Rejection sensitivity, linked with rejection-sensitive dysphoria (RSD), is a relatively new term in the world of ADHD. It involves strong emotional reactions to perceived rejection that lead to intense emotional pain. Our current understanding is that ADHD predisposes people to rejection sensitivity based on an emotional dysregulation component.
ADHD is known for impulsiveness, hyperactivity, and inattentiveness. We've known for some time that ADHD has a lot of other issues associated with it, what we call comorbidities. This includes issues such as anxiety, depression, substance use, relationship and job struggles to name a few. Rejection sensitivity has emerged as the new comorbidity on the block. Rejection sensitive dysphoria (RSD) is the term for the mood component of rejection sensitivity. It is the emotional turmoil that happens when someone interprets rejection, leading to intense sadness, frustration, or anger. This response can be much stronger than the event itself warrants. In people with ADHD, these emotional spikes can worsen feelings of inadequacy and social anxiety, creating a downward spiral.
Common signs of rejection sensitivity include feeling anxious before or after social situations, overanalyzing feedback, and imagining the worst even after minor critiques. This can lead to a cycle where people need frequent external validation, further straining relationships. At work, people might avoid tasks that could lead to criticism, like leading projects or sharing ideas, which ultimately limits their career potential. Friends and family may struggle to give feedback that isn't construed as rejection, leaving them feeling as if they are walking on eggshells. Fearing rejection can cause individuals to withdraw socially, limiting support networks and leading to loneliness. Students with ADHD and rejection sensitivity often avoid class participation or new activities to dodge criticism, affecting their academic growth and personal development.
From a brain science perspective, people with ADHD have differences in brain structure and function compared to others. These differences can account for the emotional dysregulation and rejection sensitivity seen in ADHD.
Managing rejection sensitivity in ADHD takes a broad approach that tackles both emotional control and distorted thinking. Therapy, especially cognitive behavioral therapy and mindfulness work, is usually a great choice here, but the sheer speed and intensity of emotion in rejection sensitivity can sometimes blow right past the coping mechanisms. Some early research has shown positive results with medications we've used for years to treat hyperactivity and impulsivity associated with ADHD, namely the alpha agonists guanfacine and clonidine. Stimulant medications, generally the first line of treatment in ADHD, also show some evidence of improving rejection sensitivity.
Rejection sensitivity can be a significant challenge for people with ADHD, affecting emotional health, relationships, and quality of life. Understanding its signs and underlying causes is vital for creating better coping methods. With therapy, medication, mindfulness, and strong support, individuals can better handle emotional reactions and find success.
Dr. Mefford treats ADHD and related disorders across the state of South Carolina via telemedicine. His office is located in Mount Pleasant, SC. He sees people from all areas of South Carolina including Charleston, Hilton Head, Beaufort, Myrtle Beach, Columbia, Greenville, Spartanburg, and Rock Hill.
