Is there a treatment for Rejection Sensitive Dysphoria? How can you help your child?
In my last blog, I talked about what Rejection Sensitive Dysphoria actually is. But just in case you missed it, RSD is a sudden wave of emotional reactivity when a neurodivergent person perceives rejection or criticism, even when none was intended.
It’s most common in ADHDers (Attention Deficit Hyperactivity Disorder), but can show up in autistic kids and other neurodivergent profiles too.
As a parent, you know the feeling, watching your child’s face fall over something small. Suddenly it becomes the end of the world. It might be triggered by a friend's text. A teacher calling on someone else. Or a tired tone in your own voice.
And just like that, they’re overwhelmed, crying, shut down, or furious at themselves for a mistake that no one else even noticed.
For your child, the perceived rejection doesn’t register as a small thing that they can just shake off. It is as big of a deal as they are making it.
Their body reacts to the perceived criticism the same way it would react to a bear or some other danger.
And that emotional dysregulation isn’t something they can just turn off.
So as a parent, how can you actually help your child?
RSD treatment controversy
Here's the honest answer. There isn’t even an agreement on whether or not there is anything that actually helps.
Part of the controversy is that RSD isn’t its own diagnosis. It’s not in the DSM-5. So for some people this means that it doesn’t exist at all. But to most people in the neurodivergent community, it is a common enough experience that it’s a recognized struggle.
Many people see it as a part of ADHD or other neurodivergent conditions. Some see it as part of the experience of living in a world not created for your brain, like low self-esteem.
Or it’s a “symptom” tied to the brain differences involved in being neurodivergent. Others think it needs to be studied as its own thing entirely.
So when you search for treatment for RSD, you get mixed answers. Some will tell you ADHD treatment itself helps, others focus on emotional regulation.
The lack of a single answer doesn’t mean that your child’s experience isn’t real or that nothing can help. It does mean that treatment might need to be created for your specific child, not just one size fits all.
So this blog is going to cover some promising options.
RSD treatment options that are showing some promise
Treatment for rejection sensitive dysphoria usually means a combination of things or trying different things until you know what will work.
Many of the more promising options focus on helping the nervous system itself, not just the thoughts involved. These treatments focus on the physical experience of being embarrassed and the anger that these kids experience. Not just on the thoughts as they enter the person's head.
This makes sense when you think of RSD being mostly a body response.
Somatic and grounding exercises, like deep breathing or changing your temperature, can help your child to calm themselves down once their RSD has been triggered. It helps them without needing to talk through what happened. Especially since talking about it can escalate things even further.
Narrative therapy can help your child make sense of their story around fear of rejection and fear of failure instead of just reacting.
Some skills-based approaches can also be helpful. General emotional regulation skills and things like distress tolerance skills from DBT can help your child ride the wave of emotion instead of letting it take over.
Mindfulness can also be helpful. It allows your child to be aware of what is happening in their body before it takes over completely. They learn to understand what the shame and rage feel like in their body.
Some somatic or body-based therapies can be quite helpful things like Brainspotting or Accelerated Resolution Therapy. Especially if the RSD trigger is also triggering past traumatic events.
As your child gets older, journaling might be helpful in allowing them a safe space to express their feelings and help them to develop some self-compassion.
Lastly, understanding what RSD is and why it happens can be really powerful in allowing them to feel less weird and out of control. This type of psychoeducation about neurodivergence can be extremely helpful. Group therapy with other neurodivergent kids can also help with the feeling of isolation.
All of this takes work on your child’s part. But if they are willing to do the work, it can help them to feel better in these moments when the RSD is triggered.
Medication options
There have been some reports that medication can be helpful, especially medication that treats the underlying ADHD.
Stimulant medications like methylphenidate are usually the first option, since they help with the emotional intensity that comes with ADHD, not just focus and attention.
There are also some reports that alpha 2 receptor agonists like clonidine or guanfacine can be helpful for the RSD symptoms by themselves. These work by lowering the probability of nervous system dysregulation, lowering stress signals to the brain.
It’s important to be aware that rejection-sensitive dysphoria can cause extreme mood swings, which from the outside might look like borderline personality disorder, bipolar disorder, and other mood disorders. It can be complicated to know which is which, so make sure that your psychiatrist is well informed about neurodivergent-affirming care.
The medication decision is a decision that each family makes with their healthcare provider. But it’s worth knowing that medication is an option that some parents have found effective.
But it’s definitely not the answer or even the only answer.
Cognitive Behavioral Treatment for RSD
Cognitive Behavioral Therapy, also known as CBT, is one of the most commonly recommended treatments when people search for RSD.
CBT focuses on changing your thoughts, feelings, and behaviors by helping your child to notice the cycles and thoughts that happen when RSD is triggered.
For example, the negative self-talk “no one likes me”, “everyone is going to see that I suck”, or “I’m not good at anything”. CBT would teach your child to notice those thoughts, the physical experiences surrounding them, and the behaviors involved. They would then be taught to change the thoughts, feelings, and behaviors.
It would teach them to challenge the negative self-talk when it comes up. Teach them how to keep their background stress lower, theoretically lowering the child’s reactivity.
CBT also helps them find other ways to act when they are upset. The idea is that instead of just believing the self-talk, they will learn to counter those thoughts and feelings.
The difficult part of Rejection sensitivity though, is that it’s an instantaneous reaction. It hits your child faster than a thought or any awareness. Their body has already responded before they get to the point of changing the thought or their behavior.
For some kids, it can help, but it isn’t enough on its own.
Other therapies that CBT can be paired with for higher effectiveness are DBT skills and somatic and nervous system work like some of the therapies mentioned above.
This gives your child tools to use when their RSD is triggered.
Talking About It
One of the most helpful things you can do for your child is talk about RSD and what it is. This allows both you and your child to understand that even though it feels intense, they aren’t going crazy, and neither are you,
Giving it a name and talking about how other people experience it lessens some of the shame and helps your child feel less isolated. Instead of thinking something is wrong with them, or that they are too sensitive, or dramatic, or whatever the world has been telling them.
They can understand this is their nervous system trying to protect them.
For neurodivergent kids that already struggle with low self-esteem, self-worth, and feeling self-conscious about their behavior, this is really important. Many kids with RSD are also people pleasers, as they’ve learned that going along with the flow or being perfect keeps them from standing out or being rejected.
Naming RSD and understanding what it is helps lower the pressure of perfectionism and helps them understand their reactions.
This is a conversation you will have over and over again as your child gets older, and that’s okay. It’s part of teaching your child about their own brain.
How RSD changes with age
Many parents notice that their child’s RSD seems to calm down or go away. But that’s not always what is happening.
Usually the child becomes aware that other kids don’t get as upset about things or aren’t so loud about their feelings when they are rejected. When they realize they often start to hold their reaction inside.
This is called masking. It doesn’t mean that they are no longer having the feelings or the reaction, they are just learning to hold it in.
They are still having those big feelings and mood swings, they are just internal. They just aren’t showing them in the moment. This is why, at times, your child will come home and is just grumpy. Or immediately starts crying as soon as they get in the car after an activity or even school.
They didn’t ignore the rejection, it’s still playing in their head over and over again. They are still spiralling in self-criticism, but they are just doing it quietly when they are in front of others.
In the moment, they might act like everything is fine. You might watch them go quiet all of a sudden, and they might be physically present, but you can tell emotionally they aren’t there.
Remember, just because you can’t see it when your child is in front of others doesn’t mean that it isn’t happening anymore. It just means they’ve gotten better at hiding it.
There is a big difference between the two.
The masking might mean that you see a new problem crop up on top of the RSD, things like social anxiety, depression, or even a pattern of avoidance that’s subtle, but when you look at it, it really is there.
The RSD doesn’t get smaller, it just hides under the surface.
Managing your own nervous system or RSD
Even if you don’t have RSD yourself, watching your child struggle with it is hard. If you do have RSD or you are also neurodivergent (it’s often genetic), it can hit even harder.
Watching your child go through RSD is hard, even if you don't have it yourself. If you do have it, or you're neurodivergent too, their experience can be so much harder to watch.
Your child’s nervous system isn’t the only one affected. They aren’t the only one whose body is saying You’ve got to get out of here, your life is in danger. Yours is too.
You might suddenly be aware of your chest tightening, your pulse racing, or your own urge to stop your child’s emotional pain, so it stops for both of you.
If you also experience RSD, you might experience the rejection physically with them as though it’s your own. Their rejection and embarrassment feel like your own.
Their two possible reasons for this are either you are reliving your own rejection trauma through them, or you are experiencing something called hyperempathy, which means you’re experiencing the feelings alongside them in real time.
This makes it important for you to have your own ways to stay regulated. Performing calm on the outside when you are falling apart on the inside is just going to make it worse for both of you,
It’s important to learn to be the anchor your child needs in the moment.
Therapy to help you stay regulated when your child has RSD, whether they are going through treatment or not
Playing the role of grounder for your child is a tall order and a big reason why you need to find your own ways to stay regulated.
This might look like finding your own grounding practices, learning to recognize when you are activated, or seeking your own therapy.
As your neurodivergent-affirming therapist in California, I can help you navigate figuring out what treatment for RSD might work for your child. I can also help you learn to decrease your reactivity and dysregulation in these situations.
I work with parents of kids with a broad range of needs and stages, including high-masking and non-speaking children, school difficulties, homeschooling, PDA, and transition to adulthood.
I provide supportive therapy and trauma-focused modalities including accelerated resolution therapy (ART) and Brainspotting.
These therapies can help you stay calm even when your child has a history of severe dysregulation or other traumatic events like eloping and aggression.
Even if nothing works for them they know that you are there.
You can’t help calm an overwhelmed child when you are overwhelmed yourself. Therapy is often a piece of finding the self-care you need to be present for your child.
I can help you reach that calm so you can be there for your child the way that you want to.