Good morning from The Clinical Compass! For my next blog post, I wanted to dive into a topic that impacts me on both a profession and personal level. In the field of social work, accurately diagnosing clients is highly important to ensure a client's success. While executive dysfunction linked to Attention Deficit/Hyperactivity Disorder (ADHD) are adequately established by the DSM-5-TR, the significant emotional dysregulation is often ignored. Rejection Sensitive Dysphoria (RSD), a condition that causes an extreme emotional response to a perceived rejection or criticism. RSD is often developed in early childhood and is usually a result of trauma.
RSD as an Emotional Dysregulation: Why RSD should be included
1.) A significant factor of ADHD is emotional dysregulation
Emotional Dysregulation, or ED, is most common in the inattentive type of ADHD, and it is now acknowledged by physicians and researchers as a key component of the disorder. Research conducted by experts suggest that such emotional issues are a result of problems with one's memory and hindering of controlling one's emotions.
Instable emotions, which are often more intense than participants observed in control groups, are heavily linked to ADHD (Shaw et al., 2014; Skirrow et al., 2014). As for relationships and performance reviews, RSD could be the most common aspect of this ED.
2.) Diagnostic Validity
The center point of the diagnostic criteria in the DSM revolves around cognitive thinking and behaviors. However, adults with ADHD tend to experience the most intense emotional disruptions. This often elevates the risk of suicide and can cause rifts between professional and personal relationships.
The addition of RSD to the diagnostic criteria of ADHD would enhance the validity of the disorder, especially highlighting the intense fear of rejection that comes with RSD. This is particularly a common occurrence in women and adults, who often suppress their emotions.
3.) Effect of Treatment
The benefits of recognizing RSD as ADHD diagnostic criterion would rapidly increase:
Targeted Treatment: Specific interventions could be provided by physicians more promptly. RSD symptoms can be improved with non-stimulant drugs, like guanfacine and clonidine. Stimulant drugs do not have the same impact for treating RSD.
Decreasing the Probability of a Misdiagnosis: Clients with ADHD are sometimes misdiagnosed with other disorders, such as Major Depressive Disorder (MDD) or Borderline Personality Disorder (BPD). Recognizing RSD as diagnostic criterion for ADHD could greatly decrease the chances of clients being misdiagnosed. While RSD symptoms may consist of comorbidities for other disorders, they are different in terms of planning and organization (Katzman et al., 2022).
Conclusion
The DSM would proceed to a more informed understanding of ADHD with an inclusion or RSD. At the very least, adding criterion that addresses emotional dysregulation would provide a more in depth understanding of the diagnosis. Acknowledging RSD as a social worker is the most practical decision when committing to advocating for their clients.
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