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Rejection Sensitive Dysphoria (RSD) is used to describe the extreme flooding of emotions experienced by ADHDers when perceived rejection, disapproval, dismissiveness, or criticism is experienced. It’s overwhelming and occurs suddenly and without warning. This overbearing feeling is aptly named, as ‘dysphoria’ is Greek for ‘unbearable.’ RSD can completely engulf those who experience it in feelings of shame, guilt, grief, and embarrassment. 

In my experience, RSD feeds me a constant stream of doubt about myself, my values, my abilities, and my belonging. It says that the only expectation anyone has for me is failure.

While self-report from ADHDers and scientific research continually indicates Rejection Sensitivity as a common trait of ADHD, the diagnostic criteria make no mention of it, leading it and its connection to ADHD to often be missed. Instead, diagnostic criteria focus on hyperactivity and inattention, without mention of emotion. Due to this, many practitioners aren’t aware that ADHDers experience RSD as often as we do. In fact, if someone with RSD describes their experiences with this emotional flooding, they’re likely to get misdiagnosed with things such as borderline personality, bipolar, social anxiety, PTSD, depression, and mood disorders.

Signs of Rejection Sensitive Dysphoria

  • Tending to assume the worst in social situations (like if your boss asks to speak with you, you may automatically assume you’re in trouble or will be fired)
  • Automatically assuming that no one likes you or wants to be around you socially
  • Feeling easily embarrassed
  • Overthinking social situations or feeling socially anxious
  • Being needlessly self-critical
  • Having a low-self-esteem and constantly feeling like a failure for not living up to the perceived expectations of others
  • Withdrawing from others or avoiding social situations
  • Feeling like others are upset or disappointed with you, or that they don’t want you around and they don’t approve of you or your behavior and becoming overwhelmed by these feelings
  • Experiencing intense emotional responses that you feel embarrassed by once they’ve subsided

Those of us who experience RSD tend to either internalize or externalize these flooding emotions.

Internalizers

Those who generally internalize have a greater likelihood of experiencing depression or anxiety while overwhelmed and are more apt to cry than become outwardly angry or lash out at others emotionally. They also tend to be more perfectionistic and become extreme people pleasers, in an attempt to prevent the emotional pain associated with RSD. From the outside, those who internalize their RSD tend to resemble those with the ‘Highly Sensitive Person’ neurotype, and it’s certainly possible for someone to experience/be both.

In the workplace, this might look like taking on extra responsibilities, not delegating, working late, pushing beyond reasonable limits, and not counteracting unreasonable expectations from others. Internalizers in the workplace will do nearly anything to avoid upsetting others, often coming at the cost of burning out.

Externalizers

Those who tend to externalize their flooding experiences are more likely to encounter rage or anger while overwhelmed, often leading to emotional outbursts in which they might say things they don’t mean. Rather than trying to get things perfect or people pleasing like their internalizing counterparts, those who externalize are more likely to avoid trying, to slack off, and to avoid socially engaging with others to prevent feelings related to RSD.

In the workplace, this may look like becoming defensive at even the slightest hint of criticism from managers, often retaliating and looking to blame external factors. It may also look like fearing failure or perceived rejection so much that they avoid asking for deserved pay raises or promotions, volunteering for projects they want, speaking in meetings, or anything else that may highlight their skills. They keep expectations of themselves small, to avoid the possibility of disappointing others and themselves.

Causes of RSD

While not a ton is known about the causes of RSD, much like the Highly Sensitive Person Neurotype, it’s believed that the ADHD nervous system is more highly attuned to the person’s surrounding environment. This high level of sensitivity can lend itself to overwhelming physical reactions to strong emotions such as rejection or criticism.

Impacts of RSD

Over time, RSD can take its toll on a person’s sense of self-worth. It can lead to feelings of chronic self-criticism, low self-esteem, and feelings of defectiveness. It may lead people who experience it to opt for loneliness over relationships or social interactions, in an attempt to avoid feeling RSD emotional flooding.

How Employers Can Help Employees with RSD

  • Keep impromptu meetings to a minimum and try to avoid them altogether, to avoid misinterpretation over what a meeting may be about
  • Be mindful of how you present constructive criticism/feedback
  • Try to avoid micromanaging (this can lead to feelings of ‘I must not be good enough without them hovering over me.’)
  • Deliver consistent recognition and praise when it’s warranted, to help employees feel supported
  • Try to allow ADHD employees to work in the ways they are most productive, allowing for things like breaks and late starts
  • Provide employment coaching to help ADHD employees most effectively manage their stress and time
  • Allow time and space for peer support options, such as coworking/body doubling
  • Ask what may be most helpful for them