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Rejection Sensitive Dysphoria and ADHD: What You Need to Know

Updated: Apr 4

Rejection Sensitive Dysphoria Related to ADHD?

Rejection Sensitive Dysphoria (RSD) is a complex emotional condition often linked to Attention-Deficit/Hyperactivity Disorder (ADHD).

This article looks into the intricacies of RSD, exploring its symptoms, and its connection to ADHD. We offer insights into coping strategies and treatment options.

What Is Rejection Sensitive Dysphoria? 

Rejection Sensitive Dysphoria is a described experience characterized by intense emotional pain and discomfort triggered by perceived or actual rejection or criticism. 

Unlike typical feelings of sadness or hurt in response to rejection, RSD causes overwhelming emotional turmoil, significantly impacting an individual's social interactions and self-esteem. 

Individuals with RSD might perceive rejection in situations where it isn't intended, leading to a skewed interpretation of social cues. This hypersensitivity can result in significant distress, affecting personal and professional relationships.

It’s important to note that RSD is not currently an official diagnosis and there is no significant current empirical evidence that supports its existence. RSD is a described experience that has been noted by clinicians working with individuals with ADHD. It is also a described experience that appears to resonate with the experiences of many individuals with ADHD. Although there is no significant literature on RSD at present, there is ample research that has been conducted on the construct of Rejection Sensitivity and some existing research that validates the idea it can be heightened for those with ADHD. 

How Is Rejection Sensitive Dysphoria Related to ADHD?

ADHD is characterized by symptoms like inattention, impulsivity, and hyperactivity, but it also often includes challenges with emotional regulation. Individuals with ADHD are prone to intense emotional responses and may have difficulty managing these emotions effectively.

RSD, in the context of ADHD, is an amplified response to perceived or actual rejection. The impulsivity and emotional dysregulation inherent in ADHD intensify the sensitivity to rejection, leading to the pronounced symptoms of RSD. This heightened sensitivity can exacerbate the core ADHD symptoms, creating a complex interplay that affects the individual's social interactions, self-esteem, and overall emotional well-being. 

Additionally, given that individuals with ADHD are more likely to experience challenges in all areas of their lives, they are more prone to experiencing criticism and negative feedback. Experiencing negative feedback from other people throughout life naturally leads people to become more sensitive and concerned about how others view them. This can amplify the degree to which someone anticipates rejection and the pain with which the experience comes. 

RSD, in the context of ADHD, is an amplified response to perceived or actual rejection. The impulsivity and emotional dysregulation inherent in ADHD intensify the sensitivity to rejection, leading to the pronounced symptoms of RSD.

What Are the Symptoms of Rejection Sensitive Dysphoria?

RSD presents with a range of symptoms that are intense and often debilitating, significantly impacting the emotional well-being and daily functioning of individuals.

  • Intense Emotional Responses

Individuals with RSD experience profound emotional pain and discomfort that is disproportionate to the situation. This can manifest as sudden bursts of sadness, anger, or anxiety following real or perceived criticism or rejection. Unlike typical reactions to rejection, those with RSD feel these emotions more acutely, often describing the pain as unbearable or overwhelming.

  • Social Withdrawal and Avoidance

Due to the fear of rejection, individuals may avoid social interactions, relationships, or situations where there is a risk of criticism. This avoidance can lead to isolation and can negatively impact personal and professional relationships.

  • Low Self-Esteem and Self-Confidence

Constant fear of rejection can erode an individual's self-esteem, leading to persistent feelings of inadequacy, self-doubt, and a negative self-image. This can affect their ability to engage confidently in various aspects of life.

  • Rapid Mood Shifts

Those with RSD may exhibit sudden and dramatic changes in mood in response to perceived rejection or criticism. These mood swings can be confusing and exhausting for both the individual and those around them.

  • Impaired Social Functioning

Difficulty in interpreting social cues accurately often leads to misunderstandings and conflicts. Individuals with RSD may misinterpret neutral or ambiguous interactions as negative, which can strain relationships and increase social anxiety.

  • Performance Impairment

Fear of failure or criticism can hinder academic or professional performance. Individuals may procrastinate or avoid tasks altogether, impacting their productivity and success.

  • Physical Symptoms

Stress and anxiety associated with RSD can also manifest physically, leading to symptoms like headaches, stomachaches, or fatigue, further affecting an individual's quality of life.

How Do You Cope With Rejection Sensitive Dysphoria?


Coping with RSD involves a multifaceted approach that addresses both the emotional and behavioural aspects of the condition:

  • Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a highly effective treatment for RSD, particularly in individuals with ADHD. This therapy focuses on identifying and challenging negative thought patterns and beliefs related to rejection and self-worth. Through CBT, individuals learn to reframe their thoughts in a more positive and realistic way, which can reduce the intensity of emotional responses to perceived rejections. CBT also helps in developing coping skills to manage anxiety and improve social interactions.

Cognitive Behavioral Therapy (CBT) is a highly effective treatment for RSD, particularly in individuals with ADHD. 

  • Medication

Medications used to treat ADHD and related conditions such as stimulants or antidepressants, could also potentially alleviate symptoms of RSD. These medications can help regulate mood swings and reduce the intensity of emotional reactions. It's important to consult with a healthcare professional for a proper diagnosis and treatment plan.

  • Mindfulness and Relaxation Techniques

Practices like mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can be highly beneficial. These techniques help individuals stay grounded in the present moment and develop a non-judgmental awareness of their thoughts and feelings, which can reduce the overall stress and anxiety associated with RSD.

  • Social Skills Training

Improving communication and interpersonal skills can include learning how to interpret social cues more accurately, how to express emotions in a healthy way, and how to build and maintain healthy relationships. Enhancing these skills can lead to more positive social interactions and reduce the likelihood of perceived rejection.

  • Building a Support Network

Having a supportive network of friends, family, or a support group can provide a safe space to share experiences and feelings. Knowing that there are people who understand and support you can be incredibly comforting and can help mitigate feelings of isolation often associated with RSD.

  • Healthy Lifestyle Choices

Regular exercise, a balanced diet, and adequate sleep can significantly impact emotional well-being. Physical activity, in particular, is known to reduce stress and improve mood, while a healthy diet and good sleep hygiene can enhance overall mental health.

  • Self-Compassion

Developing a practice of self-compassion can be a powerful tool in managing RSD. This involves treating oneself with kindness and understanding in moments of perceived failure or rejection. 

  • Setting Realistic Goals and Expectations

Setting achievable goals and having realistic expectations about outcomes can reduce the pressure and fear of rejection. Recognizing that rejection is a normal part of life and not a reflection of personal worth can help in maintaining a balanced perspective.

  • Educating Oneself and Others

Understanding RSD and educating those around you about your experiences can foster a more supportive environment. Awareness can lead to better understanding and accommodation in personal and professional relationships.

  • Journaling and Reflection

Keeping a journal can be a therapeutic way to express and process emotions related to rejection and RSD. Reflecting on experiences and writing about them can provide insight into triggers and patterns, aiding in the development of coping strategies.

  • Engaging in Enjoyable Activities

Participating in hobbies and activities that bring joy and fulfillment can boost self-esteem and offer a respite from the stressors associated with RSD.

  • Setting Boundaries

Learning to set healthy boundaries in relationships and at work can help manage the stress and expectations that might trigger RSD symptoms.

  • Seeking Professional Help

Seek guidance from mental health professionals, particularly for an accurate diagnosis and tailored treatment plan. For those in Toronto, consider taking an ADHD test at a mental health clinic.

Understanding RSD, particularly in the context of ADHD, is crucial for effective management and treatment. If you or someone you know is struggling with symptoms of RSD or ADHD, professional help is available. Radcliffe Psychotherapy Clinic offers guidance and support. We also provide a comprehensive ADHD Assessment in Toronto. Contact us at (289) 801 - 4133 for a comprehensive approach to managing these conditions.


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