The Connection Between ADHD and Rejection Sensitive Dysphoria

Primary Author: Sabrina Hossain | Secondary Author: Esther Fires NP

Have you heard of Rejection Sensitive Dysphoria (RSD)? RSD is extreme emotional sensitivity and pain triggered by the perception that a person has been rejected or criticized by important people in their life. Individuals with ADHD or Autism are more likely to experience RSD. And those with bipolar disorder, depression, PTSD, and borderline personality disorder will experience similar symptoms to RSD.

People with ADHD have trouble with emotional regulation, restlessness, and impulsivity. Emotional dysregulation can trigger RSD when individuals experience rejection. You might be wondering, “how does RSD manifest into behavior?” When someone with RSD experiences rejection (real or perceived), it triggers an intense emotional response. In some cases, the effects of RSD can be physically debilitating. The causes of RSD are unknown as more research needs to be done. Many dismiss these symptoms and say that people with RSD are ‘overly sensitive or emotional.’ However, this mindset is harmful and further stigmatizes those struggling with mental health conditions.

RSD is not found in the DSM-5, which is a manual used to assess and diagnose mental health disorders. RSD describes the emotional volatility one may feel when experiencing rejection. Let’s look at one example of what takes place when one experiences rejection. You made plans with a friend you have not seen in a long time and have been looking forward to this event for weeks. Suddenly, they text you at the last minute and say they have to cancel. For some, this situation may be upsetting, but they can recover quickly. While those with RSD will spiral, ruminate, or even experience physical pain from this type of interaction. They can easily find themselves engaging in negative self-talk (“She probably canceled because she hates me”). As you can imagine, rejection can feel very intense and depleting for those with RSD. That is why it is important to seek treatment once you recognize the signs.

Experience feelings of failure when you don’t meet those expectations.

Small rejections seem catastrophic.

Obsessive rumination over experiences of perceived or actual rejection.

Anyone can suffer from RSD, especially women with ADHD, because they are often diagnosed later in life and are more likely to face systemic barriers. Women and girls are expected to please people and accommodate the needs of others. As a result, symptoms of ADHD and RSD are often overlooked because women are expected to people please.

Having RSD can feel debilitating, but there is help available. The most common option would be therapy. It would be best to seek a professional specializing in Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT), as patients have felt validated through both methods. Both therapies can offer coping skills and strategies to help patients navigate their triggers. Creating a supportive environment with people who love and accept you can do wonders and help with RSD symptoms. Medication can also help alleviate some symptoms. Guanfacine and clonidine have shown some promise in helping with emotional regulation. It is important to discuss all options with a healthcare provider before trying either medication.

It is important to note that a strong emotional reaction to rejection and criticism does not mean something is wrong with you. It may feel isolating, especially if you don’t know anyone who can relate to your experience. However, many people, including most people with ADHD, experience the same symptoms. As long as you have the proper support and treatment, you will do just fine.