Many relationships can be saved with proper RSD diagnosis

KUALA LUMPUR, 7 Sept 2019:

Being stressed is a natural part of life and how you manage such pressure impacts people around you.

Common wisdom is that people generally tend to react in two ways to stress – they either revel in and laugh at it, or they just get highly-strung and need to calm down before being able to focus on whatever pressure it is they’re faced with.

While it’s clear the former group of people would be those you’d be always glad to be with in times of tension, it’s rare to find someone who readily admits they really fall into the second category.

In a work environment, it’s possible to take some time out before taking on pressures – but how often does anyone get the chance to do the same in closer relationships?

The many instances of break-ups and divorces point to aggravated stress over differences which a lot find really hard to overcome – and so, they go their separate ways with deep-rooted resentment.

But should this always be the case?

A relatively recent medical malady diagnosis called Rejection Sensitive Dysphoria (RSD) suggests one possible underlying cause of relationship tensions is simply not being able to cope with stress, leading to destructive meltdowns.

Specifically, people with RSD have a condition where they simply cannot manage any form of rejection, said Prince Court Medical Centre consultant clinical psychologist Urmilah Dass in an interview.

“How they react to any perceived rejection is by making it personal. This in turn, affects their mood negatively.”

Often mistaken for chronic depression, having anger management issues or bipolar disorder – due to many similarity in symptoms – Urmilah said there are some differences to look out for.

“It is different from poor anger management because someone with RSD perceives feedback negatively, which may cause them to act out or withdraw completely. Bipolar, depression and poor anger management may be the long term effects of unchecked RSD.”

Lack of awareness, not denial

To better understand how someone’s reaction may potentially be due to RSD, here’s an example – if that person is praised, do they welcome it or will this trigger some sort of negative reaction because they suspect a ‘but’ is coming next?

The backlash may not occur immediately – how they’re about to be denied something, insulted or receive other forms of potential rejection will churn through their minds for hours and days. This makes them cold or even rude to the person who praised them.

Others around sense tension in the RSD person and just keep their distance. They’re not sure what’s bothering this RSD person, who’s likely even unaware he or she is projecting resentment or just coming across as high-strung.

Pointing out this awkward tension or just nodding will be perceived as rejection enough to trigger an ugly outburst. So this RSD person is simply left alone to fester in their thoughts, unaware and unable to get the help they need to snap out of their bad mood.

Another possible reaction is this RSD person seeking to please over and beyond expectations, often described as being a crowd-pleaser, or coming across as being super perfectionist or sometimes even seen as hypocritical or ‘artificial’.

Any which way, this RSD person feels like a failure all the time. During outbursts, they often exaggerate how people are against them, or how much people dislike them, or they carry long-term shame. It’s clearly an over-reaction, but they can’t stop themselves.

Sadly, RSD manifests itself less when around strangers or acquaintances – it becomes highly visible mainly with people the afflicted person is close to like family or significant others, because the impact of perceived rejection is far more devastating.

What’s worse is when this RSD outburst is seen as being unreasonable by people close to the afflicted person – instead of understanding it’s beyond that RSD person’s ability to control rage. Lack of awareness escalates the fight-or-flee response. And relationships break down.

Managing RSD

Because RSD is not yet classified as an official disorder in the Diagnostic and Statistical Manual of Disorders used by the medical and psychiatric profession globally, getting it diagnosed can be difficult.

“There may be a genetic link possibility in some cases. In order to explore this area, detailed family history must be taken,” said Urmilah.

While RSD can be diagnosed from a young age, many people are unaware of their condition well into adulthood, she noted. And the treatment first starts with getting the RSD person to recognise trigger factors.

“If RSD is diagnosed when one is older, it may take a longer time to re-learn the way they think and change behaviours. It is do-able as long as the person in question wants to get better.”

Studies have found those diagnosed with attention-deficit hyperactivity disorder (ADHD) tend to develop RSD as they get older, and this condition may even be part of the autism spectrum disorder.

No official statistics have been compiled yet on RSD incidence. As an indicator, Sabah Health and People’s Wellbeing Minister Datuk Frankie Poon Ming Fung recently said 29.2% of Malaysians were identified to have mental health issues.

So, given its quick-trigger symptoms, it may actually make sense to view someone as possibly having a degree of RSD – unless it is completely ruled out.

“Prevention is better than cure. Hence, creating awareness is key,” noted Urmilah. “When self-esteem is low, negative thoughts and negative emotions arise. Negatively perceiving information becomes a learned behaviour, which in turn may become RSD.”

 Treatments in Malaysia

“Any form of mental illness is treated at public hospitals and when necessary, there is the possibility of admission. In private hospitals a mental health patient can be seen at out-patient specialists clinics or at the ER.

“Unfortunately private hospitals are not equipped for  admission of mental health patients because they do not have trained nurses in this field nor a separate wing for these patients.”

She said getting treatment and therapy in a government hospital is very cheap and affordable. “Unfortunately, there is a long wait time for follow-ups and there is the possibility of being treated by different doctors each time you go.

“In private practice or private hospitals, you have regular scheduled appointments where you see the same specialist but the cost can be quite high.”

While the first stage RSD treatment may be perceived as psychiatric in nature, Urmilah said: “Stigma about mental health has reduced over the years. Malaysia has improved in this area but we still have a way to go.

“But if needed, medication may help the RSD person process information healthily, improve self esteem and this may change behaviours.”

What to look for as RSD symptoms

While the following list isn’t conclusive without a proper diagnosis by a medical expert, a person should consider getting checked for RSD if any or all of these apply:

  • setting very high standards for oneself
  • strong emotional reaction without apparent reason
  • extreme shyness
  • depression or depression thoughts
  • constant fear of failure or loss
  • rage towards the situation or person that causes them discomfort
  • low self-esteem
  • seeking for self-approval from family, friends, and/or partners
  • feeling of hopelessness
  • criticise self and others a lot
  • unwilling to apologise or give praise to close kin