Is It Rejection Sensitive Dysphoria or Complex Trauma?

Art by Jesse Meadows

There’s a new pathological term picking up speed in the ADHD community: Rejection Sensitive Dysphoria. It describes that feeling we are all familiar with, the intense pain of criticism, both real and perceived, and the tendency to avoid situations in which we might experience it.

It’s not in the DSM yet, but many people are advocating that it should be. When I first read about it, I was comforted. I thought, YES, wow, a name for The Thing! This is why I’m like this!

But as I’ve begun to read about the ADHD industry more critically, I’m starting to wonder if framing RSD as a purely biological difference without considering environmental influence is accurate or helpful.

Am I sensitive to rejection because I am genetically predisposed to be, or am I predisposed to be because people with ADHD get rejected constantly from birth?

We know that stress can change the ways certain genes express and it has been theorized (and debated) that trauma can be passed down in our DNA, but these ideas are often missing from the RSD conversations I see online.

It’s usually “this is just how I am”, with no examination of why that might be.

The way the ADHD industry talks about RSD as if it is scientific fact (despite the fact that Dr. Dodson, who coined the term, cannot seem to provide any research supporting its biological nature beyond his own anecdotal evidence), is also alarming.

Dodson is on the board of ADDitude Magazine, an ADHD trade journal that presents itself as “peer-reviewed” yet frequently cites itself (a practice that is a journalistic integrity no-no at best, and intentionally misleading propaganda at worst).

He made a claim in this ADDitude article that “Psychotherapy does not particularly help patients with RSD because the emotions hit suddenly and completely overwhelm the mind and senses,” which flies in the face of much evidence that distress tolerance skills can be successfully learned through modalities like Dialectical Behavior Therapy.

Originally developed to treat Borderline Personality Disorder, a diagnosis characterized by emotions that also “hit suddenly and completely overwhelm the mind and senses”, DBT has been shown to…