Dear Dr. Trainwreck,

I have a friend with a few mental health diagnoses confirmed by doctors. She has many symptoms, including “rejection sensitive dysphoria”—meaning (as I understand it) she has a hard time accepting any criticism and overreacts to it. I like my friend and want to hang out with her, but this trait makes it very hard to have any kind of serious conversation or resolve any disagreement. She sees any suggestion that she do something differently for somebody else’s sake as a personal attack, shuts down, and just goes, “Why are you being mean to me?” Trying to explain that you didn’t do it to be mean makes it worse! How do I maintain this friendship while still being able to communicate?

Unsigned

Dear Unsigned,

First and foremost, let me be clear, “rejection sensitive dysphoria” (RSD) is not a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). The DSM is as close to a universally acknowledged and accepted ‘manual’ of mental health disorders as we are likely to get. Its use, and the use of the International Classification of Diseases (ICD-11), are the current and accepted means of identifying and defining mental health diagnoses. There has been, and continues to be, a good deal of criticism related to the development and usage of the diagnostic system as a whole; for now, let us put aside the many problems and controversies surrounding the development, use, and dominance of the diagnostic system and of the DSM, and simply accept that it is the system we are currently using—in insurance, in hospitals, in clinics, and even in little art magazine columns. It is ever-evolving, meant to change and grow alongside us; ideally, the DSM would be scientifically sound, immune to societal pressures and trends…

This article is available in print and in our digital edition. To read the full article, please subscribe.