Rejection Sensitivity (RSD)

What's the deal with

and ADHD?

Rejection Sensitivity, often referred to as Rejection Sensitive Dysphoria (RSD) in the context of ADHD, is an intense emotional response to perceived or actual rejection, criticism, or failure. While not officially recognized in the DSM-5 as a core symptom of ADHD, many individuals with ADHD report experiencing this heightened sensitivity to rejection, which can significantly impact their social interactions, relationships, and overall quality of life.

“Fueled by our exaggerated emotions, we overreact to criticism with fear of rejection, worries that we are inadequate, low self-esteem, and insecurity. Something as simple as a forgotten library book can bring deep shame and embarrassment. A store clerk's flippant comment about our messy purse is crushing and puts us into hiding for the rest of the day. We may never feel truly confident at work-living in constant fear that we will be fired for any small failure.” —Tamara Rosier, PhD, Your Brain’s Not Broken

What it looks like:

Rejection sensitivity in ADHD can manifest in various ways:

Intense emotional reactions to perceived criticism or rejection
Tendency to interpret neutral situations as negative or rejecting
Avoidance of social situations or new experiences due to fear of rejection
Difficulty in romantic relationships due to fear of abandonment
Perfectionism or setting unrealistically high standards for oneself
People-pleasing behaviors to avoid potential rejection
Difficulty accepting constructive feedback
Intense feelings of shame or embarrassment after perceived failures
Rapid mood swings in response to social interactions
Self-sabotage in personal or professional endeavors
Difficulty advocating for oneself due to fear of negative reactions
High anxiety, anger, or self-doubt when things don’t go as planned

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The science:

While the exact mechanisms of rejection sensitivity in ADHD are not fully understood, several factors may contribute:

Emotional dysregulation: ADHD is associated with difficulties in regulating emotions. Real or perceived rejection may cause emotional responses that are much more intense and/or long-lasting than they might be for someone without ADHD.
Brain chemicals: Dopamine is a brain chemical involved in processing social rewards and punishments. People with ADHD may have less or irregular levels of dopamine, which will impact the way they perceive and respond to social situations.
Brain activity: The amygdala is a part of the brain responsible for processing emotions, especially fear. Some studies suggest that individuals with ADHD may have heightened activity in the amygdala, which could contribute to increased emotional responses to social stimuli.
Cumulative effect of negative experiences: Individuals with ADHD often face more criticism and negative feedback throughout their lives, which may lead to a heightened sensitivity to rejection over time.

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References:

https://my.clevelandclinic.org/health/body/24894-amygdala

https://my.clevelandclinic.org/health/diseases/24099-rejection-sensitive-dysphoria-rsd

https://neurodivergentinsights.com/blog/how-to-deal-with-rejection-sensitive-dysphoria

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What you can do:

Practice mindfulness: Mindfulness techniques can help you observe your emotional reactions without immediately acting on them.
Identify mental narratives: Our minds often create negative stories when we face rejection, leading to rumination and self-blame. To break this cycle, practice recognizing these narratives as they form by keeping a log or journal. Label these stories (e.g., "Rejection script" or "Bad Friend script"). Then practice catching them in the moment. This helps you recognize them as just thoughts rather than facts.
Improve communication skills: Learn to express your needs and feelings assertively to reduce misunderstandings.
Practice self-compassion: Treat yourself with kindness and understanding, especially in moments of perceived failure or rejection.
Practice emotional acceptance: Mindfully acknowledge and allow your emotions to exist without attempting to change them, analyze them, or avoid them. This helps build up your tolerance for hard emotions.
Emotional distancing: When emotions are too big to sit with, try looking at your experience as if you are someone else; an observer. Describe the experience from this outside perspective.
Create a "success file": Keep a record of your achievements and positive feedback to reference during difficult times.
Use the STOP technique: Stop, Take a breath, Observe your thoughts and feelings, and Proceed mindfully when facing triggering situations.
Seek support: Share your experiences with trusted friends, family, a support group, therapist, or coach for individuals with ADHD.
Develop a strong sense of self: Focus on building self-esteem and self-worth that isn't solely dependent on others' approval.
Practice emotion regulation techniques: Learn and use strategies like deep breathing, progressive muscle relaxation, or grounding exercises to manage intense emotions.
Talk to your doctor: Some individuals also find that certain ADHD medications can help reduce the intensity of rejection sensitivity. Consult with a your doctor to discuss the your options.

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Go deeper:

Emotional Regulation and ADHD

The Fear of Feedback — ADHD Communication at Work

ADHD and Relationship Anxiety: What’s the Connection?

My Partner Doesn’t Understand ADHD

How ADHD Ignites RSD: Meaning & Medication Solutions

New Insights Into Rejection Sensitive Dysphoria

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