Dealing with Rejection Sensitive Dysphoria (RSD) and ADHD
Psychiatrist William Dodson developed a term specifically applicable to people with attention-deficit/hyperactivity disorder (ADHD): rejection sensitive dysphoria (RSD). Rejection sensitive dysphoria applies to people with ADHD because ADHDers tend to be particularly sensitive. While the existence of RSD is up for debate, the emotionality of ADHDers is not. Many with the disorder agree that they are extremely sensitive to rejection, criticism, and failure.
What Is Rejection Sensitive Dysphoria?
Dodson defines rejection sensitive dysphoria as the pain felt by those with ADHD when faced with criticism or failure. More accurately, it is their perception of being rejected. People with RSD might be easily embarrassed and anxious, though their impetuosity and practice hiding their sensitivity might make it difficult to detect. They overreact to slights in all sorts of ways, sometimes having a meltdown, becoming enraged, depressed, or even suicidal.
There are also numerous rejection sensitive dysphoria symptoms that occur over the long-term. Some include:
- Some overachieve and people please to avoid criticism, ignoring their own desires and goals.
- Many create self-imposed limitations, avoiding new or challenging situations and relationships.
- A few become cruel and distant to others in order to avoid attachment and risk rejection.
These episodes of depression and anger might be brief and, unlike bipolar disorder, tend to be based on events rather than cycles (How to Deal with ADHD and Anger in Adults). Still, other disorders, such as borderline personality disorder and posttraumatic stress disorder, manifest similar sensitivity and reactivity.
Because of this, many questions about RSD remain unanswered. Does rejection sensitive dysphoria without ADHD occur?
Is it hereditary or developed? Since such a high percentage of people with ADHD report symptoms of RSD, it is likely that the phenomenon is both genetic and learned.
Noelle's Experience with Rejection Sensitive Dysphoria
A family member with ADHD and I both have similar experiences with romantic relationships: we avoid them. At least, we have a history of (attempting) to remain romantically unattached. I used to wonder how others handled so many close relationships, since being rejected was almost unbearably devastating for me. However, like many with ADHD, patiently waiting for a relationship was also never my forte, so I often felt caught between restlessness and the fear of rejection (ADD and Relationships: How Adult ADHD Affects Relationships).
One of the most difficult things about being sensitive is the guilt. I thought I should be able to control my emotions. Some have expressed concern about my emotionality, citing it as an inability to make it through life. Unfortunately, comments like this simply made me more disheartened and worried. Many who are sensitive have been told that they are weak, silly, and immature.
How to Deal with Rejection Sensitive Dysphoria
Though it seems hopeless, there a number of ways to deal with RSD:
- Deal with your emotions before a meltdown. It is helpful to try to let go of the guilt, to accept your emotions, and move away from perfectionism.
- Get the right diagnosis. Because my intense bouts of depression did not usually last as long as major depressive disorder, I previously believed I could not be treated for depression. Dodson states that appropriate medications can help.
- Go to therapy with a specialized counselor. Adult ADHD therapy can help you develop strategies to cope with strong emotions. (Although Dodson dismisses therapy.)
- Take steps to reduce overall stress. This is important even when you are doing well. I find that my RSD is more manageable when I regularly make an effort to take care of myself, physically and mentally.
These are only a few methods of dealing with RSD. Have you struggled with sensitivity? What helps and what doesn't help? Do you think RSD is a helpful term, or is it too specific to those with ADHD? Let me know in the comments.
Dodson, W., M.D. (2017, November 27). Where ADHD and Bipolar Disorder Overlap. Retrieved November 28, 2017, from AdditudeMag.com
Dodson , W., M.D., & Tuckman, A., PSY.D., MBA. (2017, August 18). Free Resource: Rein In Intense ADHD Emotions. Retrieved November 28, 2017, from AdditudeMag.com
Frank, M. A., Ph.D. (n.d.). Rejection Sensitivity, Irrational Jealousy, and Impact on Relationships. Retrieved November 28, 2017, from ExcelAtLife.com
Rejection Sensitive Dysphoria. (2017, February 13). Retrieved November 28, 2017, from DodsonADHDCenter.com
Thome, J., Haeussler, K., Liebke, L., Bohus, M., Bungert, M., & Lis, S. (2015, March 20). Rejection sensitivity and symptom severity in patients with borderline personality disorder: effects of childhood maltreatment and self-esteem. Retrieved November 28, 2017, from bpded.biomedcentral.com
Matteson, N. (2017, November 28). Dealing with Rejection Sensitive Dysphoria (RSD) and ADHD, HealthyPlace. Retrieved on 2020, October 29 from https://www.healthyplace.com/blogs/livingwithadultadhd/2017/11/adhd-and-rejection-sensitive-dysphoria
Author: Noelle Matteson
Hi, just a clarification. I just listened to Dr Dobson's webinar on this subject (https://www.additudemag.com/webinar/adhd-symptoms-emotions-motivation/) and while he says that CBT does not help in eliminating symptoms of RSD in ADHD, he does clarify that he fully endorses therapy as part of the process of developing the life skills to cope.
Is the treatment recommendation by Dr Dodson pertain to children? Is there literature about how this exists wildly in children? My son with diagnosed DMDD and ADHD very specifically has these symptoms above as number one problem. Thanks!
Yes, as far as I know, children can also have RSD! Here is an article from Understood.org focusing on rejection and children with ADHD: https://www.understood. org/en/learning-attention-issues/child-learning-disabilities/add-adhd/adhd-and-coping-with-rejection-what-you-need-to-know. (Please remove the space before "org" in the link.) Thank you for visiting, and I hope this is all helpful!
I really can relate to this condition. I have mild to moderate ADHD and an obsessive personality disorder and I just had a dream last night that many of my trusted friends and acquaintances told me how much they hated me. I woke up and cried for an hour. Also, I have lost my husband. We had a car accident a year ago and he died. What books do you suggest that may be helpful about Rejection Sensitive Dysphoria?
I am so sorry, Bonnie! Losing your husband and having your trust violated by friends and acquaintances is really difficult. I wish I could recommend a good book specifically on rejection sensitive dysphoria. Instead, I will recommend searching for works by William Dodson who writes quite a bit about emotions and ADHD and searching for books + emotions + ADHD in Google. There are also a number of non-ADHD books that give advice on how to regulate emotions and deal with trauma. If you are seeing a therapist, I also suggest asking them for recommendations. Thank you for reaching out, Bonnie, and I hope things start to look up!
This is hard for me to put this out there..... I have adhd as well as multiple diagnosis. At this moment my life is falling apart and it is all my fault. I learned my sister was murdered and my mother committed suicide. My father died a few months ago on the day I was to meet him. My relationship with my “significant other” is virtually over after 13 years. He physically and mentally abused me when my adhd or other emotional problems rose to the surface. So, the other day I just snapped and confronted him and he started to choke me. I know intellectually is isn’t my fault but I am highly emotional and emotive and I still feel it was my fault because I kept pushing his buttons. I reached out to people I thought cared about me and it was the biggest impulsive most devastating ADHD decision I have ever made. They ignored me and blamed me and verbally bashed me. I don’t mean just one person, I mean EVERY person I know. The problem is that I alienated all of MY friends and family years ago because of his using my emotions to manipulate me. I have nowhere to go and it’s winter now and I am so scared. This happened a few years ago and I was raped and had physical issues from being beat as a child that were never addressed. I ended up having a failed experimental spinal surgery. Major exploratory abdominal surgery, and a hernia mesh surgery which is now failing and I have a cyst now which is infected on and off. These are facts and I am having a difficult time with my psychiatrist. I haven’t slept in days. I am getting close to just disappearing. It has to be my fault because how could everyone I know, who are all his friends, not have one caring word. I made the mistake of thinking his friends were my friends. I’m having a hard time slowing down these feeling of despair because of my adhd. I’m not blaming or making excuses..... he is going to tell me whether I’m on the street or staying home. He has all of the control....everything is in his name and I am such a stupid emotional adhd depressive anxiety ridden person. The other day I finally woke up out of a fog I was in for so long and even down to not taking good enough care cleaning and organizing the house. I don’t know what happened, it was like reality hit me in the face with a bat. I want to go back to being in a daze or die from a broken heart. I’ve been in the hospital psychiatric ward and it made me worse. So....after all that blabbing to y’all and complaining, does anyone out there want to hear me and give me some advise as to why I became clear only after my life is falling apart all around me? PLEASE JUST ONE PERSON.....does anybody understand or am I really becoming invisible and not worth the time or effort?
Hello, Adam--I am so sorry to hear what you are going through. I think we can emotionally numb out a lot of stuff when we have to, but that stuff often comes up again--supposedly when we are stronger, though it doesn't always feel like it! Please check out our list of Suicide Hotline Phone Numbers (https://www.healthyplace.com/suicide/suicide-hotline-phone-numbers/) and/or our other page of Resources and Hotlines (https://www.healthyplace.com/other-info/resources/mental-health-hotline-numbers-and-refer…). They both include websites as well as phone numbers, and the second link includes resources for abuse, assault, and even ADHD! Calling certain hotlines has helped me a lot when I have felt desperate. I really wish you the best of luck during this difficult time in your life!
Hi Adam it sounds like you have a very full plate! Mine is too! I can definitely understand your frustration and pain is person to person relationships! I have learned over my life span that I am weak in all aspects of relationships because I don't read people well! I jump right into relationships without thinking of this is healthy for me or not! I don't stop and ask myself the serious questions...and usely these relationships end up in power struggles that I immediately want to remove myself from ! But I have found that my relationship with God is the post and strength of the beam that is sunk in the ground and points to heaven! When Jesus died on the cross, that beam He was nailed to signifies the love that is between God and man so that the crossbeam where Jesus's hands were nailed signifies the relationship between man and man! You cannot have the crossbeam with the pole in the ground! That shows me that every relationship has to pass under the blood that was shed for your sins my sins everyone's sins! It becomes a different way of perceiving people around you! Your tolerance for others becomes an unselfish way of looking at people! It doesn't happen overnight but asking Gods forgiveness for our sins strengthens our tolerance for other who are also sinners! We live in a corrupt fallen world where words have thepower to. Hurt or help! I am praying that his text will help you and not hurt! Sometimes growing pains in relationships can hurt but we grow in matu
Sorry! Maturity which helps us to tolerate the acts of others better than before!
You are not invisible and if it’s worth anything what you wrote helped me !
Greetings!! Thank you very much for this informative piece. I haven't officially been diagnosed with RSD, however, all the symptoms associated with RSD are ones that have basically defined my life. I have ADHD and this is something I am thinking to bring up to my therapist. Although I don't know if any medications can help me or not with RSD, I want to know what are the available treatments that are scientifically proven to be effective with RSD.
Bringing this up with your therapist and/or doctor sounds like a great idea. If they're worth they're salt, it's one of the best things you can do, in my opinion. You might want to bring in an article or two about the condition, if you think that will help. Thank you for mentioning this, and I'm glad this piece was somewhat informational!
I have learnt to recognise the feeling and detach it from the person or persons I believe to be causing it , I have suffered it all my life and it has been a real breakthrough understanding it , it’s very empowering knowing why I feel so hurt and that it’s not real but perceived, it dilutes the emotional response and reinforces my resilience, a quality all who live with ADHD will have , even when I experience actual rejection or criticism I’m able to turn down the intensity of my feelings, this is still working progress but it feels much better than it used to
Wow, I am so glad that method is working for you Antoinette! Thank you for sharing. It is great that you are building up your resilience.
I have learned to do the same it is like the weight of the world has been lifted off my shoulders i can breath deep
Hi Antoinette... I'm going to see my Dr today at 2...I do have ADHD an Rsd... I'm so overwhelmed when I talk to anybody..even over the cell phone!! I recognize in what your saying I can relate...are you on any meds? An if so are they helping with your Rsd....oh yeah I also wanted to add my Mom wasnt nurturing..I never got told I Love you or felt " safe" ... comfortable...I read articles where they said lack of maternal love could b where it stems from...I get it....I really do...but I feel at this point it's so embedded in me...just like the air that I breathe..I want so bad to let go of it! I no as soon as I step out the door it will show it's ugly little face again!! Any feedback from anyone will be greatly appreciated
RSD makes complete sense and suddenly brings context to ALL of the social events throughout my life. I notice with people I really like, I'm a people pleaser until it falls apart. I've mostly given up and don't try to socialize. It's just the bare minimum for work. Occasionally, I have been distant and even cruel with people I've perceived as an extreme threat. I always broke up with dates before they break up with me. Afterall, they are definately going to break up with me. I have very few friends, and I don't hear from them or hang out with them. I'll never contact them either.
Hi, Patrick, thanks for sharing. That sounds really hard. A couple of my family members with ADHD also struggle or have struggled with making friends and/or being in romantic relationships. I mean, we all struggle, but sometimes I do wonder how people just put themselves out there like that. I do hope that learning a little bit about RSD helps a bit!
Yes, I can see knowing this is going to be helpful, but I'll need better meds to kick it off. Alcohol helped but I don't drink anymore, and it is only good for isolated situations anyway. Zoloft also also helped a lot, and I didn't realize why at the time 4 years ago. I am taking it again, but I think the dose is lower. My doctor doesn't want to go over 100mg for some reason (it's available up to 200mg). I might try the combination of meds Dr. Dodson recommends, I'm on one of them already, but barely anything at 1mg. The traffic here is terrible. I tend to get angry in traffic so these meds have calmed that a bit at least. I'm married, but it is heading toward failure if I don't do something. Anyway, you are a good writer, and this is a really good article. Thanks.
Thank you again, Patrick. That means a lot. In spite of your struggles, it sounds as though you are being proactive about the situation.
As an adult I struggle with Adhd most days. RSD is an issue for me but I will say that understanding what is going on with me helps me to deal with the emotions. I was a people pleaser but this invariably led me to a delirious relationship with a NPD individual. That relationship almost lead to my being suicidal, thankfully I had a greater respect for life my own and that of others which helps me to pull through it. Also I have a daughter, so I will be around for her if I have anything to do with it. I will say meditation helps because during meditation you become trained to acknowledge thoughts but to let them pass and not react on them. I think that's so important for somebody with ADD because we tend to be impulsive and react without thinking through all the way. Sure it takes more time for us to do that but ultimately we can gain peace because of making better decisions. I know ADHD also operates on a spectrum and I'm probably somewhere in the middle so that's just my personal advice of course it's not a substitute for professional medical help. Prayer also helps me.
I'm so glad you pulled through this relationship. I like the idea that training yourself to slow down and lower your reactivity can help with RSD. Thank you for your advice and for commenting, Sean.
I often distant in plutonic relationships especially when I change jobs or I move away because I few shameful of my life. I often feel like an under-achiever so I will avoid phone calls from old friends. I don't like to answer my phone or door. I get easily overwhelmed at home and more likely to get angry, we're as at work I am a people pleaser. I nearly always late to everything. I am often ashamed of my house because it is my perception that is ugly and filthy. I don't understand when family members don't share that perception. Finally I avoid awkward conversations. I even feel uncomfortable when I am present during someone else's award conversations. These are things I deal with everyday.
Gosh, that sounds familiar, Adam. Forming and maintaining relationships can be so difficult. Know that you're not alone! I appreciate your sharing, even though I know it's not easy.
I just started crying because of the part when you said you are irritable at home but a POW please pleaser at work because it hit home more than anyone knows ! Thank you for sharing . It makes me feel like I’m not an alien lol !
Thank you for your contribution, Erin!