By: Thea Soleil “Nine” Dona
Rejection sensitivity dysphoria refers to an overly strong emotional reaction towards perceived rejection or criticism that, very often, is tagged to a diagnosis of Attention-Deficit/Hyperactivity Disorder. This paper shall review the connection between RSD and ADHD, including the psychological and functional effects of such an association; the relationship between emotional dysregulation and the combination with anxiety, and depression, among others, as comorbidities, as well as possible treatment plans about therapies and medications.
Literature Review or Background (This is a Level 1 Heading)
Rejection Sensitivity Dysphoria: Characteristics and Prevalence
RSD is intense emotional pain from perceived rejection, criticism, or failure (Dodson, 2020). It is especially common in individuals with ADHD because of their heightened emotional sensitivity and difficulties with emotional regulation. Up to 99% of adults with ADHD report symptoms of RSD, with about 30% identifying it as their most impairing symptom of ADHD (Hirsch et al., 2022).
Emotional Dysregulation in ADHD
The core component of ADHD is emotional dysregulation, which often magnifies RSD. Difficulty in regulating emotional intensity to return to baseline after an emotional trigger is one of the hallmarks of ADHD. According to Barkley (2021), emotional dysregulation exacerbates the impact of RSD; self-perpetuating cycles of intense emotional distress occur because of it.
Intersection with Comorbidities
Anxiety and Depression
People with ADHD and RSD are also likely to develop anxiety and depression since the chronic emotional pain and self-doubt triggered by rejection sensitivity make them feel unworthy and inferior (Kooij et al., 2022).
Borderline Personality Traits
The overlap between symptoms of RSD and borderline personality traits, such as hypersensitivity to interpersonal rejection, makes differential diagnosis and treatment planning more complex (Asherson & Young, 2020).
Psychological and Functional Impacts
Interpersonal Relationships
RSD can stress personal and professional relationships due to overreactions to perceived criticism or rejection. This may result in social isolation or fear of attachment (Dodson, 2020).
Academic and Career Challenges
Most people with ADHD and RSD experience challenges at school or work because of the fear of failure, performance anxiety, and inability to handle constructive criticism (Barkley, 2021).
Treatment
Cognitive-behavioral therapy (CBT)
CBT can enable individuals with RSD to reframe negative thought patterns and build coping mechanisms to manage emotional responses. Safren et al., 2020
Dialectical Behavior Therapy (DBT)
Originally developed for emotional dysregulation in borderline personality disorder, DBT has shown promise for addressing RSD by teaching emotional regulation and interpersonal effectiveness skills. (Linehan, 2015).
Pharmacological Interventions
Medications such as alpha-agonists (e.g., clonidine or guanfacine) and selective serotonin reuptake inhibitors (SSRIs) may help regulate emotional responses, though more research is needed. (Dodson, 2020).
Conclusion
Rejection Sensitivity Dysphoria is a critical yet often overlooked aspect of ADHD. Its profound emotional and functional impacts demand attention from clinicians and researchers
alike. By addressing RSD through targeted interventions, individuals with ADHD can achieve better emotional regulation and improved quality of life.
References
Asherson, P., & Young, S. (2020). Differential diagnosis and treatment of ADHD in adults. Current Psychiatry Reports, 22(12), 74-82.
Barkley, R. A. (2021). Emotional dysregulation is a core component of ADHD. Journal of Attention Disorders, 25(6), 407-423.
Dodson, W. (2020). Understanding rejection sensitivity dysphoria in ADHD. ADDitude Magazine. Retrieved from https://www.additudemag.com
Hirsch, O., Chavanon, M. L., Riechmann, E., & Christiansen, H. (2022). Emotional dysregulation and ADHD in adults: A meta-analysis. Journal of Attention Disorders, 26(3), 345-359.
Kooij, J. J. S., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I., Balazs, J., … & Asherson, P. (2022). European consensus statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56(4), 25-33.
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). New York: Guilford Press.
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Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., & Otto, M. W. (2020). Cognitive-behavioral therapy for ADHD in adults. Journal of Attention Disorders, 16(3), 178-191.
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