‘Rejection Sensitive Dysphoria’ (RSD) and ADHD
For many people with Attention-Deficit/Hyperactivity Disorder (ADHD), managing everyday tasks can be challenging enough. However, there is an often-overlooked emotional component that can feel even more overwhelming: Rejection Sensitive Dysphoria (RSD). This intense emotional response to perceived rejection or criticism is common among those with ADHD but is not widely understood. While RSD is not officially listed as a diagnostic criterion for ADHD or even as a diagnosis itself, it is widely recognised within clinical and patient communities as a common experience and therefore can be a useful descriptor.
What may cause RSD?
Research suggests that the neurological differences in ADHD affect emotional regulation, making individuals more vulnerable to intense emotional responses. However, this does not mean that RSD may be biologically driven, and it may be that environmental causes (not exclusive to ADHD) may be the driving factor.
People who described their perspective as RSD often experience:
Avoidance of situations where failure or rejection is possible
Low self-esteem and chronic self-criticism
Intense emotional reactions to perceived criticism or rejection
Impaired emotional regulation: Difficulty managing emotional responses to everyday stressors
Hyperfocus on negative feedback: A tendency to ruminate on perceived failures or criticisms
Increased sensitivity to social cues: Heightened awareness of others' reactions, leading to misinterpretation of neutral interactions as negative
A Sceptical View on RSD and ADHD
Despite the growing awareness of RSD within ADHD communities, some experts remain sceptical about its existence as a distinct condition. Critics argue that the emotional sensitivity associated with RSD could be better explained by general emotional dysregulation, a well-established characteristic of ADHD. There is limited empirical research specifically on RSD, leading some to question whether it is a unique phenomenon or simply a descriptive term for a common emotional reaction.
Additionally, the subjective nature of perceived rejection makes it difficult to standardise or quantify. High quality studies outside of looking at people’s qualitative experience are almost non-existent in the ADHD literature and therefore any bold scientific claims about RSD without further research is premature at the moment. This scepticism suggests that while RSD describes real emotional experiences, more rigorous scientific study is needed to validate its status as a separate diagnostic entity.
It is also not clear whether RSD is unique to people with ADHD and many who do not have ADHD identify strongly with these feelings and experiences. Social anxiety, personality disorder and depression are all conditions where the above experiences have been shown to occur frequently.
How a sensitivity to rejection can affect ones life
RSD can affect multiple aspects of life, including relationships, work, and self-esteem. In social settings, individuals may withdraw or become people-pleasers to avoid the possibility of rejection. In professional environments, fear of criticism may lead to perfectionism, procrastination, or burnout. This emotional rollercoaster can erode confidence and foster a persistent fear of failure.
For example, a casual remark from a colleague may trigger hours of self-doubt. Similarly, not receiving immediate validation can lead to feelings of being unloved or unwanted, even in close relationships.
Manging these experiences and feelings
While living with an extreme sensitivity to rejection and criticism can be challenging, there are strategies to help mitigate its impact:
Cognitive-Behavioural Strategies: Cognitive-behavioral therapy (CBT) techniques, such as reframing negative thoughts, can help shift how you interpret feedback. Mindfulness practices can also ground you in the present and reduce emotional intensity.
Boundary Setting: Protecting your emotional well-being by setting boundaries in relationships can reduce situations where RSD is triggered. It’s okay to prioritize your mental health by limiting interactions with those who are overly critical.
Emotional Regulation Skills: Techniques like such as those used in dialectical behavioural therapy (DBT) can be used to bring more attention to negative emotions and find ways to manage them internally rather than relying on unhelpful coping strategies.
By recognising these thoughts, behaviours and patterns and developing coping mechanisms, individuals can navigate the emotional turbulence and foster greater self-acceptance. You are not alone in this experience, and with the right tools and support, it is possible to lead a fulfilling and resilient life and overcoming difficulties people commonly refer to as RSD.
References:
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.