What is ADHD Rejection Sensitive Dysphoria (RSD)?

Demi Aspey
7 mins read
Jun 2, 2023

Journeying through the multifaceted universe of ADHD feels, to me, like losing myself in a boundless labyrinth. 

Each unexpected bend and detour reveals a different facet of this condition, as if we were unravelling an otherworldly enigma. 

I mean, getting a diagnosis is one thing. Starting to learn how ADHD manifests in its many forms is another. 

One such curveball leads us to confront the enigmatic entity, Rejection Sensitive Dysphoria (RSD). 

Trust me; you're not alone in navigating these choppy waters if you've ever experienced the overwhelming emotional current that even the tiniest hint of rejection can trigger.

What's Rejection Sensitive Dysphoria (RSD), you ask?

Rejection Sensitive Dysphoria (RSD) is a challenging emotional reaction defined by extreme emotional susceptibility and a feeling of intense emotional pain in response to perceived or actual rejection or criticism. 

Frequently encountered among individuals diagnosed with ADHD, RSD is not exclusive to it but can also be entangled with other mental health conditions.

Those wrestling with RSD generally experience a rapid, immediate surge of intense emotions upon perceiving or facing rejection.

Disapproval, misinterpretation, or feeling unloved/abandoned could cause this to manifest.

Even the slightest hint of rejection can create an unexpected tidal wave of emotional pain that frequently exceeds the context of the situation itself.

People with ADHD feel emotions intensely, and we react to those feelings with an equal intensity
@adhdjesse on Twitter

It often leads me to leave emails unchecked because…Shrondinger’s Cat, you know? 

The word 'dysphoria' originates from ancient Greek, loosely translating to 'hard to bear'. 

While “hard to bear” doesn’t even scrape the tip of the RSD iceberg, it somewhat encapsulates the overwhelming and severe emotional distress that people with RSD frequently experience. 

Despite RSD's extensive prevalence and influence, it isn't officially recognised as a standalone diagnosis in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Instead, it's regarded as a signature feature of ADHD and other mental health disorders such as bipolar disorder, depression, and post-traumatic stress disorder. 

Understanding RSD is crucial, given its cross-over across mental health conditions and its impact on an individual's self-esteem, interpersonal relationships, and overall life satisfaction.

Addressing RSD with compassion, empathy, and patience is vital, acknowledging that it's not an exaggerated reaction but a bona fide psychological response.

How is RSD linked with ADHD?

ADHD and RSD perform a complex dance, each taking turns leading while maintaining their unique tempo.

As someone with ADHD, I (and many others) have experienced emotional sensitivity that makes us more susceptible to RSD. Emotional sensitivity isn’t necessarily a bad thing. It can manifest as extreme empathy, joy, and connectedness to the world around us. It can also mean more crying, bursts of anger, and irrational thinking. 

Our minds are incredible powerhouses of creativity and dynamism, but they are also prone to detect insults or criticism that may not even be real. 

It's as though our brains transform each minor hiccup into an unclimbable mountain, signalling the dramatic entrance of RSD into the scene.

Is RSD exclusive to individuals with ADHD?

The intricate dance of RSD is not strictly choreographed and restricted to the beats of ADHD. 

It finds its rhythm in diverse tunes, expressing itself in individuals grappling with conditions such as borderline personality disorder, major depressive disorder, and social anxiety. 

Therefore, even though the limelight often falls on the tandem performance of ADHD and RSD, it's important to recognise that the ballroom of RSD entertains a more varied crowd.

The Interplay of Emotional Dysregulation and ADHD

Emotional Dysregulation (ED) is a term to describe emotional reactions that are poorly regulated and that exceed the traditionally accepted scope of emotional response. 

Feelings gif with Nicholas Cage

To put it plainly, it's when our emotional reactions become disproportionate to the situation at hand. This could precipitate swift, often dramatic mood swings, intense emotions, and trouble regaining a serene, stable state after an emotional surge.

Emotional dysregulation is a hallmark trait of numerous mental health disorders, including ADHD. It's essential to acknowledge that ADHD is not simply about inattentiveness, impulsivity, and hyperactivity.It also frequently incorporates difficulty navigating emotions. But as mentioned, the DSM-V doesn’t account for the emotional side, so it’s often overlooked.

Indeed, many individuals with ADHD encounter feelings more deeply, passionately, and regularly than their peers without ADHD.

The nexus between emotional dysregulation and ADHD is still a subject of active investigation. Nevertheless, research indicates that shared neurological elements are involved. The brain regions overseeing executive functions - such as attention, focus, and impulse control - also regulate emotions. 

It's proposed that the same neurological disturbances that give rise to the classic symptoms of ADHD also impact the brain's ability to moderate emotions, leading  to emotional dysregulation. Grasping this connection is pivotal for devising effective treatment and management plans for individuals with ADHD.

What are the RSD symptoms, causes and triggers?

What are the symptoms of rejection sensitive dysphoria?

While the key symptom of Rejection Sensitive Dysphoria is intense emotional pain, it reveals itself through various symptoms, typically triggered by the perception of rejection, criticism, or failure. 

Or, if you’re me, it’s having an emotional breakdown following a fake argument you’ve had with yourself in the shower. 

self high five

On a serious note, these emotional and physical symptoms can induce substantial distress in the individual.

Intense feelings of sadness, rage, or humiliation in response to perceived rejection or criticism characterise RSD emotionally. These feelings can be so overpowering that they're deemed dysphoric or hard to endure. A person with RSD may exhibit an extreme emotional reaction to minor incidents. For instance, a slightly critical remark from a colleague could incite feelings of crushing embarrassment or self-contempt. They can also feel severe anxiety before anticipated rejection or criticsm (hence the unread emails…). 

RSD may also be the underlying factor if you often:

  • Become anxious before anticipated rejection or criticism
  • Are embarrassed or become self-conscious
  • Have low self-esteem and low confidence 
  • Focus on avoiding disapproval, criticism, people-pleasing, seeking approval
  • Overcompensate by striving for perfection and burning out
  • Struggle to start or stop tasks as a means to avoiding rejection and failure

Physically, some individuals might experience breathlessness, heart palpitations, or even full-blown panic attacks when their RSD is provoked. These physical manifestations can be alarming and may amplify the emotional symptoms of RSD. They affect your focus and ability to perceive your control in a situation.

What causes rejection sensitive dysphoria?

RSD is suspected to be rooted in neurobiology - much like ADHD; it's probably linked to the operation of certain neurotransmitters in the brain. Triggers often encompass situations where the individual feels vulnerable to possible criticism, rejection, or failure. This could involve social scenarios, performance settings (at work or school), or personal relationships. Those who struggle with RSD often have great difficulty maintaining personal relationships, leading to isolation, loneliness, and even lower self-esteem.

Keep in mind that each person's encounter with RSD is unique. Identifying these signs and understanding the triggers can be critical to effectively managing RSD.

For me, rage has been the biggest symptom of RSD. One I often felt ashamed of, but with therapy, I’ve come to realise my emotions are very much valid, and I also have the ability to control them adaptively. 

Navigating the tempest of RSD

Much like steering a ship amidst a tumultuous storm, Rejection Sensitive Dysphoria calls for a firm grasp on the wheel.

Tackling RSD entails a comprehensive approach that acknowledges the emotional and physical manifestations while tailoring it to each person's distinct needs and journeys.

Here are some tactics that I've found instrumental:

1. Psychotherapy 

Cognitive-behavioral therapy (CBT) holds significant potential for manoeuvring RSD. It assists in challenging harmful thought processes, fostering healthier reactions to perceived rejection, and bolstering resilience.

2. Mindfulness and Soothing Techniques 

Practices such as mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can aid in managing the physical symptoms of RSD. By learning to divert your focus away from distressing thoughts, you might be able to diminish the severity of your emotional reactions.

3. Lifestyle Adjustments 

Consistent exercise, a nutritious diet, sufficient sleep, and limiting caffeine and alcohol intake can all improve overall emotional well-being.

4. Pharmacotherapy 

In certain circumstances, medication could be beneficial. Some ADHD medications, along with certain antidepressants and mood stabilisers, can help mitigate the symptoms of RSD. Always seek advice from a healthcare professional for personalised guidance.

5. Support Circles 

Connecting with others who grapple with RSD can offer emotional support, shared coping mechanisms, and camaraderie.

This can be particularly helpful in alleviating feelings of seclusion.

As you are at it - you can check out Deepwrk's body doubling website to find a community of supportive ADHDers.

6. Self-care 

Allocate time for activities that bring you joy and instil relaxation. Self-care is crucial to managing any mental health condition, including RSD.

The effectiveness of these tactics will vary between individuals. It's essential to seek professional help and explore various strategies to find what suits you best.

There’s always a silver lining

In this winding expedition through the labyrinth of ADHD and RSD, I discovered that comprehension is my most reliable guiding star. 

You can find some more information and educational content listening to ADHD podcast or reading some amazing ADHD books.

And it might seem oddly simple, but ADHD body doubling online can have a profound impact for anyone with ADHD.

If you want to discover other methods to manage ADHD or RSD, we have curated a list with the best ADHD products and the top ADHD productivity tools out there. Keep in mind that if you live in the UK, you can cover some of the costs of managing ADHD with the Access to Work ADHD grant.

These tools, products, and educational resources may not eradicate the struggle, but can impart you with the knowledge to navigate it with a touch more finesse and a sprinkle of tenacity. 

So, to those tracing similar routes, remember, it's okay to falter. 

It's okay to lose your way. 

Each bend, and turn, is a fresh lesson. 

The journey is strenuous, without a doubt, but together, we can chart the intricate ADHD maze.

Find your flow with Deepwrk. ADHD body doubling to get things done solo, not alone!
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Demi Aspey
Demi is the founder of the creative agency, Sonder Script, a culture columnist for House of Coco magazine, a part-time lecturer, and a soon-to-be Doctor in screenwriting. She is a scriptwriter by speciality and a copywriting cultivator by trade. Demi is a mental health advocate and was diagnosed with ADHD as an adult.