The unbearable heartache of Rejection Sensitive Dysphoria

Written by Chantell Marshall aka Shy Little Pixie

Content warning: brief mention of suicide ideation

Do you remember how it felt as a child when you fell over and grazed the skin off your knees? How the shock hit you first, before the pain of the stinging skin flared, along with the sense of embarrassment and/or genuine sadness/injustice that the pavement could be so cruel to you? And, even in the days that followed, how every time you bent your leg to sit or walk, the healing wound would then re-open, igniting the pain all over again? 

This is how Rejection Sensitive Dysphoria (RSD) feels for me, personally. It is an experience I have grown up with, yet is one that I did not understand or have the terminology for until two years ago after my Autism and ADHD diagnoses. I quietly laughed to myself upon hearing the name, thinking how appropriate the term was because I have always been told I am ‘too sensitive’.

The word dysphoria originates from the Ancient Greek language, and literally translates to ‘unbearable’ – take a moment to let this sink in.  How often have you been accused of overreacting to a minor situation, or of attention-seeking, or of being a drama queen, or takings things too personally? I have had all of these said to me, and more, and I imagine others who experience RSD might have had this too. Yet, even the term itself states how unbearable this experience can be. 

I have always been extremely sensitive, emotionally and physically. I like to joke that I came into the world before I had grown a thick enough skin to cope with life and all it entails. I watched my peers grow up and gradually develop this thicker skin called resilience, yet mine just never grew. This meant that I have always been much more emotional than others, and lacked the ability to self-soothe – I was missing those self-regulation skills that others had.

By the time I received my Autism and ADHD diagnoses at the age of 41, I had been diagnosed with a multitude of mental health conditions, from severe social anxiety to agoraphobia to emotionally unstable personality disorder. My self-esteem was non-existent as I continually struggled to function, and had no idea how to ‘toughen up’, as was expected of me. 

Discovering the existence of RSD has been one of the greatest revelations of my ADHD diagnosis. I finally understand why I am so sensitive; why a flippant comment from someone can leave me feeling so gutted that I physically have to bend over to cope with the internal swirl of nauseous anguish, and why I simply cannot just ‘get over it’ quickly, as is the common societal expectation. 

Living with RSD is akin to walking into battle without any armour. Every comment, every sidewards glance, every criticism or rejection feels like a personal attack. I often have such a visceral reaction physically that I cannot breathe and genuinely feel gutted, as though I have been punched in the stomach. I struggle to eat or drink anything, have trouble sleeping, and my mind becomes immensely fixated on ‘How do I repair this situation?’– or I fall into a spiral of self-hatred and ruminate on how utterly useless I am.

An important aspect of RSD that is not often spoken about is that we tend to have a very critical inner voice – this is like having your worst enemy living inside your brain, continually berating you. When we then receive an external criticism or rejection from someone, we react so deeply to it because it seems to ‘confirm’ the stream of criticism we are already receiving from this inner voice.

From the outside, for us to be rejected and then spend hours crying in a heightened, irrational state, occasionally even spiralling down into suicidal ideation, this may seem like a complete overreaction to a minor situation – but in reality, it is sometimes the final piece of ‘evidence’ confirming to us that our inner critic is ‘correct’. 

It is like having a camp fire being built inside of you by this inner critic, and all it takes is one hurtful comment to act as a lit match, causing a massive bonfire – one that, of course, nobody else can see or feel. 

It is quite literally emotionally ‘unbearable’ to continually experience these internal bonfires of RSD episodes, so we tend to subconsciously develop behaviours to avoid feeling this way again. We often become hyper-vigilant about ever upsetting or annoying anyone, and instead, we try to be overly nice, known as fawning, even if this means we sacrifice our own wants or needs. We also become incredibly adept at avoiding or procrastinating due to a fear of failure and criticism. This can lead many of us to give up on our goals, or simply never even try because we are so afraid of receiving negative feedback or not succeeding, and of the subsequent spiral of emotions. 

One thing that has significantly helped me is discovering that, sometimes, it really is only my own perception of the situation, not necessarily the factual reality.

This was quite a momentous revelation for me as I was able to see that so much of my suffering is often caused by my own narrow perception. There have certainly been many occasions where I have genuinely been triggered by someone’s anger towards me, or I have been rejected in relationships, but there have also been times when I have discovered afterwards that I had taken a comment as a personal rejection when this was not the intention. Being Autistic, social interactions are often confusing to me, which means it is even more difficult for me to assess whether my perception is accurate. 

RSD can be incredibly debilitating, and there is no specific treatment available for it. We are the soldiers without armour, going into battle each and every day. All we can do is to arm ourselves with knowledge, gain insight from our fellow sensitive comrades, and allow ourselves to take a leave of absence when the attacks become too unbearable

Chantell Marshall aka Shy Little Pixie is an Autistic Advocate with Complex PTSD, ADHD, social anxiety and selective mutism.

You can find another beautiful piece she has written on social anxiety for Reframing Autism here.

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