Rejection sensitive dysphoria (RSD) is a condition in which a person feels extreme emotional sensitivity and pain due to perceived or actual rejection. RSD appears to be more common in those with ADHD.

Although rejection is not enjoyable for anyone, it can trigger an overwhelming emotional response in people with RSD.

Researchers are still unsure about the connection between RSD and ADHD. However, some suggest that it might relate to emotional dysregulation, which is the inability to manage emotional responses to stimuli and keep them within the usual range of reactions.

In this article, we discuss the connection between ADHD and RSD.

It is important to note that RSD is a controversial topic in psychiatry and that research is still ongoing. Some mental health professionals may not consider RSD a real condition and, therefore, may not treat it.

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RSD is an overwhelming emotional sensation that a person may experience in response to an actual or perceived rejection or criticism. It is a serious condition that can result in low mood and self-esteem and is not a person being overly sensitive.

A person with RSD may experience a negative feeling, such as rejection, from an innocent comment, or they may perceive a mild disagreement as being very severe.

A person may sometimes internalize this overwhelming emotional sensation, causing a low mood and withdrawal from the situation. Alternatively, they may externalize their feelings, which could take the form of sudden anger or rage.

RSD can be difficult for the person and their loved ones, and it can harm relationships. In some cases, it may even lead to rejection, particularly if a person reacts with anger or impulsive behavior toward a perceived slight.

However, RSD is a relatively new and controversial topic in psychiatry. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not yet recognize RSD, and there are no official symptoms, so it may be difficult to get a professional diagnosis.

While the diagnostic criteria for ADHD do not currently include problems with emotion and mood regulation, people with ADHD may experience these issues.

Some ADHD experts note the existence of RSD and suggest that it occurs exclusively in people with ADHD.

However, as rejection is difficult to measure, other experts may not acknowledge RSD. They may also disregard it because it can present similarly to other conditions, such as depression, bipolar disorder, borderline personality disorder, and social phobia.

Other factors associated with ADHD may also increase the risk of experiencing rejection. These include:

  • Stimuli can trigger the central nervous system differently in people with ADHD, potentially changing how they perceive and respond to rejection.
  • ADHD itself may also lead to rejection. Other people may view individuals living with this condition differently and be critical if they do not conform to “social norms.” This criticism can make a person more sensitive to future experiences of rejection.
  • The impulsive behavior of ADHD may also cause people to respond inappropriately to rejection. In turn, this can cause them to experience more rejection.

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.

Researchers have noted that difficulty regulating emotions may explain the problems that some children with ADHD experience when socializing. Other studies also report that peer rejection and victimization frequently occur among children with ADHD and may exacerbate the symptoms of RSD.

Experts continue to work on identifying the potential role of emotional dysregulation in ADHD and how it may explain the difficulty in processing emotions, such as rejection.

However, emotional dysregulation is not unique to ADHD, and not all research supports the notion that ADHD increases the risk of rejection sensitivity.

For example, a 2017 review linked rejection sensitivity to several other mental health conditions, including borderline personality disorder, depression, and anxiety, but not to ADHD.

The symptoms of RSD can vary among individuals, but they may include:

  • frequently or obsessively thinking about negative experiences, especially experiences of perceived or actual rejection
  • perceiving rejection when it is not actually occurring
  • viewing small rejections as catastrophic
  • a chronic fear of rejection
  • misperceiving constructive criticism, requests for more information, or neutral feedback as rejection
  • perfectionism or people-pleasing tendencies

RSD is neither a medical condition nor an official diagnosis. However, a therapist may determine that a person has RSD 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.

A doctor, therapist, or another mental health professional can also diagnose other conditions that may increase the risk of RSD.

At present, the treatment options for RSD are similar to those for ADHD, including using medication such as guanfacine (Intuniv) or clonidine (Catapres).

Just as when treating ADHD, people with RSD may benefit from combining different treatment methods. Treatment for both RSD and ADHD may involve:

  • Therapy: In therapy, a person may work on developing coping skills or dealing with rejection-related problems in a relationship. They may also learn how to minimize rumination, which is a common theme among people with RSD. Therapy can also help with other ADHD symptoms by supporting better time management and reducing negative impulses.
  • ADHD medications: ADHD medications, such as methylphenidate (Ritalin) and dextroamphetamine-amphetamine (Adderall), are highly effective in managing the core symptoms of ADHD. They may also help with RSD.
  • Antidepressants: Antidepressants can help with some ADHD symptoms, especially rumination or feelings of sadness. A wide range of options is available, and people should discuss the risks and benefits of each class of antidepressants with their doctor.
  • Support: Support for people with ADHD may include academic and career accommodations. Children may need behavioral interventions, such as time management help. Parents and caregivers of children with ADHD may benefit from specialized training on how best to help them.

People living with RSD may be able to develop skills and strategies for processing emotions in therapy or support groups. Some strategies that might help include:

  • Education: If a person knows that they have RSD, this may help them put their feelings into context. Learning more about the condition might help them understand how to process information.
  • Delayed responses: There is no need to respond to rejection or other negative experiences right away. People with ADHD sometimes behave impulsively. Pausing to think about how best to respond may help reduce potential conflicts.
  • Talking about rejection sensitivity: A person can make their friends, family, and other loved ones aware of their RSD. This knowledge may help people choose their words and responses more carefully when interacting with the individual.
  • Choosing the right relationships: Certain relationships, especially those involving abusive or critical people, may make RSD even worse. People in emotionally abusive relationships should consider leaving, if they feel able to do so. Those with highly critical partners may find that couple counseling helps.

Rejection can be a painful experience, especially for people with RSD. While the research is still unclear, experts suggest that RSD is more common in people with ADHD, possibly due to difficulty processing and regulating emotions.

If a person thinks that they have RSD, ADHD, or another condition that affects their mental health, they should speak with a therapist, psychiatrist, or primary care provider about the next steps.