In our last blog, we covered the basics of Attention Deficit Hyperactivity Disorder. Individuals with ADHD have an incredible sense of creativity and compassion that can lighten the lives of those around them, and propel them to great heights of success.

Alongside their large capability to empathize, this may make them sensitive to difficult criticism, which can then manifest into physical sensations. Certain individuals with ADHD may report a tendency to ruminate excessively about their emotional situations. This constant rumination and sensitivity to criticism can be indicative of Rejection Sensitivity Dysphoria. It can be extremely mild or pronounced in individuals with ADHD.

Rejection Sensitivity Dysphoria (RSD) is characterized by a strong emotional reaction to rejection and criticism in particular – both perceived, and actual. As well as rejection from external sources, rejection from oneself is also a factor – falling short of one’s own high expectations, and being overly critical of oneself. Individuals with ADHD are often very driven and intelligent, and so falling short may feel very invalidating.

What can identify RSD is its unique nature; episodes are short and intense and go beyond a feeling of mental pain. Experiences vary uniquely with each individual – for some it may be mild, for others it may be overwhelming. The intensity of the feeling has been said to be ‘awful’ and goes beyond the emotional sensation and response from people who are neurotypical. Depending on the nature of the person, RSD can be internalized to present as a bout of depression, or externalized into a strong emotional reaction at the cause of the criticism/rejection. Individuals with RSD may also find themselves looping the thoughts of rejection and criticism.

RSD is a genetic and neurological condition, not caused by childhood trauma (although it can be augmented by such traumas). Although there is a close link to occurrences of RSD in individuals with ADHD, this is not strictly a requisite.

Navigating RSD in many facets of adult life can be a challenge. Around the workplace, in social situations and relationships, a comment or situation can be perceived as a crushing disapproval even if seemingly constructive.

Sometimes certain individuals practice ‘safety behaviours’ such as pleasing and catering to the desires of others in order to reduce their chances of being rejected and criticized. This can also happen alongside asking themselves if they have said the wrong thing or hurt others around them through their actions; Individuals with ADHD may say things or act inadvertently and are also highly sensitive to the feelings of others.

They may also withdraw from social situations and opportunities as a prevention mechanism against rejection. They may avoid new endeavours, such as going on dates and speaking up for themselves generally as the risk of rejection is too much to bear.

Ultimately, these behaviours form part of a protective defense mechanism that needs to be met with compassion. It can be very easy to label and judge, without fully understanding the situation and needs of each individual.

Despite its prevalence, what makes RSD a little more elusive is that it is a relatively new topic within the ADHD world. Given its ‘unquantifiable nature’ it can be difficult to get a diagnosis for RSD.

RSD can be navigated with the support of an experienced mental health professional. They can help individuals achieve a better grasp on communication techniques, improve on their interpersonal relationship skills through learning how to respond rather than react, as well as building greater emotional distress tolerance.

Treatment for RSD varies depending on what may be the underlying cause for it. This can include a combination of psychotherapy and medication, also taking into account other physical and mental health conditions an individual may have alongside RSD.

Do you find yourself taking things very personally and feeling excessively guilty about something you may have said or heard? Do you find that you can be misunderstood or judged easily even when the intention has been only to be kind and well-meaning?

You may want to be assessed by a certified clinician.