Rejection Sensitive Dysphoria: How ADHD Makes Children Fear Rejection

July 22, 2021 The Ed Psych Practice No Comments Referrals ADHD, Emotional Regulation, Emotional Response, Experiencing Rejection, Internalised Behaviour, Psychotherapy, RSD, Social Anxiety

Takeaway: Rejection sensitive dysphoria (RSD) describes the tendency of children with ADHD to be triggered by teasing, criticism, and other types of social rejection. And this triggering can overwhelm them with hurt, anger, or sadness. As a result, they either lash out or withdraw from any social contact. And both these types of reactions make their lives worse than before. So, if you suspect your child has RSD, it’s important to get her to a specialist who can help.

All of us are afraid of being rejected by others. And even the thought of being rejected can bring up all sorts of emotions.

We humans evolved to live in groups, so trying to fit in and belong is hardwired into us. In the past, being shunned or rejected by our tribe would leave us unprotected. And we would quite literally have died. With that sort of heritage, it makes sense that rejection scares us so much. And it’s not just ‘all in the mind,’ because brain scans show that this fear activates the same parts of the brain that physical pain does.

ADHD complicates this innate fear of rejection by altering brain chemistry.

Children with attention-deficit/hyperactivity disorder (ADHD) have brains that are wired slightly differently, which makes it much harder for them to sit still, pay attention, and focus. And this is primarily because ADHD tampers with the brain’s ‘executive functions’ — i.e., the brain processes that help us do things like prioritise activities, switch focus between tasks, handle emotions, etc. The thing is that we need our executive functions to process and cope with rejection. It’s how we put things in perspective, use positive ‘self-talk’ to work through our fears, and make sense of our feelings. And since children with ADHD have issues with their executive functions, they find it much harder to process rejection. They feel it more intensely than others, and the feelings stay with them much longer.

This mix of ADHD and a fear of rejection often leads to something called ‘rejection-sensitive dysphoria’ (RSD).

Rejection sensitive dysphoria (RSD) is a term that describes the tendency of a child to be easily triggered by rejection (or even the possibility of rejection). It’s not a medical condition or an official diagnosis, but rather, helps us understand a pattern of behaviour surrounding rejection. RSD results when ADHD amplifies rejection, making it feel so much worse. (Note: This is in addition to the prejudice and criticism that children with ADHD already have to cope with.)

With RSD, children feel like they’ve lost control and are at the mercy of their emotions.

Psychologists use the term ‘emotional dysregulation’ to describe the experience of feeling emotions so intensely that they consume you in the moment. And a seemingly trivial event like being teased, criticised, or falling short of expectations can trigger this sort of emotional dysregulation in children with RSD. Their hyperaroused brains automatically magnify the tiniest rejection into a highly traumatic, horrifying experience.

So, what happens to all this uncontrollable emotion? Well, children react differently depending on their temperament.

Children release the stress of RSD in many ways, but it usually shows up as either anger or anxiety. Those that get angry tend to lash out at the person rejecting them and sometimes even direct their aggression at themselves. Meanwhile, if their primary response is anxiety, they tend to withdraw and relive the rejection in their minds in an endless loop. And this often leads to depression. Neither of these responses is healthy because they don’t solve the real problem and only make the child feel more miserable.

RSD is dangerous because it also slowly changes the way children live their lives.

Children cope with the trauma of the RSD experience in two ways. Either they try extra hard to please people and not get rejected, or they start avoiding anxiety-provoking situations altogether. So, a teenager might take up a new hobby that her friends like, even if she’s not particularly interested in it. Or she might start avoiding these friends, coming up with creative excuses to cover her retreat. Over time, these small decisions add up and start changing her life. For example, she might not go out on dates or spend time with friends, and instead throw herself into studying just to impress her teacher. The tricky thing here is that she might seem to be a driven, ambitious person doing what she loves. But really, she’s making all her decisions from a place of anxiety and fear.

Parents can pick up on signs of emotional dysregulation if they know what to look for.

You can recognise the signs of RSD just by observing your child. For example, does she get embarrassed easily or seem unnecessarily anxious in social situations? Or does she have problems making and keeping friends? Perhaps she’s too much of a perfectionist, setting impossibly high standards for herself? Or does she seem to have a low sense of self-esteem? It’s easier to spot the signs in older children because they can describe their inner world better. For example, you can ask your child if she feels emotionally out of control when criticised or rejected. Or you can probe to find out how she processes the rejection (i.e., does she feel ashamed, inadequate, angry, sad, etc.?).

It can get confusing, though. Because RSD traits are often confused with other common mental health concerns.

People with bipolar disorder, borderline personality disorder, social phobia, and other mental health conditions also show similar traits to children with RSD. For example, an inwardly-directed RSD response of depression or sadness might seem a lot like a mood disorder. This change from feeling fine to feeling sad mimics what children with rapid-cycling bipolar disorder experience. Similarly, children with social anxiety disorder feel just as uncomfortable in social situations as children with RSD do. Although, the difference here is that they’ll feel at ease around people close to them. Whereas children with RSD often feel even more hurt when the rejection comes from a loved one. It’s examples like these that make it so much harder to recognise RSD for what it is.

That’s why it’s best to bring in a specialist to help your child.

RSD is not just hard to diagnose — it’s hard to treat, too. That’s because there’s no real ‘cure’ for it. Instead, specialists can help address some of your child’s symptoms like hyperactivity, anxiety, and/or depression. The Ed Psych Practice offers face-to-face and online assessments, consultation, advice, and problem-solving strategies for parents, nurseries, schools, and universities in London. We have psychologists, paediatricians, and therapists who can help assess your child and offer guidance and support.

Phone: +44 (0) 78 3344 7356
E-mail: Office@TheEdPsych.com

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