Understanding Rejection Sensitive Dysphoria
Jenna Turnbull, a 36-year-old civil servant from Cardiff, experiences a tightness in her chest as she reminisces about her childhood. She vividly recalls being an 11-year-old girl, waiting to play netball when a boy teased her about her hairy arms. Even though she realizes how childish that moment was, the memory still invokes a deep sense of shame and embarrassment, lingering even after 25 years.
She searches for additional instances that highlight her sensitivity to teasing and recalls an outing with friends six years prior. Amid the lively conversation, someone jokingly commented about her untidiness at home. Although it was meant in jest, Jenna still feels the weight of that remark. “That comment still haunts me,” she admits, leading her to obsessively clean her home—a behavior that eventually contributed to her diagnosis of obsessive compulsive disorder (OCD). “I’ve spent four or five hours cleaning my bathroom,” she shares.
Another example surfaces when she remembers sending a mistake-riddled email to her colleagues. Upon receiving a response highlighting the error, her chest tightened, and she struggled to breathe, even fearing she was having an asthma attack. “It was a panic attack. It left me completely debilitated,” she reflects. In the past, shame has driven her to self-harm.
Jenna reached a breaking point one night in 2022, during divorce proceedings, when she called a mental health crisis line. The shame of impending single motherhood felt unbearable. “I didn’t think I wanted to make it through,” she admits. The nurse on the line suggested that Jenna, who had been diagnosed with autism in childhood, might also have attention deficit hyperactivity disorder (ADHD) and something called rejection sensitive dysphoria (RSD). While RSD isn’t a formal diagnosis, it often coincides with ADHD, and the emotional responses associated with it are gaining more recognition in recent research.
The term RSD started gaining traction in the 1960s and has since found a community online, with a robust Facebook group and numerous TikTok discussions. A recent employment tribunal awarded a worker £12,000 after her boss made a derogatory remark relating to her RSD. However, the responses to such findings can be mixed. Some people still dismiss RSD as merely an excuse for feeling hurt. Jenna often internalizes this critique, noting that some friends and family can be critical or skeptical about the existence of invisible struggles.
Dr. William Dodson, a psychiatrist and expert in ADHD, often sees similar responses dismissed. He’s treated countless ADHD patients and noticed many demonstrate intense reactions to rejection or criticism. While feeling rejected is part of being human, the dysphoria associated with RSD amplifies the pain significantly. “This is something that is just several orders of magnitude stronger than everyday rejection,” he explains.
Jenna recognizes that many undergo the pain of divorce, yet her reactions feel intensified due to RSD. “I’ll get chest pains and severe stomach pains…” She often felt labeled as someone who “took things too personally.” Upon receiving her ADHD diagnosis, she realized the significance of understanding her experiences. “Just putting a name to it was the big thing,” she notes.
In a recent study, researchers outlined how perceived rejection can lead to immediate distress for individuals with ADHD and RSD. Dr. Dodson reported that recognizing RSD in people with ADHD often leads to emotional breakthroughs in therapy sessions. “About 95% will go: ‘Oh my God, that’s me,’” he says.
Lauren O’Carroll, a 41-year-old coaching business owner, shares that she faced similar issues growing up, often feeling “oversensitive” to requests, leading to explosive reactions. Even as an adult, trivial mistakes can evoke intense guilt, and she’s admitted to lying to cover up her feelings of shame.
Dr. Shyamal Mashru, a specialist in adult ADHD, notes that some patients experience RSD’s emotional intensity so drastically that they become physically affected, some even needing emergency care. He suggests that both neurological and nurturing factors contribute to the phenomenon. “Your life plays a big role,” he asserts.
The effects of RSD can profoundly impact one’s life, forcing individuals to adapt their behaviors for self-protection. Examples include people-pleasing or striving for perfection to evade rejection. Others become so overwhelmed by fear that they retreat from socializing altogether.
Dhiren Doshi-Smith, 42, recounts avoiding social situations to protect himself from feeling rejected. He finds himself triggered by even minor communication delays and has worked hard in therapy to address these challenges.
Dr. Dodson has discovered that certain medications can be effective for RSD, although they’re not typically prescribed in the UK. Jenna, on the other hand, benefits from therapy and certain antidepressants, which have significantly improved her situation. After 18 months of therapy, she’s begun to recognize when her anxiety surfaces and learned techniques to manage it. Asking friends to cease triggering comments has also proven helpful.
After years with the same office team, Jenna ventured to apply for a promotion. “Eighteen months ago, I couldn’t have even thought about that,” she reflects. However, her courage to face potential rejection paid off as she was awarded the position.
While she acknowledges that she hasn’t fully conquered her RSD, she feels that understanding it has been essential for her journey toward acceptance. “I’m still on that journey,” she says, and it may always be a work in progress.
