Rejection Sensitive Dysphoria
Rejection sensitive dysphoria (RSD) is an extreme emotional response to either real or perceived criticism or rejection.
It is commonly experienced by neurodivergent people. It has been argued to be an exclusive emotional condition to ADHD, but others disagree, arguing that it can also be present in autism, social anxiety, and trauma, amongst others.
It was coined by Dr William Dodson:
“a triggered, wordless emotional pain that occurs after a real or perceived loss of approval, love or respect”
What can RSD look like?
Intense feelings of depression, anxiety, overwhelm or hurt
It may feel physically painful, like a stab in the stomach
Excessive people pleasing and ignoring own wants or needs
Avoidance of social interactions due to fear of rejection or criticism
Self-harm, suicidal ideation, self-sabotage or unhealthy ways of coping with pain
Challenges in relationships through self-sabotage and not being understood
What causes RSD?
People with ADHD, Autism and other neurodivergent conditions often struggle with emotional dysregulation and big emotions can be easily triggered. They can also feel emotions more intensely.
Research shows that people with ADHD experience more rejection throughout their lives (Wehmeier, Schacht & Barkley, 2010), which can lead to greater anxiety around rejection or criticism.
What can trigger RSD?
Misinterpreting a neutral or unspecific reaction as criticism
Feeling like they have failed at a task
Real or anticipated rejection or criticism
A reminder of past rejection (which they are likely to have experienced more of)
Interpreting a single comment as meaning that they are not liked
Misreading constructive feedback
Misinterpreting somebody’s tone of voice or facial expression
Low self-worth, or basing self-worth wholly on acceptance by other people
Overthinking social interactions
How to help someone with RSD:
Provide additional reassurance
Don’t minimise or dismiss their feelings
Listen and try to understand their experiences
Deliver feedback or criticism carefully
Communicate clearly and explicitly
Help them to navigate unfamiliar situations
Remind them that they are loved
Reminders for people with RSD:
Nobody is perfect
Others aren’t judging you as much as you think they are
It would take a lot more than your mistakes for everyone to hate you
You are still loved even when you make a mistake
You wouldn’t judge others as harshly as you think they judge you
It is impossible to know what other people are thinking
No-one is perfect, and it is ok to make mistakes.
References
Dodson, W. (2016). Emotional regulation and rejection sensitivity. Attention, Oct 2016, 8-11.
Dodson, W. (2023). New insights into rejection sensitive dysphoria. ADDitude. https://www.additudemag.com/rejection-sensitive-dysphoria-adhd-emotional-dysregulation/
Faraone, S. V, Rostain, A., Blader, J. et al. (2019). Practitioner review: emotional dysregulation in attention deficit hyperactivity disorder – implications for clinical recognition and interventions. Journal of Child Psychology and Psychiatry, 60(2), 133-150. https://doi.org/10.1111/jcpp.12899.
Wehmeier, P., Schacht, A., Barkley, R. (2010). Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. Journal of Adolescent Health, 46(3), 209-217. https://doi.org/10.1016/j.jadohealth.2009.09.009.
