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Rejection Sensitive Dysphoria

Most teens and adults who have ADHD are very sensitive to what other people think or say about them. This is referred to as Rejection Sensitive Dysphoria (RSD). Those who struggle with RSD often react with anger or other emotional outburst when they feel criticized or rejected. Sometimes the criticism or rejection is imagined, but this is not always the case. Research indicates that children with ADHD get significantly more negative messages about themselves compared to their peers.

There are numerous behavioral presentations for those who struggle with RSD. Some may work very hard to be liked by others. Some may feel very anxious in social situations and may withdraw to avoid situations that could lead them to feel hurt or rejected. Quite often, RSD impacts the quality of relationships with family, friends and partners. Those who struggle with RSD may feel easily embarrassed and may suffer from low self-esteem. They may set standards for themselves that are nearly impossible to meet, and may feel as if they’ve failed to live up to others’ expectations. For some, RSD contributes to self-harm behaviors. Many who struggle with RSD indicate that it is one of the most challenging aspects of ADHD.

RSD is believed to be caused by genetic factors, though made worse by childhood trauma, including abuse and neglect. There are some medications used to treat ADHD that work particularly well in the management of RSD. In addition, behavioral therapy can help one learn to handle strong emotions and deal with feelings of rejection in more positive ways. Finally, engaging in healthy behaviors, such as eating well, getting good quality sleep, and practicing yoga and/or meditation, can help with stress management and in turn with the intensity of RSD symptoms.