How ADHD May Trigger Rejection Sensitive Dysphoria (RSD)

Some of the symptoms of RSD aren't totally avoidable when you have ADHD. They're bound to happen sometimes, but with the proper ADHD treatment and strategies for coping with rejection, these symptoms are much easier to manage. Learn more about rejection sensitivity and ADHD, including how to tell whether you have RSD.

What Is Rejection Sensitive Dysphoria?

Rejection sensitive dysphoria, often simply called RSD, is a term used to describe intense emotional pain stemming from rejection. The name includes the Greek word "dysphoria," which means "hard to bear." Someone with RSD may have a very strong response to feeling rejected and may even find it hard to control their reaction.

‍

Why Do People with ADHD Have RSD?

RSD is closely associated with ADHD. In fact, nearly 100% of people with ADHD experience rejection sensitivity. Experts believe that this is because an ADHD brain doesn't regulate internal signals as much as a brain without ADHD. This allows more brain activity to go unfiltered, which makes it difficult for someone with ADHD to process information. They can become more easily overwhelmed by many things, including emotional responses. Because they aren't able to regulate the pain they feel upon being rejected, they have a more intense reaction to it.

‍

Symptoms of RSD

When someone with RSD experiences rejection, teasing, or criticism, it can trigger a strong and sudden mood shift, often involving rage or tears. They might also have this type of reaction when they perceive someone else's actions as a rejection or criticism — even if that's not how it's intended — or when criticizing themselves over a real or perceived failure.

Some of the signs associated with RSD include:

Emotional outbursts
Low self-esteem
Withdrawal from social situations
Being easily embarrassed
Negative self-talk
Thoughts of self-harm
Relationship problems
Excessively seeking approval from others
Striving for perfectionism
Avoiding activities with a possibility of failure

The symptoms of RSD can overlap with those of other mental health conditions, including bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, depression, social phobia, and post-traumatic stress disorder (PTSD). With RSD, however, episodes tend to be very intense but short-lived. With other mental health conditions, symptoms tend to last longer.

‍

Tips for Managing Rejection Sensitivity

No one likes being rejected. But for people with RSD, their reactions to these situations can become harmful, both to their own self-esteem and to their relationships with others. That's why it's so important to learn the best treatment options and coping strategies for rejection sensitivity.

Get a correct diagnosis

If you're experiencing problems with rejection sensitivity, talk to a licensed healthcare provider. It's important to find out whether your symptoms align with those of RSD. You may also need to be screened for ADHD if you have not already received a diagnosis. Make sure you see a board-certified provider with expertise in this area since it's also very important to consider whether any other mental health conditions are at play, such as depression or bipolar disorder.

Find the right treatment

There aren't medications that have been developed specifically for treating RSD. However, finding the proper treatment for your ADHD is the best way to treat RSD since these conditions affect the same area of the brain. Talk to your healthcare provider about what types of medication may be most effective in alleviating the symptoms of your ADHD and RSD.

Two alpha-agonist medications, guanfacine and clonidine, have been found to be especially helpful for RSD. Only about one out of three people see major benefits from this treatment, but it may be worth trying if your RSD is particularly debilitating. Side effects may include mild sedation, dry mouth, and dizziness when standing up too quickly.

Another option is monoamine oxidase inhibitors (MAOIs) like tranylcypromine, which may be prescribed off-label for this purpose. In addition to RSD, these medications can help with attention and impulsivity issues. MAOIs have minimal side effects, but users must avoid certain foods in their diet as well as certain types of medications.

Try therapy

In addition to ADHD medication, therapy can be helpful in managing the symptoms of ADHD and RSD. This strategy isn't likely to result in a decrease in the frequency of RSD episodes since they come on so suddenly. However, a therapist can help you develop strategies for coping with strong emotions more effectively when they surface.

If you're struggling with RSD, Done is here to help. Take our one-minute online assessment to get started. Our ADHD clinicians are here to answer your questions about ADHD, including any issues with rejection sensitivity that you've been experiencing, and help you find the best treatment to suit your needs.