Breaking the Stigma: Living with RSD (Rejection Sensitive Dysphoria)

[00:00:00] Jess: Welcome to the Women's Mental Health Podcast with Randi and Jess to licensed psychotherapists, where we talk about women's mental health, wellbeing, and strategies for coping with life's challenges and how it's all normal.

[00:00:12] Randi: Yes. In today's episode, we are going to explain and explore rejection sensitivity dysphoria, also known as R s D, and discuss practical tips and strategies for managing overwhelming emotions and improving your quality of 

[00:00:28] Jess: life. We do wanna note that RSD rejection, sensitivity dysphoria, it's one of those, I'm gonna air quote things that is not diagnosable.

It is not always recognized by doctors and clinicians. But it is a real thing, right? 

[00:00:43] Randi: It is, it's fairly new to the mental health field. They're still doing a lot of scientific research on it, so we'll be hearing more and more about it, but it's good to be aware of it. But understand it is not diagnosable yet at the time.

Not yet. 

[00:00:58] Jess: We hope in the future. We do. We do. So, listen in as we validate your feelings and find us and more resources on Randy and jess podcast.com. So have 

[00:01:08] Randi: you ever had these thoughts? 

[00:01:11] Jess: I am so terrified that a person will respond confrontationally, so I just end up ghosting the person.

[00:01:17] Randi: Why do I feel such intense feelings of shame, guilt rejection ahead of time or during, right, 

[00:01:27] Jess: right. People have said that I take things too personally or I'm too sensitive. You're highly 

[00:01:32] Randi: sensitive. You're dramatic. Dramatic. I feel like my partner is mad at me all the time, especially if he responds to me in a neutral tone.

Oh yeah, that one right there. Like no emotion, not giving anything back, and I'm just like, What's happening? Something's wrong. 

[00:01:48] Jess: Right. I can't stop thinking about how I accidentally insulted my friend and now I can't let it go. Yeah. 

[00:01:55] Randi: Just who, who else? Like replays like conversations over and over and over again in their head thinking maybe, did I say something wrong?

Did I offend somebody? Did I do something wrong? And like really, they probably like didn't even notice 

[00:02:06] Jess: anything that you said. Right. They didn't, you know, criticism literally ruins my day. 

[00:02:11] Randi: Yeah. Can send you into tailspin. 

[00:02:14] Jess: Right? So, you know, , in grad school we had this teacher, we called her Dr. Brain, right??

Mm-hmm. She, she was all about brains and Yeah. And the way they function. And I believe she was part of L G B T. Okay. And uh, we were sitting there, she said something about, was talking about being on the fence.

And I mean, to this day I still replay that moment. And I made a comment about her being on the fence and it came across as outing her or something. Oh. And I felt. Horrible. 

[00:02:43] Randi: , you didn't mean it that way, but then you were thinking like, what if she perceived it that way? And look, okay, we're gonna age ourselves too.

When Jess was in grad school, this is before it was cool to talk about this stuff. Oh, 

[00:02:55] Jess: okay. Yeah, that's true. 

[00:02:56] Randi: It wasn't as, people weren't as, Sensitive or as open as having these conversations, 

[00:03:01] Jess: and so I felt so horrible and I went and talked to her about it. Cuz I was like, oh my gosh, I'm so sorry. I didn't mean to say that it came out wrong. And she kinda laughed at me and was like, yeah, it came out wrong. You're fine. You're fine. Right? Mm-hmm. To this day though, that you still think about It still plays in my head.

On a loop. On a loop. And this is now like 15, 20 years later. Yeah, that I'm like, oh, I can't believe I said that in front of the whole class. Right. I'm so, I 

[00:03:25] Randi: feel so bad for know, and that's what rejection, so sensitivity dysphoria can be. So let's explain it a little bit. Deeper. So rejection sensitive dysphoria is a condition characterized by intense emotions and fears and worry of rejection and amplified emotional response to perceived or real criticism and rejection.

[00:03:52] Jess: and it doesn't have to be real. . And it doesn't have to be, you 

[00:03:54] Randi: just have think that maybe this could possibly, might one day. Someday could, I don't know, maybe happen, 

[00:04:04] Jess: ? I don't think, you know, Dr. Brain is sitting there thinking about that one kid in class who, you know, said something stupid, right?

So, but I do, so the word dysphoria, cuz that's a word that like it's not. It comes from the ancient Greek word that describes a strong and overwhelming feeling of pain and 

[00:04:21] Randi: discomfort. And that's what a lot of people that have R s D kind of explain it as that it's like this intense, white hot stabbing, gotta get it off of my chest, right in the moment.

Almost like a wound that's festering, 

[00:04:36] Jess: ? Like this panicky thing. Mm-hmm. I do again, wanna say this is not a DSM diagnosis, right? The DSM is the therapist and psychiatry Bible 

[00:04:45] Randi: kind of thing, right? Like , the way that you diagnose what is recognized by other mental health and medical professions as being treatable.

And so this is not in there yet. 

[00:04:59] Jess: this kind of goes, it, it feels sort of hippy dippy sometimes. It goes with the highly sensitive person kind of thing. Mm-hmm. But , this is more of a recent, the HSP, highly sensitive person was what, seventies. Mm-hmm. And then I think this one is, I mean really, truly this was not talked about in grad school.

This is a recent thing. 

[00:05:18] Randi: Yeah, so I would say like more so in the last five years, we're hearing a lot more conversation about this and because it is often linked with ADHD and other neurodivergent, diagnosises like autism. And so it really has to do with things surrounding the brain and the brain structure.

That's what we're finding. . And 

[00:05:38] Jess: what they're discovering is that the difference , is that your brain can't regulate rejection related emotions and behaviors, ? Mm-hmm. So it makes it much more intense. And so, What I teach or emphasize with my clients is the need to move beyond the shame and explore the potential for their strength and growth.

Right, right. 

[00:05:58] Randi: It doesn't need to be a negative thing. You can look at it as understanding yourself on a deeper level. 

[00:06:06] Jess: Let's go through understanding what R S D is, cuz a lot of people are like, wait, what is R S D? Right? What is this? So let's go through some of the traits and 

[00:06:14] Randi: behaviors.

, when you have rsd, it's very easy to feel embarrassed or self-conscious of your behavior. A lot of time you can have low self-esteem or you have a hard time believing in yourselves that you can do things on your own. 

[00:06:28] Jess: Trouble containing emotions 

you feel rejected, ? This is of often in like kids and like teenagers. Mm-hmm. Like the outbursts, right? Sometimes people will respond with rage or anger. Sometimes people will burst into tears. Just so you know, if you cry when you're mad, That's okay. ? I cry when I get mad, I get pissed and I'll start crying right then.

I'm mad that I'm crying because now I'm like, great. Now I'm crying. . And I'm mad. Even more mad. Yeah. But you know that part of what happens with it too. 

[00:06:56] Randi: ? And some people don't lose control of their feelings. They turn their feelings inwards, and that can look like depression or , a mood shift, an emotional shift, and , kind of like what you might see with bipolar or borderline personality disorder.

But with those, it can be like a gradual shift. And with this, with RS D it is usually instantaneous and only lasts for, , a couple minutes to a couple of hours. Mm-hmm. 

[00:07:22] Jess: A lot of times they're people pleasers. And the reason they're people pleasers is because they really want to avoid disproval , of other people, 

we don't wanna disappoint, we don't want to upset. And if we make everything perfect, there is no commotion, there is no conflict. What is the word I'm thinking of? People who are alcoholics, children of alcoholics typically become, 

[00:07:45] Randi: Like you were saying, people 

[00:07:46] Jess: pleasers, people pleasers.

But what is it that you're, oh my God, I can't think of the word right now. It'll pop into me later. Okay. 

[00:07:54] Randi: Compensating for a fear. Mm-hmm. Or a perceived fear or worrying that you're gonna fail or being rejected. Did. So a lot of times when you have Rs D you strive for perfection. You're hypervigilant about wanting to be perfect and crossing all your i's and or crossing all your T's and dotting all your i's.

And you can also avoid things like social situations, projects, tasks, goals, because you worry that if you even tried to attempt it, you could fail at it. And a lot of times you're holding yourself. Back from success because you are so, scared of failure. And so that is the downside of having R S D and how it can block you from living your life in a way.

Co-dependent. 

[00:08:41] Jess: Oh, sorry. I knew it would come to me. Codependent. Codependent, yeah. So it is the people pleasers, it's very similar to like people who are codependent. Yes. Because they're just really trying to make other people happy to avoid all of that. Okay. Sorry, that was just. Boop. Squirrels. Yeah. Okay, so let's talk about how do we shift from, , the shame.

Oh, that shame, right? Mm-hmm. Going from shame to maybe understanding more so Right. What this is. 

[00:09:07] Randi: Yeah. So when you can understand how. Your emotions affect you on such an intense level with R S D, you can have more understanding for yourself, more empathy for yourself, more self-compassion, more self-awareness, and then you're able to, what we like to call in therapy, reframe.

Mm-hmm. And reframe your perspective. So what does that look like, Jess? 

[00:09:33] Jess: Reframing. We do that with C B T, ? . It would be taking a look at it instead of saying, God, I sucked that I was late. Right. Right. Just saying, , it's okay that I was late. , it's not the end of the world and , we're gonna be okay.

Mm-hmm. Right. It is being able to look at a situation and reframe how you either a, talk to yourself, talk to other people, or think about it. And by reframing , it's literally just changing, . Changing your, flipping the script. Yeah. , I'm doing my hand here where I'm flipping things. It's just, it's flipping the script. It's, it's looking, ,, at it differently. 

[00:10:04] Randi: Creating a new narrative. Yeah. , good job. And so this helps you implement coping strategies so you can empower your. So we can explore effective coping strategies for managing R S D. And like just said, C B T, which is cognitive behavioral therapy.

And D B T Dialectical Behavioral Therapy are two really, really good therapies to utilize when working through R S D and finding strategies that can work for you. 

[00:10:34] Jess: . And , dialectical behavioral therapy is great cuz that's where you get, like your workbooks, you get your handouts.

Mm-hmm. You get a lot of, I love 

[00:10:41] Randi: that kind of stuff. I love workbooks. I love fill in the blanks. Not everybody does. So I usually ask my clients too, do you love this? Do you want these resources? Is this gonna work for you? , and So that's important too, to find somebody that hears you and what you like to do, and if that therapy would be effective for you.

[00:10:56] Jess: And sometimes I don't give homework most of the time except for , I actually, I give homework all the time. They just don't realize, cause I don't call any homework, but I want people to. You just outed yourself. I do, I do. I just want people to pay attention to it. ? Yeah. I really want them to look at, , mindfulness practices , and really look at what it takes to regulate their emotions.

Because that's what this really is, is dysregulated emotion. And really want them , to build in, that keyword for us, that self-care. 

[00:11:25] Randi: Yeah. Because then that builds resiliency. So when you have. Feelings like this, this intense, overwhelming emotions, and you can reach back into those things that you've learned and use them to kind of center yourself.

Reframe things and walk forward through it. You are giving yourself the power to. Be resilient and bounce back from it better than before. 

[00:11:50] Jess: Mm-hmm. And , I wanna talk a little bit more about why do we see it with adhd, we see it with, , autism. And we know, we said, , cuz the brain structure is different.

And really because those are two conditions. Two, , ADHD and autism. Are diagnosable, right? Mm-hmm. And both of them have dysregulated emotion anyway, right? And so a lot of times I find people end up, , with R s d, , they become these people pleasers because , , they're always messing up.

Mm-hmm. Messing up with air quotes, guys. 

[00:12:24] Randi: Messing up, not fitting into a normal, atypical 

[00:12:27] Jess: box. . You speak at a turn. Oops. Sorry. 

[00:12:30] Randi: Yeah. You show up. You're awkward. Yeah. You're awkward in social situations like you talk over people, 

[00:12:36] Jess: you don't know when to interject and you're sitting there going, do I do it now?

Do I say it now? Do I wait? Yeah. You in your head too much, right? Or you're trying to come up with a great response so you can be witty or whatever, and 

[00:12:47] Randi: it whatever comes or until it's like 1:00 AM in the morning and then you're like, this would've been great in this conversation. Or like, Jess, you're 15 years later worried about something you said in the class that nobody remembers, 

[00:12:58] Jess: right?

I don't think anybody remembers that. Yeah, I do. And so. A, a lot of people have a lot of shame that comes with this, and that's, I think what I see the most is just this feelings of shame and embarrassment especially when they have been diagnosed late in life. Mm-hmm. And that is one of the things too, is that just, , they get diagnosed late in life like you and I did, and so , you've grown up being this, , again, awkward person.

Right. And, and like freaks 

[00:13:27] Randi: and geeks, you're thinking like, I never fit in. Like I don't understand, like why? , and when you have a neurodivergent diagnosis, you are already usually about 30% behind the curve of what they would say is a typical, , brain. And so you feel like you're playing catch up even more so when you've been diagnosed late in life, , okay, now I have this understanding, but.

What do I do with it? , and like, how do I catch up with this? Or do I change myself? Like, no, or maybe just giving yourself, allowing yourself to like yourself, in a way when you haven't, or thought that you didn't fit in. 

[00:14:02] Jess: Mm-hmm. And, and , there's so much grief that goes along with getting diagnosed, like cuz you're like, Oh, this makes a lot of sense.

I wonder if I would've done things differently. , 

[00:14:12] Randi: right.. Sometimes I wanna cry over like my teenage and like youth self, thinking , you know, sweet girl. Like,, it's okay that you are this way, and like why you hated yourself, like so much thinking like you are different when you really weren't.

Mm-hmm. , 

[00:14:28] Jess: I wish they would diagnose. R Rs d like, I wish we could figure out , how to get this as a diagnosis, ? Mm-hmm. As like an add-on, because , this explains a lot of people when they read this, they go, oh God, that makes sense. I must have R 

[00:14:43] Randi: s D. Yeah. It can be confused a lot with like we were talking about borderline and bipolar and stuff like that.

but it's so much different because it's like an instant shift 

[00:14:53] Jess: oh God. So I had cooked something once. I'm an awful cook, by the way. No, I'm not awful. I am. Okay. All right. I'm an okay cook. I have some things I can make. Good. I, this didn't, was not a good day. I didn't make it good, ? And my daughter, this is not my shining moment in life, okay?

She must have been like, oh, sucks. Seven. And my husband was there. We're sitting down and she says, it was like a piece of meat. And she goes, this looks like poop. My husband starts laughing. Yeah, yeah. Right. Cause it was funny. Yeah. Now I can laugh at it. Right, right. But then you were just like, oh my God, I got so upset.

I took the meat, I threw it away. I, I made that big scene where I'm like, fine. And I just chucked it all. And my husband was like, really? You hate me? 

[00:15:38] Randi: You hate my cooking and 

[00:15:40] Jess: everything. Yes. Yeah. Yes. And so even now feels like a personal attack. It does. Yeah. And so even now when he says i's like, how was dinner?

He's like, it was okay. Oh, it's just okay. , I feel like he's saying, God, it really sucked. 

[00:15:54] Randi: Right? Even though 

[00:15:55] Jess: he's not, he's not. It really was just, 

[00:15:57] Randi: okay, you're perceiving in your head another conversation that isn't actually happening, and it's because we can live in our head a lot with d h, ADHD and neurodivergent, , thought patterns, right?

[00:16:09] Jess: And so that's part of the R s d piece of it is, is feeling like they're saying it's awful. Right. When really they're just saying it's okay. Right. You know, he just didn't like the green beans with the chicken that I put in. Yeah. And he would've done it differently. It's not 

[00:16:24] Randi: a big deal. And it's, it's okay for them to feel that way, but like when you have rsd, sometimes it can feel like a personal attack on your whole being and you're like, fine, you know, whatever.

I'm 

[00:16:34] Jess: done with this. . And then you overreact and , make a big scene and throw everything away in the trash. Right. , whatever. But that is part of what RS D is, is it's the big emotions. It's the big, he hates me. Mm-hmm. Sometimes, , if my spouse is like in a bad mood, right?

Yeah. I'll be like, oh God, did I do 

[00:16:52] Randi: something wrong? . You can't, I might get upset on as your whole onto your whole self and it could be nothing that has anything to do with you. 

[00:17:00] Jess: No, and the way I tell people and the way I try to look at it myself, , is that. They're grown ass people. Right. And they can tell me if they're upset with something.

Mm-hmm. Is to not assume it's about you. Right. In fact, it's almost like assume it isn't about you unless they say 

[00:17:14] Randi: something. Mm-hmm. And that's where reframing and working on your negative self-talk really comes in with s d and is very important. Mm-hmm. And there is a long way to go with this.

There's still a lot more research that needs to be done. A lot more advocacy. C and a lot more education, but that's why we wanna talk about this topic and get it out there so we can learn more about it, talk more about it. And so more women don't feel alone in these feelings of these intense emotions or outbursts they're 

[00:17:44] Jess: having.

And men can have it too. Let's just be real. Mm-hmm. Men can have this too. Oh yeah, a hundred percent. When, when Randy and I were researching some of this earlier, , it was talking about women with r s d and emotional and, , we're like hysteria, 

[00:17:57] Randi: like you're 

[00:17:57] Jess: hysterical. And so we are kind of cracking up and laughing like Uhhuh.

Now it's just this. But I think it's gonna be something that does come into a diagnosis just like, pm d d mm-hmm. No. Premenstrual Dysphoria Disorder. Mm-hmm. Yes. Which is the Extreme PMs. Right. That just made it into the last DSM diagnosis book update like five years ago. Right. Maybe seven. Yeah.

[00:18:21] Randi: Seven years ago. Yeah. Right. , , and we're gonna keep advocating for these type of things Yeah. That affect both women and men, just so. We have it out in the open and talking about it helps reduce the stigma around it and helps us promote empathy. 

[00:18:38] Jess: . And the thing that is really hard with RSD is vulnerability.

[00:18:42] Randi: Right. Because when you're a people pleaser . You almost feel like you need to cover up the real you, or like you said, like you and I grew up with this thinking we didn't fit into a box and so we've been masking our whole lives.

Mm-hmm. So trying to fit ourselves into this space, they're so, everybody likes us instead of just like being like, this is who I am and I'm vulnerable and I'm okay with that. Or This is who I am authentically. And 

[00:19:07] Jess: a lot of people are afraid that when they show up as who they are, they're not gonna be liked.

And that's part of R s D as well. Mm-hmm. Is that you feel like people don't like you. Right. And that's not true. Right. . It's the narrative , what you are telling yourself. 

[00:19:24] Randi: And I still think that, , sometimes, I mean, I have great friends and people love, love me. 

[00:19:28] Jess: Oh my God.

People love Randy and they all wanna be Randy's friend and, and I'm like, everybody hates 

[00:19:33] Randi: me. I have no. Friends. I've never had a friend in my life. I don't even know what friendship is. And I'm just like, okay. 

[00:19:40] Jess: I had an event with some of the women here, and they're like, is Randy coming?

Is Randy coming? Where's Randy? And I was sitting there going, what am I chocolate her? I mean, oh my God, where's Randy? I'm like, Randy, you better show up. You better show up to this thing. 

[00:19:52] Randi: Yeah. But when you have Rs D, you don't think of yourself that way. And so that's why I. This is very much like a perceived thought process.

Mm-hmm. Where you're thinking these things, but it's not necessarily true. So that's why it's can be so hard to navigate this and understand it and move from , feeling shame about it, to feeling a strength about it. 

[00:20:15] Jess: And one of the things too is to work with, if you have a spouse or a friend explaining what R S D is, and that's the vulnerable piece.

Mm-hmm. Is explaining it to them and being open about it. . Like having these big feelings. And it's okay if you don't know why. You can say, I'm having big feelings. I'm not sure what this is. I need some time to think about this. Right. 

[00:20:35] Randi: And this allows us to reclaim. Those feelings of self-worth so that we're not feeling like, so like low and down about ourselves, and we do feel like we belong more when we do have those conversations and somebody's like, oh my gosh, I feel that way too.

Like I didn't know, like I don't even know how many times Justin and I talk abouts. Stuff. And then we're like, you're feeling that way too? Oh my gosh. Me too. And I mean, we're, we're therapists, ? , , everybody has those feelings of doubt and insecurity. Especially as women, especially as, , older women and stuff too.

It feels like, when am I ever gonna grow up? You know? But it's like stuff is always rapidly evolving and changing. It 

[00:21:12] Jess: changing so funny. When are we gonna grow up? I don't know. I thought by this age I'd be grown up. I still don't feel grown up. Let me ask my mom and she might tell me when I'm gonna be grown up.

I don't know, but , part of it also is saying, , when somebody says something to you where you feel criticized is being able to tell them, I feel very criticized by that statement. Mm-hmm. , and even getting clarification is, is that what's meant?

Because I know sometimes my husband will give me an opinion. Oh, he'll go, God, that movie's terrible. And I'll take it personal 

[00:21:43] Randi: because you picked the movie. Because I picked the 

[00:21:45] Jess: movie. I kinda liked it. You're right. I liked the movie. He's like, oh God, that's a horrible movie. And I was like, no, it's 

[00:21:50] Randi: not. Oh, so you think I'm a horrible person?

Like, do you see how that, when we actually say that out loud and , like, like if we would draw a diagram that wouldn't really add up, but like in our head it makes sense at the moment, or we think it does at the moment 

[00:22:04] Jess: because it feels like he's. Criticizing mm-hmm. Me because yeah, I picked the movie and that's not what's happening.

And so, yeah. I mean, so part of this is being able to say, Hey, that kind of hurts my feelings. And he's like looking at me like I said, the movie sucked. Right? Like, what? Like, and so it is, that's where you have to do the reframing and the vulnerability. , Ooh, I'm taking this very personal right now. I don't need to take this personal mm-hmm.

, and, and talk it 

[00:22:29] Randi: through. And understanding that every day is a new day for personal growth and new self-perception about ourselves and being kind to ourselves. And I feel like we, we think we should be the same as we were yesterday and we're never gonna be that person we were yesterday.

And so, giving ourselves empathy and room to grow, understand, and change is so important in every aspect, but especially when you have Rs D 

[00:22:56] Jess: Yeah. It, it really is. And, and so part of this is, , if any of this resonates with you, , do some research, read about it, talk to your spouse, , your partner, your friend, your parent.

Yeah. , , and maybe work through some of this with them. Mm-hmm. , talk with a therapist who can help you kind of normalize this and learn to do what we call reframing and to catch yourself when you are doing 

[00:23:18] Randi: it right. Yeah. So you're not alone. Yep. In these feelings, big or small. And that's what we're here to talk about.

[00:23:25] Jess: All right. Well catch you guys later.