I’ve hinted at this third pillar for some time now. I know you may be tired of me calling out ADHDers as “sensitive” in more scientific terms than you can imagine. Rejection sensitive dysphoria is a big one, though, that requires specific attention both because of how overlooked it is as a symptom of ADHD, and the immense pain it causes ADHDers and their loved ones.
Nobody likes rejection, right? Breakups, job interviews, bullying …you will never find a person that says, “Oh man I LOVE rejection. When someone lets me know that they hate who I am and what I do, I’m like, I FEEL SO ALIVE.” But just like ADHD amplifies our emotions and our senses, it also makes us experience this already-unpleasant sensation in a unique way. Almost 100% of people with ADHD suffer from rejection sensitive dysphoria (RSD), yet very few people have found the words to accurately describe it. RSD is an extreme (dysphoria means “difficult to bear”) emotional reaction to the perception of rejection, failure, or criticism – regardless of the circumstantial reality.
Everyone I’ve talked to has articulated RSD as something intense and debilitating – either physical or emotional pain that makes them feel small and vulnerable.
“It’s like someone is stabbing me in the chest with a white hot iron.” “Rejection makes me feel like I’m a kid who lost his parents in the mall.” “Failure is so painful I would do anything to prevent it.” “It’s like my body is aching and splintering into a million pieces.” This blog post describes RSD as an “emotional sunburn,” which I love – because it makes every seemingly harmless touch feel like an assault.
RSD is perhaps such a pervasive and integral part of ADHD that it slips under the radar of the symptoms we look for; remember, this is a HUGE reason ADHD is misdiagnosed as a mood disorder such as depression or bipolar. It’s also hard to spot due to the shame it evokes in us – which, as we know, inevitably leads to secrecy. RSD – and the avoidance of it – shapes our daily lives so dramatically that it can easily meld into our very identities.
So if all ADHDers experience RSD, and it’s so difficult to identify, how could you possibly know if someone is suffering from this? Glad you asked. As you see on the above infographic, ADHDers tend to respond to rejection and/or failure – or the perception of rejection and/or failure – in one or both of these ways:
- Please everyone. There is a very good reason why so many people with ADHD become comedians, or actors, or advocates, or entertainers/performers: they’re very accustomed to anticipating and fulfilling others’ needs in order to survive. Maybe this looks like the class clown, or the peacekeeper in your family, or codependency (if I can just make sure no one else close to me feels pain, then I won’t feel pain either), or perfectionism. Maybe this response seems counterintuitive, because people pleasing inevitably leads to chaos and drama. But as long as that chaos isn’t rejection, it is worth it. One of the things I’ve learned as a therapist is how this outcome of RSD does not always look like making people happy, but instead could look like someone trying to intervene in rejection by whatever means necessary. For example, I knew a kid who had some difficulties with behavior in school, so her mom was in frequent contact with her teacher to monitor her progress. At the end of the day when mom came to pick her up and she stopped to talk with the teacher, the kid ran over and started screaming, crying, tantruming…Master Distracter. Her efforts ultimately drew even more negative attention to herself, but it prevented the conversation – and suspected criticism of her – from continuing.
- Stop trying. This is my camp. I didn’t get my driver’s license until I was two months away from graduating high school, because I was so scared I would totally fail at it. (And I did! I failed the written test my first time!) This paralyzing fear of failure and rejection bled through so many areas of my life: I quit piano lessons when we started learning songs that required BOTH my hands to play them. I wanted to be an artist, but gave up completely when I went to an arts summer day camp and someone made fun of a puppet I made or some shit like that. I LOVED theatre, but I refused to audition for things outside of my tiny everyone-gets-a-role community theatre just in case I wouldn’t get cast. Another nearly-universal ADHD experience that ties into this is procrastination. Now, as we know, RSD isn’t the only thing that can lead to procrastination; urgency is one of those things that kicks our nervous system into gear, and the ADHD brain also can’t accurately perceive time (a fun thing known as time blindness). But imagine how unthinkable it would be to walk across a rickety swinging bridge if one wrong step – that you are pretty likely to take because, let’s be honest, balance isn’t your strongest ability – would lead to a plummet towards your death? Yeah, no thanks. But wait, you need to cross that bridge to move forward in your life and achieve any kind of success or fulfillment and oh also that cliff you’re standing on is literally eroding before your eyes. Now imagine that is everything. Everything always feels like life or death. You would avoid crossing that bridge as long as you possibly can, because it’s scary and besides, maybe if you wait long enough you’ll find another way across the canyon, like a monorail or a helicopter.
Rejection sensitive dysphoria understandably impacts our ability to make and keep friends – or any relationship at all, in fact. When you are close with someone, there is always a chance they might reject you. And if you are terrified of that vulnerability, your relationships will reflect that. The more intimate the relationship, the more likely RSD is to show up – like this post about how RSD plays a role in the writer’s marriage. You can see how the above reactions could easily apply to friendships: someone may overcompensate for their fear of rejection by constantly seeking out people to charm so as to never be alone, or someone may lean more toward introversion and isolation in order to avoid the possibility that people won’t like them.
The sad news is that there is no straightforward answer to treating RSD. There are things that can help, like medications listed in the infographic above, but there is no way to eradicate it. In my experience as a mental health clinician who also has ADHD, what we can do is build coping skills that may not put out the fire but will contain or shrink it to prevent burning down the town.
We’ve gone over the ways ADHDers try to prevent rejection/failure. But how do they respond to it when it happens? Obviously every person is different, but reactions can be grouped into internalizing behavior and externalizing behavior.
People often feel a bit better after discovering that their experience has a name. And once we uncover the type of behavior RSD triggers, we can look at how to manage them. Internalized reactions tend to affect women more often, and can look like depression, withdrawal – even suicidal ideation. Coping skills for these symptoms might include:
- mindfulness and grounding exercises
- creating a safety plan or crisis card with resources for suicidality or emotional escalation
- DBT (Dialectical Behavior Therapy) distress tolerance skills to wait out the feeling
For externalized reactions, this typically looks like a burst of rage directed at whoever or whatever caused the perceived rejection/failure. Like that one time I destroyed my computer monitor because it was loading too slowly. I’m not going to tell you when that happened because it’s embarrassing. Something else mentioned in that handy infographic is that 50% of people given court-mandated anger management have previously undiagnosed ADHD. Wow! And that’s not even touching on the unbelievably high percentage of ADHDers in the prison population. So coping skills for externalized symptoms might include everything already listed above, but also incorporate ones more tailored to impulsive behavior or angry retaliation:
- regular exercise
- strengthening boundaries – i.e., I know where I stop and you start, so your actions/words don’t define me
- channeling impulsive energy into more constructive outlets
How do you respond to rejection sensitive dysphoria? Have you discovered any tips on how to deal with it?
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