What is the relationship between ADHD and rejection sensitive dysphoria (RSD)?

Have you ever been rejected? Maybe you thought you aced an interview, only to receive word that you didn’t get the job. Maybe you approached an acquaintance about getting together for coffee, but they declined. Maybe you tried out for a leading role in a performance, but the director went with someone else. 

No matter the circumstance, it’s hard to hear a “no” when you were hoping for a “yes.” Having difficulty with rejection is a normal response to a challenging situation. It doesn’t mean that there’s anything wrong with you or your mental health. 

However, some people living with attention-deficit hyperactivity disorder (ADHD) have a more intense experience of rejection called rejection sensitive dysphoria (RSD). It’s a form of emotional dysregulation that causes intense physical and emotional discomfort from negative feedback. 

While not a formally recognized symptom of ADHD, many people living with ADHD and other conditions experience rejection sensitive dysphoria. Learning more about RSD can help ensure you get the support you need.

How people with ADHD experience RSD

There’s no test for rejection sensitive dysphoria (RSD), and it’s not a formal diagnosis. But research shows that it’s a common experience for many people living with ADHD. 

People with RSD may respond to negative feedback or perceived disapproval by:

• Feeling intensely self-conscious, rejected, or embarrassed
• Doubting themselves and their abilities
• Having low self-esteem
• Becoming quick to anger or tearing up
• Having trouble regulating their emotions
• Turning their distress inward and feeling sad, depressed, or hopeless
• Striving to win approval by being a people pleaser
• Trying to overcompensate for mistakes by becoming a perfectionist
• Avoiding any task or project they fear could lead to failure
• Feeling physical pain, like knots in the stomach or headaches

As we mentioned earlier, it’s OK to struggle with rejection sometimes. It can be uncomfortable, and it happens to everyone. But keep in mind that RSD isn’t your typical response to rejection. People with ADHD often live with heightened sensitivity to criticism. This can manifest as RSD and make any form of rejection feel catastrophic. 

RSD can also cause people with ADHD to retreat from relationships or pass on opportunities for fear that they won’t succeed. This can negatively affect a person’s ability to sustain healthy relationships, flourish at work or school, and build a strong support system.

Four tips for coping with RSD 

If you have ADHD and you struggle with judgment or rejection, know that you’re not alone. There are things you can do to manage RSD so that you can have strong, healthy relationships. 

If you find yourself in a situation where you’re feeling rejected or criticized and you’re having a big reaction, try:

1. Being mindful of self-criticism: The saying is true: Often, you’re your own worst critic. So pay attention to what’s actually going on and where the rejection or judgment comes from. For example, did your partner really reject you, or is that just your interpretation? What exactly did your partner say?
2. Taking some notes: Sometimes, writing down what happened and what was said can help you see the situation more clearly. You can do this in a journal or even on your phone.
3. Getting some feedback: If you’re feeling rejected, talk to someone you trust, like a colleague or friend who may have witnessed what happened. Ask them to describe their view of the situation, and see if a different perspective can help you feel less criticized.
4. Focusing on the present: When you’re struggling with big feelings, ask yourself where they’re coming from. We all carry emotional baggage from the past that can sometimes surface in the present. But focusing on the here and now can help you stay grounded.

What sets rejection sensitive dysphoria apart from other rejection responses

On the surface, it might be hard to tell if someone is experiencing rejection sensitivity or something more serious like rejection sensitive dysphoria (RSD). So how do you tell the difference? It comes down to the severity of the experience and the impact on a person’s ability to function. 

Someone with rejection sensitivity may feel some anxiety related to a real or perceived rejection. This can have a negative impact on many aspects of their lives. But they do not experience dysphoria, the intense and overwhelming sense of physical and emotional pain that affects people with RSD. 

To illustrate the difference, let’s review an example of how RSD might show up in real life. 

Imagine setting up a first date with a friend of a friend. You decide on a time and location, and you’re really looking forward to it. But when that day comes, your date tells you they had a busy day at work and won’t be able to make it.

Now, most people would probably feel a bit disappointed in this situation. But this experience could lead to deep and severe emotional pain for someone with RSD. While most people would recover quickly from the disappointment and attempt to reschedule, someone with RSD might believe that the other person now hates them. They may feel so distraught that they decide to quit dating altogether, believing that no one would want to spend time with them.

Therapy for rejection sensitive dysphoria

Since RSD is not a mental health condition, there are no medications designed to address it specifically. However, there are several therapies that have been proven effective in treating ADHD more broadly. The following therapies focus on things like self-esteem, self-worth, trauma, and relationships. 

• Narrative therapy: This type of therapy can help you see yourself as separate from your behavior and reframe the story you tell yourself about your life.
• Cognitive-behavioral therapy (CBT): CBT can help you interrupt the negative thought patterns that might be contributing to your RSD and replace them with more positive ones.
• Rational emotive behavior therapy (REBT): A form of CBT, REBT can help you examine the “evidence” behind your unhelpful beliefs about yourself and your relationships.

Find care with Rula 

Most of us don’t like feeling judged or criticized. But if you have ADHD and you feel intense discomfort when you’re faced with difficult feedback, you might be experiencing rejection sensitive dysphoria (RSD). If RSD is creating challenges in your life, help is available. With the right support, you can learn to regulate your emotions, boost your self-esteem, and manage rejection with greater ease.

When you’re ready, take some time to explore Rula’s therapist-matching platform. We can help you find a therapist who takes your insurance and is ready to meet with you as soon as tomorrow. Plus, our network of more than 10,000 providers means you can find a therapist who can help you achieve your unique mental health goals — all from the comfort of home. 

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