Rejection Sensitivity and ADHD

A Vortex of Shame and Embarrassment

If you have ADHD, there’s a good chance you’ll never be a person who has no f*cks to give. You may wish you were, but the truth is you probably have a mountain of them. You can’t give them away fast enough…or at all. You may wish you were someone who is unbothered, unruffled, unscathed by what others think. Still, if you suffer from one of the most common features of ADHD—rejection sensitive dysphoria (RSD)—it won’t merely bother you when someone rejects, teases, or criticizes you—it will gut you. And if you’re a writer or artist—someone for whom rejection is a foregone conclusion—it may derail your creative experimentation and satisfaction.

It did for me. More than ten years ago, I tried to overcome my fear of fiction and took a stab at writing a short story. At the time, I didn’t know any creative writers or belong to any writing groups or community, so my options for feedback were limited. With trepidation, I sent the story to a cousin who was fond of me and whose writing I admired. She leaped at the chance to tell me that my story was so atrocious it made her howl. She clearly took delight in ripping it to shreds, and found not one single thing to praise or encourage. She ended it by saying, “But oh well, it’s your first try. Maybe you’ll get better.” That’s how criticism sounds to people with RSD. Magnified. Amplified. In this case, it’s also exactly what she said. I wonder what she might have said if she hadn’t been fond of me.

I’m sure my story was dreadful, as I imagine most first attempts are. But I doubt it was so loathsome as to cause someone to convulse with laughter. My cousin’s feedback, unkind and cruel, wasn’t rational, but my over-the-top response was equally uncalled for. Rather than acknowledge how bizarre her behavior was, I withered, burning with shame and embarrassment. I felt, almost literally, as if I’d been slapped in the face. And the upshot was that to this day, I’ve never again been brave enough to try my hand at fiction.

I didn’t know at the time that I had ADHD and I’d never heard of RSD. I only knew that I’d held my hand out to my cousin and she cut it off. I wasn’t about to extend it again, to her … or anyone.

If I hadn’t had ADHD, could I have acknowledged her excoriation for what it was—her own character flaw? Or might I have persevered, brushed off her smackdown, and tried again? Of course I know I wouldn’t have become the next George Saunders or Amy Bloom, but perhaps I’d have persevered, learned the craft, and produced a respectable story. I’ll never know, because even though I wasn’t aware of it then, I did have ADHD and RSD and couldn’t risk further shame and failure.

I recently relayed this story to my ADHD therapist, who insisted that I immediately write a short story. It sounds like good advice, yet I have to admit something inside of me quivered when she said it. I trust her, though, and I’m putting it on my to-do list, but you can bet just thinking about it will make me quake.

What is RSD?

Though not a recognized symptom or a formal diagnosis, RSD is increasingly believed to be a defining feature of ADHD and one of the most common representations of emotional dysregulation—a difficulty controlling emotions. Not everyone is onboard with the “dysphoria” label, but there’s widespread acknowledgement that people with ADHD are acutely vulnerable to criticism or rejection, whether real or perceived. A pain that can be both physical and emotional, RSD can also be triggered by one’s own self-criticism, anticipation of rejection, or fear of failure. It could be something as small as an innocent sidelong glance, an unanswered email, a benign comment, or a lack of praise or enthusiasm when praise or enthusiasm was expected. And what others may perceive as a minor slight, people with RSD see as a catastrophe—one that launches them into a vortex of shame and remorse. Whether you call it rejection sensitivity or RSD, it’s excruciating.

What makes RSD different from the kind of discomfort everyone feels when they’re rejected? The answer is in the name: dysphoria—a Greek word for unbearable. The reaction is outsized—beyond reason for the precipitating incident, often long-lasting, and impairing. And it’s not only visceral pain that’s triggered by an incident; an adrenaline surge can cause a racing heart, anxiety, panic, emotional outbursts, and even rage. The rejection is frequently followed by a steep mood dump that can resemble major depression and even suicidal ideation, leading to it commonly being misdiagnosed as a mood disorder. At best, the pain is temporarily overwhelming; at worst, it’s incapacitating. And some experience RSD on a daily basis, regularly teetering on the edge of a shame precipice.

If you experience RSD and feel you’re more than a little extra, it’s important to remember that neither emotional dysregulation nor RSD is a matter of being overly sensitive. It isn’t about having a thin skin or being weak. Research doesn’t exist yet that clarifies the cause of RSD, confirming, for example, whether it’s genetic, neurological, a consequence of trauma, or a combination of these and other factors. But what is known is the link with emotional dysregulation, which is at least in part a neurological response—a difference in how the amygdala and prefrontal cortex of ADHD brains function. But difficulty controlling emotions is also a consequence of living with ADHD. People affected are more vulnerable to bullying in childhood and beyond, which is traumatic. Again and again they’ve been rebuked—made to feel wrong, weird, not enough. They’ve had more than an average amount of experience with failure. Rejections have compounded and loom large in their imaginations, so it seems natural for them to be on high alert for signs that oops, they’ve done it again. Little wonder that rejection sensitivity becomes their go-to response.

The consequences can be poor self-image, low self-esteem, negative self-talk, defensiveness, impostor syndrome, perfectionism, people-pleasing behavior, and, often, a failure to try anything that might make us vulnerable to ridicule or shame. If we experience RSD—unless we’re indisputably excellent dancers or singers—we’re not going to be the people who dance like no one is watching or belt out a karaoke tune with abandon. We’re more likely to be standing in the corner, trying to disappear.

When Rejection is Inevitable

Rejection can be brutal for everyone. But when it comes to rejection of one’s work, writers—like actors and all artists—are like firefighters running into fire. It comes with the territory. Some neurotypical writers, too, cave in the face of too much rejection, but most are better able than those of us with ADHD and RSD to suck it up and move forward, recognizing that rejection has more to do with the nature of the publishing industry and less to do with their capabilities. The best writers are rejected over and over, and the stories of books that became massive bestsellers after having been rejected 20, 50, 100 times are legion. But while reminding the ADHD writer that rejection and criticism are the predictable outcomes of a life in writing may help them persevere, it won’t take away the literal and exaggerated pain of rejection or the mood destabilization and rumination that can occur in the wake of a polite message that says, “Thanks for submitting but this isn’t a good fit for us now.”

Some Strategies that May Help

Unfortunately, there’s no easy fix for RSD. Just as there are differences of opinion about the cause of rejection sensitivity, there’s little agreement about whether change is possible. It appears that certain medications, such as guanfacine, help some sufferers, but not others. And for those they do help, medications aren’t enough. Although there’s debate about the degree to which therapy helps, counseling certainly can guide you to identify triggers and understand why you experience rejection the way you do. Therapy doesn’t fully prevent RSD or relieve the pain when it occurs, but it can provide tools that might help you avoid people or situations that arouse rejection, reframe your reactions, and develop emotional resilience and shame resilience. In addition there are modalities such as Somatic Experiencing and EMDR that address trauma, calm the nervous system, and create the sense of safety that rejection erodes.

Simply knowing that it’s not hypersensitivity or weakness and acknowledging that it’s a common feature of ADHD is a first step to defusing the shame that RSD arouses and may help stem the cascade of emotions that leads to spiraling. Then these strategies may be worth exploring.

• Talk with your doctor and seek the help of a neurodivergence-affirming therapist. A well-trained ADHD coach may also be able to provide perspective and coping tools.

• Managing stress and developing a repertoire of coping skills for dealing with intense emotions may help counter emotional dysregulation. This might involve exercise, meditation, time spent in nature, distraction with enjoyable activities, or Emotional Freedom Techniques (EFT) tapping. (The Tapping Solution offers apps and books to get you started.)

• More specifically, mindfulness practices can help you anchor yourself to the present and withhold judgment, thus preventing you from ruminating about a recent or past rejection and carrying the feelings too far into the future.

• When you’re triggered, acknowledge that what you’re feeling is RSD and try to short-circuit an acute reaction by pausing to breathe and ground yourself. Box breathing (inhale for four seconds, hold for four, exhale for four) can calm the nervous system, slow the fight or flight response, and help you regulate your emotions.

• Once you’ve established equilibrium, challenge the thoughts about the incident that triggered you. Did the situation warrant the reaction? Question your story around the experience and try to reframe it. It’s not always possible to get feedback from someone you believe rejected you, but when you can, such information can lead you to understanding that there was no rejection intended. Maybe you’re spinning out because an acquaintance didn’t return your message on Facebook. You’ve convinced yourself the lack of response means they hate you or that you did something terribly wrong, when in fact they’ve been dealing with a personal crisis and haven’t had time to communicate.

• Talk about rejection with people who get you—preferably others with ADHD. It’s not just a matter of misery loves company, but company helps shoulder the feelings at the same time that it normalizes them.

• Writing down your feelings can also stop your mind from reacting and may prevent shame from mushrooming. And keeping a journal can be a useful tool for pinpointing your particular triggers.

• Practice self-compassion. Offer yourself the same kindness and grace you’d extend to a friend in a similar situation.

• Develop a community of people who understand and can support you, whether this is a group you can meet with physically, an online support group, or a social media collective.

• Spending time among peers and turning to other creatives for feedback and support can help give writers and other artists realistic perspective about their work. Other artists can commiserate about rejection and reinforce the idea that it’s a part of the creative life and not an indictment of you and your abilities.

For ADHDers with creative aspirations, the most damaging aspect of RSD is that it causes self-rejection and, ultimately, self-censorship. If you want a life in the arts, don’t let rejection steal your voice. Remind yourself, and ask your trusted friends and family to remind you, that RSD isn’t a reflection of your talents. It’s like a funhouse mirror at a carnival that distorts the way you look at yourself but doesn’t represent reality.

Resources

Not sure if you have RSD? Take an online quiz.

There are numerous podcasts about RSD that can show you you’re not alone, help you understand why you react as you do, and share what others have found helpful. Here’s a sampling.

Tracy Otsuka’s ADHD for Smart Ass Women: ADHD and Rejection Sensitive Dysphoria (RSD)

Take Control ADHD: Rejection Sensitive Dysphoria: Dr. William Dodson Brings New Insight to Emotional Regulation

The Neurodiversity Podcast: REJECTED! Now what? Overcoming Rejection Sensitivity

ADHD Chatter Podcast: The Science of Rejection Sensitive Dysphoria, Dr. James Kustow

I Have ADHD with Kristen Carder: Rejective Sensitivity is Real (But I Reject RSD)

The Neurodiversity Podcast: Rejection Sensitive Dysphoria with Dr. Bill Dodson

ADHD Women’s Wellbeing: Understanding RSD alongside ADHD with Marcy Caldwell

Hacking Your ADHD: Navigating ADHD and Rejection Sensitive Dysphoria with Jessica Summers

MissUnderstood: The ADHD in Women Channel: ADHD and: Rejection Sensitivity