Rejection Sensitive Dysphoria:

The Emotional Rollercoaster of the ADHD Brain

Have you ever felt like someone strapped you on an emotional rollercoaster without your permission?

You may have magically gotten everything set up for a great day- sleep, exercise, an awesome plan- but one thing throws emotions into a spiral and it’s all thrown right out the window. Now you feel like a mess- you’re sad, frustrated, mortified AND you can’t get a single thing done.

Yup. It’s the rejection-sensitivity freefall- and you’re not alone.

Rejection sensitivity is a condition that psychologists are still learning about. But there is growing consensus about what it is, who’s most likely to struggle with it, and what to do about it. So let's dive in:

What is Rejection Sensitive Dysphoria?

Rejection Sensitive Dysphoria is a term defined by William Dodson to describe the significant and often extremely painful emotional experience that many ADHD brains experience. There is no research backing for the condition, nor is it a formal diagnosis. But we can think of it as the ADHD version of Rejection Sensitivity (which does have significant research backing).

Rejection Sensitivity is extreme emotional sensitivity and pain triggered by perceived failure, perceived rejection, projection of possible failure, or criticism.  When you have rejection sensitivity, you feel tremendous pain, anger, or depression in the face of rejection, failure, or criticism. But the real kicker here is that it doesn't have to be actual rejection, failure, or criticism. Simply the perception of rejection or fear that someone will reject you can trigger the exact same feeling. The same is true of failure and criticism- the feelings don't just come up for actual failure- they can come up even when you’re afraid you will fail or be criticized.

What triggers Rejection Sensitivity? 

When RS is triggered by actual failure or rejection, it is often easier to understand. For example, if you bomb your big presentation and get passed over for the promotion you were promised and you hide under the covers for the next 3 days feeling like the worst human to walk the earth.  It makes sense. It's incredibly painful and may feel more extreme than you think it should, but you understand what caused it.

But RS can be triggered by possible, perceived, or even imagined failure or rejection, some of which may not even be fully conscious. And so it doesn’t always feel so clear cut- sometimes it feels like the emotions just came out of nowhere.

Despite that, RS reactions always come from somewhere- even if it’s not immediately obvious where. They can be triggered by looking at a task list full of overwhelming projects and items and having thoughts like "I’ll never be able to do this" or "I'm not going to be able to get this done; why even try." They can be triggered by an unintentional slight from a friend. Or they can be triggered by the fear of failing in front of a crowd or even from unintentional criticism like "why don't you just set an alarm, so you aren't always so late."

What does Rejection Sensitive Dysphoria look like?

Rejection sensitivity reactions exist on a spectrum- from mild sadness, frustration, or upset to full-blown depressive episodes with suicidal thoughts, extreme anger, hopelessness, or extreme social isolation. And these feelings can either be directed at yourself or they can be directed outside of yourself.

What Rejection Sensitivity looks like with ADHD

When someone with RS also has ADHD, these feelings then have a huge impact on productivity. You might look at your task list, feel overwhelmed and distracted, and imagine failing to get it all done. This leads to the pain and upset of RS, which causes more avoidance and procrastination, further emphasizing your belief that you can't do it and worsening your feelings. (For more information on this negative spiral and how to get out of it, check out The Shame Spiral post).

         Internalized Rejection Sensitive Dysphoria:

When you internalize your RSD, it looks a lot like depression. Internalized RS usually involves sadness, hopelessness, self-blame, intense shame, and self-hatred. It often sounds like: "I'm such a failure," "I never do anything right," or "I'm so stupid.” It looks like not getting off the couch, hiding under the covers, procrastinating, distraction-seeking, or numbing.

        Externalized Rejection Sensitive Dysphoria:

Externalized RSD reactions are directed outside yourself. They tend to be feelings of anger, extreme frustration, and resentment. Externalized RS reactions include yelling, temper tantrums, violence or quiet seething, passive aggression, or even determined competition. Often, externalized RSD reactions feel explosive and like they come out of nowhere, which can scare and confuse the people around you.

How do I know if it’s Rejection Sensitive Dysphoria?

Because rejection sensitive dysphoira can lead to extreme feelings, it can sometimes be mistaken for other conditions like bipolar disorder, borderline personality disorder, or social anxiety disorder. But the key difference is what triggers the feelings. If the emotions are solely triggered by failure, rejection, or criticism and are quickly turned around by success, acceptance, or productivity, they are likely the result of RSD.

Because we’re still understanding rejection sensitive dysphoria, psychologists haven’t yet agreed on its specific symptoms or criteria. But if you’re wondering if you are wondering how rejection sensitive your brain is, the How Rejection Sensitive Are You? Quiz will help you understand more if this might be part of the cause of your emotional experience.

What does Rejection Sensitive Dysphoria have to do with ADHD?

Research is starting to discover that people with ADHD (and autism) are more likely to experience Rejection Sensitivity. We do not currently understand why, but it appears to be related to the fact that people with ADHD have hypersensitive nervous systems. Not everyone with ADHD has rejection sensitive dysphoria, but if you have ADHD, you are more likely to also struggle with hypersensitivity to rejection.   

No one likes rejection. No one enjoys being criticized. As human beings, we must be part of a group; our survival depends on it. So our brains are wired to crave connection and abhor rejection. Our brains are also wired to be hyperaware of and hold onto any signal that we have made a mistake. This, too, keeps us safe. If we know where we went wrong, then we can do better next time. 

But the ADHD brain is extra vulnerable to this feeling and extra sensitive to this experience. The ADHD brain is missing a filter for what comes at it. It can't keep out the unimportant. But it also has a hard time letting go of things that seem out of place or are irritating (like that itchy tag at the back of your shirt). These two patterns of the ADHD brain may keep it from being able to keep rejection right-sized: It’s unable to filter it out, and then it holds onto it until it has made complete sense of it and it’s no longer irritating.

Okay, I have Rejection Sensitive Dysphoria; what do I do about it?

First, you’re not alone, and you’re not exaggerating your feelings. Your brain is being flooded by this discomfort because of how it is built.  Beating yourself up for it, and feeling guilty and shameful about it, only makes it worse. So getting support to manage your self-talk and beliefs about yourself is essential.

Medication

While there have been no formal research studies done, there is some ancetdotal evidence that medications such as Guanfacine and Clonodine (initially medications for high blood pressure) can help with RSD symptoms. If you are experiencing significant rejection sensitivity, you may want to speak with your psychiatrist about a trial run.

ADHD Emotional Regulation Skills Training

But medication isn’t possible for everyone and doesn’t always address rejection sensitive dysphoria for everyone. And so, additional strategies are almost always needed. But because RS reactions— particularly in ADHD brains— can come on so suddenly and can feel so overwhelming, typical emotion regulation strategies tend not to work well to navigate them.

Instead, RSD responses require ADHD-specific Emotional Regulation Strategies that are crafted specifically to work for ADHD brains- to address how to deal with the painful sensation at the moment and help resist future rejection-sensitive dysphoria responses.

Want to learn more about ADHD Emotional Regulation Skills Training? Join my FREE masterclass to learn the 5-step process for developing emotional mastery with an ADHD brain.

Therapy and Coaching

CBT, DBT, ACT, and Mindfulness-Based Therapy have all been found to be effective therapies for rejection sensitivity, but it is important that, if you have an ADHD brain, any therapist you work with is skilled and well-trained to work with ADHD brains. How do you know if a therapist is right for you and your brain? Check out 11 questions to ask before starting ADHD therapy.

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