Rejection Sensitivity Session


One thing that often goes hand in hand with ADHD is Rejection Sensitive Dysphoria: a heightened sensitivity to what people say or think about you. According to WebMD, about 99% (!) of people with ADHD are more sensitive to perceived rejection than the neurotypical population, and about a third of people with ADHD say this is actually the hardest part of living with ADHD.

(However, plenty of people without ADHD ALSO struggle with RSD--this is not an ADHD-specific condition, although many or most people with ADHD also have RSD.)

So let's talk about it!

Rejection Sensitive Dysphoria is a phenomenon that is very, very worth understanding.

"Dysphoria" comes from a Greek word that means "difficult to bear," and in English it refers to a general and pervasive sense of unease or discomfort in life. (There are many forms of dysphoria and many ways dysphorias can affect your life.) Here, RSD indicates that a major source of discomfort is sensitivity to perceived rejection.What this looks like in practical reality is that people with RSD kind of go into life expecting to be rejected--and then taking it really, really hard when they perceive that expectation to be met (even if there is no actual rejection going on). It is not that they are wimps; neurologically speaking, the pain of rejection is actually just much more severe for people with RSD.

I'm guessing most of us have experienced bouts of RSD-like symptoms in life. This would be like that time that someone says X to you and you spend the next 48 hours wondering, "did they say that because they really hate me? What did they REALLY mean by that? Maybe they think I'm not good enough? Was it a passive-aggressive way for them to let me know I failed?" or whatever. Cyclical, obsessive thoughts around what other people have said or thought about you can be one symptom of RSD.

Feeling rejected and feeling sad and sensitive about it is something that is normal to the human experience. It is not normal to never feel that way. But RSD takes what ought to be an infrequent experience and pumps it up as if on steroids. RSD is not infrequent surprise bouts of insecurity and low self esteem: it's the next level.

To me, I imagine life with RSD as kind of having a radar in your mind that is constantly searching and scanning for any sign of potential rejection. When anything--anything--shows up in life that could be perceived as rejection, the radar goes off and triggers an onslaught of negative thoughts and even physical symptoms like an elevated heart rate and other physical symptoms of anxiety.

People who have RSD typically have low self esteem, and often set impossible standards for themselves in an attempt to meet the assumed expectations of others. "If I'm just perfect in every way, no one will be able to reject me!" Then when they fail to meet those impossible standards, they beat themselves up further.

RSD can lead to heartbreaking feelings of failure, which can in turn lead to emotional withdrawal from relationships.This pervasive feeling of being judged and not good enough can also lead to surprise outbursts of anger and sometimes even violence, when all the perceived rejection just becomes too much for the person to carry. So RSD can lead to basically very erratic relationships, with large bouts of emotional withdrawal and surprise outbursts.When that happens in a relationship, it's important to realize that it's not about the PEOPLE involved, it's about the RSD. When you're in a relationship of any kind with a person dealing with RSD, and there are outbursts and withdrawals, this is not necessarily about the reality of the relationship. It is about the reality of the person's perspective that they are being constantly rejected and that they will never be good enough. And that is still a reality. But it is not the other people's fault, necessarily.Here are some examples of what this can look like.

In a parent-child relationship, any sort of correction can be perceived as a rejection and lead to withdrawal or angry outbursts. Almost any sort of discipline or correction can trigger this, because to the child with RSD, they already aren't good enough, and any correction or discipline at all can just verify this to the child. So an example of this would be Mom calmly saying, "Hey, you forgot to scoop the kitty litter! Could you please take care of that now?" and instead of saying, "Oops, sure," the child loses their mind, screams and cries, blames Mom for their own forgetfulness, screams "I hate you" and then runs away, slamming the door behind them. It looks like an overreaction to Mom, who is sitting there like-- "What just happened??" but it is NOT an overreaction to the child who seriously feels like their entire life has been ripped apart by perceived rejection.

RSD is not always about screaming and slamming doors, though. Sometimes it's just the kid sadly saying "okay" and then hiding for hours to lick their wounds--possibly STILL forgetting to do the thing that caused the instigating comment in the first place, which of course just leads to more issues later when the cycle repeats itself. They can feel so bad about not doing the thing that they forget to do the thing, which leads to someone mentioning that they didn't do the thing, which makes them feel too bad to do the thing.... on repeat.

In a romantic relationship, it can be similar. Reminders of important things left undone can be painfully triggering, and can lead to accusations, blaming, screaming or violence--or, conversely, complete withdrawal. Complete withdrawal would be where the spouse with triggered RSD shuts down, hunkers down with some electronics or books for a few days or something, and then comes out of the funk a few days later either "normal" or just a little more beaten down in general.

Obviously, RSD can wreak havoc on relationships--and it is not just traumatic for the person who deals with rejection sensitivity. RSD can be traumatic for the people who DON'T have rejection sensitivity, who feel victimized by its symptoms. When people are constantly assumed to be rejecting someone they are not rejecting, and then are subjected to outbursts or withdrawal as a result, it can be baffling and emotionally wounding--especially because to the person without RSD, the motivations for these things are nearly incomprehensible, and the outbursts or withdrawal can seem random and inexplicable.Of course, it is NOT random or inexplicable--but for someone with RSD, explaining the depth of their despair over perceived rejection can be extremely difficult as well. And the person who doesn't understand it can just get more upset, thinking, "But I WASN'T rejecting you! Why are you misreading EVERYTHING?!" This all just compounds the issue of the person with RSD feeling misunderstood or just plain not understood at all.

Understanding RSD can be helpful for a variety of reasons.If you have RSD, just knowing that this is a thing can be a comfort and a relief. No, you're not crazy! Your brain is having a hard time processing perceived rejection. And once you consciously know this is a thing, you can start taking a step back when you feel rejected and start consciously reminding yourself that the situation may not be what it seems, etc.

As a mom who does NOT have RSD but who does appear to have an RSD child, it's helpful for me to know this may be a factor in my child's behavior when I ask her to clean her room and she acts like I just attacked her. She seems way too old for the tantrums I witness, but it makes sense in the context of RSD.Understanding RSD has helped me make sense of a lot of relationships in my life. This is one reason I think EVERYONE should know about it, regardless of if you personally deal with rejection sensitivity.

RSD is not a medical diagnosis, although the symptoms of it can be treated medically with drugs like guanfacine (Intuniv) and clonidine (Kapvay).Another form of drug sometimes prescribed for RSD is monoamine oxidase inhibitors (MAOI's). This was fascinating to me because my daughter who struggles has had her genes done, and she does have a faulty MAO gene. I thought it was interesting that she has a gene that messes with monoamine oxidase and that one treatment for the symptoms she exhibits are MAO inhibitors. So clearly (to me) there is a biological, genetic basis for hypersensitivity to rejection, and it has a lot to do with monoamine oxidase.Biologically speaking, dysphorias of ALL kinds can be linked to hypoglycemia: basically, low blood sugar.And also biologically speaking, the brains of people with ADHD have decreased glucose metabolism, compared with neurotypicals. Basically: ADHD and related RSD can both come back to BLOOD SUGAR ISSUES, which are linked to a combination of diet, exercise, circadian rhythm stuff, and genetics.This is one reason people with ADHD and RSD sometimes turn to food for self-medication. They need help with their brain glucose so they crave sugary foods and carbs (makes sense, because those foods are high in glucose), but that glucose hit to the brain is also creating dopamine and serotonin, so basically, really unhealthy eating is a form of self-medication for a brain that struggles with maintaining proper blood sugar.

This is one reason that someone with ADHD is approximately FOUR times more likely to become obese than someone without ADHD.

This is also one reason that some people actually self-medicate ADHD with caffeinated soda. Just sipping on caffeinated sugar throughout the day can stimulate the brain and provide that boost of glucose the brain is craving. A lot of soda addiction may be linked to ADHD and RSD.But getting blood sugar regulated is going to be a really important thing for people with ADHD and RSD. I mentioned this in a previous post, but some people call ADHD "diabetes of the brain." The more I learn about ADHD, the more I feel that is probably true. But the good news is that in many cases diabetes is highly responsive to diet. So treating ADHD with dietary shifts like you would regular forms of diabetes may be beneficial.

Some things you can do without medication to help balance your blood sugar would include:

- Time restricted eating. A good book about this is The Circadian Code. Limiting all caloric intake to 12 hours or fewer in a day is a great idea (so only eating between 6 am - 6 pm, etc) so your body has at least 12 hrs to reset and focus on healing every day

- Avoiding sugary foods. Of course that is what the body is craving if there's RSD or ADHD involved, but if you can choose fruit instead of candy or cookies, that is better.

- Loading up on protein and veggies.

- Eating 3 meals a day at predictable times for your body.

- Getting enough SLEEP. Sleeping at a regular time every single day for at least 7 hours can help your body heal its glucose issues.

- Some people swear a ketogenic diet improves symptoms.

- Detoxing with TRS--a lot of TRS users have reported increased blood sugar stability (which in itself indicates that heavy metal toxicity may be a big player in the root cause of this condition, along with genetic susceptibility and a poor diet).

Related Resources:

How ADHD Ignites Rejection Sensitive Dysphoria:

WedMD's page on Rejection Sensitive Dysphoria:

More on MAO:

More on ADHD brains and sugar cravings and brain glucose metabolism:

Paper on ADHD and obesity:

WebMD's page on hypoglycemia:

Book on circadian rhythms and how to fix them to help with ADHD and diabetes (and a zillion other things):

Article on parenting as a parent with RSD:

Article on parenting a child with RSD:

Thanks for reading!! Remember that you are ACCEPTED today!!! Breathe out your feelings of rejection!! YOU ARE GOOD ENOUGH! Order this session if you are ready to take the next step in healing Rejection Sensitive Dysphoria. 

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