What to Know About ADHD and Rejection Sensitive Dysphoria

Rejection sensitive dysphoria (RSD) occurs when an individual experiences intense, severe emotional pain in response to perceived rejection, criticism, or failure. This goes beyond simply disliking the experience of rejection, and the individual finds these feelings intolerable or excruciating rather than just unpleasant.

People who experience RSD might have difficulty regulating their emotions or healthily expressing themselves while they experience this pain. Many people with attention-deficit/hyperactivity disorder (ADHD) experience RSD. While not everyone who experiences RSD has ADHD, and not everyone with ADHD experiences RSD, it is a common phenomenon in the ADHD community.

This article discusses the connection between ADHD and rejection sensitive dysphoria, as well as how to treat RSD and support someone with this symptom.

The Connection Between ADHD and RSD

Although limited research presently exists on RSD and its link to ADHD, research shows that people with ADHD tend to feel emotions more intensely than people without ADHD, and this contributes to emotional dysregulation. Difficulty regulating strong emotions can contribute to RSD.

Throughout childhood, people with ADHD experience rejection from adults at a higher rate than their non-ADHD peers, particularly by teachers. Increased experience of rejection in childhood may cause more intense feelings about perceived rejection in adulthood.

Several people with ADHD and lived experience with RSD share how their experience of RSD is connected to their ADHD symptoms:

• A need to prove oneself: “With my ADHD, I grew up with a constant fear of forgetting something important," says Cathie. "The frustration of not understanding easy things yet acing difficult concepts in school. I think this contributed to not having trust in the testing/valuation process and a need to prove my worth and please others.”
• Difficulty regulating emotions: “Since I have problems with memory, executive functioning, and impulsivity, I sometimes ‘act out’ and only realize it afterward," says amanda. "So I am actually feeling other people's annoyance, but a lifetime of trying to watch and understand social cues has made me more sensitive to small signs in others (and more likely to catastrophize).”
• Always feeling on the edge of rejection: “It could contribute to RSD because, like the lack of patience associated with it, can worsen when you're talking to someone online as it can lead you more on edge when someone hasn't replied in like a few hours or something like that … like in a ‘being on edge for rejection and have no patience’ way," says Void.
  
• A sense of panic: “I think it might be partly why I go into panic mode and just chaos, but I also have cPTSD and am not sure how much of a role that plays," says Christine.
  

Complications of ADHD and RSD

Dysphoria refers to feelings of distress and discomfort, and the intensity of these feelings can be unbearable. For some, RSD can be so intense that the emotional pain feels like a physical injury.

Those interviewed for this article share their experience of RSD:

• Misinterpreting others/situations: “I feel an intense and sometimes crippling anxiety that a certain person (or everyone) is mad at me, based on (mis)interpretation of their words/body language or a (perceived) screw-up on my part," says amanda. "Sometimes I did actually make a mistake, and the other person is justifiably annoyed, but I tend to make it a lot worse than it actually is.”
• Putting up emotional walls: “It's like this deep punch; it gives a sort of mental agony that is kind of really hard to describe, and it becomes harder to open up to people," says Void.
• Extreme fear: “Whenever I feel so much the fear of being rejected, it is like fearing for my life," says Christine. "My skin crawls, my breathing goes into hyperventilating, and my brain completely panics.”
• Difficulty receiving feedback: “Historically, negative feedback would hurt more intensely for me than for similar feedback to my peers," says Cathie. "I was called ‘too sensitive’ many times, by both adults and peers growing up. I would feel dissociative while crying so intensely for what others would call ‘not a big deal.’”

Diagnosing ADHD and RSD

RSD is not officially recognized as a diagnosis or symptom in the Diagnostic and Statistical Manual of Mental Disorders. However, if you see a therapist, they might note patterns of behavior and emotional responses to rejection that are consistent with RSD. Additionally, individuals might notice that their emotional experience is consistent with RSD.

If you have been diagnosed with ADHD and notice significant difficulty coping with rejection, you can learn more about RSD and talk to others with ADHD who experience RSD. If the symptoms of RSD resonate with your experience, you may be experiencing RSD.

Support and Treatment for ADHD and RSD

People with RSD can work through their experiences and develop healthy ways to communicate and regulate emotions in therapy. If you experience RSD related to a history of trauma, trauma-informed care might help your symptoms.

If someone you love has ADHD and experiences RSD, you can show them support. Those who shared their experiences for this article had feedback on how the people in their lives support them when they experience RSD:

• Listen to their experiences: “Basically, being like, ‘do you want to talk about it’ or just, y'know, listening when we're having RSD seems to help, because like we're venting our pain to someone, and it seems to help," says Void.
• Offer reassurance: “Verbally and physically confirm that I am not being rejected, that I am still loved," says Christine.
• Respect their emotions and boundaries: “Not expect me to react differently than how I react, to respect my feelings and the need for space and no physical contact when overwhelmed," says Cathie.
• Understand there are other ways of thinking/healing: “Understand that I am trying my best, and if you have criticism for me, try to deliver it gently and constructively," says amanda. "I am doing my part with therapy and medication. What is self-evident to you might not be self-evident to me, and vice versa. The way I perceive the world isn't wrong; it's just different from the (enforced) ‘norm.’ People with ADHD often have a sense of justice and egalitarianism that isn't ‘typical.’ That isn't something we should have to ‘fix.’”
  

Coping With ADHD and RSD

It can be challenging to cope with the intense feelings that come with RSD. Here is what some have found helpful:

• Getting support from a partner/family member: “Finding a partner that is very supportive and aware of my needs," says Christine.
• Acknowledging your emotions are valid: “Honestly, realizing that this is a real phenomena and not just my own ‘overreaction’ has been tremendously helpful to alleviate the shame and negative self-image," says Cathie. "Allowing myself to lean into and feel the feelings without the shame factor of ‘having to’ has made episodes less intense and in shorter duration.”
• Understanding others/yourself: “Therapy, medication, trying out different social circles, living alone, living with roommates, and just figuring out how to understand other people," says amanda. "Most of them aren't 'mean,' they're just people who have good days and bad days and are sometimes not as nice as they could be. That doesn't mean that they ‘hate’ me or that they're ‘mad’ at me. And sometimes I do annoying, impulsive, rude things. We all do.”
• Being honest and open about your feelings: “Probably reaching out and being like, ‘Oi, so the thing you said really hurt me. …Can we do a conflict resolution thing?’" adds Void. "Like just being open about your feelings if the person who hurt you is someone you consider a friend.”