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If you’ve ever over-thought a conversation with a friend until you literally had a meltdown, you might have Rejection Sensitive Dysphoria. If you’ve ever been overtaken with irrational anger because of critical feedback from your boss, you might have Rejection Sensitive Dysphoria.
Truth is, RSD is really common in those of us with ADHD. Like, really common. It’s baffling that while the research on ADHD consistently shows Rejection Sensitivity as a common symptom, the criteria for ADHD doesn’t say a word about it.
What is Rejection Sensitive Dysphoria?
Rejection Sensitive Dysphoria describes the intense emotional flooding that hits a person with ADHD when they experience perceived rejection (slash criticism or disapproval). It’s so overwhelming, most of us who experience it don’t have adequate words to describe the experience. It hits hard and fast, without warning.
It’s pretty aptly named–the word ‘dysphoria’ is Greek for “unbearable” and that is really what it feels like. If shame, embarrassment, and grief come in waves, RSD would be a Tsunami. It shoots up out of the blue, crashes into you and knocks you off your feet before disappearing.
It’s the gut punch you get when you think someone doesn’t want you around. The sickness and hot lump of tears in the back of your throat when your boss even gently reprimands or corrects you.
Basically, it’s the worst.
Is Rejection Sensitive Dysphoria a Symptom of ADHD?
Officially, no. At least, not if you’re looking at the DSM 5. But research consistently and overwhelmingly links Rejection Sensitive Dysphoria and ADHD, with some researchers saying emotion disregulation may be the core struggle within ADHD. 99% of people with ADHD are thought to experience RSD. 99%! With that level of correlation, it’s mind boggling that the DSM hasn’t caught up to the true reality of ADHD and our struggle with emotion and rejection sensitivity.
So, officially, no. But in every other sense, the answer is a resounding yes. Yes, RSD is a symptom of ADHD. Hopefully, the next version of the DSM recognizes it.
What Does ADHD RSD Look Like?
RSD is emotional flooding that comes from the perception that a person is being rejection, dismissed, disrespected, disapproved or unwanted. The experience is intense and goes well beyond the natural human discomfort of being rejected.
Signs of rejection sensitive dysphoria are:
- Get Easily Embarrassed
- Feel anxious in social situations
- Overthink social interactions
- Get particularly overwhelmed by feeling like someone is upset with you, doesn’t approve of you, disappointed with you, or doesn’t want you around.
- Avoid Social Situations and withdraw from others
- Have low self esteem and feel like a failure for not living up to other’s expectations
- Overly critical of yourself
- Tend to Assume in social situations that no one likes you
- Have strong emotional reactions that, once they’ve calmed, you tend to feel embarrassed by
- Tend to assume the worst– every time your boss “needs to speak with you” you assume it’s going to be terrible or you’re in trouble
Some people express this overwhelming experience outwardly. Some people Internalize it. That means instead of unleashing their emotion into the world, they bottle it up on the inside where it devours them.
Internalizing Rejection Sensitive Dysphoria in ADHD may look like:
- In turning the pain inward, you are more likely to experience anxiety or depression during the overwhelm.
- More likely to cry and avoid than to become angry and lash out.
- To avoid the pain, you’re more likely to become MORE perfectionistic.
Internalizers are often hard core people pleasers. Pleasing becomes a defense mechanism aimed at preventing the feelings of rejection sensitivity. These internalizers look similar to the Highly Sensitive Person. And they can definitely be both. Find out more about the overlap between ADHD and HSP here. Internalizers are more likely to be misdiagnosed with an anxiety disorder.
Externalizing Rejection Sensitive Dysphoria in ADHD may look like:
- In turning the pain outward, you are more likely to experience anger or rage during the overwhelm.
- More likely to have emotional outbursts and say things you don’t mean than you are to shut down in the heat of the moment.
- To avoid the pain, you are more likely to stop putting yourself out there or doing new things.
Externalizers are more like to stop trying, slack off, and avoid engaging to prevent Rejection Sensitivity. They may respond with anger or rage which is more likely to earn them a misdiagnosis of Borderline Personality Disorder or Bipolar Disorder.
What Causes RSD?
Rejection Sensitivity is thought to be genetic. There’s not a lot known about its cause, but the current theory actually sounds a lot like the theory for the Highly Sensitive Person.
Basically, it’s believed that the ADHD nervous system (much like the HSP) is more highly attuned. This high sensitivity creates an overwhelming physical response to strong emotions such as those created when we feel unwanted or rejected.
The Lasting Impact of Rejection Sensitive Dysphoria
While the initial emotional flooding doesn’t last all that long, the experience takes it’s toll on a person. Humans tend to do everything possible to avoid the feeling of shame, and RSD is a lot like shame.
It makes you feel worthless or “bad.” Even after the initial experience wears off, it can sometimes create this ongoing sense of being defective. This opens up self criticism and issues of chronic low self esteem.
It makes you feel like every interaction you have with another person puts you at imminent risk of this unbearable pain at any moment. So many start to avoid relationships or social interactions, experiencing loneliness instead.
Related: ADHD and Anxiety: Here’s what you need to know (especially if you have both)
The Connection between RSD and ADHD is Missed
Rejection Sensitive Dysphoria is a symptom, not a diagnosis, so it’s not listed in the DSM. Unfortunately, it’s not really listed as a symptom of ADHD either. Research may consistently show that RSD is a common, nearly universal, experience for us. An estimated 99% of people with ADHD experience Rejection Sensitive Dysphoria. Yet, the criteria for ADHD remains exclusively focused on inattention and hyperactivity without a single word about emotion listed.
Because of this, a lot of doctors and therapists aren’t aware that ADHDers often experience RSD as part of their diagnosis (though a few are certainly more aware). And if you start describing your experience with emotional flooding, you’re likely to get misdiagnosed.
Rejection Sensitivity is often Misdiagnosed
It really shouldn’t be a surprise at this point that people who experience RSD get misdiagnosed with other things. Here are some of the most common:
- Bipolar Disorder
- Borderline Personality Disorder
- Post Traumatic Stress Disorder
- Social Anxiety
- Rapid Cycling Mood Disorder
- Depression
What helps Rejection Sensitivity with ADHD?
The therapist in me really hates to say this, but the initial experience of emotional flooding from RSD doesn’t generally respond well to therapy. The experience happens so fast and is so overwhelming it leaves little time for skills. And while trauma can certainly make RSD worse, it’s not caused by trauma.
That doesn’t mean that therapy isn’t helpful at all, because it is. It can help treat the lasting impact that RSD has on a person.
Medications That May Work
When you find a doctor who either understands RSD or is willing to learn about it, there are a few medications that can be effective in treating the initial flooding.
Two are non-stimulants:
- Clonidine
- Guanfacine
One is an antidepressant class that also treats ADHD:
- MAOIs
Talking to your doctor can help you find the best treatment course for RSD.
Treating the Lasting Impact
Remember when I said therapy could help the lasting impact of RSD? Let’s talk about that for a sec…
Therapy can be really helpful for improving that low self esteem that RSD creates. It can help you avoid the critical self talk that makes everything so much worse. It can help you see yourself in a better, more accurate way than your Rejection Sensitive lenses allow.
Therapy can help teach you skills that help improve your day to day experience with RSD. Things like
- Managing your stress
- Mindfulness (yes, it IS possible even when you have ADHD)
- Dealing with traumas that may make your RSD worse
- Learning to change your inner dialogue with yourself
- Practicing self compassion to get rid of shame
- Give up Perfectionism
There are different types of therapy that can help, but some of my favorites are Internal Family Systems, ACT, and DBT. For More information on these therapies, check out this article on ADHD emotion.
Looking for a therapist but can’t find the time or struggle to remember appointments? Check out Online-therapy.com. It’s a virtual therapy service that allows you to text, chat, and video chat your therapist without having to worry so much about managing all the appointments. Use discount code THERAPY20 for 20% off.
Connect With Me
Have you experienced RSD? How would you describe the experience? Analogies are welcome since language in general just doesn’t feel like it cuts it. Let me know in the comments…
I have both externalized and internalized this. I didn’t get an ADHD diagnosis until I was 30, but I always struggled with depression and anxiety and friendships were so hard. I was convinced that every whisper, every odd look, every untoward comment, basically anything I couldn’t hear or control, was about me. And I was sure it was all negative. The problem with this disorder is that it perpetuates itself. Once you believe that someone is talking about you, the emotions start to go on override, you act on that and it distances other people. No kid wants to play with the kid who cries all the time and is paranoid that any one wrong action will make kids not want to be your friend. It does push potential friends away, but not for the reason you assume. It’s hard to be friends with someone who is paranoid that you don’t like them. In fact,my actions based on my beliefs pushed so many people away. I ended up so lonely and every rejection solidified the belief that I was worthless, broken,and didn’t deserve good things. I am nearing 40 and I have spent YEARS trying to undo all the damage I caused myself. I remind myself all the time that my brain is lying to me and that most people don’t really care as much as I thought they did and if someone dislikes me, it is their problem and I am going to be ok.
Impressive.
FINALLY. Someone GETS IT!
Verbally/emotionally abusive home, physically abusive neighborhood & school + ADHD/RSD (undiagnosed) = trauma and ALL that you mentioned. ‘you seem to have the spirit of rejection over you’ someone said decades later. DUHHHHH. NOW it makes sense. No one cared, no one tried to help me figure things out back home.
It absolutely gets to the point you ‘turn everything off’. Caring, connecting, relationships, valuing others’ opinions….stopped. Entirely.
The cardinal rule was ‘do it right the first time or don’t to it at all.’…..kids mess up, fail, do things wrong ALL DAY LONG…so I was never going to be good enough. I could go on and on about the rejection of my family. From day one, I wasn’t wanted. They made very clear, every day to tell me just how lucky I was that I was taken in.
Thank you for this post…hopefully, folks are able to get more help now and not be told to look at the world the way I was….or look at themselves, either.
This is exactly my experience. Just a tone change can make my mind tailspin. Actual physical reactions for anything mildly serious. Torture. Constant intense twisting feeling under my sternum.
very well written you nailed it. this very thing i believe lead to my heart attack among other things . thank you for writing such a to the point article…and giving links to help…
I feel like you just cracked open my brain! I have so much to think about, this was eye-opening!
Hi Tia. I’m sooo glad I found this article. My daughter is 17 and has had these syptoms all her life. We have finally found a therapist she trusts. I really want to share this info with her at our next appointment. Is there any way that I could have a printable copy of this post??
Hi! I’m so glad this is helpful! I don’t actually have a printable form, weirdly. Sorry about that! You are welcome to copy and paste into a word document (I know, it doesn’t come out the most format friendly unfortunately)
Do you know if there’s an anger version of RSD? Our son with ADHD has struggled to learn to control his anger through therapy. The way he’s described it sounds a lot like the “emotional flooding” you talk about but we don’t see a connection in this situation with rejection. His happens when situations become annoying to him.
Oh, absolutely. In two different ways:
1. Some people with RSD get angry instead of anxious/sad. And can react aggressively–physical or emotional.
2. Hypersensitivity is super common in ADHD. More than just with rejection, but with emotion in general. A single emotion can flood the ADHD brain and completely overwhelm it. A person might experience something they feel is injust and be overwhelmed with anger. Or experience a disapointment and be devastated.
Hope that is helpful!
Wow! I’m 51 and have always been told “just let it go, brush it off”, when given criticism or rejection that plunges me down emotionally, and brings my self confidence with it.
I have never heard of this before – and after reading your post it sounds exactly like everything I feel. I always learn something when I visit your site. I took notes and will discuss during therapy- I need to find a new therapist since I have new insurance ugh.
Thank you for always wanting to help your readers learn!
Holy shit! Its like my whole life has just been diagonsed…summed up… and figured the hell out,in your on point, to the friggin ‘T’ blog that describes me exactly. I recently discovered I’m an empath on top of the whole ADHD diagnosis…which I thought being an empath what was kind of made me crazy and worried about shit that no one else was worries about and was thankful to add some rhyme to my reason..literally not even the person i worried for could of have 2 shits about the things I stressed for them.? empath really seemed to fit…but holy cow…rejection sensitivity disorder…i cant wait to send this to everyone in my life….finally they can understand me and my constant defense…i used to be thr one to hold it in and woukd say i internalized it…and then as i got older i somehow flipped that and became one to externalize. Its definitely put a burden on quite a few relationships in my life. Can’t wait to talk tk my doctor about it..thanks so much for this!
I really appreciate reading this post. Is there a way to be part of That ADHD Life for Women without FB? I try to avoid a CB lot BB of social media.
Hi! I’m so glad this post was helpful. Unfortunately, without social media I don’t really have a way to organize the group. I’m not sure that there’s a way to use the group without facebook :/ If I find out anything differently, I’ll happily update this with that info.
I burst into tears ( of course, haha) when I read this because I didn’t know what I am is a thing. I am not alone and this is a real thing! Me and 2 of my 5 kids have RSD. Now to go find the help that we need.
Until I found this article I felt like I had been possessed. I was born in 1981. I had a hard time in school. Not because I didn’t want to be there. But because my mind couldn’t slow down enough to grasp it all. I tried so hard only to pretty much fail. I was even told by two different teachers that I would never amount to anything. When I was a junior in high school my two younger Cousins (by at least 5 years) were diagnosed with ADHD. I wondered if that was what was making it so hard for me. So I was tested with an elementary age test. Which at this point I had already learned to adapt and “fool the system.” I graduated high school with a one of the lowest gpa. When I got into college I explained to my professors how hard tests were for me and they took the extra time to help I had a 3.0 gpa. Even tho I am so proud of myself for not giving up and figuring it out on my own. I always had a hard time with my “attitude!” Like you say in the article it’s a huge flood of emotion that is hard to control and even more embarrassing. I feel like I’m not being heard and no one cares or respects me. The common statement from others is “oh it’s just Josie she’ll get over it.” I don’t like any of it. Thanks for the article and helping my perspective.
Thank you so much for this! I have never heard of RSD before and I have most definitely experienced it almost every day of my life! Amazingly this popped up on pintrest on a harsh RSD day 😉
**see using it already..
Thanks
THANK YOU!!!! From the bottom of my ADHD heart! This is probably the most important post I have read about ADHD. Not only has this been a significant problem in my life, this is a major phenomenon in my ADHD daughter’s life. These feelings are so overwhelming they will destroy a day in a moment. For me, being late to the diagnosis, I had massive anxiety and depression and have been treated successfully for that with venlafaxine. My young daughter in therapy talks about this (her therapist calls them Automatic Negative Thoughts, ANTs) and that is helping.
This is going to be my top post for all my ADHD friends! Thank you!
Ran across this info by accident, but as a 72 year old woman who has never been diagnoses with ADHD but who has had these severe anger flashes all of my life it was eye opening to know it has a name. I’ve always had extremely low self esteem & the inability to take criticism ( however benign it might be) has been my greatest downfall. I feel it’s too late in my life to try to make the necessary repairs so I don’t go too many places socially & have very few friends. I’m glad to learn that I may have a problem through no fault of my own instead of just being a “mean bitch.” I was diagnosed with clinical depression when I was 15 years old & that in itself has been a big problem in my life. Thank you for your post.
This article was super helpful! I have not heard of this symptom before but have observed it.
Thank you so much for explaining it & sharing the words to describe it!
Retired Sp.Ed Teacher
OMG Thank you for finally putting a description to what I have been living with for years in my professional life. I thought it was because I was extremely shy and didn’t do well with public speaking. This explains a lot. My daughter has ADHD and she experienced this same thing the other day at her job I will share your article. Thank you again.
I have lived with this all of my life. I didn’t know it was a condition. It makes living with others that are so critical so very hard. Thank you for putting this out there. Now maybe I won’t feel so alone.
Are there suggestions for partners? I can generally deal with my husband’s ADD, but the RSD is becoming insufferable. We are at the point where any and every interaction is perceived as some slight. With the pandemic, I am working full time from home and he is laid off. At least 3-4 times per week, he is having an RSD meltdown to the point all he can do is lay in bed, leaving me to care for our children, work full time, cook, clean and meals. I can’t run a household with a partner I can’t even talk to without him being triggered. Today the comment that set him off was “Would you mind cleaning the bathrooms today?” He’s been in bed for 4 hours, while I am desperately trying to work, make the kids lunch, etc…
It also occurs with those with Autism (w/o an intellectual disability), however, it’s not discussed as much or considered within our community.
I was diagnosed with ADHD when I was 16. The road to my diagnosis started with RSD symptoms when I was 12 and severe social anxiety when I was 13. Around this time, I had started my first relationship, and when we broke up, it left me destroyed. I never could convey to people how I wasn’t overreacting to the breakup, because they never experienced the intense emotions I did. For me, RSD symptoms prevented me from receiving an ADHD diagnosis. I was treated for social anxiety and depression, spent 3 separate stays at various mental health wards for suicidal ideation, saw countless therapists, psychologists, and psychiatrists, was diagnosed with Borderline Personality, Depression, OCD, Bipolar, social anxiety, PTSD, Class C traits, unspecified anxiety, hypersensitivity, everything under the moon they could add. I was severely over medicated, taking 7 pills a day (three of which were maxed out for dosages) and spent my life overweight, sick to my stomach everyday, and really no happier. FINALLY I attended a day treatment program where one miracle lady finally picked up on my speech pattern. After all that, I was tested for ADHD and passed with flying colours. We switched psychiatrists, I was weaned from my meds, I dropped 20 pounds in the first month through withdrawals, and was eventually put on one single stimulant.
I’m now 19 years old, live a successful life as an artist, horse trainer, and EAL coach for young children. I still struggle with my ADHD symptoms, but feel empowered by finally knowing my brain and how it ticks. I struggle with RSD, and its something I still am unable to explain to those around me. People see me as sensitive, and perhaps someone who overreacts to other’s criticism, but these emotions I feel are valid and very real to me.
I share my story where I can, as I feel that it is a great way to teach others. We searched for years for the answer hidden in plain sight. I was a bright student who drove herself to mental illness trying to please those around me and fight my ADHD symptoms. I believe that more teachers need to understand ADHD, so that they can point it out sooner. I believe that more psychologists need to look further into the root of symptoms.
To those of you struggling with mental illness, there was an end for me, and there will be for you too. I never would have invisioned myself as the confident person I am today, with 3 potential careers on the go and a life full of passion and excitement. Keep fighting, and remember that your feelings are valid and real, even if they seem irrational to others. You have a right to your emotions. You deserve the best the world has to offer.
I have stopped putting myself out there and now I am lonely. I always do stupid impulsive stuff because of my ADHD which is where the criticism comes from. It is awful 🙁
Ever since the psychologist that diagnosed me with ADHD, at age 46, mentioned RSD to me, I’ve been telling everyone that will listen about it. I have an individual therapist and a marriage counselor that I have told, and neither one had heard of this. It was quite ironic that I had just read about it before I was diagnosed in the ADDitude news letter. Thank you for putting it all out there, with links and helpful tips, to wrangle RSD in. I was a member of the FB group, but deactivated my account because of all the ignorance that was being put out there. I miss the group incredibly! Say hi to them!
This really hits home for me. Nothing else seemed to fit. Therapy has not been helpful, I have been told I was clinically depressed by a marriage counselor who sent me to a therapist that insisted there was no such thing as depression! I tried to get an assessment for ADHD and was told that, given my age (late 50’s), my troubles were most likely the result of trauma. Due to the embarrassing, crying mess I become when I talk about myself, I have decided to just stay away from people. Nearly everyone, including family members who just tell me it’s all in my head, causes me to feel suicidal. My husband, children, and my dogs are my only friends. I wish I could get a job and meet people, but I get in my own way every time. Any suggestions?
The more I read, the more I think I have ADHD. This has been eye-opening.
I read. I cried (inwardly, as I’m around people).
Never had it explained before. Just was always told I’m too sensitive. Take EVERYTHING to heart. I take things literally, too. Thank you. I’ll definitely be following you!
Me too! Please don’t cry is a phrase I’ve heard too many times in my life. It’s relieving to hear that it’s a real problem that I can’t control and shouldn’t be ashamed of when it happens. Maybe we are sensitive but it’s better than being insensitive I think. I’d rather feel too strongly about things than be unfazed by anything. I don’t love it when it’s happening obviously but just knowing that other people do experience it and I’m not a cry baby, pmsing girl is a good thing to finally learn. I wish I could prevent it from occurring but everyone’s got their issues, this is one of mine and I own it now. I explain it to people who are likely to experience it, like bosses, new friends/boyfriends, etc., so that when I feel it coming on I don’t need to tell them anything they know how and what I need from them to minimize my embarrassment and guilt or shame afterwards. Being honest with not only yourself but to the important people in your life can only be a positive thing for everyone. Why hide a part of us that we can’t control and defines us in so many other ways. I’m learning to not only understand myself more but to accept and even love the traits I used to try so hard to hide. This is me, like me or don’t, either way I will be happy and content knowing that I am always true to myself first before trying to make other people happy. Don’t hide your tears , embrace each one as an expression of your soul. You care so much that you physically react, not the worst thing we could do in those situations that bring out the disorder in us
I am 35, I have 3 children, 2 girls and the youngest a boy. We haven’t been officially diagnosed but I started researching when my son started his peak symptoms this year with hyper activity and found out we are all adhd. But with COVID diagnosis in the clinic hasn’t been a priority. I’m just so great full for this article, it’s been very soothing to read this when going to a professional isn’t really an option. You helped us find a bit of clarity to what is going on with us. I think my oldest daughter has been misdiagnosed. Her doctor said she has OCD, and depression. Does this happen often?
Thank you so much for writing this. I think it will help me just knowing that it’s not just me feeling this way and experiencing this. When I have voiced how I feel when I think someone doesn’t like me or is talking about me I get accused of trying to make everything about me. So not only do I feel bad enough then I end up feeling selfish on top it and that just gives me something else to beat myself up about. Thank you for putting this into words for me.
I’ve started a new job and it has exacerbated negative thoughts about my capabilities. The job requires lots of writing and a eye for details and I have a boss that points out mistakes no matter how little. In reading this and other articles on this website, I have begun to piece together that I may have ADHD. I’ve also realized that I have created many systems to overcompensate for being forgetful or other adhd symptoms. However, this new job and relationship with my boss is suffering as I am now aware that I am sensitive to their feedback, criticism, or reminders. I don’t have a system for this. Thank you for writing this it helps reinforce the positive thoughts versus the negative ones.
Oh my God. This is me! I feel like every word of this was written about me. I have struggled my entire life with all of these feelings. I could never explain to anyone how it felt; there are no words to accurately describe the pain I feel. I am a people pleaser; I always have been. It has gotten to the point now where I will work 17-18 hour days trying to get everything done. I’m a teacher, so I feel like if I don’t make myself available at all times or don’t work CONSTANTLY (I’m currently working 17-18 hour days) that my principal or that my students will be so disappointed in me or that I might get the dreaded “letter in my file”. I have to get help. I can’t continue to do this to myself. I have always been the one to say “I’m fine,” when I’m really far from it. Oh I hope that this gives me the ability to ask for help and that someone is actually able to provide some skills to help me cope. My emotional flood is so bad that it causes physical pain. Whenever it happens I have a very painful sensation in the palms of my hands and up my arms. Has anyone else ever experienced physical pain during the emotional flood? For the longest time I thought that it was normal and explained the saying “getting your feelings hurt”. I thought it was normal to physically feel your emotions or the emotions of those around you. I now know that it isn’t.
That flood feels like dying. I know it as my “cortisol flood”. I don’t have an ADHD and until reading your post I’ve always attributed it to forced removal from my mother at 7 days old. Total internaliser after being raised in adoption where my start in life was never acknowledged (or treated) till I was 32. After three marriages I met someone who didn’t need me, just wants me. We developed a “better out than in” policy when the flood washes over me. With no childhood trauma she is not phased or hooked by me actually saying what I’m feeling! This relationship is teaching me how to want not need, speak not hide, enjoy not please. Being wanted is the best medicine I’ve found to treat the flood, reduce its occurrence and tone down my pleasing (but not too much 😉)
Thank you!