If you’ve ever struggled with ADHD or known someone who has, you understand the unique challenges faced by someone with the condition. As a child, you may have been labeled as disruptive, talked too much in class, or even had a teacher go as far as telling you that you’ll amount to nothing one day. Attention-deficit hyperactivity disorder (ADHD) is a sometimes crippling condition that affects how a child or adult functions in their everyday lives. Even worse, it’s not a rare disorder that only affects some—it’s extremely prevalent in our society.

Children are most affected by ADHD. An estimated 6.1 million children throughout the United States, or 9.4 percent, between the ages of two and 17 have been diagnosed with the condition. The figures are as follows with 388,000 children between the ages of two and five, 2.4 million children between the ages of six and 11, and 3.3 million adolescents between 12 and 17. Paying attention to ADHD in children is crucial because it can ignite something known as rejection-sensitive dysphoria. 

For a reason still unknown to researchers, ADHD tends to affect a greater number of girls and women than boys and men than once reported. One such reason is the varying symptoms of women that are often overlooked, showing a bias in the diagnostic process. Either way, treatment for ADHD exists and can be extremely beneficial to restore the quality of life in the person suffering. 

What Is ADHD?

Attention-deficit hyperactivity disorder (ADHD) is considered the most common mental health disorder affecting children today. However, it also affects a significant amount of adults. The most common symptoms of ADHD include an inability to focus, hyperactivity, and impulsivity. You can understand how these symptoms would affect children in school and could make them seem like a troublemaker. Parents must bring the child to the doctor to determine if these symptoms translate into the condition. 

Many symptoms of ADHD, including a difficulty to learn, limited attention spans, and an inability to remain sitting still, are more common in younger children. ADHD is diagnosed in three ways – inattentive type, hyperactive/impulsivity, or combined type. A diagnosis is based on symptoms that have persisted for at least six months. 

Inattentive Type

Inattentive type of ADHD must include six of the following symptoms to occur regularly, or five for those over the age of 17:

  • Has issues remaining focused on tasks or activities, especially during conversations, lectures, or long reading.
  • Does not pay attention to details or makes careless mistakes during work or at school.
  • Does not listen when spoken to and appears to be “elsewhere.”
  • Will not follow through on instructions and fails to complete schoolwork, job duties, or chores. 
  • Will start tasks and lose focus.
  • Has issues getting organized for work and cannot manage time – misses deadlines, submits disorganized work.
  • Avoids or dislikes tasks that need sustained mental effort, such as completing forms or preparing reports.
  • Regularly loses things necessary for tasks or daily life, including books, school papers, keys, cell phone, wallet, or eye glasses.
  • Easily distracted.
  • Forgets daily tasks, including chores or running errands. Older teens and adults might forget to return phone calls, keep appointments, or pay bills. 

Hyperactivity/impulsive Type

Hyperactivity/impulsive type of ADHD must include six of the following symptoms to occur regularly, for five for those over the age of 17:

  • Talks too much
  • Fidgets or taps with their hands or feet and squirms in the seat.
  • Unable to stay seated in class or at work.
  • Runs around or climbs on stuff that’s inappropriate.
  • Unable to do leisure activities or play quietly.
  • Always on the move, as if they are driven by a motor. 
  • Will blurt out answers in class before the question is finished or will finish people’s sentences.
  • Is unable to wait their turn, such as when they’re in line.
  • Will always interrupt others or intrude, for example cutting into conversations, activities, or games or using other people’s stuff without permission. 

There is no lab testing available to diagnose ADHD. Diagnosis will involve gathering information from teachers, parents, and others to fill out checklists and conducting a thorough medical evaluation to rule out other medical issues. The symptoms are not the result of the child or individual being defiant or hostile. 

A medical condition that could result from ADHD is rejection-sensitive dysphoria, and it’s important to rule out all potential issues.

What Is Rejection-Sensitive Dysphoria?

Rejection-sensitive dysphoria is extreme emotional sensitivity and pain triggered by the perception an individual has been criticized or rejected by people with influence in their lives. It can also be triggered by a sense of coming up short and failing to meet their own rigorous standards or the expectations of others. 

The word “dysphoria” is Greek and is defined as “difficulty to bear.” It’s not that individuals with ADHD are weak, but rather, it is the emotional response that hurts them more than someone without the condition. No one likes criticism, rejection, or failure, but those with RSD who deal with these universal life experiences take it more severely than neurotypical people. It’s restricting, highly impairing, and flat-out unbearable.  

When a person’s emotional response is internalized, which is common for those with RSD, it can mimic a full, major mood disorder that’s complete with thoughts of suicide. The abrupt change in feelings and going from perfectly fine to intensely sad results from RSD, but it’s commonly misdiagnosed as rapid cycling mood disorder. When the emotional response is externalized, it appears more as an impressive, instantaneous rage at the individual or situation that caused the pain. 

Rejection-sensitive dysphoria will make adults anticipate rejection – even when it’s not close to being certain. It makes them try to avoid it by any means necessary, which can then be diagnosed by a medical professional as social phobia. Social phobia is different – it’s an intense fear that you’ll be embarrassed or humiliated in public or scrutinized by the outside world. 

Rejection sensitivity is challenging to dissect. Those who experience it can’t put their pain into words. The only description they can use is to say it’s terrible, awful, intense, and overwhelming. It’s always triggered by a perceived or real loss of love, approval, or respect. 

There are two ways that people with ADHD cope with this emotional hurdle, neither of which are mutually exclusive. These include:

  • Becoming people pleasers: They’ll obsessively scan each person they meet to determine they the individual praises or admires. They’ll follow this by presenting a false sense of themselves to others, which becomes a dominating goal, causing them to forget what they want in their lives. They become consumed and end up too busy making sure they aren’t displeasing others. 
  • They give up: As was mentioned above, these are not mutually exclusive because one means they try harder, and the other is they stop trying and give up. If there’s a slight possibility a person will try something new and fail or fall short in front of anyone, they’ll find it too painful or risky to make the effort. Unfortunately, these bright and capable people will avoid all activities that may be anxiety-provoking. They’ll give up dating, speaking in public, or applying for jobs. 

Other people with RSD will look for ways to adapt or overachieve. They constantly are working to be the best version of themselves and strive for perfection. In some cases, they’ll be driven beyond reproach. While it may appear on the outside as an admirable life, the pain inside is miserable. 

The Connection Between ADHD, Autism, and RSD

According to Healthline, there’s a potential connection between rejection-sensitive dysphoria and ADHD or autism. They go on to say that people with these conditions won’t necessarily develop rejection sensitivity, but having one of these conditions is a risk factor for developing it. Those diagnosed with ADHD will experience challenges paying attention, with restlessness, and won’t be able to control their impulses. Doctors have also found emotional issues in those with ADHD, characterized by an inability to control their emotional responses. 

Since these individuals are prone to experiencing emotions more intensely, they’ll likely have a heightened response to any rejection. Rejection-sensitive dysphoria has also been connected to autism. The neurodevelopmental disorder affects our central nervous system (CNS) and can trigger various symptoms. Both children and adults with autism could experience challenges socializing, communicating and find it difficult to understand the actions of others. 

The individual must also deal with emotional dysregulation and hypersensitivity to emotional and physical stimuli. It can result in either real or perceived feelings of rejection or criticism that are overwhelming. Dealing with this condition is quite the challenge, but it can be overcome by learning about the symptoms and seeking immediate medical attention if you’re concerned. 

Symptoms of Rejection-Sensitive Dysphoria

Due to the complexity of the condition, symptoms are often a challenge to identify. Rejection-sensitive dysphoria often resembles other mental health conditions, including the following:

The most common symptoms of rejection-sensitive dysphoria may also occur in the conditions we’ve listed above. These include:

  • High expectations of yourself
  • An extreme fear of failure
  • Low self-esteem
  • Avoiding social setting due to the fear of rejection and failure
  • Frequent emotional outbursts, which are caused by rejection or getting hurt
  • Feeling hopeless and that nothing will get better
  • Severe anxiety
  • Aggression and anger in uncomfortable situations
  • Constant reassurance and approval-seeking behavior

Although rejection-sensitive dysphoria can mimic other common conditions, one factor that sets it apart from the others is that symptoms are brief and will be triggered by emotional cycles, as opposed to an actual event. 

What Causes Rejection-Sensitive Dysphoria?

Those living with rejection-sensitive dysphoria are much more sensitive to rejection and will be triggered easily by specific situations. Unfortunately, the precise reasoning behind this isn’t fully understood by medical experts. From what they do know about the condition, it’s not caused by a single factor. Instead, they believe it’s caused by multiple factors. 

One potential explanation for rejection-sensitive dysphoria is a history of rejection or neglect early in the individual’s life. It could stem from a parent who was either neglectful or overly critical, meaning if the child got a 90 percent on a test, the parent would ask why it wasn’t 95 or 100 percent. These actions can impact how they feel about themselves and view their worth later in life. 

Due to this parental relationship, some may have lower self-esteem, coupled with intense fears of rejection and abandonment in their own relationships. Insecurities in relationships can lead to many problems, and the other person might leave, leading to more feelings of abandonment and low self-worth. It’s a vicious cycle. Being bullied or teased by peers can also make these feelings worse. 

Scientists are also under the impression that some might be genetically predisposed to rejection-sensitive dysphoria. It may be able to pass down through families, meaning if a parent or close relative is diagnosed with the condition, you can develop it too. However, statistics cannot determine the percentage to which you may be prone. 

How to Diagnose Rejection-Sensitive Dysphoria

As mentioned above, determining if you have rejection-sensitive dysphoria is quite a challenge due to its similarities to other conditions. The first step in figuring it out is for your doctor to rule out whether or not it’s a symptom of an underlying mental health condition. Since rejection-sensitive dysphoria is not a recognized diagnosis under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a professional diagnosis may not be possible.

To assess all of these symptoms, you must visit a counselor, psychologist, or another type of mental health professional to help determine what’s causing these issues. The doctor you see will inquire about your symptoms and family history. You’ll answer various questions about how you feel and react in specific situations. Some of these questions might include:

  • Do you feel rage or anger when you’ve been criticized or rejected?
  • Do you experience intense aggression or anger when someone hurts your feelings?
  • Do you believe that no one likes you?
  • Do people repeatedly tell you that you’re overly-sensitive? 
  • Are you a people pleaser?

The doctor may also ask questions about previous ADHD or autism spectrum disorder diagnoses. If you’ve never been diagnosed with these conditions but present symptoms, the doctor may also recommend screening to understand the underlying causes of your emotional reactions. 

How Is Rejection-Sensitive Dysphoria Treated?

Since the condition is associated with ADHD and autism, your doctor will first look to treat the underlying conditions before moving on to other symptoms. Unfortunately, there is no cure for any of these conditions. However, medication is beneficial in helping relieve associated symptoms that include depression and hyperactivity. Therapy can also help retrain our brain and help us approach situations differently. 

Cognitive Behavioral Therapy 

Cognitive behavioral therapy is an excellent option when it comes to reducing hypersensitivity and will make it easier to manage and cope with criticism and rejection. In most cases, the treating doctor will suggest psychotherapy. CBT is a traditional means of helping people cope with this condition. 

CBT is different from other forms of psychological treatment. Numerous studies have found it leads to significant improvement in functioning and quality of life. These studies have also shown that it’s as effective or even more effective than other forms of psychological therapy or medications. 

Cognitive behavioral therapy is based on several core principles, including the following:

  • Psychological issues are based partially on faulty or unhelpful ways of thinking.
  • Psychological issues are based partially on learned patterns of unhelpful behavior.
  • Those suffering from psychological issues can learn better ways of coping with them, relieving their symptoms allowing them to become more effective in their lives.

CBT will also involve efforts to change your thinking patterns. Someone who’s constantly worried about what people think will benefit from this. The strategies include:

  • Gaining a better understanding of the motivation and behavior of others.
  • Learning to recognize your distorted thinking and how it causes problems, and then how to reevaluate them realistically.
  • Using problem-solving skills to cope with challenging situations.
  • Learning how to develop self-confidence in your abilities. 

CBT also involves efforts to change behavioral patterns that include:

  • Facing your fears rather than avoiding them
  • Using role playing to prepare yourself for the possibility of problematic interactions with other people.
  • Learning to calm your mind and relax your body.

Not all cognitive-behavioral therapy will use all of the strategies listed above. In some cases, the psychologist and patient will collaborate and work together to understand the problem and develop a way to treat it. 

CBT will place emphasis on helping people learn how to be their own therapist, which is done through exercises and homework the patient will receive outside of their regular sessions. It will help them develop coping skills and learn how to change their problematic behavior and emotions. 

Medications

Medication may also be administered in conjunction with therapy for the best results. While there aren’t any FDA-approved medications for the disorder, doctors may prescribe some off-label for other conditions. One such medication, guanfacine, is a common drug used to treat rejection-sensitive dysphoria. It’s usually prescribed to lower blood pressure, but it’s known to interact with receptors in the brain, which reduces hyperactivity and emotional responses. 

Changing Your Lifestyle

You can’t go to therapy and use medication and expect your life to change without altering your lifestyle. There are some things you’ll have to do on your own to manage your emotional responses to criticism and rejection. You must keep your emotions in perspective and understand that what you’re feeling or what you perceive as rejection doesn’t exist. Yes, it’s hard to keep these feelings in check, especially when you’re hurting, but stay calm and rational instead of having an outburst when you feel shunned. You’ll get further talking it out with someone instead of getting mad. 

You can do some of this by lowering your stress levels, which will help you feel more at ease and calm. When you’re carefree, it’s much easier to control your emotions. You can also try the following to naturally boost how you feel:

  • Getting a sufficient amount of sleep each night.
  • Going to the gym or attempting to exercise regularly, including riding a bike, going on walks around the block, or hiking.
  • Eating healthy foods. By avoiding sugary drinks like soda or eating processed food, your body will feel better physically, allowing you to feel better emotionally. 

We all have our good and bad days. An occasional outburst is human nature, but at a certain point, it may warrant seeing a doctor. If your outbursts have become an issue, it may be time to get the help you need and visit a medical professional.

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