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We Explore Rejection Sensitive Dysphoria (RSD) and ADHD

What are the Signs of Rejection Sensitive Dysphoria (RSD) and ADHD?

When examining the association between Rejection Sensitive Dysphoria (RSD) and ADHD, it is important to consider the natural variation of the brain structure for individuals with ADHD. Research suggests that individuals with ADHD often exhibit variation in neural circuits and neurotransmitter systems. One significant area of interest is the prefrontal cortex, which plays a crucial role in executive functions such as impulse control and emotional regulation. Differences in this region of the brain may contribute to difficulties in managing emotional responses associated with RSD. Additionally, dysregulation in the release and reuptake of neurotransmitters, including dopamine and norepinephrine, may impact emotional processing and increase sensitivity to social cues.

Symptom Presentation of Rejection Sensitive Dysphoria or RSD

The presence of RSD in individuals with ADHD is characterised by heightened emotional sensitivity and an intense fear of rejection or criticism. This can lead to strong emotional reactions in response to perceived events or triggers, regardless of their actual intent or magnitude. The symptoms of RSD can manifest in various ways, impacting social interactions, academic or professional performance, and overall emotional well-being.

Individuals with RSD may experience overwhelming feelings of sadness, shame, or anger when they perceive rejection or criticism, which can result in avoidance of situations that may trigger these emotions.

What are Examples of RSD?

To gain a deeper understanding of how RSD can manifest in different situations, let’s explore a few examples to demonstrate the thought processes and emotional responses involved.

Example 1: Academic Setting

Situation: A student receives feedback on a school assignment, which includes constructive criticism.


  • “They think I’m stupid and incapable of doing well.”“Everyone else is better than me; I’ll never succeed.”
  • “This means I’m a failure, and no one will ever take me seriously.”

Emotional Response:

  • Overwhelming sadness, feeling defeated, and questioning self-worth.
  • Fear of being judged and rejected by peers and teachers.

Behavioural Response:

  • Avoid seeking clarification or additional help from the teacher.
  • Becoming disengaged from future assignments or class participation.
  • Negative self-talk and self-doubt, impacting motivation and academic performance.

Example 2: Social Interaction

Situation: A individual reaches out to a friend to make plans but receives a delayed response.


  • “They don’t care about me or value our friendship.”
  • “I must have done something wrong; they’re ignoring me.”
  • “They’re avoiding me because they find me annoying or boring.”

Emotional Response:

  • Heightened anxiety and fear of rejection.
  • Feeling hurt, unimportant, and socially isolated.

Behavioural Response:

  • Withdrawing from social activities or avoiding future social interactions.
  • Negative self-talk, questioning one’s likability, and self-isolation.
  • Overanalysing past interactions, searching for evidence of rejection.

Example 3: Interpersonal Interactions

Situation: A child starts to make jokes but told to be quiet.


  • “I am not important or worthy of being listened too.”
  • “I am annoying or a burden”
  • “He doesn’t care”

Emotional Response:

  • Feelings of frustration, sadness, and a sense of being overlooked or unimportant.
  • Feeling sadness and longing for validation and a desire for a meaningful connection.
  • Feeling misunderstood and not belonging.

Behavioural Response:

  • Negative self talk and confused sense of self and/or belonging.
  • Withdrawing from family or acting out in attempt to feel seen or heard.
  • Avoid asking for help from family due to fear of criticism

The Impact on the Child and Individual in Later Adulthood

Using the Example 3, let’s explore the potential impact on this child’s belief system about themselves and the world around them, throughout their adolescent and adult years.

  • Increased feelings of rejection and emotional distress.
  • Potential decrease in self-esteem and confidence.
  • Possible reinforcement of a belief that their needs are minimalised or disregarded.
  • Projecting past emotions or thoughts into new relationships. This projection can create biases and distort the interpretation of their partner’s behaviour or intentions.
  • Leading to misunderstandings, miscommunication, and a lack of empathy, potentially undermining the overall trust and connection in adult relationships.
  • Feeling of inadequacy and the belief that their needs are not important or prioritised within the family and other interpersonal relationships when projection occurs.

Strategies in Managing Rejection Sensitive Dysphoria

Drawing on Example 3, a particular approach to addressing such dynamics may involve open communication within the family, creating opportunities for individual and collective expression, and fostering an environment where each family member’s voice is heard and valued. Should there be multiple children within the family, the focus of parents is to be open to understanding the different needs of each child.

Additionally, providing the child with alternative means of seeking attention and validation, such as engaging in shared activities or one-on-one interactions. This can contribute to building a stronger bond between the child and their father.

What is the Role of Psychologists in Providing Support for Rejection Sensitive Dysphoria or RSD?

To better understand the chain of events leading to emotional responses, it is important to explore the triggering situation, thoughts, emotions, and subsequent behaviors. This is often called a chain analysis and allows us to identify cognitive distortions, challenge negative beliefs, and develop healthier coping strategies.

By conducting chain analyses, individuals with ADHD and RSD can gain insights into their emotional patterns, recognise the impact of perceived rejection or criticism, and develop strategies to manage intense emotional reactions more effectively. Each person’s experience of RSD will vary, and therefore speaking to a psychologist can help you to tailor strategies to your individual needs and circumstances. Psychologists can support you to navigate the challenges of RSD. This is key for restoring self-esteem and positive well-being but also in the development of emotional resilience.

Through therapeutic interventions, Psychologists can provide support in the following ways:


Psychologists can provide information about RSD, helping individuals to understand the link between their emotions and their experiences of rejection or criticism. By providing knowledge and information, psychologists help to empower individuals to recognise and validate their emotional responses.

Emotional Regulation Skills:

Psychologists can teach individuals strategies to manage and regulate their emotions effectively. These may include techniques such as cognitive restructuring, mindfulness, and relaxation exercises. By enhancing emotional regulation skills, individuals can develop healthier coping mechanisms when confronted with triggers related to RSD.

Cognitive-Behavioural Interventions:

Psychologists can employ cognitive-behavioural interventions to manage negative thinking patterns and cognitive distortions associated with RSD. By challenging and reframing negative beliefs and self-perceptions, individuals can develop more balanced and realistic perspectives.

Exploring Social Skills or Role Plays:

Psychologists can provide social skills training to help individuals navigate social interactions and manage RSD-related challenges. This may involve teaching assertiveness skills, effective communication strategies, and promoting self-advocacy.

Providing a Supportive Space:

Through supportive therapy, psychologists create a safe and empathetic space for individuals to express their emotions and experiences related to RSD. By fostering a therapeutic alliance, psychologists can validate the individual’s feelings, provide validation, and offer guidance in navigating the impact of RSD on their lives.

Written by Psychologist Emily Burton at Positive Wellbeing Psychology

Emily’s clients have described her as warm and genuine in her approach and often describe feelings of comfort and trust very early on in therapy. Emily’s bubbly and friendly nature tends to establish a warm and genuine professional relationship that fosters trust and comfort for her clients, which she believes is paramount in order to achieve successful therapy.

Emily has a special interest in working with her clients to assess for ADHD in adults. Emily provides assessments for ADHD (click here) along with helping clients to achieve their career aspirations, improve their relationships, and to better manage difficult family dynamics. Emily is experienced in the management of anxiety, depression, low self-worth, stress and burnout, work addiction, loss of direction in life, goal setting, perfectionism, low self-esteem, adjustment to life changes, Adult ADHD, poor body image and binge eating disorder.

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