Rejection Sensitive Dysphoria (RSD) can significantly impact relationships for individuals with ADHD, often leading to misunderstandings, emotional turmoil, and relational difficulties.
Rejection Sensitive Dysphoria (RSD) is a term used to describe extreme emotional sensitivity and reactions to rejection in people with ADHD. It is thought to be a part of emotion dysregulation, a common sign of ADHD.
Dr William Dodson, one of the leading professionals who discusses RSD explains how it is one of the most debilitating parts of ADHD:
“A person can’t continue to function. It takes over their lives for hours to days, and it’s an overwhelming emotional experience that people can’t describe.”
This heightened sensitivity to perceived or actual rejection is a common experience for many with ADHD, but it’s not always well understood.
Ironically, the behaviors and coping mechanisms that stem from RSD can sometimes lead to more rejection, creating a challenging cycle in relationships.
This article explores how RSD manifests in ADHD relationships, and its effects on both partners and offers practical strategies for managing these challenges.
By understanding and addressing RSD, individuals with ADHD and their partners can work towards building stronger, more resilient relationships.
Misunderstandings and misinterpretation
People with ADHD who struggle with RSD may misinterpret their partner’s actions even neutral or positive ones, as signs of rejection.
For example, they might misinterpret a partner’s need for space as a withdrawal of love.
They might also feel like their partner is unhappy with them and question little things their partner does.
“I am constantly under the impression my girlfriend is mad or annoyed at me when she’s been quiet for too long.”
For instance, their partner may take a few hours to respond to their messages. They immediately jump to conclusions about their partner not wanting to be with them anymore or cheating on them. In reality, they might be busy, their phone battery died, or any number of other possibilities.
A person with ADHD might experience a lot of anxiety around this and could develop trust issues based on misunderstandings.
The non-ADHD partner may be confused and frustrated by their partner’s misinterpretations and may repeatedly feel the need to defend themselves and reassure which can be exhausting.
How to manage misunderstandings and misinterpretations
Recognise RSD patterns
The first step is to become aware of your RSD triggers and how it manifests in your relationship.
You could do this by journalling, allowing yourself to write expressively to find patterns in your thoughts.
By recognizing the pattern of misinterpretations and negative thought spirals, you can start to challenge those thoughts and develop healthier responses.
Communicate openly
If you feel hurt or rejected, talk to your partner about it in a calm and non-accusatory way. Express your feelings and explain how their actions might have been perceived, without placing blame.
For example, you could say: “I felt anxious when I didn’t hear from you for a few hours. My mind jumped to negative conclusions, which might be my RSD talking. Can we talk about what happened and how to handle this in the future?”
Remember to use “I” statements to express your feelings and to avoid sounding confrontational.
Practice mindfulness
Engage in mindfulness exercises to help stay present and grounded. This can help reduce impulsive reactions and create space for more rational thought.
Sara Kelly, ADHD coach suggests using your phone for mindful breathing:
Trace your finger along the edge of your phone while inhaling for 4 seconds, hold your breath for 4 seconds, then exhale for 4 seconds while tracing the opposite edge of the phone so you are essentially drawing a rectangle with your finger.
Advice for partners
Educate yourself about RSD
Understanding the complexities of RSD and its impact on your partner is crucial. Research by reading resources like this article and learn about common triggers and reactions.
Be patient and empathetic
Remember that RSD is not a choice, but a real and often debilitating experience for your partner. Offer gentle reassurance and validate their feelings, even if you don’t fully understand them.
Communicate clearly
While it is not advisable to police every word you say, try to be mindful of your communication style and avoid ambiguous language that could be easily misinterpreted.
For example, if you need space for whatever reason, you could say to your partner: “I am feeling overwhelmed/tired/stressed right now so I am going to have some alone time to recover. We can talk when I am feeling more refreshed.”
Communicating in this way is also a good way to set healthy boundaries with a partner.
Offer support, not solutions
Instead of trying to fix the situation or dismiss their feelings, focus on providing emotional support and understanding.
Sensitivity to criticism
Being in a relationship with someone with ADHD can have its challenges such as the ADHD partner being disorganized or forgetful.
A non-ADHD partner may make critical statements to their partner such as “You always forget everything I tell you,” or “You never tidy up after yourself.”
This criticism, even if unintentional can make the ADHD partner with RSD feel extremely hurt and shameful for letting their partner down.
They might internalize negative feedback which can take a hit on their self-worth, coming to the conclusion that they are fundamentally flawed.
According to a qualitative study, adults with ADHD reported that criticism, even if it is well-received, can still have negative emotional consequences, such as anxiety.
The non-ADHD partner may feel hesitant to provide feedback or express their needs in the relationship, for fear of upsetting their partner. This can lead to resentment and a lack of open communication in the relationship.
How to manage sensitivity to criticism
Challenge negative self-talk
When you receive criticism, try to separate the feedback from your self-worth. Adjust negative thoughts like “I’m a failure” with more balanced statements like “I made a mistake, but it doesn’t define me.”
Think about what you would say to your partner if they made the same mistake. Would you call them a failure? Or would you acknowledge that mistakes are inevitable and that’s ok?
Focus on strengths
Remind yourself of your positive qualities and accomplishments to counteract feelings of inadequacy.
For example, recognize how far you have come in your relationship and the obstacles you have overcome together.
Consider what you bring to the relationship and the reasons why your partner chooses to be with you.
Practice self-compassion
Treat yourself with kindness and understanding, acknowledging that everyone makes mistakes.
Advice for partners
Choose words carefully
Be mindful of your tone and language when offering feedback. Focus on specific behaviors rather than making generalizations that can sound too critical (and are probably untrue!)
For instance, instead of saying “You never tidy up after yourself,” you could say “I’ve noticed the living room has been cluttered lately. Could we work together on keeping it tidy?”
Re-wording feedback should reduce defensive language from your partner who would otherwise feel blamed and attacked.
Sandwich criticism with praise
It’s important to make sure your own needs are being met so it’s important to share feedback with your partner if a need is not being met, but make sure this is said mindfully.
A way to do this is to start and end the feedback with positive affirmations to soften the impact of criticism.
The ADHD partner may be inclined to focus on perceived negative feedback, so make sure to make it explicitly clear what you appreciate from them and how they make you feel loved.
Reassure that although you have an unmet need, this does not define the relationship as a whole.
Focus on solutions, not blame
When addressing issues, try to create a team mentality by focusing on collaboration, rather than assigning blame.
This helps to reinforce that you are on the same side, working together to solve a problem, rather than opposing each other.
Avoidance behaviors
Due to an intense fear of rejection, people with ADHD may simply avoid getting into relationships in the first place.
Dr Dodson, who specializes in ADHD and RSD says that:
“I’ve got dozens and dozens of people in my practice who have never been on a date. The notion of asking somebody on a date, or just getting that close to somebody… the relationship could end unhappily or whatever. It’s terrifying.”
Someone with ADHD may self-sabotage as soon as they begin developing romantic feelings towards another person or impulsively break up at the first sign of perceived rejection or criticism.
Likewise, they may try anything they can to avoid having challenging conversations with their partner where their partner wants to share relationship feedback.
This avoidance can prevent the person with ADHD from experiencing the joys and benefits of close relationships.
The non-ADHD partner may feel rejected or unimportant as a result of their partner’s avoidance behaviors. They may feel like their partner is not invested in the relationship or that they are not a priority.
How to manage avoidance behaviors
Identify avoidance patterns
Pay attention to situations or conversations you tend to avoid. Recognize the underlying fear of rejection driving these behaviours.
Gradually challenge avoidance
Start by taking small steps outside your comfort zone to help challenge your avoidance patterns.
For example, if you struggle with having difficult conversations with your partner, start by discussing minor issues or concerns that feel less threatening.
Or, if face-to-face conversations feel too intimidating at first, start with text messages or emails to express your thoughts and feelings.
Create a safe word or signal
Establish a pre-agreed “safe word” or signal with your partner that either of you can use when feeling overwhelmed during a conversation or interaction.
This can provide a non-confrontational way to pause or exit a challenging situation without feeling like you’re running away or rejecting your partner.
Advice for partners
Encourage open communication
Create a safe space for your partner to share their fears and concerns without judgment.
Respect their boundaries
Don’t pressure them into situations they’re not comfortable with because this can cause them to avoid further.
Support their efforts to challenge avoidance at their own pace and go slowly if this works better for them.
Reassure them of your commitment
Regularly express your love and appreciation to help alleviate fears of abandonment. However, make sure you are not overly reassuring to the point that it is exhausting for you.
Intense emotional reactions
Being sensitive to rejection can mean that people with ADHD might display more ‘explosive’ emotions when they experience real or perceived rejection in their relationships.
They might become angry or cry uncontrollably due to the hurt they are experiencing.
They might be seen as ‘oversensitive’ or taking everything personally. They may make a small relationship problem into a massive problem that takes a long time to recover from and resolve.
These intense emotional reactions can be overwhelming for the person experiencing them and can damage their relationships.
The non-ADHD partner may feel frightened or overwhelmed by their partner’s intense emotional reactions. They may also feel like they are walking on eggshells, constantly worried about triggering an emotional outburst.
How to manage intense emotional reactions
Have some space
While it can be tempting to impulsively react when you experience real or perceived rejection or criticism, try to step away from the situation to reflect.
Sara Kelly advises waiting at least 24 hours before responding. Use that time to process your emotions, gather perspective, and think about how you are going to respond.
Communicate needs
Let your partner know what you need from them during emotional moments. For example, you might need space to calm down or a reassuring hug.
It might help to vocalize to them that you are feeling intense emotions so you are putting a label to it. You could say: “I feel very upset because I am feeling rejected, although I know this is not accurate.”
Seek professional support
Therapy can help you understand and regulate your emotional responses more effectively.
Advice for partners
Stay calm and grounded
When your partner is experiencing intense emotions, try to remain calm and present. This can help de-escalate the situation.
If you also react with strong emotions, this could elevate the situation. Give yourself space if you need to calm yourself.
Validate their feelings
Avoid dismissing or minimizing their emotions. Acknowledge their feelings and offer empathy while also calmly advocating for your own feelings and needs.
This does not mean that you should tolerate hurtful words and yelling. If this happens, explain that you do not appreciate being spoken to like this and that you will give them time alone to calm down.
Respect their need for space
If they need time alone to calm down, give them that space without taking it personally.11
People-pleasing and perfectionism
People with RSD often adopt coping mechanisms to avoid the pain of rejection. These can include becoming people-pleasers who constantly strive to meet their partner’s needs and expectations, potentially losing themselves in the process.
“I feel like I can be a bit much in relationships because I am so worried about being rejected that I am always trying so hard to maintain the relationships which sometimes ends up pushing people away.”
Others may become perfectionistic, driven by a fear of being criticized or found inadequate. They may attempt to hide their mistakes so as to not disappoint their partner. This could mean they lie to hide their perceived flaws.
While people-pleasing may seem helpful on the surface, it can be detrimental in the long run. Dr. Dodson warns that people-pleasers often neglect their own needs and desires, leading to resentment and a loss of self.
The non-ADHD partner may initially appreciate their partner’s efforts to please them. However, over time, they may start to feel suffocated by the lack of boundaries and the constant need for approval.
The relationship may lack authenticity, as the person with RSD is not expressing their true self. Likewise, if their partner catches them out in lies or cover-ups, this could damage the trust in the relationship.
How to manage people-pleasing and perfectionism
Identify people-pleasing patterns
Recognise when you are saying “yes” to things you don’t want to do or sacrificing your own needs to please your partner.
If you try to be a perfectionist, consider the reasons why you feel the need to be perfect and what your perfectionist behaviors are.
Practice setting boundaries
Start saying “no” to requests that you are not comfortable with. Communicate your needs and limits clearly to your partner.
Practice vulnerability
If you tend to use perfectionist strategies to hide mistakes, try to start small by sharing minor mistakes or struggles with your partner.
When admitting to a mistake or struggle, focus on your feelings and experiences rather than making excuses. For example, “I feel ashamed that I forgot to pay the bill, and I was afraid to tell you.”
You can even approach this with humor to reduce the seriousness and create a more relaxed atmosphere.
For example, “So, remember how I said I’d handle dinner tonight? Well, good news and bad news. The good news is I’ve discovered a foolproof way to trigger every smoke alarm in the house simultaneously. The bad news? Our dinner may have achieved a state of matter previously unknown to science. Shall we order pizza instead?”
Advice for partners
Encourage authenticity
Let your partner know that you value their true self and that you don’t need them to constantly please you. Foster a judgement-free environment.
If your partner shares something vulnerable with you, no matter how small, respond kindly and positively such as thanking them for opening up.
It’s equally important to be authentic with your partner and share your mishaps and worries so they feel more encouraged to share their own.
Respect their boundaries
Support their efforts to set limits and say “no” when necessary. Reassure them that they have the right to say no to things and to have their own thoughts and opinions that differ from yours.
Focus on connection, not perfection
Encourage activities that foster emotional connection, such as sharing experiences, discussing values, or simply spending quality time together.
Conclusion
While RSD is a challenging aspect of ADHD, it’s crucial to recognize that the behaviors it triggers can inadvertently lead to more actual rejection in relationships.
Misinterpretations, avoidance, intense emotional reactions, and people-pleasing can strain even the most loving partnerships, potentially pushing away the very people individuals with RSD fear losing.
Managing RSD is not just important for the person with ADHD, but for their partner as well. For the individual with ADHD, addressing RSD can lead to improved self-esteem, more authentic relationships, and a reduction in emotional distress.
For their partner, it can result in a more stable, trusting, and fulfilling relationship.
By working together to understand and navigate the challenges of RSD, couples can break the cycle of perceived and actual rejection, fostering a stronger, more resilient bond.
References
Beaton, D. M., Sirois, F., & Milne, E. (2020). Self-compassion and perceived criticism in adults with Attention Deficit Hyperactivity Disorder (ADHD). Mindfulness, 11, 2506-2518. https://doi.org/10.1007/s12671-020-01464-w
Beaton, D. M., Sirois, F., & Milne, E. (2022). Experiences of criticism in adults with ADHD: A qualitative study. Plos one, 17(2), e0263366. https://doi.org/10.1371/journal.pone.0263366
Canu, W. H. (2004). Rejection sensitivity, self-monitoring, and heterosocial adjustment of young men with attention-deficit/hyperactivity disorder (ADHD). The University of Texas at Austin.
Dodson, W. W., Modestino, E. J., Ceritoğlu, H. T., & Zayed, B. (2024). Rejection Sensitivity Dysphoria in Attention-Deficit/Hyperactivity Disorder: A Case Series. Neurology, 7, 23-30.
Ginapp, C. M., Greenberg, N. R., MacDonald-Gagnon, G., Angarita, G. A., Bold, K. W., & Potenza, M. N. (2023). “Dysregulated not deficit”: A qualitative study on symptomatology of ADHD in young adults. PloS one, 18(10), e0292721. https://doi.org/10.1371/journal.pone.0292721
Greenblum, M. (2023). The impact of ADHD on quality of life and peer relations in college students.
Müller, V., Mellor, D., & Pikó, B. F. (2024). Associations Between ADHD Symptoms and Rejection Sensitivity in College Students: Exploring a Path Model With Indicators of Mental Well-Being. Learning Disabilities Research & Practice, 09388982241271511. https://doi.org/10.1177/09388982241271511
