Rethinking Rejection Sensitive Dysphoria (RSD)
The feelings are real, but they got the cause all wrong
Rejection sensitive
You may have heard this term going around, referring to something called “Rejection Sensitive Dysphoria”, or RSD.
There are a number of possible reasons those of us with ADHD experience emotions more intensely than others. We often struggle with emotional lability, emotional impulsivity, emotional dysregulation, and negative intent attribution.
This has led to a lot of discussion about the term Rejection Sensitivity Dysphoria (RSD) in the ADHD community over the past few years. The detailed descriptions of what RSD feels and looks like resonate with so many people who also have ADHD.
I even wrote an extensive piece about it in the summer.
However…
Did you know that RSD is not in the DSM-V, nor is it recognized in the psychiatric or psychological communities?
Don’t get me wrong, people don’t need their experiences to be medicalized in order for them to be 100% real and valid. It can be extremely validating to have our feelings put into words and to find out that so many others have similar experiences.
The description of RSD is very real, as an overwhelming majority of the ADHD population can attest to, which is why I was so drawn to exploring and researching it in the first place.
People don’t need their experiences to be pathologized in order for them to be entirely real and valid.
But now I want a do-over because I’ve learned a lot more and, as a result, have some important things to add. Notably, the fact that RSD is attributed to ADHD and neurodivergence has me thinking about this whole concept more critically.
There is very little actual research done on Rejection Sensitive Dysphoria (read: none), so it’s very difficult to critique research that doesn’t exist.
RSD is a term made up by Dr. William Dodson to describe the experience of many of his ADHD patients. In fact, he claims an alarming 99.9% of his patients experience RSD and cites it as their biggest problem, a figure for which the doctor provides zero data.
The primary information about RSD is available on the ADDitude Mag website and on Dr. Dobson’s own website, neither of which cites any peer-reviewed research. Dr. Dobson’s website has zero citations, and ADDitude Mag’s website only cites itself and takes you in circles around other articles on their website.
Dr. Dodson took old descriptions of atypical depression from an “old psychiatric textbook” (specific source not provided), which had cited RSD as part of a mood disorder.
Dr. Dodson instead says that RSD is directly caused by ADHD.
At least he does acknowledge that criticism is a common experience in the lives of people with “unrecognized and untreated ADHD”, yet says nothing about the very real and continued criticism many of us experience after ADHD is diagnosed and treated.
It’s not disordered when it’s a rational response to actual repeated rejection
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