RSD is when a person experiences intense, overwhelming feelings of pain, anxiety and discomfort when rejected or perceiving rejection. These feelings can be so intense they lead to suicidal ideation, bouts of sudden rage, or a debilitating perfectionism that stops people from living a full life.

Rejection Sensitivity Dysphoria (RSD) and the Brain

There’s been a lot of discussion about Rejection Sensitivity Dysphoria (RSD) in the neuroscience community lately. And, as ever, the internet offers lots of information, though some of it is contradictory.

Fortunately, when it comes to brains, brain injury, neuroscience and all things grey matter, the Brain Injury Alliance of Arizona has got you covered.

First things first – remember RSD is not an independent syndrome or disorder. Rather, it is largely thought to be associated with people with autism spectrum disorders or attention deficit hyperactivity disorder, or ADHD. It is concept pioneered by psychiatrist Dr. William Dodson.

There is much we don’t know about RSD, and there are not many formal or peer-reviewed studies about it. However, as a general condition that impacts some people’s lives, and appears to be particularly prevalent among those with ADHD, RSD clearly warrants better understanding.

What We Know for Certain About RSD

RSD is when a person experiences intense, overwhelming feelings of pain, anxiety and discomfort when rejected or perceiving rejection. The primary characteristic of RSD is that the rejection is felt physically, sometimes with people hunching over as though they’ve been stabbed. These feelings can be so intense they lead to suicidal ideation, bouts of sudden rage, or a debilitating perfectionism that stops people from living a full life.

Importantly, RSD is differentiated from rejection sensitivity primarily by the degree and intensity of the emotional experience. The episodes may only last a few hours, however, a person can endure several episodes a day, leading to mental and emotional exhaustion.

For example, someone who applied for a job they were sort of interested in but not passionately striving for may get rejected for that job. And then they’ll feel a bit glum for a couple of hours. Generally, however, the person would be able to focus on their work and stay present, and this rejection wouldn’t impact their life in any significant way.

A person who experiences RSD, however, may physically feel that rejection in their body. It will overwhelm them with distractions and may even cause them to be unable to function properly. They may fall into a mildly depressed state, ruminate about the rejection or spiral into negative, self-esteem-reducing thoughts such as being inherently undesirable as an employee. Though the episode will pass, usually fairly quickly, its intensity can be debilitating.

RSD is not a mood disorder, however. It likely stems from differences in a person’s prefrontal cortex and other areas of the brain responsible for regulating emotions. The “filters” in these parts of the brain in a person who experiences RSD are less active. As a result, something like a job rejection sets off the body’s alarm system at a level 10 – telling your body it’s being abandoned in a dangerous jungle and will be eaten by a jaguar at any moment – instead of a more reasonable level 2, which matches sitting indoors in a cubicle.

This inability to react proportionally to emotional stimuli is known as emotional dysregulation. Though people who are navigating trauma also suffer from emotional dysregulation, it’s important to note that RSD specifically is not a result of trauma. Some even argue that RSD isn’t a condition at all but rather the specific type of basic emotional dysregulation experienced by people with autism and ADHD.

How RSD is treated

RSD is usually addressed through medications prescribed for autism or ADHD as it helps centers of the brain responsible for emotional regulation perform better.

Additionally, psychotherapy may also be beneficial, at least in terms of helping patients learn to self-soothe and mitigate extreme impacts like suicidal ideation.

What we don’t know

Despite numerous studies of RSD, both as an independent condition and a byproduct of ADHD or autism, there is still much we don’t know about it.

We don’t know why it is present in some people but not others, for example. We also don’t understand whether it is, in fact, the result of having ADHD or autism or simply a byproduct of the social stigma many people with those conditions have to endure.

What we do know is that there are possible ways to address intense emotional reactions in a way that keeps them from being debilitating and enables people with that experience to go on to lead rich, fulfilling lives.

ABOUT BRAIN INJURY ASSOCIATION OF ARIZONA

The Brain Injury Association of Arizona (BIAAZ) is the only statewide nonprofit organization dedicated to improving the lives of adults and children with all types of brain injuries through prevention, advocacy, awareness and education. BIAAZ also houses the Arizona Brain Health Resource Center, a collection of educational information and neuro-specific resources for brain injury survivors, caregivers, family members and professionals.

What began in 1983 as a grassroots effort has grown into a strong statewide presence, providing valuable life-long resources and community support for individuals with all types of brain trauma at no charge.