The Link between ADHD and Rejection Sensitive Dysphoria

When we face rejection, it is normal to feel disheartened and upset for a short period of time. Some people may be able to take it in stride and shake it off. However, if one feels an overwhelming reaction to rejection that causes intense emotional pain, it may not be normal. This extreme emotional response is called Rejection Sensitive Dysphoria. While RSD can affect anyone, it is a lot more common in those with ADHD and those on the autism spectrum. 

What causes Rejection Sensitive Dysphoria? 

While there is no one reason that causes RSD, multiple factors may contribute to Rejection Sensitive Dysphoria. There is a possibility that RSD could be caused by a childhood history of neglect or rejection. This can come from having a parent who was overly critical or neglectful, which impacts how these individuals view themselves. This may cause the individual to have low self-esteem and an intense fear of rejection and abandonment in their own relationships. Being bullied as a child or having faced childhood trauma may also be a contributing factor. Throughout childhood, people with ADHD experience rejection from adults at a higher rate than their non-ADHD peers, particularly by teachers. This makes them even more sensitive to real or perceived rejection well into adulthood. 

There is also believed to be a genetic component to rejection-sensitive dysphoria, as it can run in families. A parent who might have RSD may pass it on to their children. 

Also read: Is There Any Real Benefit to Cognitive Behavioural Therapy for ADHD?

What are the symptoms of RSD? 

The symptoms of rejection-sensitive dysphoria can be difficult to identify since they often resemble many other mental health disorders such as depression, bipolar disorder, BPD, or PTSD. Often, people can’t find the words to describe its pain. They say it’s intense, awful, terrible, and overwhelming. It is always triggered by the perceived or real loss of approval, love, or respect. Typical symptoms of rejection-sensitive dysphoria(that may also occur in some of the above conditions) include:

• Low self-esteem

• Avoidance of social settings

• Fear of failure

• High expectations for one’s self

• Frequent emotional outbursts after being hurt or rejected

• Feelings of hopelessness

• Approval-seeking behaviour

• Anger and aggression in uncomfortable situations

• Anxiety

• Perfectionism or people-pleasing characteristics

• Experiencing rejection when none is truly present

• Minor rejections are viewed as disastrous

What is the link between ADHD and RSD? 

William Dodson, MD, was one of the first ADHD specialists to use the term “rejection-sensitive dysphoria.” Though there is limited research present on the co-occurrence of these two, there is sufficient evidence to tell us that those with ADHD do face issues with emotional regulation. They tend to feel emotions more intensely, which could be a contributing factor to RSD. 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, suggesting that it may explain social dysfunction in those with ADHD. 

However, it is important to remember that RSD is neither a medical condition nor an official diagnosis, as it is not listed in the DSM V or ICD 10. However, a therapist may determine that a person has rejection-sensitive dysphoria based on the symptoms they describe in therapy. The therapist may diagnose it either as part of another condition, such as ADHD or as a separate issue. 

Also read: Is There Any Real Benefit to Cognitive Behavioural Therapy for ADHD?

When to see a therapist for RSD? 

Everyone has good days and bad days, so having an occasional outburst or emotional response doesn’t necessarily mean that you need to see a doctor. If you think you might have ADHD, or if your reaction to rejection is debilitating, it might be helpful to see a mental health care provider.