Rejection Sensitive Dysphoria and ADHD

What is RSD?

Rejection is not enjoyable for anyone. But for individuals who have Rejection Sensitive Dysphoria (RSD), it can trigger an overwhelming emotional response.

“Dysphoria” comes from a Greek word that means “hard to bear.” Rejection sensitivity dysphoria refers to intense feelings related to the belief that you’ve let other people down, embarrassed yourself, failed at something, or made a serious mistake and, as a result, people pull back their support, love, or respect. RSD causes extreme emotional pain that plagues both children and adults. It can be triggered by perceived or actual rejection, teasing, or criticism.

It seems that people with ADHD may be more susceptible to RSD. While researchers are still uncertain about the connection between RSD and ADHD, some suggest that it might be related to emotional dysregulation. This is the inability to manage emotional responses to stimuli or situations. RSD is one of the most disruptive manifestations of emotional dysregulation—a common but often misunderstood symptom of ADHD, particularly in adults.

How to Recognize the Signs of RSD

The symptoms of RSD can vary among individuals, but may include:

  • Frequently or obsessively thinking about negative experiences, especially experiences of perceived or actual rejection
  • Perceiving rejection when it is not actually occurring
  • Viewing small rejections as catastrophic
  • A chronic fear of rejection
  • Misinterpreting constructive criticism, requests for more information, or neutral feedback as rejection
  • Perfectionism or people-pleasing tendencies
  • Obsessively thinking about negative experiences, especially experiences of perceived or actual rejection
  • A sense that you’re not liked by others
  • Low self-esteem based on how you feel others relate to you
  • Social withdrawal
  • Negative self-talk
  • Emotional outbursts
  • Sometimes think about hurting themselves

Treatments for RSD

Just as with treating ADHD, individuals; with RSD may benefit from combining different treatment methods. These can involve

  • Therapy – This may include working on developing coping skills or dealing with rejection-related problems in a relationship. Therapy may also help with learning how to minimize negative self-talk, which is a common theme among people with RSD.
  • ADHD medications: ADHD medications can be highly effective in managing the core symptoms of ADHD which may also help with RSD.
  • Antidepressants: Antidepressants can help with some ADHD symptoms, especially rumination or feelings of sadness. A wide range of options is available, and people should discuss the risks and benefits of each class of antidepressants with their doctor.
  • Support: Support for people with ADHD may include academic and career accommodations. Children may need behavioral interventions, such as time management help. Parents and caregivers of children with ADHD may benefit from specialized training on how best to help them.

People living with RSD may be able to develop skills and strategies for processing emotions including:

  • Awareness – If a person knows that they have RSD, this may help them put their feelings into context. Learning more about the condition might help them understand how to process information with greater clarity.
  • Delayed responses – There is no need to respond to rejection or other negative experiences immediately. People with ADHD sometimes behave impulsively. Pausing to think about how best to respond may help reduce potential conflicts.
  • Talking about rejection sensitivity – An individual can make friends, family, and other loved ones aware of their RSD. This knowledge may help people choose their words and responses in a more considered way when interacting with the individual.
  • Choosing the right relationships – Certain relationships, especially those involving abusive or critical people, may exacerbate RSD. People in emotionally abusive relationships should consider leaving, if they feel able to do so.

While RSD is not always clinically recognized, it’s very real for the person experiencing it. If you think you or someone you know has RSD, you should consult a therapist, psychiatrist, or primary care provider about the next steps.



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