What is Rejection Sensitive Dysphoria: What Does RSD Look Like in ADHD?

What is Rejection Sensitive Dysphoria? Does everyone with ADHD deal with it?

How do you support yourself when RSD symptoms arise? 

Whether you’ve known about your RSD for years or you’ve just recently learned the word, you’re in the right place.

In episode 139 of the I’m Busy Being Awesome podcast, we’re diving into each of the above questions and so much more.

If you or someone you love struggles with extreme emotional sensitivity, especially from perceived rejection or falling short of high expectations, keep reading…

And if you know anyone who’d benefit from learning about RSD or knowing they’re not alone in feeling this way, would you be a rockstar and share this episode with them? 

You can listen to the episode above or stream it on your favorite podcasting app here:   

Prefer to read? No problem! Keep scrolling for the entire podcast transcript.

In Episode 139: What Is Rejection Sensitive Dysphoria & What Does RSD Look Like In ADHD, You Will Discover… 

  • What Rejection Sensitive Dysphoria is
  • The different ways RSD presents itself
  • How to support yourself if you struggle with RSD and ADHD

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Episode #139: What is Rejection Sensitive Dysphoria: What Does RSD Look Like in ADHD? (Transcript) 

What is Rejection Sensitive Dysphoria - What You Need To Know

One of my clients asked me to do an episode on Rejection Sensitive Dysphoria probably back in September or October of last year.

She mentioned how eye-opening and helpful it was for her to know more about RSD when it came to her own journey with ADHD. And I knew that I wanted to share this topic with everyone on the podcast because it is so important and I know that it has impacted most if not all of my clients in one way or another and certainly my life as well.

But I kept pushing it off. I kept kicking it down the lane. And at first, the excuses sounded really valid. I would tell myself, it’s not quite the right time. This isn’t what people really want to hear about during — insert any excuse here — time of the year. Or it didn’t fit with the theme of whatever it was I was talking about.

But the reality is — with a kind of ironic twist — that the reason I wasn’t doing an episode on RSD was because of my own RSD.

My rejection sensitive dysphoria was keeping me from releasing the episode because I was afraid that I would get it wrong, or I would misrepresent the information out there. And then I would disappoint all of you amazing listeners, and then feel rejected.

So instead, I rejected everything ahead of time by continually not releasing it for months and months.

But then this past week the topic of RSD came up a few different times in my group program, We’re Busy Being Awesome, as well as with my private clients.

When so many people were resonating with this concept in one week, it was a strong reminder of how important it is that we talked about it.

So today, we’re talking all about RSD

We’ll explore:

  • What rejection sensitive dysphoria is
  • How RSD often presents itself in people
  • How RSD can impact our lives
  • Different ways you can support yourself or someone else who might deal with RSD when symptoms get triggered

At the bottom of the transcript, you’ll find links to the great resources I used for my research.

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What Is Rejection Sensitive Dysphoria?

So perhaps it’s best to start with the definition. What in the world is RSD?

As I mentioned, it stands for rejection sensitive dysphoria.

And I should first say that it’s not a formal diagnosis. You won’t find it in the DSM-5, which is The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Instead, it is one of the most common forms of emotional dysregulation, and it tends to show up most often in ADHD, especially with adults.

I have also seen research suggest that it can present itself for people with Autism as well.

And quoting William Dodson from one of his articles from ADDitude magazine, he explains that…

“RSD is a brain-based symptom that is likely an innate feature of ADHD… dysphoria is the Greek word meaning unbearable; and its use emphasizes the severe physical and emotional pain suffered by people with RSD when they encounter real or perceived rejection, criticism, or teasing.”

William Dodson

And he goes on to explain, “the emotional intensity of RSD is described by my patients as a wound. The response is well beyond all proportion to the nature of the event that triggered it.”

In other words, RSD is an incredibly intense and often painful feeling of rejection.

People with ADHD experience this rejection much more intensely than a neurotypical brain. And this rejection might be actual rejection or criticism, or it might be simply perceived or anticipated as criticism or rejection.

With RSD (and ADHD) You might find yourself in situations like this:

  • Spinning out from negative feedback on a report or presentation and work – which could be taken as criticism.
  • Ruminating because somebody hasn’t texted you back. So you’re convinced that they don’t want to talk with you.
  • Or it could present itself (as it did for me with this episode) as potential rejection in the future. And to avoid feeling that rejection, you might hold back from doing the thing so you don’t have to feel rejected.

And we’ll talk about all three of these more in-depth today. But as a general overview, that is, in a nutshell, RSD.

Understanding Rejection Sensitive Dysphoria & Why This Matters

women worried

Now, even if you don’t resonate with what I just described here. If you don’t have ADHD or you don’t struggle with this intense feeling of rejection and sensitivity, I suggest that you continue listening for a few reasons.

1. Nobody likes feeling rejected

So when you inevitably experience this emotion at some point, you will have some tools and strategies to support yourself.

Additionally, about 1 in 20 people has an ADHD diagnosis. And as awareness increases around ADHD, that number is increasing, because people who were missed in the diagnosis process when growing up are now finally getting the treatment they deserve.

So one in twenty people have ADHD, and the research suggests these adults and teens are much more sensitive to the feeling of rejection.

Plus, one in three of those ADHDers say it’s the hardest part of living with ADHD. So chances are good that you know at least a couple of people who deal with this. And the more that we can educate one another, the more that we can create understanding, acceptance, and support for everyone who needs it. And that’s what it’s all about. 

Now one other thing that I want to mention before we really dive in is that there is no simple treatment or quick fix for RSD. There are some medications out there that people can use, and they work for some people. So if you are interested in the medication route, I highly recommend checking with your psychiatrist or whoever prescribes your medicine.

2. Educate Ourselves on RSD To Raise Awareness of Emotional Dysregulation

That way when it happens, or as it unfolds, we know how to support ourselves and take care of ourselves without letting it consume our days or weeks, even months.

I also want to do my best to normalize this experience.

If you’re a person who feels this kind of rejection, hurt or pain and things that don’t seem to trip up other people, you’re absolutely not alone.

You’re not overly emotional.

You’re not too sensitive.

You’re not too dramatic.

You are a human experiencing really intense emotion and it’s real. It’s valid. And I see you.

What Does RSD Look Like?

What is ADHD Rejection Sensitive Dysphoria & How To Deal with It

So with all of that, let’s talk about how RSD might present itself. What might this look like?

RSD can get triggered for a person whether it was actual rejection, perceived rejection, or anticipated rejection.

And when any brain feels a sense of rejection and even more so when it’s intensified with RSD, it feels dangerous and unsafe.

This makes sense when we think about the way the brain has evolved.

Remember, belonging was crucial for survival thousands of years ago. You had to make sure that you fit in with the group because if you were cast aside you had to survive in the elements on your own, which probably wasn’t going to happen.

In other words, fitting in and belonging was safety, and rejection meant death.

So when your body experiences this feeling of rejection, and it feels incredibly strong, it can send the body into that fight, flight, or freeze response. It goes into that stress response and tries to keep you safe.

This can show up in different ways.

Fight Response:

It might look like a panic or rage. You might be fighting back and defensive and angry.

Flight Response:

It can also present itself in terms of avoidance, where you are in flight. You might be experiencing feelings of shame or humiliation, and you might believe that you disappointed people.

Freeze Response:

This stress response can also show up in terms of freezing. You might experience a sense of despair or hopelessness and you might shut down. You might stop participating and stop putting yourself out there so you never have to risk experiencing it.

Internal & External Rejection

I also want to note that this kind of rejection can be internal or external rejection.

You might actually receive bad feedback. You might learn about someone saying something unkind about you or someone might roll their eyes at one of your ideas.

But it could also be your own internal criticism of thinking your ideas are not good enough. Or thinking you don’t belong and others won’t like you, so you don’t put yourself out there to meet your people.

Now people with hyperactive ADHD often talk about how they can’t turn off their racing, overactive brains. This hyper-aroused state means often means that our thoughts, feelings, and actions are more intense than a typical brain. And because of this, we experience higher highs and lower lows.

When we are in this hyper-aroused state — meaning that everything seems much more intense to us — it makes it very challenging for us to differentiate between what might be considered constructive feedback versus criticism versus unintentional actions from humans being humans.

Example: Maybe you are texting back and forth with a friend. You make a joke in the text, and she doesn’t respond right away. A neurotypical brain might see this and think, “huh. she must be busy.” Or maybe they even think, “maybe she didn’t like the joke. oh well.”

But the ADHD brain – or perhaps it’s better if I just speak for me. MY ADHD brain would do down the ruination rabbit hole convinced that she hated the joke, doesn’t think I’m funny, and she has no intention of being friends with anymore. And because the brain CAN hyperfocus on things it’s interested in – whether it feels good or not – my brain will ruminate on those thoughts over and over for hours.

I know this sounds extreme, but that’s what my brain does.

I have a feeling I’m not alone, which is why I am sharing this.

Because again, I think when we can talk about how RSD shows up and bring it into our awareness, then we can start noticing it more often.

We can say out loud what we’re thinking and talk it through. For example, with the text situation, I might think to myself: okay, I know that my friend has three kids, I sent the text at bedtime. It’s very possible that she hasn’t seen it yet. Or maybe she did see it but couldn’t respond because bedtime is insanity.

There are so many reasons that don’t include total rejection.

So, to put RSD further into context, I thought I would give a few more examples from my own experiences. Because again, this is something I absolutely deal with. And I really want to normalize it for anybody who resonates.

My Personal Experience with RSD: 3 Ways RSD Pops Up

When I have my RSD triggered, I tend to show up in three different ways or a combination of them together.

And while I work on this regularly, as I mentioned earlier, there is no be-all-end-all cure.

Instead, it’s all about raising your awareness and learning how to adjust. So I’m always working on increasing my awareness of these responses. And I’ve gotten better at noticing it when it’s coming or when I’ve been triggered.

But it still happens. And that’s okay.

1. People Pleasing and RSD

The first way this often shows up for me is people-pleasing.

Rather than potentially upsetting someone or saying the wrong thing or inconveniencing anyone, I quickly shift into people-pleasing mode.

My brain tries to convince me that I can control other people’s emotions and keep them happy by people-pleasing so I don’t disappoint them. Essentially, my automatic toddler brain just thinks it should say yes to every request.

I have a strong memory of this behavior from college. It was one that really stuck with me, but it didn’t make sense until I learned about my ADHD diagnosis is and started learning a lot more about RSD.

When I was an undergrad, I was in the University Wind Ensemble. I was really involved in the music program since I was a music major, and one day after rehearsal, the wind ensemble director said to me me, “I have a favor to ask you.” And I said in an immediate knee-jerk response, “sure, it’s no problem.”

He kind of looked at me for a minute and in his gruff, growly voice said to me, “if I can offer you some advice. Don’t ever agree to something when you don’t even know the request.”

I paused for a minute. And I heard him. It landed a little bit. But it took a while to really sink in. It took a while to realize how ingrained in me that habit was.

I did everything I could to avoid disappointing people, which to me meant saying yes to essentially everything.”

2. Overworking and RSD

This leads to another way that RSD often presents itself, and this is – again – very true for me, which is overworking and over-performing.

As ADHDers, many of us tend to think that if we overwork and over-do and over-perform and over-provide.

If we can achieve enough and do enough, then we can somehow sidestep rejection.

This is where perfectionism comes in as well. If we tweak and perfect and put in all the bells and whistles, we help mitigate any opportunity for criticism.

And so we work and work and work, completely rejecting our own needs so that we have a chance of avoiding rejection from others.

3. Avoiding and RSD

This shows up for me specifically is in terms of avoiding challenges, putting myself out there, voicing my opinion, etc.

In grad school, for example, I would never raise my hand in the seminars because I assumed that everyone would criticize me – either in their mind or out loud. (It is grad school after all.)

I anticipated criticism with all of my internal rejection, I avoided raising my hand or expressing any ideas. Again, it happened with this very podcast as I mentioned at the beginning of the episode. My client had suggested doing this in September or October, and it’s coming out in March. Soooo there’s that.

Here’s what this might look like:

  • Not setting goals
  • Being very careful about what you say – reading and re-reading emails and texts.
  • Censoring every word that comes out of your mouth and then rehashing everything that you DID say after the event is over.

And because of this kind of self-censoring and masking, it is exhausting.

I call it the chameleoning effect

You chameleon from one set of people’s expectations and standards to the next – it’s easier to just avoid it altogether by turning down invitations and avoiding others.

For many of us, we start to play a smaller life.

We don’t put ourselves out there. We don’t go to gatherings or parties. We are very careful about what we say and it can be pretty lonely.

I see this with several of my clients

I’ve seen a theme in terms of avoiding hobbies, passion projects or learning new skills.

They don’t want to start doing anything because they’re not perfect at it yet. And their internal rejection is so strong, and their fear of rejection from others is so strong, that they don’t allow themselves to try a new hobby or learn a new skill.

And even though they intellectually know that they have to practice to improve the skill, it’s so uncomfortable to be bad at it but it takes work to try.

Support for Rejection Sensitive Dysphoria

So what can we do?

There is no one-size-fits-all cure. I wish there was. There are some medications out there, I know guanfacine is one of them. And if that is an avenue you want to pursue, do talk with your psychiatrist about it.

Here are some ways to help you deal with RSD:

Have Self Awareness

Remind yourself that you are not wrong for feeling this way and you’re not the only one who feels this way.

You’re not being overly dramatic or too sensitive. What you’re feeling is real.

Take Care of Yourself

Now that you are focusing on awareness of RSD symptoms you can learn how to take care of yourself after the RSD is triggered.

For example: If you often experience RSD symptoms at big family gatherings, when you have meetings with particular coworkers, or after your performance evals at work, ask yourself these questions…

  • How can you create time and space for you to step away, breathe, and take care of yourself?
  • Who are the people who you can talk with when you’re hurting? (Know who your safe people are – whether it’s your partner or a best friend or a therapist or a coach).
  • What do you need to support yourself when it happens? 

Connect with Others Who Understand

It can be really empowering to be with others who understand what you’re going through as well.

It can be such a relief to be in community with others who can say, “I totally get it. I’ve been there too. I see you.”

In fact, I’m about halfway through my January cohort of We’re Busy Being Awesome, and someone posted something in the community that literally brought me to tears.

They wrote, “this group has made me grow in so many ways and even ways I’m not noticing yet. Ultimately because I know I’m not alone.”

Rejection Sensitive Dysphoria: My Message To You

  • If you’re navigating RSD, it IS hard, so please be gentle with yourself.
  • If you notice the negative self-talk and criticism in your mind. If you’ve slipped into the spin cycle of rumination, take some time to write it down. Separate the thoughts from the facts. What’s actually true?
  • Reach out to one of your people and talk through whatever’s on your mind.
  • Do whatever you need to do to remind yourself of the incredible, empathic, caring, busy-awesome human you are. Because that is the truth.

Want To Join Our Group Coaching Program?!

I will be opening the doors for the next cohort of We’re Busy Being Awesome in a couple of weeks!

Add your name to the waitlist so you’ll be the first to know about program dates and times, plus how you can sign up if it’s a great fit for you.


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