The quick read
- RSD (Rejection Sensitive Dysphoria) is a common experience for many adults with ADHD and is closely tied to emotional dysregulation.
- RSD spirals can lead to rumination, people-pleasing, perfectionism, avoidance, or defensiveness after real or perceived rejection.
- Recognizing your triggers and learning to respond instead of react can help you break the spiral and improve relationships, work, and self-esteem over time.
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Do you feel crushed when a new friend doesn’t text you back? Do you people-please to avoid making others upset with you? The intense feeling of being inadequate and in trouble has a name: rejection sensitive dysphoria (RSD).
Research shows that most adults with ADHD relate to the intense emotional pain associated with rejection sensitive dysphoria (RSD). While RSD is not currently an official diagnosis, research consistently shows that emotional dysregulation is a core feature of ADHD, making emotional experiences with incredible speed and intensity. In particular, people with ADHD experience intense emotion around being criticized or rejected.
While many people identify with the feelings of RSD, few people understand how it impacts them and how to cope. RSD can cause anyone with ADHD to spiral for hours with emotional dysregulation and self criticism.
Unsure if you are experiencing RSD? Take our free RSD quiz to see if there are RSD patterns in your daily life. If you’re certain about RSD, this blog explores the endless spirals of negative self-talk, avoidance, and hurt that come along with RSD, and offers tips on how to cope.
What is Rejection Sensitive Dysphoria?
RSD is a term coined by Dr William Dodson, who observed that his patients with adhd were struggling with more than
focus. Research continues to support that ADHD and emotional dysregulation are as common as ADHD and forgetfulness and procrastination. RSD is a form of emotional dysregulation, grounded in the trauma of being chronically criticized from childhood to adulthood.
RSD causes people with adhd to miscalculate the possibility of being rejected or criticized, and it is physically painful. In fact, it’s named after the Greek word dysphoria, for unbearable. Many of us respond accordingly and shut down or explode in response to the emotional pain.
What triggers RSD?
Social media
Social media is in our faces 24/7. We can’t go a minute without seeing what our friends are doing. Inevitably, we will see pictures of people we know having fun without us. That’s enough to keep an ADHDer up for hours as they worry about rejection.
Projects
Have you ever spent hours on a project trying to make it perfect? There’s a reason. RSD causes perfectionism. To avoid failure and criticism, many people with ADHD wear a mask of perfection.
Dating
People with RSD struggle to be themselves. As you worry about rejection and failure, you people-please. Tell everyone what they want to hear. This causes inauthenticity in relationships and struggles to meet someone you click with.
Workplace
Many people with adhd put a lot of weight on work. It’s time to shine! We think, time to prove our middle school math teacher wrong! This raises the stakes for promotions, career opportunities, and job security. However, RSD causes many people to worry constantly that they’ll be fired or overlooked.
Marriages
RSD and being married is an interesting topic. You would think RSD isn’t an issue in marriage. I mean, why would you worry someone who’s already committed to you hates you? There’s two reasons: the first is that RSD is based in the emotional brain. When we are designed to fear rejection, the emotional brain doesn’t know that your wife didn’t return your text. On the other hand, RSD lowers your self-worth and can cause you to never set boundaries or communicate clearly, causing you to, quite frankly, get walked all over.
What is an RSD spiral?
An RSD spiral is your reaction to the initial burst of emotion when feeling an RSD trigger. Here are some common examples:
Avoidance
Dr. Dodson has written extensively about how RSD causes people to shut down entirely when triggered. This might look like canceling the date or job interview or avoiding communication. From the outside, this could look like apathy, lack of follow-through, or passive communication. All of which can rob anyone with ADHD of the opportunity for positive connection.
Defensiveness
When people feel threatened, we defend ourselves. It’s only human. But when someone with RSD is triggered, it could look like shouting, yelling, or pleading your case. Unearthing the hard exterior can be a deep shame for feeling like a failure. Sadly, this reaction to RSD only decreases the opportunity for validation.
Rumination
Do you ever review your mistakes in your mind for hours? That’s rumination, and it often distracts you from the task at hand.
People-pleasing
In order to avoid rejection, many adults with RSD try and get into other people’s minds. You offer them favors before they ask, abandon your values, and say yes to everything. Here’s the problem: people-pleasing creates barriers in relationships. Without the ability to say what you need and set boundaries, you can get really taken advantage of and wind up burnt out and overwhelmed.
Perfectionism
Perfectionism is surprisingly slippery. You might not even realize it’s shaping your life.
Most people with ADHD don’t see themselves as perfectionists because they spend so much of their lives feeling imperfect. But that’s exactly what makes perfectionism so easy to miss. Deep down, your brain struggles to accept the possibility of being seen as flawed, so you pour enormous amounts of time and energy into looking like you have it all together.
Alas, perfectionism can cause hours and hours of time wasted. As you try to present a perfect front, you neglect your own needs and joy.
Living in Dysregulation
Jeff experienced every single RSD response you could imagine. He overcommitted at work, ruminated on his failures for hours, and avoided taking any risks. At the age of 40, he felt burnt out, overwhelmed, and more unmotivated than at any other point in his life.
Years of RSD spirals lower self-esteem. You live in a negative headspace as you can’t seem to untangle from the wounds of criticism you experience each day. Most days, you feel like you’re wearing a mask to simply cope with the pain under the surface.
Once Jeff learned the right tools to manage RSD, that’s when life started to even out.
How to Manage Rejection Sensitive Dysphoria Spirals
While the initial feelings that come with RSD are hard to shake, stopping an RSD spiral is within reach. Here are some places to start:
RSD Awareness
Step one to managing RSD is being aware of RSD. Without awareness, it’s easy to get swept up in a negative self-talk loop. However, with awareness, you can identify that your RSD is being triggered and can grab the right coping skills.
Five, four, three, two, one.
A big risk with RSD is taking action reactively. For example, cancelling plans, speaking out in a rage, or shutting down all day. Before going down that road, take a breath and count down from 10. Still upset? Repeat. The point is, you need to build in a break before a spiral even starts.
Trigger management
If you look closely, you’ll find a pattern surrounding RSD triggers. Does social media trigger you? Does a certain friend tend to overtly criticize you? Sometimes managing RSD is organizing the world around you to be less triggering. While we can’t ever
remove all situations that carry risk of RSD flare-ups, we can compromise. For example, if work is stressful anyway, maybe block social media during the day so as to not increase the likelihood of a compounding RSD spiral.
Self-compassion
Research continues to suggest that having self-compassion is key to managing RSD. What does this look like in practice? It means challenging the negative thoughts that arise when thinking thoughts like “I’m lazy,” etc.
Connection
RSD creates a feeling of shame. When we feel ashamed, we tend to hide. Once we hide, we usually stay hidden. This process only makes us feel more alone. One way to deal with an RSD trigger is to find a connection. This could be through connecting with a loved one, spending time with a pet, or engaging with a creative project you enjoy.
Moving From Reacting to Responding
When you put all the pieces together, the goal of RSD management is to respond rather than react. To act from a place of authenticity and your own values, rather than reacting to the shame and fear holding you back from a successful and happy life.
Start ADHD Counseling in Columbus, OH
Wondering how to cope with RSD? You don’t have to live your life feeling disconnected and alone. ADHD counseling can help you find solutions to living with RSD. Our Columbus, OH, counseling practice has caring therapists who specialize in ADHD treatment. To start your counseling journey, follow these simple steps:
- Fill out the contact form to schedule a free 15-minute phone
- Meet with one of our caring therapists.
- Stop feeling the sting of rejection and start finding confidence and calm.
Other ADHD services offered at Focused Mind ADHD Counseling
Adult ADHD testing is not the only service we offer at our Columbus, OH, counseling practice. At Focused Mind ADHD Counseling, we offer a variety of mental health services, including ADHD treatment. As an adult with ADHD, you may also benefit from anxiety treatment for ADHD, counseling for men with ADHD, counseling for women with ADHD, ADHD-focused couples therapy, and depression counseling for ADHD. You can also view our blog for more resources and helpful info.
About the Author
Billy Roberts, LISW-S, LCSW, is the founder of Focused Mind ADHD Counseling and a licensed psychotherapist specializing in adult ADHD. Based in Columbus, Ohio, he provides ADHD testing and therapy to help adults better understand challenges related to time management, focus, emotional regulation, and relationships. He is the author of the forthcoming book: Wired to Please: Unmasking the ADHD People-Pleaser. His ADHD-informed approach to assessment and treatment has been featured in Time Magazine, CNN, HuffPost, and Forbes, where he shares insights on helping individuals gain clarity about their symptoms and develop practical strategies for daily life.
FAQs
How is Rejection Sensitive Dysphoria diagnosed by a professional?
RSD is not currently a diagnosis, it’s a strong part of life with ADHD. Evaluating for RSD is a part of ADHD testing. Because emotional regulation is a symptom of ADHD, how you experience your emotions, including those related to RSD is key to an accurate ADHD diagnosis.
What causes rejection sensitive dysphoria?
The root of RSD is twofold. First, RSD is a form of emotional dysregulation in the ADHD brain, which struggles to regulate intensity and reaction to emotion. Second, RSD stems from a lifetime of harsh criticism. In essence, it’s a reaction to the trauma of hearing thousands of critical statements since childhood.
How long does an RSD episode last?
An RSD spiral could last hours to days. RSD is a cycle. The feelings of shame and fear can be all consuming and lead to avoidance and isolation. As you spend more time alone, you never hear the positive feedback that would snap you back into a more confident frame of mind.
Start with our free Rejection Sensitive Dysphoria Quiz. If you’re looking for more personalized answers, an ADHD evaluation can help determine whether emotional dysregulation and rejection sensitivity are part of your ADHD profile.
