Haunted by Rejection? Understanding RSD in ADHD
When Rejection Feels Like a Jump Scare
Are you haunted by criticisms? Is the comment about your appearance or your work playing on repeat? Do you have a voice in your head screaming ‘they hate me!’ or ‘I am such an idiot’? Has your kiddo ever come home from school and said their teacher hates them even though it seems as if they were just reminded to sit still? This voice in your head (or in your kiddo’s head) is the voice of RSD.
October is spooky season and ADHD Awareness Month. This is the perfect time to talk about this monster under your bed, Rejection Sensitive Dysphoria. The creepy thing about RSD? Rejection Sensitive Dysphoria is an intense emotional reaction to perceived or actual rejection, criticism, or failure — common in ADHD, yet not officially listed as a diagnostic criterion for ADHD.
Let’s pull back the mask and look at what’s really haunting so many ADHD brains.
Jessica McCabe from How to ADHD explains RSD in this video.
What Is RSD — and Why Isn’t It in the DSM?
Let’s break this term down by its components.
Here is what our word nerd friends at Merriam-Webster say:
Rejected/rejection: “not given approval or acceptance”
Sensitive: “highly responsive or susceptible: such as easily hurt or damaged especially : easily hurt emotionally: delicately aware of the attitudes and feelings of others”
Dysphoria: “a state of feeling very unhappy, uneasy, or dissatisfied” from the Greek word “hard to bear”
When we put these terms together it explains the experience of RSD as reacting to a trigger because we are more susceptible to it and the response to that trigger is much bigger than one would expect. The enormity of this emotion leaves us feeling so awful that it’s hard to hold the weight. To add insult to injury, because this experience is so intense, we are on high alert for it to happen in the future making us uneasy and quick to react the next time we perceive or experience a rejection.
If it’s common with ADHD, why isn’t it part of the diagnosis?
The Diagnostic and Statistical Manual (DSM) is the collection of “official” mental health diagnoses. Each mental health diagnosis has a list of criteria that must be met for a clinician to assign a mental health diagnosis.
The criteria for ADHD listed in the DSM are more about observable behaviors rather than emotional experiences. I am speculating that because the disorder must be present in childhood, the criteria will be based on observations of caretakers rather than self-report of the child.
The DSM is missing a critical component of ADHD symptoms
The criteria that the DSM lists are a result of underdeveloped executive functions. One of these executive functions is responsible for emotional regulation, which ignites RSD. People with ADHD are more prone to RSD because we easily become dysregulated and because we typically experience more criticisms than our peers, so naturally, we would be more sensitive.
Experts in the ADHD community talk about emotional dysregulation as part of ADHD. But ask your pediatrician or family doctor and they might not make the connection (no judgment). It’s like the ghost of ADHD symptoms — everyone feels its presence, but it’s not officially recognized.
More about emotional dysregulation in ADHD
Two things to consider when talking about emotions in the neurodivergent brain. That aren’t explained in the DSM:
The expression and regulation of emotions is a developmental milestone. The older you get the better able you are to identify and manage your emotions. A neurodivergent brain has less neuropathways and less neurotransmitters to police their emotions.
A neurodivergent child hears 10,000 more negative messages than their neurotypical peers. They grow up in a world where they are constantly told do better, sit still, pay attention, and just apply yourself.
Neurodivergent children get the one-two punch of emotional dysregulation – first they are hit with criticisms and emotions then their brain doesn’t have the ability to navigate it.
How RSD Shows Up: The Emotional Jump Scares
So, what does RSD look like? We have these huge emotional reactions that sweep us off our feet. This is what it looks like in real life:
The Phantom Critic — replaying small mistakes or offhand comments until they become emotional horror reels. This can be a comment from a stranger in the grocery store about a food choice, it can be the person honking their horn because you zoned out at a red light or maybe you said something awkward in a conversation with a co-worker. Your brain goes over the scenario again and again, each time reinforcing the idea that you are an idiot.
The Disappearing Act — withdrawing from people or projects to avoid rejection. I mean, who in their right mind would intentionally risk that horrible feeling of rejection? You can’t be criticized for work you didn’t do, am I right?
The Perfectionist’s Curse — overworking to prevent perceived failure or criticism. If you have decided to take on a task, you will go above and beyond to make it perfect. You can stay up all night completing work that should have been done during the day. Or maybe you are up all night agonizing over the details, just in case you missed something.
The Possession of Emotion — reactions that feel instant and overwhelming, often followed by shame or exhaustion. I have this image from The Exorcist, the little girl is possessed and turns into this crazy, vomit spewing, demon. The adults are perplexed, what got into this child? At the end of the movie, the little girl is okay. She looks tired and has some scars on her face, and everyone is worn out. That’s a day in the life with RSD.
The Science (and Mystery) Behind the RSD Monster
I touched briefly on the brain chemistry of ADHD. I will do a deep dive here.
ADHD is a neurodevelopmental disorder. That means the structure and function of the brain develops differently than a neurotypical brain. A neurodivergent brain processes information differently because it’s different. Imaging of neurotypical and neurodivergent brains show structural differences, though imaging is not sufficient for a diagnosis of ADHD.
Emotional dysregulation is a result of the structural differences in the neurodivergent brain. It not something explained away because a person is just being a kid, being a brat, being dramatic, or being an asshole. The neurodivergent brain processes emotions differently and experiences them at a different intensity. Keep in mind ADHD is not a free pass for you to be an asshole, sorry.
When working with clients, I use the analogy of diabetes. A person with diabetes processes sugars differently. Treatment involves medication and behavioral changes. We don’t tell people with diabetes to just process sugar differently and you’ll be fine. If a person with diabetes wants to live a healthier life, they need to change habits and potentially take medication. If a person with diabetes doesn’t treat the diagnosis, there can be immediate and long-term effects. This is the same for a person with ADHD.
Exorcising the RSD Ghost: How to Manage Rejection Sensitive Dysphoria
Name the Monster – Awareness is power. Labeling RSD helps separate fact from fear. I use the phrase “name it to tame it”. There is something empowering about labeling our experience.
Reality Check Rituals – Pause before reacting. Ask: “What evidence do I have that I’ve been rejected?” If you feel criticized by someone else, you may be able to ask them “what did you mean by that?” Warning: having a conversation is only possible if you are regulated. Responding to emails, messages, or comments when you are dysregulated will more than likely make things worse.
Potions & Practices – Mindfulness, journaling, or grounding techniques to calm the emotional surge. These are best practiced when you are feeling calm, not when your head is spinning and you’re cursing like the possessed child. If you routinely care for your mind and body, you will build resilience to navigate the zombie apocalypse. It’s like learning to swim in the shallow end of the pool, not when you are thrown overboard will setting traps for crab with the crew of Deadliest Catch.
Summon Your Supports – Therapy (especially CBT for ADHD), ADHD coaching, or peer support groups can help tame the monster. The Sanderson Sisters didn’t bewitch children on their own, teamwork makes the dream work.
If RSD has been haunting you, therapy can help you stop running from the ghosts and start understanding them. This Halloween, let’s unmask RSD — it’s not a monster to fear, just a part of ADHD that deserves understanding.
Don’t let RSD haunt you another season. Learn how therapy for ADHD can help you quiet your inner critic and reclaim your emotional balance. Schedule a consult today.