Rejection Sensitivity Dysphoria
February 25, 2019 12:18 PM   Subscribe

I think a loved one may have this, but I've only heard of it very recently in association with ADHD. I cannot find books or scholarly articles about it (admittedly finding articles is not a strength of mine). Is it real?

For context, I'm wading into the confusing morass of information about ADHD in kids and adults. Especially at the beginning, it's of course hard to tell what's solid info and what's bunk. Hence my question. When I heard about Rejection Sensitivity Dysphoria on an ADDitude podcast I thought - wow, that could finally explain my husband's anger issues and inability to accept criticism. The thought that he could get more help for this (on top of the SSRIs that have truly improved things) gives me hope. I'm trying to research the subject. As my child was just diagnosed with ADHD, we are now looking at whether my husband has it. Can you help me learn more about this condition, if it even is one? For example, is it in the DSM? Is it a concept stolen from Borderline Personality Disorder? Etc.
posted by kitcat to Health & Fitness (12 answers total) 10 users marked this as a favorite
When I was looking into this a while ago, it seemed like all the google hits for it were traceable back to a single researcher who was pushing the idea. This guy, who's a psychiatrist, found something similar when he looked into it more recently. (He also then does a miniature informal survey on it, which I don't find especially convincing; the part of the post I'm interested in is the very beginning, where he talks about struggling to find published support for it beyond the un-peer-reviewed say-so of this one guy.)

There's a lot more google hits now, but it's not clear to me if that corresponds to any greater scientific consensus on it. Mostly they seem to all be pop-psych articles linking to each other.

That said, the idea really clearly hit a nerve with a bunch of people. There are all those google hits, and In the last year or two it's gone from "something I never hear about" to "something a lot of my mentally ill friends talk about and identify with."

If I had to bet, my bet would be on "Rejection-sensitivity is a common aftereffect of trauma, and people with all sorts of different mental illnesses are more likely to have trauma — ADHD included." But that's just more unscientific speculation. I think all we can actually say with confidence is that one researcher, and a bunch of patients and journalists, think it's an interesting idea that deserves some attention.
posted by nebulawindphone at 1:20 PM on February 25, 2019 [6 favorites]

I'm a licensed clinical social worker and I've never heard this term used in a clinical context. That didn't mean it's not real, or that people aren't making up new terms for things all the time because, people are. I definately heard ADHD in children causing significant social anxiety and frustration.

How children with and without ADHD cope in social situations definately impacts the way social relationships go as adults, but adults do have more control over their behavior and ability to change coping mechanisms that don't work for them. But the person in question must put in the work to do that.
posted by AlexiaSky at 1:23 PM on February 25, 2019

There doesn't need to be a hyper-specific diagnosis for this to be treatable. "Inappropriate reaction to correction or criticism" is 100% a phrase you can discuss with a therapist. "Difficulty managing anger or strong emotions" is another.

This definitely IS something a lot of people strongly relate to, which means therapists deal with it all the time.
posted by Lyn Never at 1:52 PM on February 25, 2019 [11 favorites]

Thanks for those specific terms. I'm actually filling out forms for my husband to go through an extensive physician's visit for possible ADHD diagnosis, and I was thinking of writing about this 'rejection sensitivity', but those phrases are much more descriptive and suitable.
posted by kitcat at 2:32 PM on February 25, 2019

Also, just to be clear, your husband can get help with this stuff even if it's not part of the ADHD diagnosis. Regardless of whether it's connected to his possible ADHD, he can talk about it with a therapist, or he can mention it to a psychiatrist and say "What could be causing this?"

I totally understand the desire for a tidy explanation — one where you can say "There were ten annoying things about my life, and this diagnosis explained all ten, and now I'm fine!" But more often a new diagnosis is like "This explains five of my things, and it gives me more energy and more free time so I can work on Thing Six and Thing Seven, and once that's straightened out maybe I'll take a closer look at Things Eight Thru Ten." So, this could be his Thing Six, and it could turn out the ADHD diagnosis and treatment plan didn't do anything about it — and it could still be worth his going back to a therapist or some other provider and saying "Okay, let's work on this too."
posted by nebulawindphone at 5:58 PM on February 25, 2019 [2 favorites]

People with ADHD often have a lot of shame. Sensitivity to criticism is also from shame. And executive dysfunction can cause problems managing emotions. But RSD is a pop psych term as far as I know. I seem to recall there are medications being prescribed for RSD but it's definitely not an official diagnosis.
posted by crunchy potato at 6:31 PM on February 25, 2019 [2 favorites]

One thing to keep in mind is that ADHD is neurological. It's not an illness or a defect that needs fixing. With that in mind, you can apply reasoning such as, with adhd comes poor impulse control. Therefore, a hyper sensitivity to rejection is part of the necessary balance of inherent traits that would keep a person with poor impulse control from doing personal damages to other human beings by, for example, bulldozing right through all of a person's boundaries and personal space.
Please just make sure you aren't treating your family members genetic difference as something they need help with fixing, 'cause that tends to really feel like harsh rejection for a person with adhd, because it's something we will never be able to change.
The shame comes from social judgement. It wasn't too long ago in history that adhd was known as "minimal brain dysfunction" and regarded as mild retardation. The stigma prevails.
posted by OnefortheLast at 6:31 PM on February 25, 2019 [1 favorite]

Sensitivity to criticism and/or rejection is a feature of borderline PD, so are emotional dysregulation, a short attention span, and other behaviours that can look like ADHD. More women than men are diagnosed with BPD, some think because of clinical bias (which is not to say that more women necessarily have it, it may be that some men are missed. Some get diagnosed with bipolar instead, and it wouldn’t be out of the realm of possibility for ADHD to be an alternate diagnosis. A way to think about it is that ADHD is primarily about inattention or hyperactivity. Borderline is primarily about emotional dysregulation. People can have both or traits of one or the other [and like with most mental illnesses and neurological conditions, there’s a spectrum]. It can be confusing, though, even for psychiatrists, which is why many people with BPD aren’t diagnosed with that for quite a while.)
posted by cotton dress sock at 8:41 PM on February 25, 2019 [1 favorite]

(Ie maybe people who have borderline features have been diagnosed with ADHD instead, but recognize this characteristic in themselves.)
posted by cotton dress sock at 8:49 PM on February 25, 2019 [1 favorite]

The only hit from PubMed that's even remotely close is Negative interpretation bias as a mechanism of the relationship between rejection sensitivity and depressive symptoms. (2017)

It's in 'Cognition and Emotion' which has a not-horrible impact factor of 2.56, but is not ADD/ADHD specific.
posted by porpoise at 10:31 AM on February 26, 2019

Disclosure: I am not a huge fan of the DSM-5, our Holy Book of psychiatric diagnosis in the US.

Per the DSM, this kind of sensitivity can be traced back to a couple different kinds of illnesses. The one that stands out for me is that oversensitivity to rejection can signal atypical depression (despite the name, it's a common diagnosis). It can also be connected to avoidant or borderline personality disorder. The root cause may decide the diagnosis.

Tldr: this is a real documented thing, though I generally question the validity of labeling it a symptom of an illness that requires fixing or medicating or retraining unless it shows up at truly pathological levels.
posted by executive_dysfuncti0n at 9:04 PM on February 26, 2019

There's a lot of buzz over this term in ADHD circles, but the more general family of ADHD symptoms that relate are difficulties with emotional regulation and impulsivity, and the subsequent and compounding social issues that can arise. I never had fits of rage as a child but I was an age-inappropriate crier; I was going home in tears repeatedly with hurt feelings as late as my early teens and was always getting told not to be so SENSITIVE.

I tend to have fairly intense and short-lived moods that average out over time, but I also tend towards getting very overwhelmed in periods of stress and suddenly completely losing my ability to cope over relatively minor "last straw" type stuff.

Adults with undiagnosed ADHD tend to have comorbid conditions such as depression and anxiety quite often, because untreated ADHD can be extremely difficult to live with and people internalize a lot of shame, which can then manifest in various ways. The reason the gold standard of treatment is meds plus therapy is that the meds correct the neurochemical imbalance that causes the ADHD symptoms, and the therapy helps the patient learn appropriate strategies to deal with issues that cause them trouble. Without the meds, a lot of people have trouble applying the strategies, but without the strategies, people usually still flounder on the meds because they never learned HOW to do certain things, even if they now could manage the focus to do them. Plus, the therapy can help you with things like negative self-talk, shame spirals, perfectionism, etc.

For diagnosis purposes, focus on behavior/symptoms and impact. "Has a hard time controlling anger, has angry outbursts that have damaged relationships with friends." "Despite trying many strategies, fired from X jobs for persistent lateness."

Good luck to you.
posted by oblique red at 11:53 AM on February 27, 2019 [1 favorite]

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