What Is Rejection Sensitive Dysphoria?

Rejection Sensitive Dysphoria (RSD), while not a formal diagnosis, is commonly recognized as contributing to the emotional dysregulation experienced by adults with ADHD. Under-researched and often misunderstood, RSD is not caused by trauma but instead results from the unbearable pain of perceived or actual rejection. This can come from teasing, criticism, or even internal interpretations of behavior that conclude rejection, even without factual evidence. Self-criticism or negative self-talk can also trigger these emotional responses.

Understanding Rejection Sensitive Dysphoria

RSD shows up with a few distinct characteristics. Individuals often experience sudden emotional outbursts following either real rejection or perceived rejection. They may begin to withdraw from social situations to avoid this experience and have an increase in negative self-talk. This can lead to low self-esteem and a deflated sense of self. Because folks are often perceiving an attack, this can cause a high level of defensiveness in relationships, creating problems with people who are close to them.

While RSD is not a formal symptom of ADHD, emotional dysregulation is. The diagnostic criteria used to confirm ADHD were developed through observing behaviour in children and do not consider someone's internal experience, including thoughts, emotions, perceptions, or thinking styles. These factors need to be considered when exploring ADHD in adults, as many of us use our internal experience to control our behaviour and mask our symptoms. RSD can be difficult to use to determine ADHD as it comes in sudden bursts and is not always present. The impact is difficult to measure and often hidden, as folks feel a sense of embarrassment or shame about their intense reactions.

When examining emotional dysregulation in the context of ADHD, we notice that the emotions tend to be short-lived, intense, and can seem exaggerated, with a return to baseline in a few hours. This can also cause confusion for those around us as suddenly we seem fine when only a few hours ago we were experiencing such intense distress. This is part of what distinguishes RSD from other experiences like depression or mania, which last for a prolonged period of time and are typically experienced more consistently. Those with social anxiety also differ in that anxiety is experienced for a long duration, typically at least six months, while RSD is related specifically to social experiences where there is a belief that one could be rejected.

Signs and Symptoms of Rejection Sensitive Dysphoria

Emotional Reactivity

Extreme sadness or intense rage can be present quickly and then dissipate just as quickly. You may look back on your behaviour and not even feel clear on why you responded as intensely as you did. These intense emotions often come with physical pain, and folks may equate the sensation of rejection to feeling similar to a punch in the gut.

Hypersensitivity to Feedback

Folks with RSD are wired to assume the worst-case scenario. This can manifest as expecting any meeting with your boss to lead to firing, or interpreting your partner's desire to have a conversation as a sign of the relationship ending. Consequently, feedback is often perceived harshly and seen as a personal failing, making constructive conversations about change or moving forward challenging. One way to support someone with RSD is to include the purpose of the meeting or conversation in advance when scheduling, which helps prevent their brain from catastrophizing.

Behavioral Responses

People-pleasing tendencies are common to prevent any sort of perceived or actual criticism. The fear of disappointing others can cause folks to ignore their own wants and needs, which can also build resentment.

Impact on Relationships and Self-esteem

RSD causes individuals with ADHD to interpret neutral reactions as negative, significantly impacting relationships and self-esteem. Expecting rejection, they may shy away from new social interactions or experiences, finding relationships draining due to the effort required to anticipate others' needs or be perfect to avoid disappointment.

Suicidal Ideation

While not experienced by everyone with RSD, suicidal ideation can be a part of the experience and is an important risk to screen for. Because folks with ADHD may have difficulty accurately interpreting others’ reactions to them, they can feel incredibly betrayed and see themselves as failures. Often, these experiences are internalized, causing them to feel further isolated. This can lead to the false belief that their absence in the world would not be impactful. If you notice this tendency in yourself, please reach out. Having a therapist support you as you begin to test those assumptions instead of trusting them as fact can be an important part of recognizing where your brain may be leading you astray.

Living with Rejection Sensitive Dysphoria

One of the best ways to manage RSD is to pause and engage in assumption checking. Often, we automatically trust what our brain tells us as truth. Taking the time to question our assumptions can confirm whether our perception is accurate. For example, I might ask my partner something like, ‘when you said “_____”, I heard “_____”, is that what you meant?’ This can feel scary to do, but often we discover that our beliefs are not accurate, and it can be relieving to hear that our loved ones do not perceive us as negatively as we once believed.

Regulating our nervous system is also important in managing the reactivity that comes with RSD. Down-regulating activities like yoga, cold plunges, meditation, breathwork, and other relaxation strategies can all be effective. Daily cardio and exercise can help get any jitters out so we are more able to be present with what is really happening in the moment.

Practicing self-compassion and appreciating our sensitivity is also helpful! When we view sensitivity as a gift instead of severely criticizing ourselves, we can appreciate the ways we notice how others experience the world emotionally and attune to that positively. Acknowledging the effort it takes to stay regulated can help us take better care of ourselves and recognize when environments are overstimulating and we need a break.

Next Steps

If what we have described here resonates with you, Additude Magazine has developed a self-assessment tool to help identify RSD. Understanding that your experience is partly due to the way your brain is wired to process information can be the first step in reducing the distress that comes with these intense emotions. At The Commons Wellness Collective, we would be honoured to work with you and provide support on your journey toward self-acceptance and regulation. Please reach out if you feel like therapy might be the missing part of your support plan!