Good News: Everyone Doesn’t Hate You – What is RSD and How Do You Deal With It?

Beyond the high-profile symptoms of Attention-deficit hyperactivity disorder (ADHD) like hyperactivity, interrupting, and trouble paying attention in class lies a deeper emotional landscape. Many people with ADHD report feeling more intense emotions than their peers—and while the delight of a new hyperfixation can be a boon, many people experience just as overwhelming emotions on the less pleasant side.

Enter: Rejection sensitive dysphoria.

Called RSD for short, rejection sensitive dysphoria is defined as a strong, painful, and usually sudden emotional reaction to real or perceived rejection, criticism, or failure. The emotions involved often include sadness, fear, rage, shame, or any combination of these. Rejection sensitive dysphoria is often reported as a completely overwhelming feeling—a reaction on a much larger scale than the rejection that caused it. And while RSD isn’t a part of the official diagnostic criteria for any type of ADHD, a survey of teens and adults with ADHD reported that up to 99% say they are more sensitive than usual to rejection, and nearly 1 in 3 say it’s the hardest part of living with ADHD.

What’s the difference between RSD and just being hurt or embarrassed?

Good question! Unfortunately, life happens to the best of us- we all feel hurt, embarrassed, ashamed or rejected sometimes. But what’s the difference between that and rejection sensitive dysphoria? The first main difference is in the intensity of emotions. The word dysphoria comes from the Greek dysphoros, meaning “difficult to bear.” The feelings of rejection are often overwhelming, so much so that it can become almost impossible to remember the coping mechanisms we might otherwise use for uncomfortable feelings.

One of the other main differences between embarrassment and RSD is the reaction to perceived rejection. This is not to invalidate anyone’s feelings, RSD in reaction to perceived rejection can be just as overwhelming, and often comes as a self-defense mechanism against a past pattern of events. If you’ve experienced crushing RSD from an instance of rejection, criticism, or failure before—it makes sense to want to try to anticipate those instances in the future!

What does rejection sensitive dysphoria look like?

Here’s a situation that many of us have experienced a version of: Imagine you’ve just sent a finished project to your teacher/boss/supervisor for final review. You’ve worked really hard and used the ADHD tactics you’ve learned to get this product finished, but when your supervisor looks it over, they just send back notes on what they’d like you to change. No pleasantries, no notes on what was working well, no exclamation points in their email, even. And suddenly, this project that you were so proud of just a few minutes ago is now just a source of embarrassment You feel like a complete idiot for not noticing the things you should have fixed earlier and all you can think about is if this is the last straw that gets you fired. It’s easy to fall into the cognitive trap of letting all these little signs paint a negative picture, but with RSD, that negative picture can turn into a shame spiral that’s difficult to escape.

That’s just one example of the many different ways RSD can manifest. Some people can become people-pleasers, overriding their own boundaries in hopes of appeasing others and avoiding rejection. Other people stop trying altogether when faced with the prospect of possible failure, avoiding any circumstance they could possibly be vulnerable to missing the mark. Other people respond with rage at the people or things that they perceive are rejecting them, or by closing off and suffering these feelings alone. Rejection sensitive dysphoria can be so overwhelming that some people report experiencing suicidal ideation and other severe mood symptoms, which means without another diagnosis, RSD can be misattributed to other mood disorders such as bipolar disorder or depression. In other instances, avoiding situations that could potentially cause RSD may look like a social phobia. In any of these responses, however, the feelings are often sudden, and almost always overwhelming. If you experience many of these symptoms, speak with your doctor about treatment options:

• Overly high standards for yourself
• Withdrawal from social situations
• Negative self-talk 
• Low self-esteem
• Being easily triggered to feel guilt or shame
• Isolating yourself to avoid rejection altogether
• Aggressive or rageful behavior toward those you feel have hurt or rejected you, holding grudges
• Poor self-perception
• An uncomfortable physical reaction due to being misunderstood or “othered”
• Overwhelming thoughts after an interaction about how you did or said something wrong

What causes RSD?​

Like ADHD, researchers are still exploring what causes rejection sensitive dysphoria. There are some theories that suggest there is a genetic component to whether or not you experience RSD, but it’s also been theorized that RSD is simply an element of emotional dysregulation, and a natural display of an ADHD nervous system’s tendency to react more strongly to external stimuli in general. While neither RSD or emotional dysregulation are currently a part of the DSM-IV’s diagnostic criteria for ADHD, the European Union (EU) has added emotional dysregulation to their criteria.

There is also circumstantial reasoning: Researchers found that by age 12, children with ADHD heard 20,000 more negative messages about themselves than other kids their age. So, after a life of ADHD, many of us are trained to be on the defensive. If you’re used to criticism in response to not meeting neurotypical standards, or the expectation that you’d fail before you even tried, it makes sense to be easily reactive! 

How do you deal with rejection sensitive dysphoria?​

The good news is that there are a lot of ways to help manage RSD! There are medications that can help lessen the frequency and intensity of RSD emotions specifically, and some people report that treating their ADHD overall with a typical stimulant medication helps as well. Guanfiacine and clonidine are two medications that may be prescribed specifically for RSD symptoms, and Monoamine oxidase inhibitors (MAOIs) have also been used to treat symptoms of ADHD—emotional ones included. Talk to your doctor if you want to learn more about targeting your emotional symptoms of ADHD with medication.

As well, there are some psychotherapeutic techniques that can help you ease and move through these overwhelming feelings when they do happen. Learning to practice self-awareness is a great place to start! If possible, working with a therapist is the best way to find out what the most effective methods are for you. 

Lastly, one of the most important things to remember about Rejection Sensitive Dysphoria is this:

You are not alone.​

You’re not the only person that feels this way! And even though what you’re feeling may seem overwhelming at the moment, learning that RSD is what’s actually happening to you will help you to remember that it will pass.