How ADHD Can Trigger Rejection Sensitivity Dysphoria

Adults with ADHD can suffer from an extreme reaction to perceived rejection. According to William Dodson, MD:

Rejection sensitive dysphoria (RSD) is an extreme emotional sensitivity and emotional pain triggered by the perception—not necessarily the reality—that a person has been rejected, teased, or criticized by important people in their life. RSD may also be triggered by a sense of failure, or falling short—failing to meet either their own high standards or others’ expectations.”

The word dysphoria is of Greek origin and means “difficult to bear.” in this context, it means that the emotional response to perceived rejection hurts them much more than it does people without ADHD. Having ADHD does appear to raise your risk of RSD significantly. There are several factor that may contribute to this:

  • The central nervous system tends to be triggered in different ways in individuals with ADHD.
  • People with ADHD may sometimes have behaviors that put them outside of typical social norms. So this could create situations where those with ADHD sense signals that they are being seen as “other,” creating a vicious cycle.
  • The tendency toward impulsivity that typically accompanies ADHD can make someone interact in ways that sabotage their social  interactions further.

The condition can manifest in two ways.

  • The emotional response is directed inward- RSD can imitate a full, major mood disorder including thoughts of suicide. The rapid shift from feeling perfectly fine to feeling intensely sad that results from RSD is often misdiagnosed as rapid cycling Bipolar Disorder. Physicians may take a long time to recognize that these symptoms are caused by the sudden emotional changes associated with ADHD and rejection sensitivity, while all other object relations appear completely normal.
  • The emotional response is directed outward – RSD looks like instantaneous rage at the person or situation responsible for causing the pain. In fact, research shows that 50% of people who are assigned court-mandated anger-management treatment have previously unrecognized ADHD.

RSD can make people with ADHD expect rejection— even when it is anything but certain. The rejection is intensely painful and triggered by the perceived or real loss of approval, love, or respect. The coping response of Individuals with ADHD can include:

  • Becoming “people pleasers” – They scan every person they meet to figure out what that person admires and praises. Then, that is the false self they present. Often this becomes such a dominating goal that they forget what they actually wanted from their own lives. They are too busy making sure other people aren’t displeased with them.
  • Stop trying – If there is the slightest possibility that a person might try something new and fail or fall short in front of anyone else, it’s just too painful and too risky to even consider. So, these individuals just don’t. These are the very bright, capable people who do nothing with their lives because making the effort is so anxiety-provoking. They give up going on social interactions, relationships, applying for jobs, or putting themselves forward in meetings.
  • Use the pain of RSD to overachieve – They constantly work to be the best at what they do to remain above reproach. This can mean striving for perfection, which is never attainable, and are constantly driven to achieve more.

Rejection sensitivity dysphoria has a neurologic and genetic basis, and almost 100% of people with ADHD experience some level of rejection sensitivity. Currently, the condition is treated with medication. Psychotherapy has proven less effective for patients with RSD because the intense emotions occur suddenly and completely overwhelm the mind and senses. It can take some time for a person with RSD to recover after an episode.

ADDitude magazine offers a self test you can take to see if you might have RSD.


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3 Responses

  1. CP

    this is me exactly, both internal and external

  2. Lygia Yarborough

    This is very interesting, this seems to be what my daughter is going through, what if any treatment is there to help individuals? My daughter is 30 and struggling with so many things.

  3. Susan Balogh

    Thank you. I am a middle school teacher and so much of the “baggage” and pain of social interactions among students can be linked to RSD and untreated ADHD. I will share this with colleagues.