Rejection Sensitive Dysphoria (RSD) and ADHD: Understanding Your Inner World

If you’re living with ADHD, chances are you’ve come across the term Rejection Sensitive Dysphoria, or RSD for short. Perhaps you’ve even felt that crushing, overwhelming emotional pain that seems to come out of nowhere after a bit of criticism, rejection, or even just a perceived slight.

In this article, we’ll unpack exactly why people with ADHD are more prone to RSD, how it shows up in the brain and body, and most importantly, what you can do to ease its grip.

I’m sharing this through my lens as an ADHD specialist and coach, mindfulness-based stress reduction teacher, and trauma-informed practitioner. Plus, I’ve had my fair share of lived experience too, which means I know just how deeply this can affect everyday life.

What is Rejection Sensitive Dysphoria (RSD)?

Let’s begin by defining it. Rejection Sensitive Dysphoria refers to the intense emotional response people with ADHD can experience when faced with criticism, rejection, or even the mere thought of disapproval.

To be honest, when I first heard this term, I thought, "What on earth is this?" Dysphoria itself isn’t technically a medical diagnosis, and initially, I found myself questioning whether we really needed another label that might just create more helplessness.

But over time, I came to appreciate what Dr William Dodson did for the ADHD community. He gave us words to describe a feeling that so many of us know all too well, but previously couldn’t explain.

Having a shared language for something so difficult is incredibly powerful. Still, the biggest question remains once we can name it, how do we manage it?

Why Does Rejection Sensitive Dysphoria (RSD) Affect People with ADHD So Strongly?

Understanding the ADHD Brain

To understand why RSD hits people with ADHD so hard, we need to take a closer look at how the ADHD brain works.

At the heart of it all is your prefrontal cortex, the part of your brain responsible for emotional regulation, planning, decision-making, and impulse control. In people with ADHD, this part of the brain often has impairments or simply works a bit slower.

When your prefrontal cortex is sluggish, your brain defaults to operating from the limbic system, where emotional responses are fast and reactive.

The Emotional Chain Reaction

When something triggers your nervous system, such as criticism or rejection, your amygdala fires up, sending alarm signals throughout your body. You may not even realise it at first, but your body reacts before your brain has a chance to think it through.

Here’s what usually happens:

• You feel a physical reaction perhaps a racing heart, tense muscles, or a churning stomach.
  
• Your brain jumps in, creating a story about what just happened. Thoughts like, “They must be laughing at me” or “I can’t believe I messed that up again” start running on repeat.
  
• This often leads to quick, automatic behaviours like withdrawing, people pleasing, or snapping back.
  

For many people, these reactions stem from years of past experiences and deeply ingrained patterns that play out subconsciously.

The Link Between Trauma, ADHD and RSD

Many people with ADHD also have a history of trauma, whether that’s childhood trauma or repeated emotional wounds built up over time.

Here’s the key insight - trauma doesn’t have to be one huge, dramatic event. Often, it’s a result of repeated emotional experiences (these don’t have to be factual experiences, they can be made up or either perceived or real “painful emotional events” big or small) that slowly erode your sense of safety or self-worth.

For many people with ADHD, life can feel like a constant cycle of mistakes, corrections, and misunderstandings. These experiences accumulate over time, shaping your self-perception and leaving you highly sensitive to rejection.

The second hugely important bit to this is, that most people with ADHD (and many without) didn’t grow up with a fully individuated sense of self). What does this mean I hear you ask? Well….. If we had grown up with every painful experience ending in full psychological safety, as in an adult caregiver had brought our nervous systems from feeling crappy about ourselves into an “it’s not you, it’s just a  crappy situation” type of deal, then we would have grown up with a high sense of self, meaning we don’t have to rely on getting our self worth and value from external sources. We would have felt (and here’s the ultimate key) SAFE to be ourselves, with all our fallible parts and awesome parts. Instead, most of us grew up learning that the fallible parts made us unworthy people. And so when that nervous system senses a threat to our sense of self, and threathens to expose those fallible parts - ergo the RSD dingaling aling aling huge alarm bell goes off. By then its a big visercal wohoopmh to the body (where implicit memories are stored, the ones that are trying to protect those fallible parts from being exposed) and the “dysphoria” just means that our brain and body feel unconnected - the shame spiral starts or the defensiveness or sadness or whatever awful emotions and feelings get kicked off in that moment and cloud everything.

The Life Cycle of an Rejection Sensitive Dysphoria (RSD) Episode

To effectively manage RSD, it helps to understand how it typically unfolds. Here’s the typical pattern:

1. Scanning for Threats: Your brain constantly scans for danger, asking, “Am I safe?” This includes both physical and emotional safety.
   
2. Trigger Event: Something happens, a comment, a look, or even an email and your nervous system goes on high alert.
   
3. Emotional Response: Your body reacts instantly, and feelings of shame, fear, or inferiority surge.
   
4. Internal Storytelling: Your brain starts constructing a story around the situation, often jumping to conclusions about how others see you.
   
5. Reaction and Behaviour: You act based on those thoughts perhaps by people pleasing, withdrawing, or reacting aggressively.
   

This whole process happens quickly, mostly below conscious awareness, driven by past experiences and patterns of thinking.

How RSD Often Shows Up: People Pleasing, Perfectionism and Avoidance

In my coaching work, I see three common patterns where RSD tends to show up:

1. People Pleasing: Constantly trying to keep others happy to avoid rejection or criticism.
   
2. Perfectionism: Setting impossibly high standards to prevent any negative feedback.
   
3. Risk Avoidance: Avoiding situations where rejection could happen, even if it means missing out on opportunities.
   

All three behaviours have one thing in common: an intense focus on how you’re perceived by others.

When you don’t have a strong internal sense of self, your safety becomes dependent on external validation. This makes rejection or criticism feel like a threat to your very identity.

Can You Change Your Response to RSD? Absolutely.

Here’s the most encouraging part: you can rewire your brain’s response to RSD.

Thanks to neuroplasticity, the brain has the ability to reshape itself in response to new experiences and conscious effort. Every time you respond differently to an RSD trigger, you are creating new neural pathways that gradually change your default reactions.

Two Essential Tools for Healing Rejection Sensitive Dysphoria (RSD)

1. Closing Emotional Loops

One of the most important skills for managing RSD (Rejection Sensitive Dysphoria) is learning how to “close the loop” on painful emotional experiences.

When something happens that triggers your RSD, the goal is to process the emotion fully rather than suppressing it. This means:

• Acknowledging the feelings without judgement.
  
• Validating your experience, even if it feels uncomfortable or “irrational.”
  
• Soothing your nervous system on a body-based level, not just intellectually.
  

It’s not about convincing yourself everything is fine or pushing through with logic. The healing comes from allowing the emotion to pass through your body, returning yourself to a place of safety.

2. Building a Stronger Sense of Self

Another key step is developing a solid sense of self.

This involves learning to:

• Know your values and needs.
  
• Stand by your opinions, even if others disagree (hard I know, this is why we do this work incrementally, in a challenge zone rather than an overwhelm zone, teaching our bodies its safe to honour ourselves).
  
• Trust your own internal voice, instead of seeking constant approval. Your gut always knows.
• Truly, honestly accept and love yourself (because if we don’t - guess who is rejecting us and confirming the sub-concsious belief??? Yep you guessed it, our very selves).

The more connected you are to your authentic self, the less power RSD has over you. You begin to realise that your worth isn’t determined by others’ opinions or fleeting moments of criticism.

A Real-Life Example of Rewiring Rejection Sensitive Dysphoria (RSD)

One of my clients shared her recent experience of shifting her RSD response. Here’s what she said:

“I had to attend a meeting with important stakeholders. At first, I felt awkward, stiff and overwhelmed by the small talk. My body tensed up, and I just wanted to run away. But then, I reminded myself that I was safe, and there was no real danger. The next time, I did it again. Slowly, the meetings felt easier, and I felt more connected. It’s been a complete game-changer.”

Each time she made a conscious choice to soothe herself and stay present, she reshaped her brain’s response. Little by little, her confidence grew, and the RSD began to lose its grip.

Final Thoughts: Rejection Sensitive Dysphoria (RSD) Doesn’t Have to Control You

Rejection Sensitive Dysphoria can feel overwhelming, but it doesn’t need to define your life. By understanding your nervous system, practising raising your sense of self, and gently rewiring your brain, you can begin to break free from its grip.

The goal isn’t to eliminate sensitivity altogether. Sensitivity can be a gift when used wisely. The aim is to no longer let it run the show.

This work takes patience and persistence but every time you respond with curiosity and kindness toward yourself, you are taking a powerful step towards healing and emotional freedom.

FAQs About Rejection Sensitive Dysphoria (RSD)

What does Rejection Sensitive Dysphoria feel like in the body?

Many people with ADHD feel RSD first in their body often before their brain catches up. It can feel like a racing heart, tight chest, nausea, or even muscle tension - my clients and I often describe it as “The Jolt”. It’s your nervous system reacting before you’ve even had a chance to think things through. This body-based reaction is why RSD can feel so overwhelming and hard to control at times.

Is Rejection Sensitive Dysphoria a form of trauma?

It can overlap, yes. While not every experience of RSD stems from trauma, many people with ADHD have experienced years of emotional wounding or childhood difficulties that shaped their nervous system. These small, repeated moments of shame, criticism, or misunderstanding can accumulate over time, making the brain more sensitive to rejection and disapproval.

Can ADHD medication help with Rejection Sensitive Dysphoria?

Some people do find that ADHD medication, particularly those that help with emotional regulation, can lessen the intensity of their RSD reactions. However, medication usually doesn’t resolve RSD on its own - it suppresses it. Emotional resilience building often requires additional strategies, such as body-based practices, learning individually how to tailor your RSD toolkit (the two non negotiables are to sooth the feelings in the body and let them do their thing, and also on a cognitive level understand how it just happened and the whole process there, because its always valid even if not accurate) and learning how to "close emotional loops" to fully process these feelings.

Why do people with ADHD please more often?

Pleasing people can be a nervous system survival strategy. For many with ADHD, it’s a way to avoid the pain of rejection. It often shows up as saying “yes” when you want to say “no” or going along with others just to avoid disapproval. While it can feel like keeping the peace in the short term, it can actually lead to self-rejection and even more emotional exhaustion.

How can I start reducing the impact of Rejection Sensitive Dysphoria?

The first step is awareness, learning to spot your RSD triggers and noticing how they feel in your body. From there, soothing practices can help bring your nervous system back to safety. Understanding what just happened is totally key, because then you can feel compassion rather than confusion. Working with an ADHD coach or therapist to process past emotional wounds and strengthen your sense of self can also make a huge difference over time.