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Have You Heard of Rejection Sensitive Dysphoria?

Emotional regulation, as part of executive functioning, has long been an important part of the discussion for clinicians, parents of, and constituents with neurodiversity, especially Autism and ADHD (possibly because those diagnoses get all the attention.)

Over the past few years a new topic has emerged in clinical and anecdotal discussions about elements associated with neurodiversity, and while it hasn’t entered the DSM5 yet, Rejection Sensitive Dysphoria is now a part of the discussion around Autism and ADHD and emotional regulation.

The term “Rejection Sensitive Dysphoria” was coined by Dr. William W. Dodson of the Milton E. Hershey Medical Center to describe the extreme mental and emotional pain that even the mere perception of rejection can trigger in some people.

The outsized pain can lead to serious perseveration, avoidance of trying new things, and sometimes avoidance of new friendships. In other words, it can be hugely damaging to the emotional and social development of adolescents (and others!)

Considering the high incidence of actual bullying that neurodiverse adolescents (and adults) may regularly experience, the additional burden of RSD has the potential to be absolutely crippling.

WebMD lists some of the signs on RSD as:

  • Becoming embarrassed very easily

  • Getting very angry or have an emotional outburst when they feel like someone has hurt or rejected them, this could include mild correction or coaching from parents or teachers

  • Setting high standards for themselves they often can't meet

  • Having low self-esteem

  • Feeling anxious, especially in social settings

  • Having problems with relationships

  • Staying away from social situations and withdraw from other people

  • Feeling like a failure because they haven't lived up to other people's (perceived) expectations

Considering that adolescence is a time of amplified emotions, limited sense of perspective and impatience for all teenagers, it might initially be difficult to discern the difference between a couple of bad days and RSD. Experts note that unlike a couple of bad days, episodes of RSD usually happen very suddenly and without warning.

Currently, there are medications that help with RSD symptoms, but as with almost everything, avoiding stress, eating well and exercising can also help.


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