Rejection Sensitive Dysphoria

Linda Meredith

Rejection Sensitive Dysphoria (RSD) is a condition commonly associated with attention deficit hyperactivity disorder (ADHD). It involves intense emotional sensitivity and fear of rejection or criticism from others.

Rejection sensitive dysphoria (RSD) is extreme emotional sensitivity and pain triggered by the perception that a person has been rejected or criticized by important people in their life. It may also be triggered by a sense of falling short—failing to meet their own high standards or others’ expectations.
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[Self-Test: Could You Have Rejection Sensitive Dysphoria?]

Dysphoria, derived from the Greek term meaning "difficult to bear," refers to an intense emotional response that individuals with attention deficit disorder (ADHD or ADD) experience. It is essential to understand that this heightened emotional reaction is not a sign of weakness or lack of resilience, but rather a result of the condition itself. Rejection, criticism, and failure, which are universal life experiences, are magnified in their impact on individuals with ADHD and Rejection Sensitive Dysphoria (RSD). These experiences become unbearable, limiting, and significantly impairing for them.
In cases where individuals with RSD internalize this emotional response, it can resemble a full-fledged mood disorder, even including thoughts of self-harm. The sudden shift from feeling fine to overwhelming sadness, which stems from RSD, is sometimes misdiagnosed as rapid cycling mood disorder.
Physicians often require considerable time to recognize that these symptoms are a direct result of the abrupt emotional changes associated with ADHD and rejection sensitivity. This recognition is especially challenging because individuals with RSD tend to exhibit typical social interactions in all other aspects. However, it is important to note that RSD is a common trait among adults with ADHD.
On the other hand, when this emotional response is externalized, it manifests as intense and immediate anger directed towards the person or situation perceived as the source of pain.

Key elements of rejection sensitive dysphoria:

Extreme Emotional Reactivity: Individuals with RSD may have intense emotional reactions to perceived or actual rejection, criticism, or failure. These emotional responses can be disproportionate to the situation and may include feelings of sadness, anger, shame, or worthlessness.
Hypersensitivity to Rejection: RSD can make individuals highly attuned to signs of rejection, whether real or perceived. They may constantly seek reassurance and validation from others, fearing negative judgment or abandonment.
Fear of Criticism: People with RSD often have an intense fear of being criticized or judged by others. They may anticipate criticism even in situations where it is unlikely or not intended, leading to anxiety and self-doubt.
Avoidance Behaviors: Due to the fear of rejection or criticism, individuals with RSD may engage in avoidance behaviors. They may avoid social situations, relationships, or activities where they feel vulnerable to potential rejection.
Low Self-Esteem: RSD can contribute to feelings of low self-worth and inadequacy. Individuals may internalize negative feedback or experiences, further damaging their self-esteem and confidence.
Emotional Dysregulation: Emotional dysregulation is common in RSD. People may struggle to manage their emotions, experiencing rapid mood swings, impulsivity, or emotional outbursts in response to perceived rejection.
Overcompensating Behavior: In an attempt to avoid rejection, individuals with RSD may engage in overcompensating behaviors. They may strive for perfectionism, overachieve, or become people-pleasers, constantly seeking approval and validation from others.
Relationship Challenges: RSD can significantly impact relationships. Individuals may struggle with trust, vulnerability, and forming deep connections due to the fear of rejection. The fear of criticism may also lead to conflict or avoidance in relationships.
It's important to note that RSD can significantly impact an individual's daily functioning, emotional well-being, and relationships. Seeking professional support from a mental health provider familiar with RSD and ADHD can be beneficial in managing and understanding these experiences.

RSD Symptoms

RSD Triggers

External Triggers: These are events or situations that occur in the external environment and can contribute to RSD:

Criticism or negative feedback from others: Receiving criticism, even if it is constructive, can trigger intense emotional reactions and feelings of rejection.
Rejection or exclusion: Being left out or rejected by friends, peers, or romantic partners can significantly impact individuals with RSD.
Failure or setbacks: Experiencing failure or setbacks in personal or professional endeavors can trigger feelings of inadequacy and fear of rejection.
Conflict or confrontation: Engaging in conflict or experiencing confrontational situations can heighten the fear of criticism and rejection.

Internal Triggers: These triggers arise from within the individual and can be related to their thoughts, emotions, or self-perception:
Negative self-talk: Engaging in self-critical or self-deprecating thoughts can amplify the fear of rejection and trigger intense emotional responses.
Perfectionism: Striving for perfection and having unrealistic expectations of oneself can increase vulnerability to RSD triggers.
Low self-esteem: Having a negative self-image and low self-worth can make individuals more susceptible to feeling rejected or criticized.

Perceived Triggers: These triggers are based on perceived threats rather than actual events:
Anticipation of rejection or criticism: Individuals with RSD may anticipate rejection or criticism even in situations where it may not be present, leading to heightened sensitivity and emotional responses.
Hypersensitivity to social cues: Perceiving nonverbal cues, such as facial expressions or body language, as signs of rejection or criticism can trigger RSD symptoms.
Fear of disappointing others: The fear of letting others down or not meeting their expectations can create a constant state of anxiety and vulnerability to RSD triggers.

It's important to note that these triggers can vary from person to person, and individuals with RSD may have specific sensitivities or triggers that are unique to their experiences. Understanding these triggers can help individuals develop coping strategies and seek appropriate support to manage their RSD symptoms effectively.
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Adhd vs Ptsd and the overlap

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Link to information

ADHD & PTSD/C-PTSD are perhaps two of the most difficult diagnoses to distinguish. At times I was tempted to scrap this week's post and opt for an easier one! The research has some inconsistencies, and there are many different perspectives out there (some who passionately suggest we are overdiagnosing #PTSD as ADHD and others who suggest we are over-diagnosing #ADHD as PTSD). And there is a high co-occurrence of conditions. emerging research suggests ADHD is a risk factor for developing PTSD (Gurvits et al., 2000) & exposure to complex trauma in childhood may trigger ADHD (Crenshaw & Mayfield, 2021).

Gurvits et al. found 30% of adults w/ PTSD had ADHD, compared with only 11% of the adults w/o PTSD.

Adler et al., found 36% of veterans w/ PTSD had co-occurring ADHD.


Working memory impacted in both (Swick et al. 2017).

Hyperarousal vs. hyperactivity. Hyperarousal can look like hyperactivity. Hyperarousal (which is a natural response to the body’s overactive fight-or-flight response) is characterized by increased arousal, agitation, anxiety, hypervigilance, irritability, & exaggerated startle response. These symptoms will look a lot like hyperactivity (i.e. fidgeting, excessive moving, stimming, & restlessness) Szymanski, 2011

Disorganization: Difficulty organizing thoughts and tasks--key part of ADHD. Intrusive memories and thoughts can cause a person to be more distracted/disorganized/difficulty listening (Szymanski)

Flashbacks/Impulsivity: Flooding of intense emotion can look like impulsivity. Particularly for children--can overwhelm their systems & lead to disorganized, impulsiveness, & agitated behaviors (Szymanski).

Avoidance vs inattention: Avoidance is a key component of PTSD. This can result in distractibility & forgetfulness which looks like inattention (Szymanski)


🦋 Recommended screening for both whenever 1 is being assessed.
🦋 When co-occurring treatment of ADHD will help with PTSD and vice-versa

Trauma vs Adhd and the overlap

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Ptsd vs Cptsd and the overlap

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