• Rejection Sensitivity Dysphoria is a common condition that often coexists with ADHD.
  • RSD can lead to significant impairment in daily life, including social relationships, academic and professional performance, and overall well-being.
  • With proper diagnosis and treatment, individuals with RSD can learn to manage their symptoms and improve their quality of life.

“He’s too sensitive!” Have you heard that sentiment in an IEP meeting? Or something similar? I know I have. And I wish I had known about rejection sensitivity dysphoria and ADHD.

Rejection Sensitivity Dysphoria (RSD) is a common condition that often coexists with Attention Deficit Hyperactivity Disorder (ADHD). It is characterized by an intense emotional response to perceived rejection, criticism, or failure.

A man experiencing ADHD RSD wearing a beanie on a foggy day.

People with RSD may experience overwhelming emotional pain, anxiety, and depression when faced with rejection or criticism.

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Understanding Rejection Sensitivity Dysphoria is critical to managing the condition. It is essential to recognize that RSD is not a stand-alone disorder but rather a symptom of ADHD.

It is also important to understand that RSD can lead to significant impairment in daily life, including social relationships, academic and professional performance, and overall well-being.

However, with proper diagnosis and treatment, individuals with RSD can learn to manage their symptoms and improve their quality of life.

A woman experiencing ADHD rejection sensitivity dysphoria, with her hands covering her face.

What is ADHD Rejection Sensitivity Dysphoria?

It’s important to note that doctors and experts didn’t really begin to identify and study ADHD until the 1960s.

The RSD component or profile of ADHD is just beginning to be studied and understood.

RSD ADHD Symptoms

Rejection Sensitivity Dysphoria (RSD) is a condition that is linked to ADHD. It is characterized by an intense emotional response to perceived rejection or criticism.

Individuals with RSD are extremely sensitive to negative feedback and may experience feelings of shame, anger, or sadness in response to it.

According to Psychology Today, some of the common symptoms of RSD include:

  • Fear of rejection
  • Avoidance of social situations (due to the fear or anticipation of rejection)
  • Difficulty forming new relationships
  • Hypersensitivity to criticism
  • Overreacting to perceived criticism or rejection
  • A feeling of worthlessness or inferiority

While RSD is not an official diagnosis, it is a recognized phenomenon that can significantly impact an individual’s quality of life.

A person with ADHD sitting in front of a window looking at the ocean.

RSD in the Context of ADHD

RSD is often seen in individuals with ADHD, although it can occur in those without the condition as well.

According to a Cleveland Clinic article, RSD may be more common in individuals with ADHD due to differences in brain structure that affect emotional regulation.

It is important to note that RSD is not the same as social anxiety disorder or generalized anxiety disorder, although it can be a comorbidity with these conditions. Treatment for RSD may include therapy, medication, and lifestyle changes such as stress reduction techniques and self-care practices.

Understanding RSD is crucial for individuals with ADHD and their loved ones. By recognizing the symptoms and seeking appropriate treatment, individuals with RSD can improve their emotional well-being and quality of life.

RSD at School

I really wish I had known about this with my clients in the past. Knowledge is power. Over the years, I have had many school staff tell us things like “he’s too sensitive!” and the like.

Or, I’ve had kids report that “the teacher hates me!” when I was certain that couldn’t be true.

Remember that perception is reality. A child with RSD really thinks that the teacher hates them. Even if they just said something very benign as a correction or feedback.

Both teachers and parents have to come together to understand RSD and coach a child through situations. Neural pathways are still very flexible in children!

I wish teachers had enough time during a school day to do realtime feedback on these interactions, but I’m sure that’s not possible. For this reason, parents should supplement at night with conversations at the dinner table.

Ask what happened during the day and be alert for possible RSD situations. If a child perceives they’ve been rejected or disliked, ask them to expound upon it, and help them see a different viewpoint.

Of course, teasing and bullying does occur at schools all the time. Always handle a child’s IEP and situation on a case by case basis and handle bullying as warranted.

But, we must teach our kids coping strategies and how to overcome thought processes li

Diagnosis and Clinical Recognition

Rejection Sensitivity Dysphoria (RSD) is a condition that is commonly associated with Attention Deficit Hyperactivity Disorder (ADHD).

Diagnosis of RSD can be challenging as it is not yet recognized as a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). I find it similar to PDA and autism.

That is, PDA Pathological Demand Avoidance, is not its own diagnosis. It is a subset or profile of autism. RSD does not have its’ own diagnosis. It is considered a subset or profile of ADHD or anxiety.

Clinicians can use various assessment strategies to identify RSD in individuals with ADHD.

One of the most commonly used assessment strategies for RSD is self-report measures. Clinicians can use validated scales such as the Rejection Sensitivity Questionnaire (RSQ) to identify the presence and severity of RSD symptoms in individuals with ADHD.

The RSQ assesses an individual’s sensitivity to rejection across multiple domains, including romantic relationships, friendships, and work-related situations.

Another assessment strategy that can be used to identify RSD is a clinical interview. Clinicians can ask individuals with ADHD about their emotional responses to rejection and failure to determine the presence of RSD symptoms. In addition, clinicians can use behavioral observations to identify RSD symptoms in individuals with ADHD.

Differential Diagnosis

Diagnosing RSD can be challenging as its symptoms can overlap with those of other psychiatric conditions, such as anxiety and depression. Therefore, clinicians must conduct a thorough differential diagnosis to rule out other conditions that may present with similar symptoms.

For example, individuals with anxiety may also exhibit sensitivity to rejection and failure. However, anxiety-related sensitivity is often more generalized and not specific to rejection or failure in particular.

Although RSD is not yet recognized as a formal diagnosis, clinicians can use various assessment strategies to identify its presence in individuals with ADHD. Clinicians must also conduct a thorough differential diagnosis to rule out other conditions that may present with similar symptoms.

Impact on Daily Life

Individuals with Rejection Sensitivity Dysphoria (RSD) and ADHD may experience several challenges in their daily lives. These challenges can affect various aspects of their lives, including social interactions and emotional well-being.

Risk Taking and Friendships

People with RSD hate rejection. So, they often do whatever it takes to avoid rejection. This includes “putting yourself out there,” as they say. Someone with RSD may not extend invitations to others because they don’t want to risk rejection.

Friendships are reciprocal. So if someone never invites you to do something, you’re less likely to ask them to do something social. As a result, friendships fail to develop.

They also struggle to challenge themselves and try to achieve something great. They know the repercussions of not setting a goal will be devastating, so they don’t aim as high. Choosing a lesser goal, one is certain to achieve means they do not risk rejection or “failure” in not achieving the stretch goal.

Social Interactions

RSD can make social interactions particularly challenging for individuals with ADHD. They may experience intense emotional reactions to perceived rejection or criticism, leading them to avoid social situations altogether. This can result in feelings of isolation and loneliness, which can negatively impact their mental health.

Individuals with RSD may struggle to maintain healthy relationships due to their intense emotional reactions. They may perceive even minor disagreements as rejection, leading to conflict and misunderstandings. This can make it difficult for them to build and maintain friendships and romantic relationships.

Job Performance

We all hate annual performance review time at work, don’t we? But they are common for most employers.

People with RSD do not handle criticism well, even constructive criticism or job feedback.

This manifests itself in different ways in the workplace.

  • Poor job performance, because “why even bother”
  • Asking for too much guidance and direction, not independent enough for the employer, because of fear of failure; too “needy”
  • Overachieving to avoid failure, but leading to personal mental health crises and burnout
A man and woman diligently working on a laptop in an office, dealing with the challenges of ADHD and rejection sensitivity dysphoria.

Emotional Well-being

RSD can also have a significant impact on an individual’s emotional well-being. They may experience intense feelings of shame, anxiety, and depression due to their sensitivity to rejection. These emotions can be overwhelming and can interfere with their ability to function in their daily lives.

Individuals with RSD may struggle with self-esteem and self-worth. They may feel that they are not good enough or that they are flawed in some way, leading to feelings of inadequacy and self-doubt. This can make it difficult for them to pursue their goals and aspirations, leading to a sense of aimlessness and a lack of direction.

Individuals with Rejection Sensitivity Dysphoria and ADHD may experience significant challenges in their daily lives. These challenges can impact their social interactions and emotional well-being, leading to feelings of isolation, loneliness, and low self-esteem. It is important to seek support and treatment to manage these challenges and improve their overall quality of life.

Management and Coping Strategies

Individuals with Rejection Sensitivity Dysphoria (RSD) and ADHD can experience significant emotional pain and distress when faced with rejection.

However, several management and coping strategies can help individuals deal with RSD and ADHD.

Therapeutic Approaches

Therapy can be an effective way to manage RSD and ADHD. Cognitive-behavioral therapy (CBT) can help individuals identify negative thought patterns and develop coping strategies to manage their emotions.

Dialectical Behavioral Therapy (DBT) can also help manage RSD symptoms, as it teaches individuals how to regulate their emotions and improve interpersonal relationships.

Medication and Treatment Options

Medication can also help manage RSD and ADHD symptoms. Stimulant medications, such as Adderall and Ritalin, can improve attention and concentration, while non-stimulant medications, such as Strattera, can improve mood and reduce anxiety.

Self-Help and Support Networks

Self-help strategies can also be effective in managing RSD and ADHD symptoms. Exercise, meditation, and mindfulness can help individuals reduce stress and improve mood. Additionally, joining support networks, such as ADHD support groups, can provide individuals with a sense of community and support.

There are several management and coping strategies that can help individuals with RSD and ADHD. Therapeutic approaches, medication and treatment options, and self-help and support networks can all be effective in managing symptoms and improving quality of life.

Dr. Sharon Saline, a psychologist and ADHD expert, suggests daily affirmations, such as:

  • “I am stronger than I think.”
  • “My mind is uniquely wired and creative.”
  • “I can make a mistake and be a good person.”
  • “I can take risks and see what happens.”

Of course, I’m not here to diminish the very real struggles of RSD and ADHD. Waking up and repeating a sentence a couple of times doesn’t make any mental condition go away.

But, as part of an overall healthy lifestyle and mindfulness approach, perceptions and life experiences can become more positive.

A woman with ADHD enjoying a comforting cup of coffee on a cozy bed.

RSD ADHD Research

While RSD is not an official diagnosis yet, the evidence is starting to build supporting these conditions.

Recent Studies

Recent research on Rejection Sensitivity Dysphoria (RSD) in ADHD has focused on understanding the neural basis of this condition. A study published in PLOS ONE found that individuals with ADHD and RSD exhibited increased activity in the insula and anterior cingulate cortex when exposed to social rejection cues [1]. Another study published in the Journal of Abnormal Psychology found that individuals with ADHD and RSD showed greater activation in the prefrontal cortex and amygdala in response to negative social feedback [2].

In addition to neuroimaging studies, recent research has also explored the relationship between RSD and other symptoms of ADHD. A study published in the Journal of Attention Disorders found that RSD was positively correlated with symptoms of hyperactivity-impulsivity and inattention in adults with ADHD [3]. Another study published in the Journal of Abnormal Psychology found that individuals with ADHD and RSD were more likely to experience emotional dysregulation and negative mood states [2].

Future Directions

Although recent research has shed light on the neural basis and symptomatology of RSD in ADHD, there is still much to be understood about this condition. Future research could focus on developing interventions that specifically target RSD in individuals with ADHD. One potential intervention could be cognitive-behavioral therapy (CBT), which has been shown to be effective in treating RSD in individuals with borderline personality disorder [4]. Another potential intervention could be medication, such as selective serotonin reuptake inhibitors (SSRIs), which have been shown to be effective in treating symptoms of anxiety and depression [5].

The recent advancements in research on RSD in ADHD have provided valuable insights into the neural basis and symptomatology of this condition.

However, further research is needed to develop effective interventions that can alleviate the negative impact of RSD on individuals with ADHD.

Sources:

  1. Dysregulated not deficit: A qualitative study on symptomatology of Rejection-Sensitivity Dysphoria in adults with ADHD
  2. Rejection Sensitivity Dysphoria in ADHD
  3. Cognitive-behavioral therapy for rejection sensitivity in borderline personality disorder
  4. Selective serotonin reuptake inhibitors (SSRIs) for depression in adults with ADHD

Frequently Asked Questions

What treatments are available for managing Rejection Sensitive Dysphoria (RSD)?

There is no specific treatment for Rejection Sensitive Dysphoria (RSD). However, individuals with RSD can benefit from therapy, medication, and lifestyle changes. Therapy can help individuals with RSD learn coping strategies to manage their emotions and develop healthier ways of dealing with rejection.

Medication, such as antidepressants, can help manage symptoms of anxiety and depression that often accompany RSD. Lifestyle changes, such as exercise, healthy eating, and stress reduction techniques, can also help manage symptoms.

Can RSD occur in individuals who do not have ADHD?

While RSD is commonly associated with ADHD, it can occur in individuals who do not have ADHD.

However, individuals with ADHD are more likely to experience RSD due to their sensitivity to rejection and criticism.

What are the common symptoms of Rejection Sensitive Dysphoria?

Common symptoms of Rejection Sensitive Dysphoria include extreme sensitivity to rejection and criticism, feelings of shame and worthlessness, anxiety, depression, and avoidance of situations that may trigger rejection or criticism.

Is Rejection Sensitive Dysphoria recognized in the DSM-5?

Rejection Sensitive Dysphoria is not recognized as a separate diagnosis in the DSM-5. However, it is a common symptom of ADHD and is often treated as such.

How does Rejection Sensitive Dysphoria differ from general sensitivity to rejection?

Rejection Sensitive Dysphoria differs from general sensitivity to rejection in its intensity and duration. Individuals with RSD experience intense emotional pain and may have difficulty moving past the rejection or criticism. This can lead to avoidance of situations that may trigger rejection or criticism.

Are there any coping strategies or techniques for individuals with RSD to handle intense emotions?

Yes, there are several coping strategies and techniques that can help individuals with RSD handle intense emotions. These include mindfulness, cognitive-behavioral therapy, self-care, and seeking support from friends and family. It is important for individuals with RSD to develop a support system and to seek professional help if necessary.

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