For many individuals with Attention-Deficit/Hyperactivity Disorder (ADHD), there is increased sensitivity to feelings of rejection, which is appropriately named, “rejection sensitivity.” This could be outright rejection (such as a child being told that no one wants to play with him) or perceived rejection (such as misinterpreting a friend saying they’re busy as purposefully avoiding you). In either event, the feelings of rejection can feel more intense for individuals with ADHD and lead to emotional distress. When this distress becomes overwhelming or begins to interfere with daily and/or social functioning, they are experiencing a phenomenon known as “rejection sensitive dysphoria” (RSD).
RSD can present in several different ways. An individual may internalize their distress, meaning they focus their pain inward. This can mimic depression, with feelings of sadness, tearfulness, and withdrawal. The feelings of rejection can be so intense that an individual may even contemplate suicide, or a child may express, “I just don’t want to be here anymore.” RSD can also present with more outward symptoms, such as anger or anxiousness. In both cases, an individual with RSD can seem fine one minute, and then have a strong reaction at another when they feel slighted or rejected. This can be very confusing to others around them, and some may feel they need to “walk on eggshells” to avoid unintentionally upsetting them.
As expected, RSD creates many social challenges. It can be difficult for individuals with RSD to interact with others because they are constantly alert to the potential for rejection and tend to misinterpret and overreact to even minor incidents. As such, friendships, romantic relationships, and even family relationships can be strained. In other instances, an individual with RSD may be so worried about being rejected or criticized, that they avoid social interactions all together. In this way, RSD can seem like typical “social anxiety,” but actually has a different root cause. Because RSD can mimic other emotional disorders, it is important to seek an evaluation to determine a true diagnosis. Clarity of diagnosis is critical in order to establish the proper treatment and help relieve some of this felt distress.