If you’ve ever overthought a conversation with a friend until you literally had a meltdown, you might have Rejection Sensitive Dysphoria. If you’ve ever been overtaken with irrational anger because of critical feedback from your boss, you might have Rejection Sensitive Dysphoria. Rejection Sensitive Dysphoria (RSD) is an extreme emotional sensitivity and pain triggered by the perception—whether real or imagined—of rejection, criticism, or failure. Those with RSD often experience intense emotional reactions to situations that others might brush off. Overthinking, anxiety, and disproportionate emotional responses can strain personal and professional relationships. Understanding RSD and employing coping strategies, such as mindfulness, cognitive-behavioral therapy, and seeking support, can help manage these overwhelming feelings and improve overall well-being. Truth is, RSD is really common in those of us with ADHD. Like, really common. It’s baffling that while the research on ADHD consistently shows Rejection Sensitivity as a common symptom, the criteria for ADHD doesn’t say a word about it. This oversight leaves many struggling to understand why they experience such intense emotional pain in response to perceived rejection or criticism. Despite the clear link between ADHD and RSD, the lack of formal recognition in diagnostic criteria means that many people suffer without knowing why or how to cope. Raising awareness about this connection is crucial for better support and management of ADHD as a whole. Rejection Sensitive Dysphoria describes the intense emotional flooding that hits a person with ADHD when they experience perceived rejection, criticism, or disapproval. It’s so overwhelming that most of us who experience it don’t have adequate words to describe the sensation. It hits hard and fast, without warning, leaving us feeling emotionally shattered and often unable to articulate the depth of our pain. This sudden and powerful wave of emotions can make it difficult to navigate everyday interactions, as the fear of rejection or criticism looms large, ready to trigger another overwhelming response.
RSD Symptoms Rejection Sensitive Dysphoria (RSD) is the emotional flooding that occurs from the perception that a person is being rejected, dismissed, disrespected, disapproved of, or isn’t wanted. This intense emotional response can be triggered by even the slightest hint of disapproval or criticism, whether real or imagined. For those experiencing RSD, these perceptions can cause overwhelming feelings of sadness, anger, and anxiety, often leading to emotional meltdowns. The intensity of these reactions can make everyday social interactions and professional environments particularly challenging, as the fear of rejection or disapproval looms large and ever-present. Some of the signs you’re experiencing rejection sensitive dysphoria are:
Internalizers tend to become hard-core people pleasers in an attempt to prevent the feelings of rejection sensitivity. This behavior is a coping mechanism, driven by the intense emotional pain they experience at the slightest hint of disapproval or criticism. By constantly striving to meet others' expectations and avoid conflict, they hope to shield themselves from the gut-wrenching feelings of rejection. However, this can lead to a cycle of anxiety and exhaustion, as the fear of rejection never truly dissipates and the need to please others becomes a relentless pursuit. Recognizing this pattern is the first step towards healthier coping strategies and self-acceptance. These internalizers tend to look similar to the Highly Sensitive Person. And they can definitely be both. Find out more about the overlap between ADHD and HSP here. Other People Externalize the flooding:
Externalizers are more likely to stop trying, slack off, and avoid engaging to prevent Rejection Sensitivity. Instead of striving to please, they withdraw from situations where they might face criticism or rejection. This avoidance behavior serves as a protective shield against the intense emotional pain triggered by disapproval or failure. By disengaging, externalizers hope to minimize their exposure to rejection, even if it means missing out on opportunities for growth or connection. This coping mechanism, while self-protective, can lead to unfulfilled potential and a sense of isolation, highlighting the need for strategies that address the root causes of Rejection Sensitivity. WHAT CAUSES IT?Rejection Sensitivity is thought to be passed on through genetics. While there’s not a lot known about its exact cause, the current theory mirrors the understanding of Highly Sensitive Persons (HSPs). Both conditions involve heightened sensitivity to external stimuli and emotional experiences. People with Rejection Sensitivity, much like HSPs, are more profoundly affected by social interactions, leading to intense reactions to perceived rejection, criticism, or disapproval. This genetic predisposition suggests that some individuals are inherently more sensitive, making them more vulnerable to the emotional flooding characteristic of Rejection Sensitivity. Basically, it’s believed that the ADHD nervous system, much like that of Highly Sensitive Persons (HSPs), is more highly attuned. This heightened sensitivity creates an overwhelming physical response to strong emotions, such as those elicited when feeling unwanted or rejected. Individuals with ADHD often experience intense emotional reactions to perceived rejection or criticism, which can be attributed to their highly sensitive nervous system. This profound emotional sensitivity can lead to a cascade of physical reactions, from racing heartbeats to a lump in the throat, amplifying the distress associated with Rejection Sensitivity. Understanding this connection sheds light on the complex interplay between neurobiology and emotional experience in conditions like ADHD and Rejection Sensitivity. THE LAST IMPACT OF REJECTION SENSITIVITY DYSPHORIAWhile the initial emotional flooding doesn’t last all that long, the experience takes its toll on a person. Humans tend to do everything possible to avoid the feeling of shame, and Rejection Sensitive Dysphoria (RSD) is a lot like shame. It lingers, leaving behind a residue of doubt, insecurity, and self-criticism. Even after the initial wave of intense emotions subsides, the impact of RSD can continue to affect one's thoughts and behaviors. The fear of experiencing rejection or criticism again can lead to avoidance strategies, such as withdrawing from social interactions or refraining from taking risks. Over time, this avoidance can limit personal and professional growth, reinforcing feelings of inadequacy and unworthiness. Recognizing RSD as akin to shame underscores the importance of addressing its underlying causes and developing healthier coping mechanisms to break free from its grip. Rejection Sensitive Dysphoria (RSD) can make you feel worthless or "bad." Even after the initial experience wears off, it can sometimes create this ongoing sense of being defective. This opens up self-criticism and issues of chronic low self-esteem. The intense emotional reactions triggered by RSD can leave lasting imprints on one's self-perception, fostering a constant cycle of negative self-talk and self-doubt. The fear of experiencing rejection again can fuel this sense of inadequacy, leading to a persistent belief that one is inherently flawed or unworthy. Breaking free from this cycle requires challenging these negative beliefs and developing self-compassion and resilience to counteract the damaging effects of RSD on self-esteem. Rejection Sensitive Dysphoria (RSD) can make you feel like every interaction you have with another person puts you at imminent risk of this unbearable pain at any moment. The fear of experiencing rejection or criticism can loom large, casting a shadow over even the most casual conversations. This constant anticipation of emotional pain can lead many to start avoiding relationships or social interactions altogether, opting for solitude to shield themselves from potential hurt. However, this avoidance often results in feelings of loneliness and isolation, exacerbating the emotional toll of RSD. Breaking free from this cycle requires learning to navigate social interactions with resilience and self-compassion, while also seeking support from understanding friends, family, or mental health professionals. Related: ADHD and Anxiety: Here’s what you need to know (especially if you have both) It’s is NOT in the DSM 5 and It’s Connection to ADHD is MissedRejection Sensitive Dysphoria is a symptom, not a diagnosis, so it’s not listed in the DSM. Unfortunately, it’s not really listed as a symptom of ADHD either. Research may consistently show that RSD is a common experience for us, but the criteria for ADHD remain exclusively focused on inattention and hyperactivity without a single word about emotion listed. This oversight can be frustrating for those grappling with the intense emotional reactions characteristic of RSD, as it means that their experiences may not be fully understood or acknowledged within the diagnostic framework. As a result, many individuals with ADHD may struggle to find appropriate support or treatment for managing the emotional challenges associated with RSD. Advocating for greater recognition of RSD within the context of ADHD is crucial for improving awareness and ensuring that individuals receive the comprehensive care they need. ![]() Because of this, a lot of doctors and therapists aren’t aware that ADHDers often experience Rejection Sensitive Dysphoria as part of their diagnosis (though a few are certainly more aware). And if you start describing your experience with emotional flooding, you’re likely to get misdiagnosed. This lack of awareness can be incredibly frustrating for individuals seeking support and understanding for their emotional struggles. Without proper recognition of RSD within the context of ADHD, there's a risk of misinterpretation or dismissal of symptoms, leading to inadequate treatment or support. It's essential for healthcare professionals to be educated about the intersection of ADHD and RSD to ensure accurate diagnosis and effective management of symptoms. Rejection Sensitivity is often MisdiagnosedIt really shouldn’t be a surprise at this point that people who experience RSD get misdiagnosed with other things. Here are some of the most common:
How to Treat Rejection Sensitive DysphoriaMy therapist told me she hates to say it, but the initial experience of emotional flooding from Rejection Sensitive Dysphoria doesn’t generally respond well to therapy. The experience happens so fast and is so overwhelming it leaves little time for skills. And while trauma can certainly make RSD worse, it’s not caused by trauma. This insight sheds light on the complex nature of RSD and its resistance to traditional therapeutic interventions. While therapy can play a crucial role in addressing underlying issues and developing coping strategies for managing RSD in the long term, it may not provide immediate relief during the intense emotional episodes characteristic of the condition. Understanding this distinction is essential for individuals seeking support for their RSD, as it underscores the importance of a multifaceted approach to treatment that addresses both immediate symptoms and underlying factors contributing to the condition. ![]() That doesn’t mean that therapy isn’t helpful at all, because it is. It can help treat the lasting impact that Rejection Sensitive Dysphoria has on a person. While therapy may not offer immediate relief during the intense emotional flooding episodes of RSD, it plays a crucial role in addressing the long-term effects and developing coping strategies. Therapy provides a safe space to explore and understand the underlying factors contributing to RSD, such as past experiences or cognitive patterns, and helps individuals develop resilience and self-compassion. Through therapy, individuals can learn to challenge negative beliefs, build healthier relationships, and cultivate strategies for managing emotional reactions in the face of perceived rejection or criticism. Thus, while therapy may not offer a quick fix for RSD, it remains an invaluable tool in the journey towards healing and emotional well-being. Medications That May WorkWhen you find a doctor who either understands RSD or is willing to learn about it, there are a few medications that can be effective in treating the initial flooding. Two are non-stimulants:
One is an antidepressant class that also treats ADHD:
Talking to your doctor can help you find the best treatment course for RSD. Treating the Lasting ImpactRemember when I said therapy could help the lasting impact of RSD? Let’s talk about that for a sec… ![]() Therapy can be really helpful for improving the low self-esteem that Rejection Sensitive Dysphoria (RSD) creates. It can help you avoid the critical self-talk that makes everything feel so much worse. By providing a supportive and non-judgmental space, therapy allows individuals to challenge negative beliefs and develop a more compassionate inner dialogue. Through therapy, you can learn to see yourself in a better, more accurate way than your Rejection Sensitive lenses allow. With guidance from a therapist, you can cultivate self-awareness, identify strengths and positive attributes, and gradually shift your perspective towards one of self-acceptance and worthiness. Therapy equips you with the tools and strategies needed to navigate the emotional challenges of RSD and build resilience in the face of perceived rejection or criticism. Therapy can help teach you skills that help improve your day to day experience with RSD. Things like
Looking for a therapist but can’t find the time or struggle to remember appointments? Check out BetterHelp. It’s a virtual therapy service that allows you to text, chat, and video chat your therapist without having to worry so much about managing all the appointments.
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