Rejection Sensitive Dysphoria (RSD) is a term used to describe extreme emotional sensitivity and reactions to rejection in people with ADHD.
Although RSD is not a formal diagnosis or a part of the diagnostic criteria for ADHD, it is widely discussed among clinicians and in ADHD communities.
While anyone can feel hurt or disappointed by rejection, RSD in ADHD is often described as intense emotional responses that can be long-lasting and feel unbearable.
RSD is not specific to ADHD and can be present in other mental health conditions, however, the prevalence of RSD appears to be significantly higher in people with ADHD.
Dr William Dodson, one of the leading professionals who discusses RSD, states that RSD is present in “around 99%” of people with ADHD. However, it is important to note that this percentage is based on clinical observations rather than empirical data.
Dr. Dodson explains that emotion dysregulation is such an important and debilitating feature of ADHD. This means their emotions may be heightened so the emotional impact of rejection is significantly more profound in these individuals.
Other researchers acknowledge that while rejection sensitivity and emotional symptoms are prevalent in ADHD, it is unclear whether these are inherent to ADHD traits or if they are learned responses to repeated rejection.
Signs of RSD in ADHD
If someone with ADHD struggles with RSD and experiences rejection (or perceived rejection), they may display the following signs:
- Sudden emotional outbursts (e.g., crying and anger)
- Complete withdrawal from the situation
- Negative self-talk
- Feeling like a failure
- Feeling intense shame and guilt
- Rumination on the rejection or past rejections
- Respond to the rejection defensively
- Avoid future situations where rejection is possible
- Stop trying or quit completely (e.g., quit a job)
- Overcompensate or overachieve
- Display people-pleasing behaviors as a way to avoid further rejection
- Over-analyze and catastrophize interactions
- Hide their intense emotional reactions to rejection
“When I feel like I’ve been criticized or rejected, it feels like a punch in the gut. It’s this deep upset that’s hard to describe in words, and it often processes alongside an intense anger toward myself or the person the criticism came from.”
“I was sick of never knowing when it was going to hit, of feeling like I had shit together and everything was going great, only to have the rug pulled out from under me and feel like everything was crashing down.”
Examples
- Becoming physically upset at constructive criticism at work, interpreting it as a sign that you are going to be fired
- A friend disagrees with your opinion about something and you take this as a personal attack and believe the friendship will soon be over
- You pass someone you know in the street and they don’t look at or greet you so you believe that they hate you.
- Your partner mentions that you forgot to buy an ingredient for dinner and this makes you feel overwhelmed with guilt and shame
- When the teacher asks a question to the class and you know the answer but you are too afraid to raise your hand in case you are wrong and everyone will think you are stupid
- You talk to someone who has a neutral facial expression or tone of voice and you believe you have done something wrong and they are upset with you
“I am CONSTANTLY feeling rejected by my friends even if the reason they haven’t called/texted in a few days has absolutely nothing to do with me.”
Consequences of RSD in ADHD
RSD can have significant consequences for individuals with ADHD, affecting various aspects of their lives:
Social relationships
People with ADHD may avoid social situations so as to avoid potential rejection, which can make it hard to maintain relationships with others.
Misinterpreting interactions as a rejection could lead to complete withdrawal from relationships.
They may find it extremely difficult to date and have romantic relationships if they interpret a slow response to messages as being ghosted or take every criticism from their partner as a personal attack.
“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.”
Low self-esteem
The negative self-perception associated with RSD can severely damage self-esteem and self-worth. Individuals with ADHD may internalize perceived criticisms, leading to feelings of inadequacy, shame, and worthlessness.
“My self esteem suffers greatly because of it and I find myself ruining things before they even start so there’s no possibility of me getting rejected.”
Diminished work and school performance
The fear of failure and criticism that can naturally come with school and work tasks might lead to people with ADHD avoiding challenges, procrastinating on tasks, or underperforming.
They might not apply to certain jobs or further education for fear of being rejected or quitting when things get hard.
Perfectionism
An alternative to diminished performance is that people with ADHD may overexert themselves and become perfectionists as a way to avoid any sort of rejection.
“Some people try to be perfectionists. Above reproach, always the most admired, accomplished person in the room, but it’s a trap. They have to keep on producing all the time, and they’re constantly running scared lest somebody discover them.” Dr. Dodson.
Perfectionism could result in more frequent burnout from overworking. Also, if these individuals are covering up their struggles with perfectionism, this can result in imposter syndrome.
People-pleasing
Dr. Dodson also explains how people with ADHD and RSD may become people pleasers:
“They have the ability that within two seconds of meeting somebody new, they can tell you exactly what that person likes, approves of, will praise, and that’s what they do. So much so, that very commonly they lose track of what they wanted for their own lives.”
It makes sense that people who fear rejection will just do whatever they believe other people want so as to avoid the pain of being rejected.
However, people-pleasing can contribute to continuing the cycle of RSD. In the cycle of anxiety, failing to test your fears can make anxiety worse – this is also the case with people-pleasing.
If someone is failing to share an opposing opinion (for instance), they are not testing their fear of rejection, and so they are making their RSD worse by continuing to people-please.
Mental health
RSD is closely linked to other mental health challenges common in people with ADHD, such as generalized anxiety, social anxiety, depression, and emotion dysregulation.
Elements of RSD such as catastrophizing relate closely to anxiety disorders. Withdrawing from social situations is a feature of social anxiety. And feelings of guilt, shame, and low self-esteem are common in those with depression.
Therefore, it could be common for people with ADHD to develop one of these disorders as a result of RSD.
Managing Rejection Sensitive Dysphoria in ADHD
Below are some tips for managing RSD if you have ADHD:
1. Become a Detective to Your Internal Narrative
Dr. Sara Kelly, ADHD coach, emphasizes the importance of challenging your thoughts:
“Becoming the detectives to our internal narrative with RSD can bring a little bit of that logical brain into our headspace where so much of our emotional brain is usually taking over the real estate of our brain.”
How to implement:
- When you notice negative thoughts, pause and ask yourself: “Is this a fact or an assumption?”
- Look for evidence that supports or contradicts your thoughts.
- Consider alternative explanations for the situation.
Example: If a friend hasn't replied to your text, instead of thinking "They hate me," ask yourself: "What evidence do I have that they hate me? Could there be other reasons they haven't responded? Have they been reliable in the past?"
2. Practice the Power of the Pause
While it is tempting to impulsively respond to rejection, it can be helpful to wait a while first. You might find that you respond to rejection with more of a level head. Sara Kelly advises:
“Always wait at least 24 hours before responding to perceived or actual rejection.”
How to implement:
- When you feel the urge to respond immediately to a perceived rejection, set a timer for 24 hours.
- Use this time to process your emotions and gather perspective (it might be helpful to seek advice from a trusted person)
- After 24 hours, reassess whether and how you want to respond.
Example: If you receive critical feedback at work, resist the urge to defend yourself immediately. Instead, thank the person for their feedback and say you'll reflect on it. Take 24 hours to process your emotions and consider the feedback objectively before deciding how to respond.
3. Recognize and Validate Your Feelings
Both Dr. Barkley and Sara Kelly emphasize the importance of acknowledging your emotions. Rejection hurts and you should not feel ashamed for feeling hurt. Kelly states:
“Your feelings are valid and rejection does happen and at a way higher rate for us as ADHDers.”
How to implement:
- Name the emotion you’re feeling (e.g., hurt, angry, sad).
- Acknowledge the feeling without judgment (e.g., “I’m feeling hurt, and that’s okay”).
- Remind yourself that your feelings are valid, even if the perceived rejection isn’t real.
Example: If you feel hurt after not being invited to a colleague's party, you might say to yourself: "I'm feeling hurt and left out. These feelings are valid, even if there wasn't an intention to exclude me."
4. Use Physical Techniques for Emotional Regulation
Physical techniques can help ground you in the present moment rather than focusing on negative self-thoughts and self-criticism. Sara Kelly suggests:
“A great way to regulate your nervous system when you are in that fight or flight mode is to Splash cold water on your face or to get some frozen vegetables or an ice pack and put them on your face and your neck.”
How to implement:
- Keep ice packs in your freezer or at work.
- When you feel overwhelmed by RSD, apply the ice pack to your face, neck, or wrists for 15-30 seconds.
- Focus on the physical sensation as a way to ground yourself.
5. Practice Mindful Breathing
Mindful breathing, the practice of deliberately focusing on your breath, can help manage RSD by interrupting rumination on perceived rejections, calming the heightened emotional responses typical of RSD, and creating a mental space to respond more rationally to triggering situations.
Sara Kelly describes a breathing technique using your phone or something rectangular-shaped that you can easily access.
How to implement:
- Hold your phone in front of you.
- Trace the outline of your phone with your eyes, breathing in for 4 seconds.
- Hold your breath for 4 seconds.
- Exhale for 4 seconds while tracing the phone’s outline in the opposite direction.
- Repeat until you feel calmer.
6. Seek Support from a Trusted, Logical Friend
Talking to a person who is good at maintaining a balanced perspective can help ground you when you are feeling overwhelmed by perceived or real rejection or criticism. Kelly advises:
“Call a trusted logical friend to gain perspective. You don’t want to call someone who is going to add fuel or logs to your emotional fire.”
How to implement:
- Identify friends who are good at providing objective, calm perspectives.
- Reach out to them when you’re experiencing RSD.
- Explain the situation and ask for their viewpoint.
Example: "Hey [friend's name], I'm feeling really upset because my boss critiqued my presentation. Could you help me look at this situation objectively?"
7. Practice Self-Compassion
Be kind to yourself and your thoughts. Know that you are not alone in experiencing the pain of rejection.
It might help to imagine someone else experiencing your thoughts and emotions and thinking about what you would say to them. Kelly asks:
“Would you speak to your 10 year old self the way you talk to yourself when you are being hard on yourself?”
How to implement:
- When you notice self-critical thoughts, pause.
- Imagine you’re speaking to a younger version of yourself or a close friend.
- Rephrase your self-talk to be kinder and more supportive.
Example: Instead of "I'm so stupid for making this mistake," say to yourself: "It's okay. Everyone makes mistakes sometimes. What can I learn from this?"
Remember, managing RSD is a process. Be patient with yourself as you practice these strategies, and celebrate small improvements along the way.
Opposing Viewpoint: Challenging RSD in ADHD
Not all experts agree with the concept of Rejection Sensitive Dysphoria (RSD) in ADHD. Dr. Russell Barkley, a prominent ADHD researcher, argues against its validity:
“RSD is not a valid disorder. RSD is not necessary to be added into ADHD in order to understand the strong emotional reactions that people with ADHD have.”
Barkley contends that emotional dysregulation is already an inherent part of ADHD due to executive functioning deficits:
“ADHD already has a basis for explaining the high levels of emotional behavior that we see in people with ADHD.”
He cautions against creating new disorders for specific emotional reactions and advocates for addressing these issues through established ADHD treatments like medication, cognitive behavioral therapy, and mindfulness practices, rather than introducing new concepts with limited scientific basis.
Do You Experience Rejection Sensitivity Dysphoria?
Reflect on these questions to explore whether you might be struggling with RSD:
- Do you often feel devastated or experience intense emotional pain when you perceive criticism or rejection, even if it’s minor?
- Have you ever avoided opportunities or relationships due to fear of potential rejection?
- When someone doesn’t respond to your message immediately, do you tend to assume they’re upset with you or don’t like you anymore?
- Do you find yourself going to great lengths to please others, often at the expense of your own needs or desires?
- Have you ever reacted with sudden anger or withdrawn completely after perceiving rejection in a social or professional situation?
- Do you frequently replay past interactions in your mind, focusing on moments where you felt judged or rejected?
- When receiving feedback, do you struggle to separate constructive criticism from personal attacks?
- Have you ever quit a job, ended a relationship, or abandoned a project due to a perceived slight or fear of future rejection?
Note: While these questions can help you reflect on your experiences, they are not a diagnostic tool. If you consistently relate to many of these scenarios, consider discussing your concerns with a mental health professional who specializes in ADHD.
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
