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ADHD Rejection Sensitive Dysphoria: A Guide

June 10, 2024
Written By: Hero Journey Club

Some people with ADHD may experience rejection sensitive dysphoria (RSD). RSD is a dysphoric mood state that makes feelings of rejection, inadequacy, or failure feel monumentally difficult to contend with. 

Some members of Hero Journey Club experience RSD in conjunction with their ADHD, and many people have found effective coping strategies that work to make their intense feelings manageable. 

What Is ADHD Rejection Sensitive Dysphoria?

Attention-deficit/hyperactivity disorder (ADHD) is among the most common neurodevelopmental disorders someone can experience. Most people with ADHD are diagnosed as children or adolescents. The ADHD experience can be slightly different for everyone. People with ADHD often have difficulty staying focused, inattention, or controlling their impulses. They may also have difficulty staying still for long periods of time.


Rejection sensitive dysphoria (RSD) is an emotional state often experienced by people with ADHD — it’s commonly considered a side effect of ADHD. Rejection sensitive dysphoria is an inwardly negative reaction to rejection or failure. People who experience RSD experience emotional dysregulation in response to situations of perceived rejection. They may become angry or profoundly sad. The feeling is intense and often very difficult to control.

Most people with ADHD don’t receive an official diagnosis of RSD. Instead, their healthcare provider will speak with them about their symptoms and help them determine if RSD is an emotional state they’re prone to experiencing.

It’s important to note that rejection-sensitive dysphoria isn’t recognized as an independently existing medical condition and there are no official diagnostic criteria. It’s a self-described challenge with regulating self-critical emotions that are commonly experienced by people who have difficulty managing their internal processes. However, this doesn’t mean that RSD isn’t “real” or that you aren’t experiencing it. 

Plenty of people frequently experience negative emotions that impact their ability to navigate situations. A good example of this is people who get “hangry”, or experiencing feelings of anger, crankiness, or frustration due to being hungry. 

If you get hangry, you might feel a heightened sense of dysphoria if something interrupts your normal routine and interferes with your ability to nourish your body. While a doctor cannot diagnose someone as being prone to getting hangry, it’s a completely recognized, real phenomenon that plenty of people deal with. 

What Causes Rejection Sensitive Dysphoria in ADHD?

There is no core cause of RSD in people with ADHD. One or more factors or pre-existing conditions can increase the likelihood of dysphoric mood experiences for people who live with ADHD.

  • Neurological Factors: ADHD is a neurodevelopmental condition, which means that people with ADHD sometimes don’t process information or emotions through “typical” pathways. This can lead to experiences like RSD. 
  • Genetic Predisposition: ADHD may have a genetic component, and RSD is a symptom sometimes experienced by people with ADHD.
  • Chemical Imbalance: The brain produces chemicals to regulate itself, including the way things like memories are stored or the intensity with which emotions are felt. A chemical imbalance can intensify feelings, including negative emotions. 
  • Early Life Experiences: Rejection or feelings of inadequacy can come from negative early life experiences. This is especially true for people who grew up without nurturing caregivers. Fear of rejection can remind some people of adverse childhood experiences where they experienced actual rejection from a loved one.
  • Co-Existing Mental Health Conditions: Mental health conditions that have a negative effect on someone’s sense of self or conditions that increase baseline levels of anxiety can exacerbate the feelings associated with RSD. 
  • Impaired Social Skills: People with impaired social skills may have difficulty verbalizing their feelings, which can make it difficult to manage strong feelings like RSD.
  • Lower Self-Esteem: If you already live with lower self-esteem, situations that negatively impact your self-esteem may cause dysphoria.
  • Emotional Dysregulation: RSD occurs when someone has difficulty regulating their emotions. Feeling rejected or feeling as though you’ve failed can be difficult for anyone to handle, but people with RSD may experience these feelings much more intensely. 

Dysphoria is an intense emotional state that often stems from a variety of factors simultaneously having a negative impact on the way that someone feels. You may relate to or identify with many potential causes for rejection sensitivity. 

How Common is Rejection Sensitive Dysphoria in People with ADHD?

ADHD is often diagnosed in childhood, but it’s been largely misunderstood for decades. Some adults are receiving diagnoses much later in their lives — even in their fifties! 

People of all ages live with ADHD, and anyone with ADHD can develop side effects associated with their condition. There is no hard data on how common RSD may be in people who live with ADHD. Estimates are all over the map, with some sources reporting that as few as 30 percent to as many as 99 percent of people with ADHD will experience RSD related symptoms on a regular basis. 

What Are the Symptoms of ADHD Rejection Sensitive Dysphoria?

RSD can cause a wide variety of symptoms that may negatively impact someone’s everyday life. 

People with RSD find that maintaining friendships or relationships can be difficult, especially if they fear criticism from someone they love or trust. School or work can be difficult because people with RSD never want to feel like they’re letting down their coworkers or performing poorly.

  • Intense emotional response
  • Rapid mood swings
  • Low self-esteem
  • Social withdrawal
  • Fear of failure
  • Fear of rejection
  • Negative self-talk
  • Anxiety and depression
  • Social anxiety or avoidance of social situations
  • Perfectionism
  • Rumination, or “overthinking”
  • Sudden emotional outburst
  • Feelings of shame

Symptoms can be different for everyone. Intense emotions aren’t always outward-facing. Some people deal with RSD almost exclusively internally, where the people around them wouldn’t be able to tell that they’re withdrawing within themselves to mask their emotional pain. 

What Are the Traditional Therapeutic Approaches to RSD? 

Many therapeutic approaches can be targeted to a specific goal. In the case of RSD, many traditional mental health practices and therapies can help someone learn to understand and cope with their negative feelings. 

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is a therapeutic process that helps people explore their feelings, the root cause of those feelings, and identify better coping strategies. CBT is a form of talk therapy that focuses on moving forward into a healthier, happier life rather than exploring the past. 

Prescription Medication

Only a healthcare provider will know if prescription medication is an option for you. This is a conversation you should have with your prescribing provider if you feel like medication may be a helpful tool for you.

Psychoeducation

Psychoeducation incorporates learning, skill building, and cognitive behavioral therapy into a comprehensive approach. The idea behind psychoeducation is that learning how your brain works and grasping the clinical intricacies of how a condition affects you can give you a stronger mastery over your feelings.

Social Skills Training

Social skills training teaches people how to express themselves, which can reduce emotional turmoil. Productively expressing your feelings may help you avoid letting your feelings overcome you or cloud your judgment.

Mindfulness and Relaxation Techniques

Mindfulness and relaxation techniques are helpful mental health tools that can be entirely self-managed. Some people incorporate brief mindfulness sessions into their everyday lives to keep their stress levels low throughout the day. 

Support Groups

Support groups are a judgment-free environment to find empathy and community among other people who are attempting to overcome issues similar to yours. Support groups can meet in person or online. Hero Journey’s gaming-based, therapist-led support groups are exclusively online. 

Family Therapy

Family therapy can be especially helpful for children who experience RSD because their caregivers will be instrumental in helping them through difficult times. If the whole family goes to therapy together, everyone will understand what they can do to be supportive in the moments where they’re needed the most.

Lifestyle Modifications

Lifestyle modifications can go a long way in improving mental health. Going low contact or no contact with a harmful person or switching to a less stressful career can do a tremendous amount of good for people who would benefit from a little more calmness in their life. 

How Can Hero Journey Club Support Individuals with RSD? 

Hero Journey Club acts as a support group for people who live with conditions like ADHD or symptoms like RSD. We believe in the therapeutic benefits of gaming as a productive leisure activity that provides healthy stimulation. 

We utilize evidence based techniques and shape our strategies based on clinical outcomes. The majority of people who game with new friends through Hero Journey Club report feeling better after every session, with nearly three-fourths of participants showing an improvement to clinical measures of their wellbeing.

Our small gaming groups provide people who live with ADHD or experience RSD with a place to engage in comfortable social interaction. Everyone is glad to enjoy the company of everyone else. There is no winning or losing. It’s a shared experience where people with similar struggles can work together to support each other. 

Hero Journey Club isn’t a replacement for therapy. Our club exists as a support group and a safe space for people who feel as though they would benefit from positive social interaction and an empathetic community. There are no winners or losers in Hero Journey Club. We’re all growing, learning, and sharing an experience. 

Conclusion: What is the Prognosis for People with ADHD Rejection Sensitive Dysphoria?

RSD can have a significant impact on the daily lives of people who live with ADHD. If you feel like you may be experiencing RSD, it’s important to mention your symptoms to your medical care provider as soon as possible. A clinician can review treatment options that may help you manage the symptoms of RSD.

People with RSD may benefit from additional social support and an empathetic community. Hero Journey Club exists exactly for situations like these. Our social support system is overseen by a mental health professional to help guide the conversation and make sure everyone feels valued. Game with new friends, relax, and feel a little better. 

Get started with Hero Journey Club today to find support in gaming and community.

Sources:

Attention-Deficit/Hyperactivity Disorder | National Institute of Mental Health (NIMH)

Rejection Sensitive Dysphoria (RSD): Symptoms & Treatment | Cleveland ClinicIs Being 

‘Hangry’ Really a Thing ― or Just an Excuse? | Cleveland Clinic

What is Cognitive Behavioral Therapy? | American Psychological Association

Psychoeducation as an Opportunity for Patients, Psychiatrists, and Psychiatric Educators: Why Do We Ignore It? | Academic Psychiatry

How ADHD Ignites Rejection Sensitive Dysphoria | Additude Mag