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RSD: Rejection Sensitive Dysphoria

Probably the most under rated ADHD trait that we didn't know about, until recently. Understand & manage RSD.

The first time I heard about RSD was during my Coach training, even though I am 8 years post diagnosis. I remember thinking, wow, another relatable concept that people need to know about. However it wasn't until I heard Dr. Bill Dodson talking about it when I could really see myself in the story. It all made sense, as flashes of past experiences were coming to mind where I was paralysed by debilitating emotional pain.

Read on to learn more about RSD and my personal experiences with it.

RSD: Rejection Sensitive Dysphoria
RSD: Rejection Sensitive Dysphoria

Because we have ADHD, and we understand that you might too, we have broken the post down into 4 seperate sections. You can click the links below and they will bring you directly to a specific aspect of the conversation around RSD, incase you are not interested in reading a lot.

We also highly recommend using Speechify or Natural Reader to help make learning easier!


#1: What is RSD: Rejection Sensitive Dysphoria?

RSD or Rejection Sensitive Dysphoria is when you experience extreme emotional reactions due to rejection or criticism, perceived or actual. People with RSD often experience intense emotional pain, anxiety, and even physical pain in response to rejection or criticism.

Closely linked with ADHD, experts reckon due to the differences in our brain structure, we find it difficult to regulate emotions that are related to any form of rejection. It is believed to be related to the brain's regulation of dopamine and norepinephrine, which are neurotransmitters that play a role in regulating mood and emotions.

RSD can cause significant emotional distress and mimic symptoms of mood disorders like depression and bipolar disorder. This can include feelings of worthlessness, hopelessness, and suicidal ideation. The mood shift is thought to always have an identifiable trigger, and after an RSD episode has passed, it is common for individuals to experience feelings of shame or embarrassment for lack of control and the intensity of their emotional reactions.

Important things to note about RSD:

  • RSD is not officially recognized as a symptom or a diagnosis.

  • The intense pain can occur immediately post trigger.

  • It is not something that you can just snap out of.

  • When the episode is over, most people will not likely forget the intensity of the pain.

  • To date there is limited scientific research on the topic.

#2: How is RSD different?

So you are probably thinking, but nobody likes rejection….and you would be correct, but there is a difference between sensitivity to rejection and rejection sensitive dysphoria.

While rejection is something people in general find hard to take, the negative emotions that come with RSD:Rejection Sensitive Dysphoria are extremely intensely and can be difficult to manage. People with RSD are also more likely to interpret vague interactions as rejection and find it difficult to control their reactions.

ADHDers experience emotional dysregulation. Our brains have different networks that are responsible for doing different jobs, such as managing memories, emotions, input from your senses, etc. An ADHD brain has a difficult time trying to regulate the signals related to your emotions. What this really means is that an ADHDer’s emotions are too loud for the brain to manage, and are experienced as feelings of overwhelm and pain.

When faced with rejection, most people may notice anxiety/negative emotions before an anticipated rejection, interpret vague interactions as rejection, and may find it difficult to control their reactions. However when an RSD episode occurs, these 2 features are coupled with an intense/overwhelming/unbearable level of emotional, and sometimes physical pain.

#3: My lived experience of RSD

I don't remember a lot about my childhood, but most of the things I remember, are because of the intense pain I felt. Even as I type the examples out below, I was reminded of just how difficult it is to find words to describe the intensity of the pain felt with RSD.

"Knowing what the actual rejection would do to me, I used to be motivated to do anything and everything in my power to avoid it."

When I was in primary school I was incredibly shy and not performing academically. I had barely any friends, as I wasn’t very confident or talkative until about 6th class. I was, however, known for being sporty, but even then, I was never picked first, and mostly always picked last for teams. I would dread PE and lunch times because of this. I can’t imagine any line up being comfortable, but this for me was humiliating, and it left me feeling not wanted. I felt incredibly small, and I would be so consumed with the pain that it would often impact my performance. Frequently, I would pull a sicky or insist I wasn’t taking part to avoid the pain, which then got me into trouble with the teacher.

When I went on to train basketball teams as an adult working with kids, I made sure I selected teams or handed out numbers to avoid anyone feeling like I did.

Growing up my two best friends were avid singers, and they had beautiful voices. We would take turns to sing like ‘Ariel from the little mermaid’ and one day they told me I couldn’t do it. Even though I loved to sing and dance, for years I refused to sing in front of people or on my own, and if I was ever caught, I would feel deep shame and embarrassment. I believed that I was bad at singing, and the pain accompanying this belief meant that it didn’t change until I had to sing nursery rhymes for the children I worked with and my niece, and my niece is always making requests. People started telling me I was a good singer, I started to believe it, and now I sing everyday, and the pain went away.

Anytime that I had conflict or arguments with friends or family members I would be absolutely and utterly devastated. Like pick me up off the floor - floods of tears - hyperventilating - still thinking about it days later type of scenarios, which were over something trivial like they didn’t sit with me at lunch or forgot to text back situations. I would be absolutely heartbroken, causing me to be unable to take part in the resolution of the problem, because I was either completely frozen with the pain of acting out really angrily.

  • In my history of dating, I have had a pattern of getting in there first and breaking things off with a guy for fear that he was going to break up with me first.

  • If I was ever mistreated, or slagged, it felt like I had been stabbed in the heart. People told me that I couldn’t take a joke.

  • For years, I would not put myself forward or accept opportunities that came my way, for fear that it all went wrong and I wouldn’t be able to cope.

  • I have been fearful of expressing my opinion or answering questions, in case I got it wrong and people thought badly of me.

  • My whole life, people have been telling me it's not that bad, just get over it, forget them, don't be worrying about that, & I always wondered why I couldn't just.

Thankfully, as I have spent a lot of time uncovering my strengths, acknowledging my success, and redefining who I am as a person, my episodes of RSD are less severe, and occur less frequently. Most importantly, when I know I am in the middle of one, I am now able to coach myself, and remind myself that this is just RSD and that it will pass. I also have a huge ADHD tribe who get it.

#4: Living with RSD & Resources

As RSD has not been formally studied as of yet, there is no real evidence-based response or guidelines for managing it but this will change in the future.

Today we know so much more about ADHD, with a accurate understanding of its presentations and impact. As it stands, there is nothing related to emotions taken into account when assessing for ADHD, and for many, this could be the most challenging part.

What we do have though, thanks to the amazing ADHD community online, is peoples lived experience of RSD, and some examples of the things that help them to live with RSD.

You could try some of these to better understand & respond to RSD:

  • Identify sources of potential triggers.

  • Inform loved ones of the concept.

  • Pick out friend you can turn to when it is happening.

  • Meet yourself with compassion.

  • Practice regular self care.

  • Create a step by step strategy to follow, for pre, during and post episode.

  • Have a list of your strengths, achievements, worth and values ready to read over.

  • Engage in coaching or talk therapy for maintenance.

Here are some Resources you might be interested in:

Learn about the 12 Features of RSD

Read how other ADHDer's describe RSD

Complete ADDitude's online RSD Symptom Checklist

To keep up to date with RSD research visit this website.

So there you have it, a little bit about RSD. One more thing I would like to add, from personal and professional experience, most ADHDer's have plenty of previous experience stored in their memories where they were actually rejected, by themselves, by family, by teachers and by society. All because they didn't fit the neurotypical box, and we didn't know why. This in itself, is an incredibly painful thing to experience, repeatedly.

If you like what you have read, please show some love. And if there are other resources you are aware of, please do share with us so we can add them to the list for readers!


1 Comment

Jul 14, 2023

The website you link to, to keep up to date with latest research on the issue isn't working unfortunately!

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