Rejection-sensitive dysphoria: what it is, symptoms, causes and treatment

Dysphoria sensitive to rejection is a discomfort that greatly limits the social life of those who suffer from it.

We all feel bad when we feel rejected by others, however, there are people who find this feeling more overwhelming, so they have greater difficulty in overcoming it and moving forward.

When a person suffers from what has been called rejection-sensitive dysphoria, he or she usually experiences suffering when he or she feels rejection by other people, whether this rejection is rejection or can even be imaginary in some cases. Therefore, this person has a great sensitivity towards criticism or judgments towards him or herself, as well as towards rejection.

In this article we will explain in more detail what rejection-sensitive dysphoria consists of and also we will expose some signs that could allow to detect when a person suffers from this type of dysphoria and in addition we will see with what mental disorders it is usually associated.

What is rejection-sensitive dysphoria?

When a person experiences dysphoria sensitive to the rejection has an increased sensitivity to criticism, valuation and rejection by others, experiences that everyone has experienced.These are experiences that everyone has experienced to a greater or lesser extent at some time in their lives.

However, in cases of rejection-sensitive dysphoria these experiences can feel unbearable for the person and, in many occasions, a bad experience at a social level will be the starting point for the person to work very hard and obsessively in different aspects of his/her life in order to please others (physically, academically, in the way he/she dresses, at work, etc.).

Rejection-sensitive dysphoria can even cause the person to be continuously alert to any possible sign of disapproval, criticism, rejection or displeasure towards him or herself, so that in many cases some of these signs of disapproval, criticism, rejection or displeasure may be perceived as a sign of rejection.In many cases, an action that hurts their feelings could come from an act on the part of another person that has been misinterpreted and, in reality, what they believe the other person has done in a derogatory way, has actually been the fruit of their imagination.

Therefore, these misinterpretations could have repercussions on their relationships, so that rejection would occur, which could be referred to as a negative self-fulfilling prophecy..

Among the causes associated with rejection-sensitive dysphoria are negative social experiences (e.g., having suffered bullying, rejection by peers at school, having overly critical parents or sentimental rejection) and has also been linked to a genetic predisposition in the case of a family history.

Diagnosis of rejection-sensitive dysphoria.

In the diagnostic manuals of mental disorders (DSM-5 and ICD-11) there are no official criteria for diagnosing rejection-sensitive dysphoria. However, this psychopathological condition has been widely recognized among mental health professionals, and there have been numerous studies on the subject, so it is useful to keep it in mind.

Rejection-sensitive dysphoria shares a number of common symptoms with other mental health problems, so that before "diagnosing" rejection-sensitive dysphoria it would be advisable to find out if the symptoms you are dealing with are due to another mental health condition..

To find out if it is a rejection-sensitive dysphoria, a series of questions could be asked, such as those shown below:

What do you feel after experiencing criticism or rejection by others? Have you ever experienced a neutral act by another as if it were rejection? Do you worry too much about failing in some area of your life? Have you been told on several occasions that you are too sensitive? Do you worry about being judged by other people? Do you like to please other people? From 1 to 10, how would you rate your level of self-esteem?

Symptoms

The symptoms that more have been associated to the cases of dysphoria sensitive to the rejection are the following:

• Anxiety symptoms.
• Avoidance of situations that you feel could lead to rejection of you.
• Being very perfectionistic in various areas.
• Tendency to act in order to please others in order to be socially accepted.
• Belief that he/she is not being accepted and/or liked by other people.
• Having low self-esteem.
• Negative cognitive biases.
• Acts of impulsivity with feelings of anger in situations of social rejection.
• Ruminative thoughts about experiences of social rejection.
• Rejection-sensitive dysphoria can significantly interfere with a person's life.
• Rejection-sensitive dysphoria can interfere negatively in all relationships.

In the most severe cases, people with rejection-sensitive dysphoria can become very fearful of the possibility of rejection, to the point of social isolation in order to prevent future rejection. in order to prevent possible future rejection by others, which forms a vicious circle of weakening their relationships and further isolation, so that they feel they are suffering even greater rejection.

While it is true that we all feel bad to live any kind of negative social experience or rejection by others, people with rejection-sensitive dysphoria also feel that they are suffering even more rejection. are more likely to become obsessed with any negative social experience, so that it is harder for them to forget and overcome it than for others.They have more difficulty than other people in forgetting and overcoming such experience.

Mental disorders in which it is more common.

Rejection-sensitive dysphoria has been linked to a wide variety of mental disorders, including the following.These include the following: mood disorders (depression and bipolar disorder), social phobia, schizoid personality disorder, Post-Traumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder (OCD), Borderline Personality Disorder (BPD), Autism Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorder (ADHD), with the latter two being the most studied with respect to their relationship to rejection-sensitive dysphoria.

A study conducted with people with adhd and others with ASD found a high prevalence of cases with rejection-sensitive dysphoria, who had high emotional sensitivity.

It was also observed that they may have difficulty regulating their emotions and communicating, so that this leads them toThis leads them to have a perception of being rejected by other people, which can also give rise to misinterpretations regarding other people's actions, which can sometimes be neutral acts with no intention of offending anyone.

In addition, this high sensitivity to rejection this high sensitivity to rejection makes those who suffer from it more prone to suffer symptoms of depression and anxiety, as well as to have thoughts of self-harm.Therefore, special care should be taken in therapy when encountering cases of rejection-sensitive dysphoria, with special emphasis on the treatment of the associated symptoms.

On the other hand, it should be noted that any person could suffer from rejection-sensitive dysphoria without having any mental disorder.

Rejection-sensitive dysphoria in people with ADHD.

A study of 1235 young Germans measured sensitivity to fairness, self-esteem, behavioral problems, ADHD symptoms, and rejection-sensitive dysphoria.

The results showed a high relationship between rejection-sensitive dysphoria and ADHD symptoms, which led to the development of a hypothesis about the contribution of rejection-sensitive dysphoria and sensitivity to fairness in the occurrence and also in the maintenance of problems commonly related to ADHD symptoms. Therefore, it would be advisable to take rejection-sensitive dysphoria into account in psychological therapy sessions with people with ADHD.

Studies have found that ADHD symptoms may worsen the suffering of rejection-sensitive dysphoria and thus intensify the feeling of being rejected.

Furthermore, these studies found that more than 60% of people with ADHD reported having symptoms related to rejection-sensitive dysphoria (i.e., experiencing negative emotions (e.g., suffering excessive negative emotions that they could not control); while in people without ADHD, symptoms of rejection-sensitive dysphoria were found in 15% of the cases.

Treatment

In cases of comorbidity between ADHD and rejection-sensitive dysphoria, the most commonly used treatment within the national health care system is usually medication, which is usually used to treat the core symptoms of ADHD. In addition to medication, psychotherapy and the recommendation of lifestyle changes is often used in order to establish a series of healthy habits in the patient's life.

Cognitive-behavioral therapy (CBT) has the largest number of studies that have demonstrated its effectiveness in these cases, with psychologists using this model in therapy aiming to help the patient identify destructive or ineffective patterns in their behavior and thoughts, as well as teaching and training with the patient a series of effective techniques in order to manage rejection, stressful situations and other associated problems.

CBT can be effective in helping people with rejection-sensitive dysphoria to recognize those negative emotions that cause so much discomfort in their lives, learning to detect whether they might be excessive and also to process negative emotions in a healthy way.