is inevitable.

There are a few ADHD individuals who adapt to rejection sensitivity by overachieving, and becoming perfectionists or workaholics. But accomplishments and even excellence don’t erase the RSD, or the internal turmoil it causes.

Dr. Dobson claims that rejection sensitivity dysphoria is an integral part of ADHD — nearly 100 percent of ADHD individuals experience it. He also explains that the emotions are so intense and overwhelming that psychotherapy isn’t a useful treatment, but there are two medications that can help: alpha agonists and monoamine oxidase inhibitors. These are considered fairly safe medications, but come with a range of side effects.

Perhaps the most important thing is to recognize the legitimacy and the severity of the emotions ADHD people experience. It’s not possible to take away the pain or prevent any emotional upset; in fact, the  emotional distress often isn’t even caused by actual rejection — the perception of rejection is enough to trigger an extreme emotional reaction.

But it is possible to acknowledge the emotional response and not criticize those suffering from it for being dramatic or self-indulgent. It’s part and parcel of dealing with ADHD, and ADHD individuals who experience RSD need understanding and support above all.

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Mental HealthPsychology
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