CW: suicidal ideation mentioned in an article linked to this one.
A few days ago, I stumbled upon an article that describes a condition called Rejection Sensitive Dysphoria. For the better part of a decade, I thought I was dealing with generalized and social anxiety disorder. But reading that article made me come to realize that I was instead struggling with rejection sensitive dysphoria and that I was struggling with it my whole life. Now I know that these intense feelings that come out of nowhere was my brain simply misunderstanding small slights and and failures as something catastrophic, even when I was fully aware that it was just a small slight or a small failure or fearing that one was going to occur. And the word dysphoria literally means “unbearable”.
Rejection sensitive dysphoria is little known, but a major struggle for many who have ADHD. Those who struggle with it and don’t realize it often cope with it in one of three ways;
- They become people-pleasers. They go out of their way to make others happy in the hopes that they won’t face rejection–often at the expense of their life goals and ambitions.
- They stop trying. The anticipation and fear of rejection is too unbearable to cope. They often have dealt with it numerous times in the past and this is the only way to reduce the chance of rejection occurring–often at the expense of their life goals and ambitions.
- They strive for perfection. They must be the best at what they do or else they’ll face criticism and rejection, which they cannot afford to deal with. And when this goal inevitably fails…you can probably guess what’ll happen.
As for how it appears, from my research it primarily presents itself in one of two ways
- The extreme emotional reaction is internalized, and appears to be a major depression episode if it’s a particularly bad episode. Depression can sometimes occur, though.
- The emotional reaction is externalized, which can manifest as a sudden, intense rage towards the situation or person that caused the reaction.
It appears that rejection sensitive dysphoria is present from birth as it seems to be genetic, and could be a part of ADHD itself. It’s often confused with many other conditions such as PTSD, social anxiety disorder, borderline personality disorder, persuasive demand avoidance, and bipolar disorder.
Many ADHDers were probably diagnosed with one or more of those and got the necessary treatment, for that condition. And when the treatment failed, they probably wondered what was wrong with them and why the treatment failed.
All of a sudden, many of my anxiety issues and extreme emotional reactions over the years made sense. It also explained why most people didn’t experience such an extreme reaction to rejection and criticism.
- Why I’d always fall apart after a real or perceived rejection, slight or wrong.
- Why I could not maintain a goal of doing everything in moderation for any longer than a few months. This is one of the main reasons I’m dealing with extreme autistic burnout right now.
- Why the thought of disclosing my autism was so painful, much more so than disclosing my ADHD.
- Why I’d sometimes feel that I have to get things absolutely perfect the first time, even when that is impossible to achieve, such as trying something new.
- Why I’d restrict myself to avoid disappointing or worrying others.
- Why I sometimes feel the need to be unnecessarily strict with myself when there was no need to. In fact, this never made things better, only worse.
- Why crippling anxiety hit when I needed to ask for help or applying for a job. Although in my case, the latter has a very real chance of occurring.
- Why my anxiety would nearly always get bad when I was offered anything suddenly, causing me to refuse it in the heat of the moment, like a reflexive reaction against something dangerous. It didn’t matter if if I wanted it or not. This has deprived me of potential job opportunities, friendships and romantic relationships over the years.
- Why I always expect rejection, even when the chance of it occurring is little to none. This didn’t really become an issue until the rejections started to pile up.
- Why I always expect criticism if I don’t get things “perfect”. Like rejection, it didn’t really become an issue until they piled up. Thanks to the systematic ableism in society, criticisms were plentiful if I didn’t do stuff the neurotypical way and pace.
It makes sense that this gets worse when rejections and criticisms pile up as is often the case for those with ADHD due to executive dysfunction, dysregulated attention span as well as impulse and emotional control issues. And it gets worse with co-morbid conditions, which are also subject to discrimination.
In my case, it was present during my childhood and presented problems on occasion, but didn’t become a severe problem until I became an adult and wanted to move forward with my life.
- Seeking work became nearly impossible. The high risk of rejection because I’m autistic didn’t help either.
- Agreeing to go to an event became a promise to myself to attend, a promise that must never be broken under any circumstance, even when there was no promise made and the other party would understand if I didn’t show up.
- Why I couldn’t give both myself and a college student a second chance at becoming friends with me after being ostracized by her friend in October 2013. Internalized ableism was part of the issue, but rejection sensitive dysphoria was also to blame.
- Why I felt like a failure if I needed help on something like a class assignment, even if it is an assignment the entire class is struggling to understand.
- Why I felt the need to set impossible to achieve goals. Bet you can guess what happened when the goals inevitably fell short.
- Why the realistic goals I had were so hard to achieve….because my mind was focused on the unrealistic ones to eliminate the chance of criticism and rejection.
- Why I felt so guilty when extreme autistic burnout hit in August 2018. I’m still dealing with this burnout as of June 2019 when this was written.
- Why I have such a hard time giving myself permission to do just the things that I can do and at my own pace instead of always being productive and always achieving. It’s the sole option for me in order to move forward these days, and one of the hardest things I’ve had to do in my entire life. Staying away from stress helps.
- Why it’s so hard for me to relax and rest during any period of time that I’m awake, especially if I had drank too much caffeine.
- Why my anxiety didn’t go away entirely when I stopped taking Adderall. I was dealing with rejection sensitive dysphoria all along, both before I went on it, while I was on it and other stimulant medications, and when I went off of it. Stimulant medications while very effective for hyperactivity, impulsivity, inattention and executive dysfunction, they are useless for rejection sensitive dysphoria.
- Why I’d sometimes leave Skype groups and Discord servers on impulse when I was dealing with episodes of imposter syndrome, emotional overload, internalized ableism and rejection sensitive dysphoria at the same time. Believe me, dealing with all four at the same time is pure agony. And there is no warning beforehand, so I don’t see it coming until it’s too late.
Now that I know about the primary cause of my anxiety, that means that I have a name for it at the minimum and that things make sense. And I have a fighting chance to get it treated so that I can have a fair shot at life without extreme anxiety and fear of rejection taking over whenever I try. And more importantly, I have a fighting chance to be at peace with myself and reduce the risk of extreme autistic burnout in the future.