Rejection Sensitive Dysphoria and ADHD: What to Know

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Rejection is not enjoyable for anyone. But for people with a condition called rejection sensitive dysphoria (RSD), getting turned down, criticized, or rebuffed can trigger an overwhelming emotional response.

RSD is characterized by extreme emotional sensitivity to being criticized or rejected, whether real or perceived rejection. While researchers are still unsure of the cause, it seems that people with attention deficit hyperactivity disorder (ADHD) may be more susceptible to RSD.

In this article, the symptoms, treatment, and the link between RSD and ADHD will be explored.

Woman feeling excluded by colleagues

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The Link Between RSD and ADHD

While the diagnostic criteria for ADHD do not currently include problems with emotional regulation, people with ADHD may experience these issues.

Although RSD can impact any individual, RSD cases seem to be more common in people with ADHD. The nervous system in many people with ADHD immediately responds to a sense of rejection, whether real or perceived.

In a 2019 study, children aged 10–15 years with ADHD presented high levels of sensitivity when they received feedback as part of a virtual game. Youths with elevated ADHD symptoms exhibited higher sensitivity to peer rejection.

Researchers have noted that difficulty regulating emotions may explain the problems that some children with ADHD experience when socializing. They found that hyperactivity was associated with reacting aggressively to rejection in affected children.

Other studies also report that peer rejection and victimization frequently occur among children with ADHD and may worsen the symptoms of RSD.

Rejection is hard to measure, and some experts may not acknowledge RSD. They may also disregard or misdiagnose it because it can present similarly to other conditions, such as depression, bipolar disorder, borderline personality disorder, and social anxiety.

Symptoms of RSD

The symptoms of RSD can vary among individuals, but they may include:

  • Obsessively thinking about negative experiences, especially experiences of perceived or actual rejection
  • Perceiving rejection when it is not actually occurring
  • Viewing minor rejections as catastrophic
  • Misreading constructive criticism, or requests for more information as rejection
  • A sense that you’re not liked by others
  • Low self-esteem based on how you feel others relate to you
  • Social withdrawal
  • Negative self-talk
  • Emotional outbursts
  • Perfectionism or people-pleasing tendencies

Although symptoms of RSD can mimic other conditions, one distinguishing factor is that symptoms of RSD tend to come on suddenly and can feel very intense.

Treatment of RSD

RSD can't be cured, but since it may be caused or worsened by ADHD, most healthcare providers will want to treat ADHD first. ADHD is often treated with medication, therapy, and lifestyle changes, which may also help those with RSD.

There are no FDA-approved medications for RSD, but some may be prescribed off-label or for other conditions. Two types of medicine that appear to help with symptoms of RSD include:

  • Intuniv (guanfacine) and Kapvay (clonidine), drugs that lower blood pressure, and also show promise helping with RSD symptoms.
  • Monoamine oxidase inhibitors like Parnate (tranylcypromine) treat the inattention, impulsive behaviors, and emotional symptoms of ADHD.

Therapy can help manage symptoms of ADHD. Cognitive behavioral therapy (CBT), a type of talk therapy that teaches coping techniques, is often recommended for RSD. In CBT you’ll learn how to handle stressful situations, resolve relationship conflicts, and improve communication.

Practicing self-care and adopting relaxation and stress-relief techniques can help you manage feelings of discomfort from RSD. Telling friends and family about RSD can help them be more understanding when you have an emotional reaction to something they say or do.

Summary

Many people with ADHD experience RSD—an intense emotional reaction to being rejected or criticized. While RSD is not always clinically recognized, it’s very real for the person experiencing it.

There’s still a lot we don’t know about RSD, so more research is needed in this area.

Helpful ways to manage RSD may include medication, cognitive behavior therapy, and stress-relief strategies.

A Word From Verywell 

If RSD is affecting your life, know that while there is no cure, treatment may help you manage your symptoms. Speak to your healthcare provider about medications you can try and consider a course of CBT. Talk to friends and family about RSD so they can better understand your emotional reactions to situations where you feel rejected and work with you, so you feel more supported.

Frequently Asked Questions

  • Does RSD only occur in people with ADHD?

    As well as ADHD, RSD also has a connection to autism spectrum disorders (ASD). People with ASD often have trouble reading social cues and difficulty recognizing and expressing emotions. Combined with heightened sensory reactions, this can add up to extreme hypersensitivity to criticism.

    A review of 75 studies suggests there may be moderate links between RSD and other mental health conditions, such as depression and bipolar disorder.

  • Is RSD curable?

    There isn't a cure for RSD, but medication and talk therapy can be useful in learning to manage your emotional responses and other symptoms.

  • What triggers RSD?

    Everyone's RSD triggers are different, but they may include:

    • Being rejected or thinking you’re being rejected, like not getting a response to a text message or email
    • A sense of falling short or failing to meet your own high standards or others' expectations
    • Being criticized for something you can’t control
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10 Sources
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