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Rejection Sensitivity Dysphoria ADHD: Coping and Treatment

Apr 19, 2024

Rejection sensitivity dysphoria (RSD) is a psychological state experienced by many with attention deficit hyperactivity disorder (ADHD), characterized by an intense and pervasive reaction to perceived or real rejection. It can significantly impact one's mental health and daily functioning. In this blog post, we will delve into the nature of RSD and its connection to ADHD.

We will explore coping strategies for dealing with RSD in adults with ADHD, such as people pleasing and social withdrawal due to fear of failure. Additionally, we'll discuss treatment options for managing symptoms associated with this condition, including psychotherapy approaches tailored towards individuals dealing with rejection sensitivity and medications that help manage symptoms.

Furthermore, practicing self-compassion while living with rejection sensitivity dysphoria is crucial for maintaining a healthy mindset. We'll provide guidance on developing a positive self-talk routine and fostering self-compassion through various strategies. Lastly, building supportive relationships and improving emotional regulation are essential components of managing RSD in those diagnosed with ADHD; thus, we'll offer tips for cultivating understanding among friends and family along with techniques for practicing effective emotional regulation.

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Table of Contents

Understanding Rejection Sensitive Dysphoria (RSD) and Its Connection to ADHD

Rejection sensitive dysphoria (RSD) is a condition often overlooked in adults with attention deficit hyperactivity disorder (ADHD), characterized by extreme emotional sensitivity and pain triggered by the perception of being rejected. This overwhelming emotional response can imitate a full major mood disorder, complete with suicidal ideation. RSD is very common in individuals with ADHD.

The nature of RSD

RSD is an intense emotional reaction that occurs when someone perceives they have been rejected or criticized, whether it's actual rejection or just perceived. It's not uncommon for those experiencing RSD to feel as if their world has come crashing down around them due to intense feelings of shame, embarrassment, and self-loathing.

As an example, imagine Sarah, a graphic designer with ADHD, who is particularly sensitive to feedback due to RSD. One afternoon, during a team meeting, her manager briefly critiques a design Sarah submitted, suggesting some minor adjustments. While the feedback is constructive and mild, Sarah perceives it as a profound rejection of her abilities.

Internally, her reaction is immediate and intense. She feels a surge of embarrassment and shame, disproportionately magnified by her RSD. Her mind races with thoughts like "I'm not good enough," and "They must think I'm incompetent." The rest of the meeting becomes a blur as she's engulfed in these feelings, unable to focus on anything else being discussed.

Externally, Sarah might try to mask her turmoil, but she's visibly shaken. She becomes withdrawn for the rest of the meeting, not participating as she usually does. After the meeting, she might avoid interactions with her colleagues, fearing further criticism or perceived rejection. This episode could impact her work performance and self-esteem for days, all stemming from a relatively benign comment that her non-ADHD colleagues would likely brush off without much thought.

This heightened sense of emotional dysregulation can make it difficult for people with RSD to maintain healthy relationships or function effectively at work. They might also struggle with other mental health conditions such as anxiety disorders, borderline personality disorder, bipolar disorder, social phobia, or depression.


Adults with ADHD are particularly susceptible to developing RSD because difficulty regulating emotions is a core symptom of ADHD. In fact, some experts believe that RSD may be a key aspect of the ADHD experience.

People with ADHD often struggle to process and respond appropriately to emotional stimuli. This can lead them to misinterpret neutral or positive social cues as negative ones, triggering their rejection sensitivity. Additionally, people with ADHD are more likely to have experienced actual rejection throughout their lives due to impulsivity and other behavioral issues related to their condition.

Research suggests that there is a genetic component involved in both ADHD and RSD. Studies have found an overlap between genes associated with these conditions and those linked to other personality disorders such as borderline personality disorder or bipolar disorder (Gatt et al., 2015). Yet, further investigation is required to accurately ascertain the correlation between these psychological health issues.

Proper treatment tailored specifically towards addressing this complex interplay of factors contributing towards emotional dysregulation is crucial for individuals living with both ADHD and RSD symptoms to effectively manage their emotions and improve overall quality of life.

Key Takeaway: Rejection sensitive dysphoria (RSD) is a condition often overlooked in adults with ADHD, characterized by extreme emotional sensitivity and pain triggered by the perception of being rejected. RSD can imitate a full major mood disorder, complete with suicidal ideation. Proper treatment tailored specifically towards addressing this complex interplay of factors contributing towards emotional dysregulation is crucial for individuals living with both ADHD and RSD symptoms to effectively manage their emotions and improve overall quality of life.

Coping Strategies for Dealing With RSD in Adults With ADHD

Rejection sensitivity dysphoria (RSD) can lead to intense negative feelings when facing rejection, which may result in two main coping strategies among people suffering from this condition. These coping mechanisms include becoming people pleasers or withdrawing from social situations altogether out of fear of failure. Unfortunately, these consequences feed into a vicious cycle where past traumas are repeated, leading to further distress.

People Pleasing as a Coping Mechanism

One common way that individuals with RSD try to avoid perceived rejection is by becoming people pleasers. This involves constantly seeking approval and validation from others while suppressing their own needs and desires. Although appearing to be a successful approach, over time this craving for external affirmation can have damaging effects on one's mental health and overall wellbeing.


  • Recognize your worth independent of other's opinions.
  • Create healthy boundaries between yourself and others.
  • Prioritize self-care activities that promote emotional well-being.

Social Withdrawal Due to Fear of Failure

The second coping mechanism often employed by those dealing with RSD is avoiding social situations altogether due to fear of failure or perceived rejection. This avoidance behavior can manifest itself in various ways such as declining invitations, not pursuing personal goals or interests, and isolating oneself from friends and family members who could provide support during difficult times.


  • Challenge negative thoughts and beliefs about yourself.
  • Seek professional help to address the root causes of your fear of failure or rejection.
  • Gradually expose yourself to social situations that you find challenging, starting with less intimidating scenarios and working your way up.

For those with ADHD and RSD, it is critical to replace unhelpful coping strategies with healthier approaches such as mindfulness meditation or CBT for emotional regulation. Additionally, seeking support from friends, family members, or mental health professionals who understand the unique challenges faced by those living with both ADHD and RSD can be invaluable in helping them navigate their journey towards improved well-being.

Further reading on RSD, its connection to ADHD, and potential treatment options can provide valuable insights into managing this condition effectively while fostering a more fulfilling life experience overall.

Key Takeaway: People with ADHD who suffer from rejection sensitivity dysphoria (RSD) may cope by becoming people pleasers or withdrawing from social situations altogether. However, these coping mechanisms can lead to a vicious cycle of past traumas and further distress. To break free from these unhelpful strategies, individuals should recognize their worth independent of others' opinions, create healthy boundaries, challenge negative thoughts about themselves, seek professional help and gradually expose themselves to challenging social situations while learning new emotional regulation techniques such as mindfulness meditation or cognitive-behavioral therapy (CBT).

Treatment Options for Managing Symptoms Associated With RSD

Living with rejection sensitive dysphoria (RSD) can be challenging, but there are various treatment options available to help manage the symptoms. Both psychotherapy and medication have been shown effective at helping those suffering from RSD cope better with their strong emotions. Let's explore some of these treatments in more detail.

Psychotherapy approaches tailored towards individuals dealing with rejection sensitivity

Cognitive Behavioral Therapy (CBT) is a popular approach that focuses on identifying and changing negative thought patterns related to perceived or actual rejection. By addressing these thoughts, individuals can develop healthier coping mechanisms and improve emotional regulation.

Dialectical Behavior Therapy (DBT) is another therapeutic option specifically designed for people struggling with emotional dysregulation. DBT combines CBT techniques along with mindfulness practices, which helps individuals become more aware of their emotions while learning how to respond effectively during times of distress.

Medications that help manage symptoms associated with this condition

In addition to therapy, medications may also be prescribed as part of a comprehensive treatment plan for managing RSD symptoms. Some potential medications include:

  • Alpha agonists: Medications such as guanfacine or clonidine can help reduce anxiety and hyperactivity often experienced by those living with ADHD and RSD.
  • Selective serotonin reuptake inhibitors (SSRIs): These medications are commonly prescribed for depression and anxiety disorders, but they may also help alleviate some symptoms associated with RSD. SSRIs like fluoxetine or sertraline can improve mood stability and reduce emotional sensitivity.
  • Monoamine oxidase inhibitors (MAOIs): Although not specifically approved for treating ADHD-related conditions like RSD, MAOIs have been shown to be effective in treating both mood and anxiety disorders. They work by increasing the levels of certain neurotransmitters in the brain that help regulate emotions. It's worth noting that MAOIs can have serious side effects.

It's important to note that medication should always be taken under the supervision of a healthcare professional who is familiar with your specific mental health conditions and needs. Consult with a medical professional before initiating any new regimen.

In addition to these treatments, lifestyle changes such as regular exercise, maintaining a healthy diet, getting adequate sleep, practicing mindfulness techniques like meditation or yoga can all contribute positively towards managing ADHD symptoms along with rejection sensitive dysphoria.

Treating ADHD-related RSD requires patience and persistence from both individuals living with this condition as well as their support network. By exploring various treatment options available and working closely alongside healthcare professionals, it's possible to find an approach that works best for you while improving overall quality of life.

Key Takeaway: Living with rejection sensitive dysphoria (RSD) can be challenging, but there are treatment options available to help manage the symptoms such as psychotherapy and medication. Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are effective in addressing negative thought patterns while medications like Alpha agonists, Monoamine oxidase inhibitors (MAOIs), and Selective serotonin reuptake inhibitors (SSRIs) may also be prescribed under medical supervision. Additionally, lifestyle changes such as regular exercise, maintaining a healthy diet, getting adequate sleep, practicing mindfulness techniques like meditation or yoga can all contribute positively towards managing ADHD symptoms along with RSD.

Practicing Self-Compassion While Living With Rejection Sensitivity Dysphoria

To live successfully alongside rejection sensitivity dysphoria (RSD) requires practicing self-compassion - treating oneself kindly during moments of perceived failure just as one would approach comforting someone else experiencing similar difficulties. Positive self-talk plays a critical role in building confidence while quieting our inner critic.

Developing a Positive Self-Talk Routine

Positive self-talk is an essential tool for managing the emotional pain associated with RSD. By replacing negative thoughts with more supportive and encouraging ones, you can help to improve your overall mental health and better cope with the intense feelings that come from perceived or actual rejection. Here are some tips for developing a positive self-talk routine:

  • Create affirmations: Develop a list of personal affirmations that resonate with you and remind yourself of these statements daily.
  • Mindfulness practice: Engage in mindfulness exercises like meditation or deep breathing to help calm your mind and focus on the present moment.

  • Journaling: Write down your thoughts, feelings, and accomplishments regularly to keep track of progress and identify patterns in your thinking.
  • Cognitive restructuring: Learn how to recognize negative thought patterns related to RSD symptoms, such as catastrophizing or black-and-white thinking, then challenge them by considering alternative perspectives.

Strategies for Fostering Self-Compassion

In addition to cultivating positive self-talk habits, it's essential to practice self-compassion when living with RSD. Self-compassion involves treating yourself kindly and understanding that everyone experiences setbacks, disappointments, and failures. Here are some strategies for fostering self-compassion:

  • Be kind to yourself: Recognize that it's okay to feel hurt or upset by perceived rejection but remind yourself of your strengths and accomplishments.
  • Acknowledge your feelings: Allow yourself to experience the emotional pain triggered by RSD without judgment or criticism.
  • Treat yourself as you would a friend: Imagine how you would comfort a loved one experiencing similar difficulties, then apply those same words of encouragement and support to yourself.
  • Seek professional help if needed: If you're struggling with managing symptoms related to ADHD or RSD, consider seeking guidance from a mental health professional who can provide tailored treatment plans for individuals dealing with these conditions. Mental health conditions like ADHD, bipolar disorder, and borderline personality disorder can make it difficult to regulate emotions and measure rejection accurately, leading to intense feelings of emotional pain and social phobia.

Fostering self-compassion while living with RSD is crucial in improving overall well-being and navigating the challenges associated with this condition. By developing positive self-talk routines and practicing kindness towards oneself during moments of distress, individuals can better manage their emotions related to perceived or actual rejection - ultimately leading more fulfilling lives despite their struggles.

Key Takeaway: Living with rejection sensitivity dysphoria (RSD) requires practicing self-compassion, positive self-talk and mindfulness exercises. By acknowledging emotional pain without judgment or criticism, treating oneself kindly during moments of perceived failure and seeking professional help if needed can improve overall well-being for individuals dealing with RSD.

Building Supportive Relationships and Improving Emotional Regulation

Individuals with ADHD and RSD require supportive friends and family members who understand the unique challenges they face. Practicing emotional regulation techniques, such as taking time to consider responses before reacting impulsively or negatively, can help improve interpersonal relationships while reducing instances of rejection-related distress.

Tips for cultivating understanding among friends and family

  • Educate loved ones: Share information about rejection sensitive dysphoria, attention deficit hyperactivity disorder, and their impact on your life. This will help them better comprehend what you're going through.
  • Create a safe space: Encourage open communication within your support network so that everyone feels comfortable discussing their feelings without fear of judgment or actual rejection.
  • Set boundaries: Establish clear expectations regarding how you would like others to respond when you are experiencing intense feelings related to RSD. This may include asking for reassurance or simply requesting some alone time to process emotions.
  • Show appreciation: Acknowledge the efforts made by those around you in supporting your mental health journey. Expressing gratitude can strengthen bonds between individuals dealing with similar struggles.

Techniques for practicing effective emotional regulation

The ability to regulate one's emotions is crucial in managing symptoms associated with both ADHD and RSD. Here are some strategies that may be helpful in achieving greater emotional stability:

  1. Mindfulness meditation: This practice involves focusing on the present moment non-judgmentally, allowing you to observe your thoughts and feelings without becoming overwhelmed by them. Research has shown that mindfulness can help improve emotional regulation in individuals with ADHD.
  2. Cognitive restructuring: This technique involves identifying negative thought patterns and replacing them with more balanced perspectives. For example, if you tend to catastrophize perceived rejection, remind yourself that not every setback is a disaster or personal failure.
  3. Breathing exercises: When feeling anxious or upset due to RSD symptoms, try engaging in deep breathing exercises such as diaphragmatic breathing or the 4-7-8 method. These techniques can help calm your nervous system and reduce emotional distress.
  4. Seek professional support: Working with a therapist who specializes in treating ADHD and related mental health conditions may provide valuable guidance on how best to manage emotions associated with rejection sensitivity dysphoria.

Incorporating these strategies into your daily routine can lead to improved emotional regulation skills while fostering supportive relationships among friends and family members who understand the unique challenges faced by those living with ADHD-related RSD.

Key Takeaway: Individuals with ADHD and rejection sensitivity dysphoria (RSD) can improve their emotional regulation by practicing mindfulness meditation, cognitive restructuring, breathing exercises, and seeking professional support. Building supportive relationships with friends and family who understand the challenges of RSD is also important through education, creating a safe space for communication, setting boundaries, and showing appreciation.

FAQs in Relation to Rejection Sensitivity Dysphoria ADHD

What is Rejection Sensitivity Dysphoria (RSD)?

Answer: Rejection Sensitivity Dysphoria (RSD) is a term used to describe intense emotional pain and discomfort triggered by the perception of rejection, criticism, or failure. Although not officially recognized in diagnostic manuals, it is commonly associated with Attention Deficit Hyperactivity Disorder (ADHD) and is characterized by sudden, severe emotional reactions to what the individual perceives as rejection or failure.

How is RSD related to ADHD?

Answer: Many individuals with ADHD experience heightened emotional sensitivity and reactivity, which can include symptoms consistent with RSD. The ADHD brain processes emotions differently, leading to more intense emotional experiences. RSD can exacerbate the challenges faced by individuals with ADHD, affecting their social interactions, self-esteem, and overall mental health.

What are the symptoms of RSD?

Answer: Symptoms of RSD may include extreme emotional sensitivity to perceived criticism or rejection, sudden mood swings in response to such perceptions, intense feelings of shame or inadequacy, social withdrawal, and in some cases, aggressive behavior as a defensive response. These symptoms can significantly impact an individual's quality of life and relationships.

How is RSD diagnosed?

Answer: Currently, there is no formal diagnostic criterion for RSD in major diagnostic manuals such as the DSM-5. Diagnosis is typically based on clinical interviews and the observation of symptoms in relation to ADHD. Health professionals may use questionnaires or assessments to understand the extent of emotional dysregulation related to perceived rejection or criticism.

Can RSD be treated or managed?

Answer: Yes, RSD can be managed through a combination of approaches. Treatment may include medication (such as alpha agonists, SSRIs, or other mood stabilizers), therapy (cognitive-behavioral therapy, emotional regulation therapy), and lifestyle changes (exercise, mindfulness practices). Each individual's treatment plan should be tailored to their specific needs and symptoms.

How can therapy help with RSD?

Answer: Therapy can be highly effective in helping individuals understand and manage the intense emotions associated with RSD. Cognitive-behavioral therapy (CBT) can teach coping strategies to deal with the thoughts and feelings of rejection. Emotional regulation therapy can help individuals learn to identify, understand, and manage their emotional responses.

Can lifestyle changes impact RSD symptoms?

Answer: Yes, lifestyle changes such as regular physical activity, mindfulness meditation, adequate sleep, and a healthy diet can help manage symptoms of RSD. These practices can improve overall emotional well-being and resilience, reducing the intensity of reactions to perceived rejection or failure.

Is medication necessary for managing RSD?

Answer: Medication is not necessary for everyone but can be beneficial for some individuals. Medications that are commonly used to treat ADHD can also help manage RSD symptoms, especially if they include significant emotional dysregulation. A healthcare provider can offer guidance on whether medication might be a helpful component of a comprehensive treatment plan.


Living with rejection sensitivity dysphoria (RSD) can be tough, especially for adults with ADHD, but understanding the nature of RSD and its connection to ADHD is key to managing symptoms.

Implementing coping strategies like self-compassion, building supportive relationships, and seeking treatment options such as psychotherapy or medication can help individuals with rejection sensitivity dysphoria and ADHD improve their emotional regulation and quality of life.

Apr 19, 2024

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