My entire life, I’ve felt too sensitive for this world. I’ve often described my capacity to feel emotion as infinitely deeper than the average human's, envisaging a rainbow-like spectrum of colours dictating emotions that are nonexistent for most people. My ability to fluctuate between serenity and incandescent rage is eternal. One iota of criticism can send me spinning into a pit of self-deprecation; sometimes I don’t arise from this pit for days. Every disappointment or upset causes a visceral, physical reaction in my chest. I feel the pain saturating my body. It’s exhausting.
After I was diagnosed with ADHD (attention deficit hyperactivity disorder) at 23, I embarked on an important journey of self-discovery. I learned that I wasn’t alone in the intense emotional pain I’d been experiencing. As I became acquainted with what's sometimes known as rejection sensitive dysphoria, or RSD, a lightbulb went off inside my head. I realised that there was a term for what I was experiencing and that it was interconnected with my ADHD. It made me feel like I wasn’t crazy.
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ADHD is defined as a neurological disorder that impacts the parts of the brain that help us plan, focus on and execute tasks. According to Harvard Medical School: "A person with the disorder may be disruptive or impulsive, may have trouble in relationships and may be accident-prone." Here, the link between ADHD and relationships is fundamental in explaining the prevalence of RSD. Defined as "severe emotional sensitivity and emotional pain triggered by the perception that a person has been rejected or criticised by important people in their life", RSD can imitate mood disorders through suicidal ideation or rage.
Fundamental to understanding RSD is that the ADHD brain cannot always decipher the difference between real and perceived criticism. This is very relevant in my experience. I’ve crumbled at the perception of rejection, even when, with hindsight, it’s been totally construed rather than realistic. When I turned 21 I organised a fancy dress birthday party, inviting friends from both university and home. When many people couldn’t make it – for totally legitimate and understandable reasons – I became plagued by a feeling of loss. I convinced myself that I was universally unloved and that nobody cared or wanted to celebrate with me. I cancelled the party, pre-empting further emotional turmoil.
In the workplace, one slightly to-the-point Slack message can send me down a road of existential despair. I constantly compare myself to others, as though their success detracts from my own. I set such high standards that I find it impossible to keep up and, inevitably, I crumble under my own expectations. I love my job but my RSD leads me to question my career choices on a daily basis.
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Beth, 34, was diagnosed with ADHD last year. Growing up, she too experienced the debilitating pain that is RSD but didn’t have a label for her emotional turmoil. "I was very sensitive. If someone gave me constructive feedback, I’d have a panic attack," she explains. Over time, Beth’s experiences led both her counsellor and her family to suspect that she had ADHD, and she referred herself for a private assessment. "RSD has a huge impact on me. A strong feeling of not fitting in has meant that I’m sensitive about rejection. I set high standards for myself, and my self-criticism has been tough to handle," she says.
Beth understands that her RSD, like mine, manifests both at work and in her wider relationships. "I’ve lost friendships because I’ve overreacted to comments, flying off the handle rather than being diplomatic. At work I stress about not being good enough and I’ve never had confidence in my abilities. When I started my career I spent so much time crying in the toilets and being given verbal warnings for not being assertive enough."
Twenty-three-year-old Chloe has been in the system for an ADHD diagnosis for a year. She has suspected that she suffers with ADHD and, in turn, RSD for three years now. "As a writer, I receive rejection emails pretty much daily and for the most part I’m able to conceptualise that they’re not really about me. However, I know the RSD is kicking in when, despite all of my coping strategies, I feel extreme pain anyway. That’s when I know I need to step away from my laptop," says Chloe. "In terms of coping strategies, I always talk things out with somebody who is removed from the situation. Taking a break is also helpful – I usually experience most RSD symptoms when overworking myself. Fixing that can bring about a calmer headspace," she concludes.
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Angela Karanja is a psychologist, parenting teenagers’ expert and founder of Raising Remarkable Teenagers. An expert in RSD, she recognises the intense pain it can wreak among girls and women, who she says are disproportionately impacted by both RSD and suicidal ideation. "RSD is highly correlated with and associated with ADHD. Although you will not find RSD in the Diagnostic and Statistical Manual of Mental Disorders, RSD is 'real' for those experiencing it," says Angela.
"People with RSD experience an extreme fear of being rejected, criticised or excluded," she continues. "When they are rejected, whether real or imagined, they get terribly upset and unsettled. Some of the most common symptoms include exhibiting low self-esteem, emotional outbursts when they perceive rejection and harbouring thoughts of being a failure for not meeting their own lofty standards."
So how can women learn to cope with RSD? "The first thing is always to speak to your doctor if you are experiencing this kind of discomfort. Depending on the gravity of the situation and other co-occurring conditions, your doctor can organise either psychosocial interventions or medication," says Angela.
As rule number one of self-care, Angela recommends using the 4C process to dismantle negative self-talk and self-defeatism. "Firstly, catch it: be real with yourself, be present and aware of self-destructive thoughts. Secondly, coin it: talk to the thought as if it were a person and make it aware that you know what it’s doing to you. Thirdly, challenge it! Label it as not life-giving and life-advancing. Finally, calibrate: once you’ve challenged the thought, you get your power back. Now, you can state who and how you want to be and respond next time," she says. "Becoming aware and developing a willingness to learn diverse ways of responding to certain trigger situations can be helpful. Question and challenge the truthfulness of your thoughts."
I’m still on my RSD journey but validating its existence was a pivotal moment for me. Now I can perceive when RSD is manifesting in my behaviour, although my emotional pain is still as deep. When I start to tread the fine line between being mildly upset about a friend forgetting to reply to my text and transforming it into an existential statement on my existence in the world, I recognise these behaviours and I can begin to dissect them. While nothing is perfect – nor will it ever be – I’ll continue to attend therapy and take my tablets, and in my darkest moments I’ll remember this: living with RSD doesn’t detract from the validity of my emotions. I’m a human being and a human living, despite it all.