Paris Hilton just highlighted her experience with rejection sensitivity dysphoria in a new interview.
No one is excited to deal with social rejection, but people with a certain mental health condition may struggle with this more than others. It’s called rejection sensitivity dysphoria, and Paris Hilton just highlighted her experience with it in a new interview.
“Any thought of a negative perception—if you think someone is being rude or you feel something...you will feel it like it's physical pain and it's not even real,” the 44-year-old shared on The Skinny Confidential Him & Her Show. “It's kind of just this, almost like a demon in your mind that is, like, saying negative self-talk to you.” Hilton says that people with rejection sensitivity dysphoria experience negative feelings “on such a deep level.” She also noted that the condition is especially common in people with attention-deficit/hyperactivity disorder , which she was diagnosed with in her late 20s. Hilton said she wasn’t even aware that rejection sensitivity dysphoria was a thing before her diagnosis, but she’s learned that many people with ADHD feel the same way as she does when it comes to social rejection. Rejection sensitivity dysphoria isn’t a condition most people are familiar with and it’s not well defined in scientific literature. What is it and how does it differ from a standard fear of rejection? Psychologists explain. Rejection sensitivity dysphoria can cause intense emotional pain. Rejection sensitive dysphoria is not in the DSM-5, the handbook used by healthcare professionals to classify and diagnose mental health conditions, Gail Saltz, MD, clinical associate professor of psychiatry at Weill Cornell Medical College and host of the How Can I Help? podcast, tells SELF. “The term appears to have originated in popular discourse about ADHD but lacks a clear clinical definition, validated diagnostic criteria, or empirical research base in peer-reviewed medical literature,” Dr. Saltz says. Jessica Bodie, PhD, a licensed clinical psychologist at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania, agrees. “The evidence base just isn’t there,” she tells SELF. Instead, Dr. Bodie says that people with rejection sensitive dysphoria may be dealing with a subtype of obsessive compulsive disorder around social connections—and that is in the DSM-5. So, there’s no exact criteria that someone needs to meet in order to be diagnosed with rejection sensitive dysphoria. Still, mental healthcare providers say this is a thing. “It’s one of those things that the internet made popular in certain circles,” Thea Gallagher, PsyD, clinical associate professor at NYU Langone Health and cohost of the Mind in View podcast, tells SELF. Rejection sensitive dysphoria is when a person feels intense emotional pain related to rejection, according to the Cleveland Clinic. That can lead to a strong and possibly overwhelming feeling of pain or discomfort that’s hard to manage. 'Fear, shame, upset, anxiety, overwhelm, and anger are all common emotional responses, while pain, feeling unwell, exhaustion, and nausea are common physical experiences,” Barbara Sandland, PhD, a research fellow at the Autism Centre for Education and Research at University of Birmingham, tells SELF. As Hilton said, RSD is strongly linked with ADHD. “In people with ADHD, sometimes you can hyper-focus on a moment and be very dialed in to what you’re feeling,” Dr. Gallagher says. “That may lead to an extra-strong reaction to rejection or perceived rejection.” This is different from standard feelings around social rejection. Social rejection can be upsetting to anyone, but people with rejection sensitive dysphoria experience it differently. They may even interpret vague interactions as rejection, like someone not saying hi when they’re in a rush or taking a longer time to respond to a text, Dr. Gallagher says. “Things feel deeply personal and much more,” she says. The “rejection sensitivity” part refers to the tendency to “anxiously expect, readily perceive, and intensely respond to cues of rejection or criticism from others,” Dr. Saltz says. She notes that this can cause “significant distress through unpleasant bodily sensations, anxiety, and misery.” While most people who face rejection may shrug it off by telling themselves that not everyone has to like them or maybe they didn’t receive an invitation to a gathering because the host didn’t think they’d like it, Dr. Gallagher says that those with rejection sensitive dysphoria will struggle to move beyond it. “The emotional volume is turned up, so someone feels it more strongly,” she says. Everyone has the potential to ruminate over a social situation or what you did or didn’t say, “but folks with an obsessive level around a social area will have a higher intensity and a higher level of interference,” Dr. Bodie says. “It lasts a lot longer and is more significant,” she adds. Ultimately, rejection sensitive dysphoria taps into a person’s core beliefs about themselves, making someone feel that they’re unloveable and unworthy, Dr. Gallagher says. “We talk about a ‘shame spiral’ where one experience of rejection is automatically associated with past experiences and feeds the inner voice that seeks to make the individual blame themselves for the rejection they have experienced,” Sandland says. People with rejection sensitive dysphoria may experience these symptoms, according to the Cleveland Clinic: Feeling easily embarrassed or self-conscious. Having trouble believing in themselves. Struggling to contain emotions when they feel rejected. Suddenly turning their feelings inward, which can mimic severe depression. Being a “people pleaser.” Avoiding starting projects, tasks, or goals where there’s a chance of failure. Compensating for fear of failure or rejection by striving for perfection. It’s possible to have rejection sensitive dysphoria without ADHD, but they tend to happen together, Dr. Saltz says. “Children and adolescents with ADHD symptoms demonstrate significantly higher victim-perspective rejection sensitivity and more frequent perceptions of injustice compared to those without ADHD,” she explains. Treatment is available. Treatment for RSD usually overlaps with ADHD therapies. That includes medications like stimulants and alpha-2 receptor agonists to treat the ADHD, along with psychotherapy to help someone cope with the feelings around rejection sensitive dysphoria. Psychotherapy for rejection sensitive dysphoria tries to help people look at their feelings in social situations more objectively, according to Dr. Gallagher. “It helps people reduce catastrophic thinking. So, instead of someone not inviting you to an event because they hate you and you’re unloveable, you’re looking at it through a manageable lens like, ‘I have people in my life who appreciate me,’” she says. A mental healthcare provider may also encourage you to regularly check in with a trusted friend to get honest feedback on social situations that really bother you. “Ultimately, it’s learning to tolerate uncomfortable feelings, while trying to avoid thinking that something is wrong with you,” Dr. Gallagher says. “You can still have patience and self-compassion for the feeling that you’re having—but it doesn’t mean that everyone hates you.” If you suspect that you have rejection sensitive dysphoria, Dr. Gallagher recommends consulting a mental healthcare provider. They can assess you for the condition, along with ADHD, and recommend next steps from there. Related: ADHD Diagnoses Rise in Moms of Preschoolers, but Why? 11 Realistic Meditation Tips for People With ADHD How to Take Rejection Way Less Personally Get more of SELF's great journalism delivered right to your inbox—for free.
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