04.19.23
Have You Heard of Rejection Sensitive Dysphoria Yet?
If even a whiff of criticism sends you spiraling, read this.
No one loves rejection, but we generally accept that it’s a necessary part of living life and taking risks. For some people though, especially those with ADHD, being rejected can lead to such an intense negative emotional response that it can seriously mess with their lives. We’re talking about rejection sensitive dysphoria (RSD), a term that’s trending on social media and in mental health circles lately.
On first scroll through the rejection sensitive dysphoria hashtag on TikTok (which has over 60 million views and counting!), RSD might seem like just an overreaction to feeling slighted. After all, assuming your date is mad at you if they aren't matching your enthusiasm or thinking your friend hates you when they leave your text on read has probably happened to the best of us at some point, right?
But what makes RSD different from your run-of-the-mill disappointment is the intensity of this emotional response, according to William Dodson, MD, a board certified psychiatrist who specializes in adults with ADHD and has been studying this exact thing for nearly 20 years.
“When people talk about having an episode of RSD, it's not just a little thing,” explains Dr. Dodson. “The person can't function any further. It is a severe, intense, highly impairing emotional experience,” he says, adding that RSD is “separate from [the] day-to-day human experience” most people feel after being rejected or criticized.
While it isn't a symptom or diagnosis that you'll find in the latest edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5-TR), it's a concept that's clearly resonating with people—especially on ADHDTok. And, as someone who was recently diagnosed with ADHD at 33, I can relate.
Case in point: I perform stand-up comedy as a hobby, and after a show last month, I experienced what I could only describe as a depressed downward spiral even though my set went…fine? Sure, I forgot a couple jokes, and at one point I had to reach into my pocket and check my notes, which I hadn’t done the last time I performed on a similarly big show. But, by all measures, I had a decent set—the audience laughed, I kept going even after I stumbled, and I didn’t cry and run off stage. Despite the positive feedback from the crowd and my friends who saw the show, I continued to drown out the compliments with my own negative self-talk.
For the next 48 hours, I kept ruminating on my mistakes and beating myself up about it. I couldn’t shake the feeling that I didn’t give the best performance I could have, how the audience wasn’t as enthused as they were last time, and how that was unacceptable. I was stuck in this miserable funk.
It turns out, according to Dr. Dodson, this relentless self-criticism after a real or perceived rejection is a recurring theme he's heard from countless ADHD patients over the years.
What's the link between RSD and ADHD?
The concept of rejection sensitivity has been around for decades, mostly in reference to atypical depression, but Dr. Dodson seems to be the first to connect it to ADHD. More specifically, he's investigated how it relates to emotional dysregulation, aka having a really hard time regulating or processing your emotions in response to whatever you're faced with.
Emotional dysregulation is something that a lot of people with ADHD are familiar with, since it affects about 70% of adults with the condition, according to a meta-analysis published in BMC Psychiatry in 2020.
“People with ADHD tend to be very emotionally sensitive and have feelings come on pretty intensely and pretty quickly,” explains Michelle Frank, PsyD, clinical psychologist and author of A Radical Guide for Women with ADHD.
One theory, as explained by Dr. Frank, is that the part of the brain responsible for emotions and motivation (the amygdala) can be easily overwhelmed in people with ADHD. So while a neurotypical person might not read too much into a barista being short with them or a friend not texting back right away, someone with ADHD might interpret this as rejection and immediately feel sad or anxious.
Another theory of why RSD can happen to people with ADHD has to do with just how hard it is to live with this condition. Folks with ADHD, especially those who weren’t diagnosed until adulthood, often carry a lot of shame from a lifetime of struggling with executive function, impulsivity, and behaviors that others might interpret as “lazy,” “careless,” or “scatterbrained” (*raises hand*). A lot of ADHDers internalize this feeling of failure, and it can be triggering to be in situations that bring these feelings to light.
“There are a lot of experiences, both real and perceived, of failure that have built up over time,” Dr. Frank explains. Think: memory lapses, tuning out during class, speaking impulsively, or feeling like you're not living up to your potential (and even getting that exact feedback from parents and teachers).
“These moments where people with ADHD feel their differences very profoundly have oftentimes run up against really, really painful experiences of judgment and rejection,” says Dr. Frank, adding that people with ADHD often tend to be high achievers as a way of masking their true struggles and to avoid further criticism and rejection.
For me, I have spent a lot of my life overcompensating for my perceived failures tied to my late ADHD diagnosis (years of poor time management, losing homework and important items, forgetting important details, not bringing myself to complete even the most basic of tasks or just focus, dammit). I spent the first three decades of my life masking these symptoms and ramping up my sense of perfectionism.
Being rejected, or even just personally feeling like I’ve failed, reignites the internal dialogue I’ve had my whole life about about how I’ll never live up to my potential and how my mistakes are proof that I’m lazy or incompetent. So, as someone who lives with ADHD, it's not hard to see why RSD is resonating with so many of us.
That said, Dr. Frank explains that RSD isn't exclusive to ADHD and can pop up in a range of mental health conditions, including anxiety and relational traumas (or trauma that occurred within a close relationship).
How to deal with rejection sensitive dysphoria.
While TikTok can be great for sharing information and spreading awareness, it’s not a substitute for legit treatment. So if scrolling through videos about RSD makes you feel seen, it's worth bringing this experience up with a mental health provider, especially if it’s disrupting your daily life.
As with other symptoms related to ADHD, therapy can help you manage intense emotional responses like RSD. Licensed therapist and board-certified behavior analyst Laurie Singer, LMFT, who happens to have ADHD, says people experiencing RSD tend to have feelings of low self-worth. Talk therapy like cognitive behavioral therapy (CBT) can help interrupt these negative thought spirals and give you tools to help make dealing with rejection (real or perceived) suck a little less.
“It’s important for each individual to learn that RSD, ADHD, or any other mental health disorder does not define who they are as a person,” says Singer.
One strategy she uses with clients is the signal plan, which uses the colors of a stoplight to help you deal with negative thoughts when they pop up. When someone starts to have a negative thought about themselves (for example: I fumbled my performance and I was so unprepared, I’ll never get my shit together to be a real comic), she tells them to think of the color red to stop those negative thoughts in their tracks. Then think about the color yellow, which signals you to slow down and change that negative thought into something positive or more neutral (like: I had to briefly check my notes for a set, which even established comics do often. This is all a part of the process of practicing and getting better). Finally, think of the color green, which signals you to go on or move forward while focusing on this more positive mindset. (Pro tip: Singer suggests practicing this strategy before you're already spiraling for best results.)
It's also possible that bringing these symptoms up with a therapist might prompt a conversation about mental health medication. Dr. Dodson says that alpha-2 agonists, which are non-stimulant drugs that are FDA approved to treat ADHD, can help some people with ADHD and RSD. That said, it’s important to see a qualified psychiatrist to receive a thorough assessment and discuss if medication is right for you.
So, will we ever see RSD in the DSM alongside other ADHD symptoms? Dr. Dodson thinks it would be helpful, but notes that it's been hard enough to update the ADHD criteria to include anything more than inattention, hyperactivity, and impulsivity. Even emotional dysregulation is only listed as an "associated feature" of ADHD in the DSM-5-TR, rather than a key part of the condition.
But despite it being ignored by much of the research community, RSD isn't something you should just shrug off if you're experiencing it. While we can’t live a life free of rejection and failure, we can learn to manage our dysphoria around those unavoidable experiences.
“You'll have to use some of your strategies to get through it and remind yourself, ‘I've come a long way. I know I can do this. Sure, I've got problems. But you know what? I'm OK,’” Singer says.
Wondermind does not provide medical advice, diagnosis, or treatment. Any information published on this website or by this brand is not intended as a replacement for medical advice. Always consult a qualified health or mental health professional with any questions or concerns about your mental health.
