Unmasking the Invisible Battle: RSD and ADHD in Women

 

RSD, or Rejection Sensitive Dysphoria, is a set of traits that are often associated with ADHD. RSD is characterized by extreme emotional response ( often felt in the body) to perceived or real rejection or criticism.

Adhd people may be more prone to experiencing RSD due to their heightened sensitivity and difficulty regulating emotions.

What are the symptoms of RSD in Individuals with ADHD?

RSD isn’t in the DSM yet, but many experts advocate for it to be on the criteria for  ADHD. If you have RSD, you feel intensely hurt, shamed, and angry when blamed or rejected. If you have RSD, and as an ADHD woman, you may also experience this severe, intense, painful reaction when you:

Imagine yourself being criticized or rejected

or

Believe that these situations might be occurring ( even if they aren’t)

or even

If you fear that they might happen.

Three symptoms of RSD when you have ADHD are Ruminating, Self Blame, and Somatization.

Rumination

One symptom of RSD in ADHD women is rumination, which is the tendency to repeatedly think about and dwell on negative thoughts and emotions associated with an episode as if you are stuck in a loop. This can magnify the experience and make you feel terrible.

Self Blame

If you find yourself blaming and criticizing yourself for something that happened where you feel you were criticized over and over, you might be experiencing RSD.

Body Feelings

Somatization is also a common symptom of RSD in ADHD women. Somatization refers to the physical manifestation of emotional distress, where the individual may experience physical symptoms such as headaches, stomachaches, or muscle tension as a result of the intense emotional reactions associated with RSD. RSD episodes are traumatic.

How common is the co-occurrence of RSD and ADHD?

The only research to date exploring RSD suggests that RSD is higher in women than men (Ginapp et al., 2023).

  • For males, 3 out of 7 reported RSD. This can be expressed as a percentage: 37×100=42.86%73×100=42.86%
  • For females, 30 out of 36 reported RSD. This can be expressed as a percentage: 3036×100=83.33%3630×100=83.33%

Anectodal studies have consistently suggested very high rates of RSD in adhd people.


How does RSD impact relationships and social interactions for individuals with adhd

It consists of the tendency to:

  •  Withdraw socially: Rejection sensitivity can cause women with ADHD to withdraw from social situations when they feel overwhelmed by stress or believe they are being criticized. This withdrawal can further contribute to feelings of depression and anxiety, isolating them from potential sources of support and connection.
  •  Be easily embarrassed: Those experiencing rejection sensitivity may avoid social interactions out of fear of embarrassment. They may mistakenly interpret others’ actions or comments as unfavorable and become angry with others without provocation when embarrassed.
  •  Have low self-esteem: Continuous experience of perceived rejection, both in the mind and in reality, can significantly impact a woman’s self-worth, leading to low self-esteem.
  •  Misunderstand social cues: Women with ADHD and rejection sensitivity often misinterpret social cues, perceiving them as criticism or rejection. This can further intensify their fear and anxiety in social situations.
  • Adopt perfectionism. Some people with RSD may adopt standards for themselves that are impossible to meet to avoid rejection. Others, rather than aiming for perfectionism, may give up.
  •  Be highly anxious. People with RSD are often anxious because of the fear of being hurt or rejected, and the thoughts and feelings that rejection will cause them.
  •  Have problems with relationships. People with RSD often have trouble in relationships because they often feel fearful that others will hurt them, imagine they will hurt them, or tolerate people who do hurt them!
  •  Feel angry and have emotional outbursts, often due to feeling rejected or criticized by others. Women who have ADHD and RSD struggle with intense feelings of “not good enough.” They feel guilty, broken, and flawed. You might feel like you will never fit in! This may cause you to explode or ignite when you feel you are being attacked.

Are there any specific Triggers that can worsen RSD symptoms in individuals with RSD

Feeling Abandoned

  • When individuals perceive that the people they love or rely upon are pulling away or distancing themselves, it can trigger feelings of abandonment. This experience is particularly intense for a brain prone to Rejection Sensitive Dysphoria (RSD). The fear of being left alone or the perception that someone important is withdrawing their affection or support can lead to profound emotional pain. Individuals with RSD may interpret minor changes in behavior or communication as indicators of abandonment, causing significant distress and prompting strong emotional reactions.

Feeling Left Out Socially

  • Social exclusion or the sensation of being left out can be a potent trigger for RSD. This can occur in various settings, such as not being invited to gatherings, being overlooked in conversations, or feeling disconnected from peer groups. For those with RSD, these situations can evoke intense feelings of rejection and inadequacy. The emotional response is often disproportionate to the situation because the individual’s sensitivity to perceived rejection amplifies the distress and can lead to withdrawal or overcompensation in social interactions.

Underachieving Academically

  • Academic underachievement can be a significant source of distress for individuals with RSD. The inability to meet one’s own or others’ expectations in an academic setting can feel like a profound personal failure. This experience is not just about the grades themselves but the perceived rejection and judgment from teachers, peers, and oneself. The fear of not living up to potential can lead to avoidance of academic challenges, perfectionistic behaviors, or significant emotional turmoil when academic performance is perceived as inadequate.

Receiving Critical Feedback at Work

In a professional setting, receiving critical feedback can be particularly challenging for someone with RSD. Constructive criticism, meant to foster growth and improvement, can be misinterpreted as outright rejection or a sign of personal inadequacy. The emotional response can be swift and intense; it very quickly ignites, leading to feelings of shame, anger, or anxiety. Individuals with RSD might find it exceptionally difficult to separate their self-worth from their professional performance, making workplace interactions that involve feedback or evaluation highly stressful and potentially triggering.

What causes RSD?

Bill Dodson describes RSD as part of the emotional regulation syndrome of ADHD and is genetic. However, a well-known statistic often cited by ADHD researchers is that by the age of 12, most kids with ADHD have heard 2000 more negative messages than those without ADHD. It’s difficult to tease out the impact of this kind of environmental criticism on ADHD.

Rejection Sensitivity Dysphoria has also been identified in people who have social anxiety disorder and bipolar disorder.

Can RSD be misdiagnosed as anxiety or depression in adhd people?

Yes, RSD can often be misdiagnosed as anxiety, depression, or even borderline personality disorder or bipolar disorder in adhd women. The symptoms of RSD, such as intense fear of rejection, sensitivity to criticism, and emotional outbursts, can overlap with mood disorders. This misdiagnosis can happen because RSD is a relatively new construct and isn’t widely recognized. A clinician who doesn’t specialize in adhd could make this mistake.

ADHD women must be aware of the possibility of misdiagnosis and advocate for themselves when seeking mental health support. If you suspect that your symptoms may be due to RSD rather than anxiety or depression, it is important to discuss this with a knowledgeable healthcare professional who understands the nuances of ADHD and RSD.

How does Rsd affect academic performance and work productivity in ADHD people?

RSD (Rejection Sensitive Dysphoria) can have a significant impact on academic performance and work productivity in individuals with ADHD.

Fear of rejection can cause you to avoid any task or challenge that you might fail at work and school. This can result in underachievement and a sense of personal failure, adding to their emotional distress.

.Shame, which is the feeling that you are bad and unworthy, can lead to spirals where you shut down completely and cannot focus.

Moreover, the constant fear of rejection and the anticipation of negative feedback or thoughts that you might have failed can create a heightened sense of anxiety and stress, making your day-to-day uncomfortable. This can even lead to chronic stress and even physical illness!


Are there any treatment techniques or approaches that therapists use to address RAD in individuals with ADHD

  1.  Psychoeducation: Learning about rejection sensitivity and its connection to ADHD can help women understand and validate their experiences. A recent study suggests that just knowing about RSD reduces it (Ginapp et al., 2023).
  2. Advocacy: Teaching people about rejection sensitivity so they can adapt how they interact with sensitive people
  3.  Cognitive Behavioral Therapy (CBT): CBT can help individuals identify and challenge negative thought patterns associated with rejection sensitivity. This treatment is only recommended if delivered by an individual trained in neurodivergent-affirming care.
  4.  Mindfulness and self-compassion practices: Incorporating mindfulness and self-compassion exercises into daily routines can help manage the emotional reactions associated with rejection sensitivity. These practices promote understanding, self-awareness, and self-acceptance.
  5. Support groups: Participating in support groups specifically tailored for women with ADHD and rejection sensitivity can provide a safe space to share experiences, gain support, and learn from others who face similar challenges.

How can I help my loved one who has ADHD and RSD? 

Here are some things you can do in a handy image file! 

ADHD and RSD: Medications

Medications such as clonidine and MAO inhibitors can help; guanfacine is also sometimes used and has been linked with symptom improvements. Ask and communicate with your doctor.

 Can RSD symptoms in individuals with ADHD vary in severity and intensity over time?

Yes, RSD symptoms in individuals with ADHD can indeed vary in severity and intensity over time.

For women with ADHD, RSD symptoms can fluctuate depending on various factors such as stress levels, hormonal changes, and overall emotional well-being.

Is RSD a lifelong condition, or can it be managed and improved over time?

RSD can be managed and improved.


When a group of rare adders without RSD was asked why they didn’t have RSD, they thought one of the key differences was the support system(Ginapp et al., 2023).

Learning how to Surround yourself with people who accept you just as you are is a tremendous help. Women with ADHD can sometimes choose partners who shame them because it is familiar. They may be with people ( friends and partners) who criticize them, and it will exacerbate their RsD. This is the worst kind of relationship you can pick.

Pick people who love and embrace you for who you are. Pick a cheerleader who is in your corner and supports you. Have people in your life who continuously validate that you are lovable exactly how you are. The messages need to be constant.


 

 

If you like this information, you can download a fact sheet here at the link below/

RSD-fact-sheet.pdf RSD and ADHD


References for RSD and ADHD

  1. ADDitude Editors. (n.d.). Rejection Sensitive Dysphoria and ADHD Symptom Test. ADDitude. Retrieved from https://www.additudemag.com/rejection-sensitive-dysphoria-adhd-symptom-test/
  2. Rabb, J. K. (2019). The Highly Sensitive Person: What to Do with Rejection Sensitivity Dysphoria. Presented at the 2019 International Conference on ADHD, Philadelphia, PA, November 8th, 2019.
  3. Dodson, B. (2018). Shame and Fear of Rejection: Regain Control. Presented at Women’s Palooza 2018.
  4. Ginapp, C. M., Greenberg, N. R., MacDonald-Gagnon, G., Angarita, G. A., Bold, K. W., & Potenza, M. N. (2023). “Dysregulated not deficit”: A qualitative study on symptomatology of ADHD in young adults. PLoS One, 18(10), Article e0292721. https://doi.org/10.1371/journal.pone.0292721

Medical information obtained from this website is not intended as a substitute for professional care. If you have or suspect you have a problem, you should consult a healthcare provider.

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