Rejection Sensitivity Dysphoria

Rejection Sensitivity Dysphoria (RSD) is a brain-based symptom that is likely an innate feature of ADHD, rather than the result of trauma. It is characterized by intense emotional pain triggered by perceived or actual rejection, teasing, criticism (even when constructive), or self-criticism following a perceived failure.

These episodes often result in sudden and overwhelming mood shifts, described by individuals with ADHD as “awful,” “terrible,” “catastrophic,” or “devastating,” though the exact emotional experience can be difficult to articulate. RSD also frequently overlaps with social anxiety, perfectionism, and imposter syndrome, further complicating its impact.

Research suggests that RSD originates from the neurobiological differences associated with ADHD, particularly in emotional regulation and sensitivity to interpersonal dynamics (Faraone et al., 2019).

Understanding this symptom is vital, as it is a defining yet often misunderstood aspect of ADHD, influencing self-esteem, relationships, and overall well-being.

RSD

What does RSD in adults feel like?

Rejection Sensitivity Dysphoria (RSD) feels like an emotional gut punch, a sudden and overwhelming wave of intense pain and distress that can consume every thought and feeling in the moment. People with RSD describe the experience as “awful,” “catastrophic,” or “devastating,” but often struggle to put the quality of the emotional experience into words. It’s not just a simple hurt feeling or embarrassment—it’s an intense and deeply personal reaction that can feel unbearable and out of proportion to the triggering event.

RSD can be triggered by real or perceived rejection, teasing, criticism (even when constructive), or even self-imposed feelings of failure. For some, it might be a fleeting comment or a dismissive glance that spirals into a flood of thoughts like, “I’m not good enough,” “I’ll never succeed,” or “They don’t respect or care about me.” This response is not an overreaction but a brain-based symptom of ADHD, rooted in heightened sensitivity to interpersonal dynamics and impaired emotional regulation.

The emotional toll of RSD often feels like being trapped in a whirlwind of shame, self-criticism, and hopelessness. It can manifest as a deep sense of inadequacy or unworthiness, leaving individuals questioning their value in relationships, work, or even their self-worth. The emotional intensity can lead to feelings of isolation or fear of social interactions, driving behaviors such as perfectionism, imposter syndrome, or avoidance of situations where rejection or criticism might occur.

Physically, RSD can feel like a tightening in the chest, a racing heart, or an overwhelming sense of discomfort, as though the body itself is reacting to the perceived threat. These reactions are fast and automatic, often leaving the individual feeling emotionally and physically drained once the episode subsides.

While the pain of RSD is profound, it is important to remember that this response is not rooted in trauma but rather in the unique neurological wiring of ADHD. Understanding and validating the intensity of this experience can provide relief and help individuals develop strategies to cope, build resilience, and manage these challenging emotional shifts.