ADHD Emotions: Why You Feel Rejection Sensitive Dysphoria

Rejection Sensitive Dysphoria

No one likes to be criticized. Everyone experiences pain when they feel rejected. For people with attention-deficit disorder (ADD), or attention-deficit hyperactivity disorder (ADHD), however, the emotional pain can be far more extreme than in neurotypical people. This is called rejection sensitive dysphoria (RSD), and it can trigger flashes of rage, negativity, or suicidal ideation. In some cases, it can be misdiagnosed as depression, certain types of anxiety disorders, or rapid-cycling bipolar disorder. Here’s how to recognize the signs of RSD and tips to manage it.


No one likes to be criticized. Everyone experiences pain when they feel rejected. For people with ADD/ADHD, however, the emotional pain can be more extreme. It’s called rejection sensitive dysphoria. Click To Tweet


Rejection sensitive dysphoria involves excessive emotional pain when a person feels rejected, judged, criticized, or ostracized—whether the insult is real or only perceived. Some people with RSD may also experience exaggerated emotional sensitivity when they feel like they don’t meet their own high standards or the expectations of an important person in their life.

Any instance of real or perceived rejection can cause extreme reactions, such as anger at the person who made the critique. Others may feel mired in negativity, with depressing thoughts that loop endlessly, making them feel sad, hopeless, and helpless. Feelings of failure can send self-esteem on a downward spiral.


These unbearable feelings can lead people with RSD to become hypervigilant or to avoid situations where they may be judged. This can negatively impact your life in several ways. Here are 4 signs of rejection sensitive dysphoria:

  1. Some people with RSD think the best way to circumvent criticism is to be perfect at everything they do. They attempt to lead exemplary lives and tend to be overachievers—working long hours and taking on more responsibility than necessary. Unfortunately, toxic perfectionism often means people fail to pay attention to self-care and can experience heightened stress or burnout.
  2. Holding back due to fear of failure. RSD makes some people so terrified of being judged or of falling short that they shy away from trying new things or from going for what they want in life. This can lead to a life as an underachiever where you don’t live up to your potential.
  3. People-pleasing behavior. To avoid feeling judged, critiqued, or disliked, some people with RSD may turn their efforts to pleasing others. They spend so much time trying to be liked by others and managing potential rejection that they may forego their own personal goals, according to a study in the Journal of Research in Personality. This can ultimately contribute to feelings of resentment and blame.
  4. Social avoidance. In some cases, people opt to isolate themselves from others to prevent being judged or critiqued. This type of social anxiety increases loneliness, which is detrimental to emotional well-being.


Statistics show that nearly 100% of people with ADD/ADHD struggle with rejection sensitive disorder, and for about one-third of them, it’s the most challenging symptom to cope with. Being hypersensitive to criticism doesn’t mean ADD/ADHD people are thin-skinned. It just means their emotional reactions are more intense.

Although RSD is strongly associated with ADD/ADHD, it is not exclusively found in people with focus and attention issues. A review of 75 studies found that RSD is also common in people with other mental health issues, such as anxiety, depression, borderline personality disorder, body dysmorphic disorder, and autism. This review also points to an association between RSD and loneliness, which may be related to social avoidance.


ADD/ADHD is a brain-based disorder that is associated with abnormal blood flow and activity in the brain. Based on the world’s largest database of brain imaging scans related to behavior—over 200,000 scans and growing—Amen Clinics has found that one of the most common patterns seen on SPECT scans is low activity in the prefrontal cortex during concentration. The prefrontal cortex is the part of the brain responsible to focus, attention, and more. This means that the more people with ADD/ADHD try to concentrate, the worse it gets.

Similarly, rejection sensitive dysphoria is associated with abnormal activity in certain regions of the brain. According to brain imaging research in the journal Social Neuroscience, people with higher levels of RSD experience heightened brain activity when viewing facial expressions that convey disapproval. Interestingly, the RSD individuals did not experience increased brain activity when looking at faces that expressed anger or disgust. It was only disapproving expressions that triggered the activity.


If you’re struggling with rejection sensitive dysphoria related to ADD/ADHD, it’s important to treat the underlying condition as well as the RSD symptoms.

Know your ADD/ADHD type.

The brain imaging work at Amen Clinics has helped identify 7 types of ADD/ADHD. Each type has unique symptoms and treatment plans. Knowing your type is the first step to finding the most effective, targeted treatment for your needs.

Manage your thinking.

If you get stuck on thoughts of not being good enough or being judged harshly, learn to stop these thoughts in their tracks. Notice that you’re stuck and write down your thoughts to help get them out of your head. Then ask yourself if these automatic negative thoughts (ANTs) are true. With practice, you can

Focus on your strengths.

Whenever you’re paying too much attention to something you think you did wrong, shift your attention to the things you do well in life. Make a list of your strengths and meditate on them.

Create a “cool-down” plan.

If you have a tendency to lash out in anger when criticized, develop a relaxation plan to help you calm down. For example, take a few moments to breathe deeply. Inhale for 4 seconds, hold it for 1 second, then exhale for 8 seconds.

Get moving.

Regular exercise has been proven to increase the availability of the feel-good neurotransmitter dopamine, which is often low in people with ADD/ADHD. Physical activity is also known to boost moods, enhance self-esteem, and improve focus in people with ADD/ADHD. Think of it as your daily dose of natural medicine.

ADD/ADHD, anxiety, depression, and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.

1 Comment »

  1. This is so very good…and…absolutely true of myself!

    Comment by Susan Miller — September 16, 2022 @ 4:39 AM

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