Nobody particularly enjoys feeling rejected, whether the rejection is relatively minor or, at the other end of the spectrum, completely devastating. Making an offer that isn’t received can feel sad, embarrassing, frustrating, humiliating, and discouraging. You may think that you experience these incidents the same way others do, but if you have ADHD, there is a good chance you also have Rejection Sensitive Dysphoria. This means that rejection impacts you differently than it does other people. If you’ve ever felt that your emotions were beyond your control in the fact that rejection, or even the idea of rejection, RSD might be the culprit.

Rejection Sensitive Dysphoria (RSD) is commonly linked to ADHD, where it causes intense emotional reactions to perceived rejection or criticism. Individuals with ADHD/RSD may feel overwhelmed with emotions such as sadness, anxiety, or anger, often leading to avoidance of situations that trigger these feelings. Understanding RSD is crucial for individuals with ADHD, their loved ones, and therapists to develop effective management strategies and improve their quality of life.

What is Rejection Sensitive Dysphoria in ADHD?

• Extreme emotional sensitivity and pain are triggered by the belief that a person has been rejected and/or criticized by their loved ones.
• It can imitate a major mood disorder, complete with suicidal ideation.
• People with RSD in ADHD typically cope in the following ways: 

4 Complications of ADHD/RSD

1. Putting up emotional walls: RSD/ADHD can make it hard to open up to others, as they may not understand how intense and deep the feelings of distress are. Feeling vulnerable and then feeling misunderstood can be isolating and increase the distress already being experienced.
2. Extreme fear: The fear of rejection can manifest into fear for your life as your brain goes into panic mode. This is a nervous system response that can strike in an instant, making it difficult to regulate.
3. Difficulty receiving feedback: Negative feedback from loved ones may feel like you are being rejected by them, which is highly triggering for those with RSD/ADHD. No matter how minor their comment is or how gently they address the issue, you may feel incredibly hurt by their words.
4. Misinterpreting situations: Misinterpreting others’ words and actions often leads to intense feelings of crippling anxiety and self-blaming, although that may not be true.

3 Ways to Manage Your ADHD and RSD

1) Cognitive-Behavioral Therapy (CBT):

CBT can help individuals with ADHD and RSD to identify and reframe negative thought patterns that may trigger emotional responses to rejection or criticism. CBT can also help individuals learn coping strategies to manage their emotions and improve their overall mental health.

If you already attend therapy for ADHD, you have probably experienced CBT in some form. Adults with ADHD often have current issues to address in therapy, as well as those stemming back to childhood.

This can be especially true if the diagnosis happened later in life. You might find that you reflect on a lifetime of seemingly unfortunate events, mishaps, and wrong turns and recognize that you were struggling with something nobody could name for you yet. Regardless of when you were diagnosed (or if you are still seeking an official diagnosis), there will be a common theme of not feeling “able to get it together,” which has likely lowered your self-esteem.

Cognitive Behavioral Therapy is goal-oriented. It seeks to restructure thought patterns and therefore rewrite how you feel about yourself. The thought patterns you have, the way you speak to yourself in your mind, and your immediate responses to events can all be impacted by low self-worth. The good news is that CBT works to rewrite your internal narrative, such as the idea that you won’t succeed or that something isn’t worth trying because you won’t be able to do it perfectly.

In CBT sessions, the first step is identifying your worldview, beliefs, thought processes, and patterns. For example, you may tend to assume you know what others are thinking or how things will end up (this is usually an assumption of a negative outcome). You may experience very black-or-white thinking, where you see one event as proof of a pattern or outcome – a positive experience leads you to believe that you’re on top of the world, and a negative experience does the opposite; if you make one mistake, you’ve “failed” your entire undertaking. You may be incredibly hard on yourself, feeling like you “should” do this or that, that you are responsible for any negative events or outcomes that befall you.

Once your point of view has been established, therapy will help you find the patterns in your thoughts. Where did these connections begin; where do they persist? What are the most common triggers for these critical thoughts? When are you most likely to experience obstacles in your day that lead to frustration and distress? How do these patterns support the narrative that others will likely reject you? How can you address the symptoms of ADHD that make you feel as though you deserve to be rejected by those you love?

If, for example, you are constantly late to meet up with a friend, you may feel more and more guilty about it. You want to show your friend that you value their time. You want to display that getting together is important to you. But time management is a struggle for you. In therapy, you will come up with ways to stay on track: putting clocks in front of you as often as possible, setting alarms, and keeping a physical planner on your desk that you can refer back to throughout the day. You may come up with an affirmation that you practice, such as, “I have my appointments written down,” or “I will respond to my alarm immediately.” You may also connect checking your calendar with things you do daily, such as eating breakfast, brushing your teeth, and so on.

Cognitive Behavioral Therapy will teach you how to identify, address, and adjust your actions through diligent affirmations, scheduled routines, and a willingness to revisit your patterns and adapt your toolkit as you go.

2) Mindfulness Meditation:

Having a steady range of emotions is the foundation for self-care and self-support. Getting into that window of regulation can be very tricky. If you have ADHD, you are probably used to experiencing very powerful emotions and high sensitivity. This may have been the case for as long as you remember; the idea of being able to calm your nervous system might sound like a huge undertaking. Mindfulness meditation is a foundational practice, much like drinking enough water or getting enough rest. It doesn’t prevent triggers from occurring, and it doesn’t mean that now your emotions will be perfectly mastered at all times. What it means is that you spend more time at a tolerable level of emotion, which makes an increase in stress more tolerable by default. If you’re always on the line between feeling okay and losing your cool, the smallest incident might send you over your threshold. Bringing yourself into a space of more calm and less stress empowers you to stay within a comfortable emotional range.

The more you practice mindfulness, the more natural it will feel to you. Meditation is not about sitting still for half an hour and trying not to have any thoughts whatsoever, regardless of what you might have seen or heard. Some people meditate for a few minutes while listening to a guide. Some do so when out for a walk, or folding laundry. Some people prefer to sit or lay down. The key is discovering a method that allows you to connect and listen to yourself in real time. Are you aware of your five senses? How do you feel in your body? Are you experiencing a heavy emotion; how do you know it? Where do you feel your stress physically; is it in your stomach, shoulders, and head?

When meditating, you practice having and acknowledging thoughts without judging them. A thought may arise during a meditation – you can know it is there, accept that you’ve had it, and then release it. By focusing on your breathing, or specific imagery or sounds, you maintain a sense of calm while being acutely aware of your feelings. If you feel your mind start to wander to the past, or worry about the future, ground yourself in the present through the use of your senses. What do you feel, smell, taste, hear, see? How do those reflect where you are in the present moment?

3) Medication:

Medication can be an effective treatment for ADHD and RSD, especially in more severe cases. Stimulant medications, such as Adderall or Ritalin, are often prescribed to help individuals with ADHD to focus and regulate their emotions. ADHD treatment can include medication as part of the plan, as it has been found to be beneficial. However, medication should always be prescribed and monitored by a healthcare professional. There is still a stigma surrounding medication for mental illness and neurodivergence, but the truth is that medication that helps a person with ADHD better regulate attention is just as vital as an inhaler is for an asthmatic or insulin is for a person who requires it for diabetes. We see and understand the value of effective medication here at our therapy practice in Woodland Hills. Because ADHD often coexists with other mental health disorders, such as depression and/or anxiety, some people are prescribed antidepressants for ADHD.

While medication is a great boost, it works best in conjunction with therapeutic treatment and mindfulness. Think of living with ADHD as going on a road trip. Operating the vehicle, and all of the skills involved with driving, are your responsibility. Knowing what route you are going to take, being aware of the road signs along the way, and filling up at gas stations as needed, are all essential. Medication is like clearing the windshield or effective headlights once it gets dark. Depending on how well you respond to medication, it removes a barrier or, at the very least, reduces it. You still have to do the work of operating the vehicle. A medication enables you to do so with greater ease and a more clear point of view to see where you are trying to go.

You and your doctor may need to revisit your prescription over time, and your therapist might have tactics to guide you in determining what is working best for you. Medication for ADHD is a great helper for attention regulation, making the rest of your practices more straightforward. Being open with your medical professional(s) about how your medication impacts your daily life will help you make the most of your treatment and safeguard against potential issues.

Adults with RSD regularly report feeling trapped in their circumstances. They are often angry at the loss that they perceive is coming and bracing for what they view as inevitable rejections. They resent their efforts to be liked; they are exhausted by trying to please everyone else and don’t know how to stop. They feel sorrow at their self-imposed isolation; they have pushed so many people away over the years to try to avoid feeling abandoned. The perception that ADHD makes them unappealing may have been bolstered by people throughout their lives complaining about their scattered behavior, forgetfulness, high emotions, and inability to do what they promise. 

There are ways to manage your ADHD and your RSD, which means there are also ways to take care of yourself. Offer yourself grace and patience. Prioritize self-care, including the fundamentals of health as far as rest, hydration, nutrition, and moving your body. Give yourself permission to try new things, to make missteps, and to try again.

ADHD Treatment at Embracing You Therapy

ADHD symptoms can be life-altering and debilitating if not managed well in our adult lives. It can show up at work and in our personal lives in how we interact with others. ADHD Treatment in our offices in Woodland Hills is designed to identify the unique challenges of your ADHD brain and create action steps that can be easily and effectively integrated into your life. Contact us today for your complimentary 20-minute phone consultation with our Client Care Coordinator.