American media personality Paris Hilton recently shared on a podcast that she suffers from rejection sensitivity dysphoria, or RSD.
Hilton, who has been diagnosed with ADHD, said the condition is common in people with the disorder. She also described the impact it has had on her mental health, calling it “like a demon in your mind” and “extremely painful”.
RSD is not actually a clinical condition recognised in diagnostic manuals. What Hilton may be referring to are two related psychological concepts: emotional regulation and rejection sensitivity.
Emotion regulation is an umbrella term. It refers to a person’s overall ability to manage emotional reactions in a given situation.
Rejection sensitivity falls under this umbrella. It describes a strong emotional reaction to rejection, including perceived rejection by others. People may experience anger, shame, shutting down or becoming defensive following criticism.
People with healthy emotional regulation skills are better able to keep emotions under control, even if a situation becomes stressful or tense. They are also less likely to develop rejection sensitivity.
Difficulties in regulating emotions are part of being human, but life experiences can shape how we perceive and regulate emotions.
For instance, if growing up you had a parent who repeatedly criticised you, you may be more likely to develop low self-worth. We often internalise the negative things people say to us. In the future, this can make someone more sensitive to criticism.
Between 25% and 45% of children with ADHD, and 30% to 70% of adults with ADHD, experience difficulties with emotion regulation.
These difficulties often show up as catastrophizing, blaming others or feeling vulnerable to perceived rejection. Perceived rejection or criticism can also cause emotional discomfort.
Some people with ADHD try to hide their emotions when feeling rejected, while others may become overwhelmed, lash out or disengage. Over time, these reactions can contribute to emotional distress and affect relationships, education and employment.
The causes of emotion regulation difficulties in ADHD are not fully understood, though research has explored several possible mechanisms.
In one study, we compared the brain waves of boys aged six to 11 with and without ADHD.
Both groups listened to angry, happy or neutral voices through headphones. The study showed that in boys with ADHD, their brains were more active when listening to threatening, angry voices. The findings suggested an automatic hyper-vigilance to threat in people with ADHD.
Another study found that youth with ADHD showed a larger brain reaction when rejected by their peers, and a smaller reaction when they were accepted.
Past experiences of threat or rejection can have lasting effects and may influence how the brain develops. Although the exact mechanisms remain unclear, research suggests experiences of rejection can shape brain development in ADHD.
ADHD is not the only condition linked to rejection sensitivity. Autism, borderline personality disorder, depression and anxiety are also associated with it. However, the way rejection sensitivity appears in these conditions can differ.
People with ADHD may become very emotionally reactive when facing a difficult situation, while autistic people may be more likely to withdraw.
Some prescription treatments used to manage ADHD symptoms may offer temporary relief from the emotional distress linked to rejection sensitivity, but they do not cure it. This approach can help reduce ADHD symptoms, though it does not necessarily improve emotion regulation in ADHD.
The Conversation