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Rejection Sensitive Dysphoria - The Often Missed Element of ADHD

Updated: Mar 16, 2023

We can all be a bit sensitive to rejection at times, but for people with Rejection Sensitive Dysphoria (RSD), it is especially hard to navigate. RSD is often overlooked as a symptom of ADHD, but a recent survey has revealed that over 90% of adolescents and adults with ADHD are more sensitive to rejection than those without ADHD. In fact, 1 in 3 of these participants listed hypersensitivity to rejection as one of the most difficult aspects of their ADHD. So what exactly is RSD and how can we recognise it in children with ADHD?

'Overreaction' in ADHD

People with ADHD lead very intense lives. Things that they are not interested in or care about don't even register on their radars, but therefore, things that they do care about, they care very deeply, about. You may have seen a person with ADHD get very fixated about, what may appear to us, as minor details. The ADHD brain struggles to distinguish between real threats and minor problems. You may have seen this in action where a child with ADHD seems to have little sense of actual danger (e.g. rushing out into roads, climbing high trees) but will get very 'worked up' over minor or relatively small challenges. The ADHD brain is rarely quiet and it has been described at constantly going at 100MPH

Feelings of Shame and Guilt in ADHD

A recent study showed that children with ADHD hear an additional 20,000 critical or negative messages before they are 12 compared to their neurotypical peers. This may be due to their hyperactive or impulsive behaviours being perceived as 'naughty' behaviour and therefore being told off by parents or teachers more frequently. The impact this will have on their mental well-being, emotions and sense of self will be immense. Many children with ADHD grow up feeling like they are 'less than' others, 'defective' or 'a bad child' - and all of this results in huge feelings of guilt, shame and a poor self-image. Psychologist Freud referred to shame as the 'master emotion' as it dominates all other emotions and also impacts on when and how other emotions are processed and expressed.

The shame and guilt that children with ADHD have grown up with is often so intense that it negates any positive feedback they receive from parents or teachers.

What is RSD?

Rejection Sensitive Dysphoria causes overwhelming and emotional responses to being or feeling;

  • Rejected (this may be real rejection or perceived rejection)

  • Teased or humiliated

  • Criticised

  • Like they have disappointed someone in their life.

  • Disappointed in themselves for not reaching their own standards

Most individuals who have been diagnosed with ADHD will also experience RSD - but why? It could be due to the fact that people with ADHD struggle with self-regulation - in other words, their nervous system cannot cope with or manage stimuli from the outside world. Therefore, if they feel a sense of rejection, their stress response can go into overdrive and cause an emotional response that is a lot larger than usually expected, hence the word 'dysphoria' which comes from the Greek for 'unbearable'.

The rejection may be real (e.g. a child saying they don't want to be friends with them anymore) or perceived (e.g a child not laughing at their joke). Due to the frequent criticism and the difficulty in differentiating major and minor challenges, anything that feels even slightly like rejection can be perceived as something more severe than it is. Either way, the emotional pain felt is very real and should not be dismissed as an overreaction.

It’s often difficult for children to describe the feeling with words, so they might react by lashing out through angry outbursts or withdrawing. It might seem “out of the blue” to onlookers who don’t realise what the child is feeling.

Symptoms of RSD;

  • Extreme anxiety triggered by small changes

  • Difficulty forming words or expressions to describe their feelings

  • Hyper-focus on negative traits

  • Feeling so afraid of disappointing someone else (a teacher, parent, etc.) that they overwork themselves and stress over tiny details

  • Avoiding social situations due to fear of embarrassment or criticism

  • Frequent people-pleasing

  • Struggling to make or maintain friendships

  • Difficulty or trepidation on trying new things for fear of failing them

Impact of RSD

As stated previously, around one third of people with ADHD have said that the most debilitating aspect of their ADHD is the RSD. Where their ADHD impacts on academic or work, adaptations can be made, but the RSD is present in every aspect of their lives. For example, even just talking to someone and misinterpreting a minor change in tone of voice or facial expression can cause huge emotional distress.

Most people with RSD become people pleasers. They have a great ability to be able to quickly read a person, figure out what they admire and like and then they will often present a false self to those people and the wider world. They are so focused on pleasing others, or avoiding displeasing them, that they may even lose sight of their own goals and desires. Often, there is a lot of resentment built up after years of trying to please others with little to no return.

Another way people with RSD try to protect themselves from its potential impact is by avoiding trying anything new unless there is a near certain chance of success. The idea of trying something and being turned down or failing is too painful, so they often won't apply for jobs, try dating other people, speak up in meetings or make their needs/wants known to others all due to the fear of rejection.

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