Rejection Sensitive Dysphoria

How ADHD Ignites Rejection Sensitive Dysphoria

The extreme emotional pain of perceived rejection is a feeling unique to people with ADHD/ADD, and it can be debilitating. Learn how RSD may be impacting your patients.

A woman with rejection sensitive dysphoria hiding her face with her hand
Woman showing hand stop sign while standing at night



Rejection sensitive dysphoria (RSD) is an extreme emotional sensitivity and emotional pain triggered by the perception — not necessarily the reality — that a person has been rejected, teased, or criticized by important people in their life. RSD may also be triggered by a sense of failure, or falling short — failing to meet either their own high standards or others’ expectations.

Dysphoria is Greek for “difficult to bear.” It’s not that people with attention deficit disorder (ADHD or ADD) are wimps, or weak; it’s that the emotional response hurts them much more than it does people without the condition.

When this emotional response is internalized, it can imitate a full, major mood disorder complete with suicidal ideation. The sudden change from feeling perfectly fine to feeling intensely sad that results from RSD is often misdiagnosed as rapid cycling BPD.

It can take a long time for physicians to recognize that these symptoms are caused by the sudden emotional changes associated with ADHD and rejection sensitivity, while all other object relations are totally normal.

When this emotional response is externalized, it looks like an impressive, instantaneous rage at the person or situation responsible for causing the pain. 50% of people who are assigned court-mandated anger-management treatment have previously unrecognized ADHD.

[Self-Test: Could You Have Rejection Sensitive Dysphoria?]

RSD can make people with ADHD anticipate rejection — even when it is anything but certain. This can make them vigilant about avoiding it, which can be misdiagnosed as social phobia. Social phobia is an intense anticipatory fear that you will embarrass or humiliate yourself in public, or that you will be scrutinized harshly by the outside world.

Rejection sensitivity is hard to tease apart. Often, people can’t find the words to describe its pain. They say it’s intense, awful, terrible, overwhelming. It is always triggered by the perceived or real loss of approval, love, or respect.

People with ADHD cope with this huge emotional elephant in two main ways, which are not mutually exclusive.

1. They become people pleasers. They scan every person they meet to figure out what that person admires and praises. Then, that’s the false self they present. Often this becomes such a dominating goal that they forget what they actually wanted from their own lives. They are too busy making sure other people aren’t displeased with them.

2. They stop trying. If there is the slightest possibility that a person might try something new and fail or fall short in front of anyone else, it’s just too painful and too risky to even consider. So, these people just don’t. These are the very bright, capable people who become the slackers of the world and do absolutely nothing with their lives because making any effort is so anxiety-provoking. They give up going on dates, applying for jobs, or speaking in meetings.

[Exaggerated Emotions: How and Why ADHD Triggers Intense Feelings]

Some people use the pain of RSD to find adaptations and overachieve. They constantly work to be the best at what they do. Or, they are driven to be above criticism/reproach. They lead admirable lives, but at what cost? They strive for perfection, which is never attainable, and are constantly driven to achieve more.

How to Treat RSD

Rejection sensitivity is part of ADHD. It’s neurologic and genetic. Early childhood trauma makes anything worse, but it does not cause RSD. Often, patients are comforted just to know there is a name for this feeling. It makes a difference knowing what it is, that they are not alone, and that almost 100% of people with ADHD experience rejection sensitivity. After hearing this diagnosis, they know it’s not their fault, that they are not damaged.

Psychotherapy does not particularly help patients with RSD because the emotions hit suddenly and completely overwhelm the mind and senses. It takes a while for someone with RSD to get back on his feet after an episode.

There are two possible medication solutions for RSD.

The simplest is to prescribe the alpha agonists guanfacine and clonidine together. These were originally designed as blood pressure medications. The optimal dose varies from half a milligram up to seven milligrams for guanfacine, and from a tenth of a milligram to five tenths of a milligram for clonidine. Within that dosage range, about one in three people feel relief from RSD. When that happens, the change is life altering. The treatment can make an even greater difference than a stimulant does to treat ADHD.

One study by Harvard University found that raising the dose of guanfacine to four milligrams and clonidine to seven or eight tenths of a milligram (above the dosage limits the FDA approves), achieved a 40% higher response rate. However, this comes with side effects that can include dry mouth, mild sedation, and sometimes orthostatis, or becoming dizzy when you stand up too quickly.

The second treatment is prescribing monoamine oxidase inhibitors (MAOI) off-label. This has traditionally been the treatment of choice for RSD among experienced clinicians. It can be dramatically effective for both the attention/impulsivity component of ADHD and the emotional component. Parnate (tranylcypromine) often works best, with the fewest side effects. Common side effects are low blood pressure, agitation, sedation, and confusion.

MAOIs were found to be as effective for ADHD as methylphenidate in one head-to-head trial conducted in the 1960s. They also produce very few side effects with true once-a-day dosing, are not a controlled substance (no abuse potential), come in inexpensive, high-quality generic versions, and are FDA-approved for both mood and anxiety disorders. The disadvantage is that patients must avoid foods that are aged instead of cooked, as well as first-line ADHD stimulant medications, all antidepressant medications, OTC cold, sinus, and hay fever medications, OTC cough remedies. Some forms of anesthesia can’t be administered.

[Free Download: Inattentive ADHD — Explained]

Dr. William Dodson is a member of ADDitude’s ADHD Specialist Panel.

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  1. I’d like to believe what’s written in the article, but I find it suspicious that the only one with any informative information on the topic is the author, whether it’s from this article, or from the website of the author’s practice.

    1. While I agree with you on his lone voice, and understand the place of skepticism in light of that, the fact that he explained my life without ever meeting me in this very short article trumps any doubt for me. He’s clearly a practitioner, not a researcher, and a brilliant one to be able to put this together through his own observation of his patients. I say that as someone with ADHD who read this and found more explanatory power than pretty much anything I’ve ever read on ADHD. Enough that I consider flying to Boulder and paying his consultation fee to get a bit of his time.
      If you have ADHD and this doesn’t resonate with you, try working it backwards. When you lash out at someone you love, consider whether maybe you were feeling something akin to “rejection”, suggestion of failure or not being good enough when you lashed out. When you find yourself depressed after a difficult experience, again, what was the trigger? When you withdraw or stop trying, ask yourself why? Or if you’re avoiding commitments or being pleasing to avoid disappointing other people, ask yourself why you might be doing that. In my experience, he was spot on. I hope that researchers will pick up on this and put it to the test. When someone like Dr Dodson says “nearly 100%” of patients have this symptom, the academics and researchers should listen, call him, inquire, and put together a decent study. But I guess when academic types here him say “I’m not a believer in the executive function theory… I don’t find it helpful,” they probably write him off, because they don’t have ADHD and they’ve never experienced the futility of finding a planning system “that works” 🙂

      1. I totally agree with you Dr Dodson absolutely has it figured out and has explained me better than I could have put into words myself. It’s depressing that both my psychiatrist and my kids paediatrician don’t know even a tiny bit of this stuff. I would pay $$ to see this doc if i could arrange it for my kids treatment I’m desperately trying to figure out how to not screw up my newly diagnosed kids treatment I don’t have mine under control even I’ve been medicated (sort of/subotimally) for years but only started really looking into this a couple years ago and I’ve learned so much from this site but dr Dodson especially

    2. Excellent comment. Extraordinary claims require extraordinary proof, and Dodson offers none.

      There are many explanations for what he idiosyncratically calls “RSD” and this pattern often responds to competent treatment for ADHD+

      The idea of recommending guanfacine, clonidine, and MAO inhibitors!! The special dietary limitations that MAO inhibitors pose make it a non-starter for most people with ADHD if their symptoms are not well managed.

      Gina Pera

      1. Gina,
        You will not find “official” studies about “Rejection Sensitive Dysphoria” because most, if not all of the research on ADHD is sponsored by the drug companies. Since the medications Dr. Dobson recommends are already on the market and do not cost nearly as much as the drugs used to treat ADHD, there is no interest by the pharmaceutical companies to do research.
        As for evidence that RSD is real, the fact that he actually listened to his patients for 25years and recorded their answers is evidence enough for me. Since you do not have ADHD yourself how can you be certain we as ADDers are making these feelings up? I have educated psychiatrist and psychologist about RSD and they have thanked me. The DSM-5 only looks at the symptoms of ADHD visible from the outside. Another place you will see rejection sensitivity is in the DSM-5 under severe depression and bipolar disorder so this is nothing new or made up. While the RSD differs from the rejection sensitivity found in these two disorders it is just as real. I trust Dr. Dodson’s instincts and experience and do not take his information lightly or feel misled. Please give the ADHD community more credit for being responsible enough to know the difference between internet click bait and real medical information. As for your poo-pooing the medications he recommends, the medical community has been using “off-label” approach for years for all kinds of conditions. Again, please give the ADD community credit for common sense and know that they will discuss any changes to their medication ritual with their medical provider.

        1. Agnes Green, before you attack someone publicly, you really should try to understand their position and to have your facts.

          You have done neither.

          Facts do matter.

          Dodson has quite irresponsibly convinced the online ADHD community—and by extension the plethora of amateur sites on ADHD+—that this Rejection Sensitivity Dysphoria is part and parcel of ADHD and then he guarantees the three medications he recommends will fix it. That is highly irresponsible.

          Experts, including myself, understand the full complexity of ADHD (especially late-diagnosis ADHD) and therefore the emotional dysregulation component of ADHD along with the “emotional baggage” that can accrue during years of no diagnosis, misdiagnosis, and/or poor treatment—including expecting to be rejected by the world.

          It is no state secret. It has been written about exhaustively, including in my own books and the chapter Dr. Russ Barkley asked me to write for his “gold standard” clinical guide.
          People who consume solid information on ADHD might read an article in an online consumer magazine by a physician who operates on the fringes and conclude: “Oh he understands me! He alone understands this!”

          That’s the problem with being poorly educated on ADHD and reading only online articles by self-promoters: One can be led astray. And that means the chances of finding appropriate treatment diminishes.

          What “sounds good” isn’t always true. The research done on RSD and ADHD has shown no increased presence of RSD: https://www.ncbi.nlm.nih.gov/pubmed/17242422

          Everyone in the ADHD community should be concerned about this. But online, opinions and understanding tends to be superficial and scattershot.

          To solve problems, we need to understand the nature of the problems. And that means being respectful of truth.

          1. To correct a typo.

            This: People who consume solid information on ADHD

            Should read: People who consume NO solid information on ADHD

          2. I really appreciate your comment and reminder to be careful with what we read. Is it your opinion that RSD doesn’t exist or that it is a separate disorder independent from ADHD? I’d like to learn more about these symptoms — what are the names of the books that you mentioned? Thank you

          3. Kady — sorry that I am just now seeing your response. Also, this interface won’t allow me to respond to you directly.

            You might want to read the comment I wrote to Ivan.

            thanks,
            Gina

          4. Gina – The doctor who wrote this article actually states that the medications he listed are “possibly” effective and that to the 1st two meds “guanfacine and clonidine”, only 1 in 3 respond. He does not state they are “guaranteed” to fix RSD. He also does not state that MAOI’s are a “slam dunk” and that the study for use was done in the 60’s. I find it interesting that you would misquote a doctor’s article to suit your own outlook/attitude/feelings/research on the subject of ADHD and RSD. When other “professionals” are not open to the comments/opinions/findings of other “professionals” we all lose out. It is the coming together of minds (practitioners and sufferers) that heals us all. There is always something to learn or to take away from each other on any subject, including a subject you feel you are a SME on. You couldn’t possibly know or understand all there is to know on this subject. You are only one person and I’m sure there are thousands (if not hundreds of thousands) of other voices that agree and/or disagree with your outlook/attitude/feeling/research on ADHD and RSD. And someone is not necessarily “working on the fringes” just because they have an opinion about RSD and ADHD that differs from yours.

            Using misquotes to try and get your own point across only causes you to lose credibility with your audience/readers. Well, I can’t really prove that, but I can agree that is how I think/feel after reading your rants. (I call them rants because of all the exclamation points you use in your comments. Like CAPS, it felt as though you were yelling.)

            As someone who suffers from ADHD finding an article about RSD and the symptoms associated with it were eye opening whether or not you can find RSD in the DSM-V (it got me to thinking that maybe I’m not introverted or a-social, but in fact have Rejection Sensitivity since I can agree with all 9 of the symptoms and I don’t agree with “all” the symptoms on any of my other diagnosis-es). Just because it isn’t there doesn’t mean it shouldn’t be. I’m sure if you look through the years of the DSM you find that it evolves (sometimes much too slowly for sufferers). Studies are being done every day, some that are long overdue. Being open to what Dr. Dodson is saying will open the doors to study so that others like yourself may or may not get on board. But knowing that his findings are from his observations with his patients lead me to believe that he is a caring doctor who wants his patients to succeed in life. I don’t believe his personal findings in his own practice are meant to mislead or confuse anyone.

            Every article/book on-line or published should be read with an open mind and not taken for gospel. If you find something that resonates with you, do your own research and of course discuss it over with people you trust, including your doctor.

            P.S. Here is a handout that was given at the annual CHADD conference in 2017 by Dr. Dodson. It gives more detail and sources for his thinking/information. I hope it benefits those that are open to hearing it.

            (http://www.chadd.org/portals/0/Content/CHADD/Conferences_Training/Annual_Conference/2017/handouts/TB01_%20Redefinding%20ADHD%20for%20the%20Rest%20of%20Us%20_%20William%20Dodson.pdf)

  2. Also bang on with my serious rage problem. After a bout of severe depression and hospitalization I was given Van la faxine a norepinephrine and serotonin reuptake inhibitor and the results over time have been spectacular. Primarily because they have removed the total fear of failure at times. Although i sang i was very reluctant to sing loud enough to be heard unless of course there were many others ..Being singled out for anything would result in that rejection induced rage. The times i raged at my wives were all because of that rejection fear. Thanks to the New SNRI i no longer feel that need to pounce. PS now i have the opposite problem singing too loud lol.

  3. As a youngster i vividly remember my brother approaching to show me how i was practice punting a football wrong. I left immediately to avoid the sheer humiliation of him zeoing in on my mistakes. In school i learned to channel the rage at the teacher when they would point out any of my mistakes . With a genius I Q and a family history of political involvement in some of our countries vital moments discussed regularly at the dinner table it was only too easy to point out their faux pas. No Noth America has more than three countries ( grade three) the answers to quadratic equations when he copied them wrong on the blackboard grade 11 two weeks before they expelled me for failure to do any homework. 8 older siblings and parents and not one of them brought home work. In my mind if it couldnt be done in school they should reduce the work or increase the time. I had no trouble finishing it in detention. In the real world work was not done at home.
    This however did not hinder me in the job market because i worked for those same family members in the real world from the age of 12. Every summer, spring break, and had no trouble getting jobs when i was 16. A week after school ended. And another after xmas when the first provd unable to earn a decent wage and again 9 months later when i joined the armed forces to continue my education in a foreign land (Montreal).

  4. This is me in a nutshell. I’m a people pleaser and then when I screw up, I stop trying. In 20 years of ADHD advice, treatment and research, I’ve NEVER heard of RSD. I’m going to talk to my Doc about it ASAP.

  5. I’ve tried to respond with links to other articles but they don’t display here. Maybe they have to be approved.

    Try googling ‘deficient emotional self-regulation (DESR)’. DESR describes similar symptoms to RSD and there are many scholarly articles available. Particularly see Surman or Barkley.

  6. I have a 4-year old who is not diagnosed but exhibits many characteristics of ADHD. There is no history of trauma and we have been very intentional not to use shaming or physical punishment as forms of discipline. I do notice a heightened sensitivity to correction and that often looks like rage. You mention medication as a way of addressing RSD but are there other things we can be doing to help my son with his socio-emotional development that takes RSD into consideration that does not involve medication?

    1. I would highly recommend implementing strategies from handinhandparenting.org and ahaparenting.org which out of all therapies and supplements have been the most successful over time for us. Be ready to put in the work and change your entire concept of parenting and behavior. But you will be rewarded with a much better relationship with your child in the long run. (Keep a journal to track progress over time so you can see the results of your awesome work). Best!

  7. Does anyone experience depression instead of rage, when rejection hits? I’ve heard depression is anger turned inward, and that would make sense.

    Most of the time I get sad and withdrawn, not outwardly angry. Which is also in line with people pleasing, even with giving up.

    Don’t offend or I’ll be rejected even more. Or somehow it’s all my fault, so who am I to get angry. Actually, that’s what really fits. How wimpy, irritating that sounds–to me! And I’m the one feeling it!

    The depression-not-rage thing is the only way this doesn’t entirely fit for me. Otherwise, it’s like someone took a look into my interior landscape and described it perfectly.

    1. Hi, Concentrate. I’m right there with ya!!
      I’ve never heard of this but it explains a “spell” I had last year… and why therapy and regular anti-depressants didn’t work!

    2. I have never been diagnosed, however the article fits me and I experience depression and anxiety attacks as a result. If I could get this diagnosed & treated so I do not feel like I’m going to die every time I need to ask for help my life could be so much better. I hate my job but I can’t get myself through the application/interview process without major meltdowns and I hate it so much. I am smart enough to get through college but I can’t function in the real world, I’ve been somewhat satisfied to hold down my job for the last 6 years but I could contribute so much more and be so much happier.

      1. Consider the strong possibility that you would be diagnosed as positive if you were to get in front of an appropriate clinician. This is the same place in the process that catches so many of us with ADHD and RSD. We do not want to even be rejected by those monitoring the rejection symptoms. Thankfully not everyone with our afflictions suffer the lack of following up and thru the process. I do.

        So recommendation: find that neuro typical or fellow ADHD’er and come clean. Share the situation and share the road block. Even having someone to be accountable to can serve as a motivation to power thru.

        It can be a powerful assistance. I found that person. You can too. Good luck.

  8. Yes I have turned the rage inward in one particular case.
    .My first comment up above mentioned being in hospital for a major depression. This occurred as my wife was packing to leave permanently and leaving boxes of her stuff in our dining room each weekend. 5 years before i had lost it and yelled at her and hung up on the doc she was trying to contact. ( i was going through a thyroid storm at the time and she was attempting to call for help. I was paranoid. She followed this by calling police to report domestic abuse. Even 10 years ago our police had a Zero tolerance policy and would evict you the first time and convict you on the second call.
    After this instead of flying into a rage I would turn silent and quit communicating. This tale spin ended up with me voluntarily admitting myself to the psych ward for a 2 week evaluation. And ultimately the major depression diagnosis and the Ven lafaxine prescription. Which have been so good for this. Ultimately the ADHD diagnosis Concerta and Ami trytilene added to the mix.

  9. Decades lost due to an ignorant Psychiatrist labeling me as BPD now the new Psychiatrist has come along to prove it was always ADD.

    Of course now, thanks to this illuminating article it’s clear I’m blessed with a generous helping of RSD.

    There is no doubt that “Sometimes Dead Is Better”

    1. Same here. Almost 30 years misdiagnosis and treatment. Gender bias? Who knows. I reported year after year my symptoms, still “depression/PTSD” diagnosis then morphed to “bipolar disorder” to possible “borderline personality disorder”… pump the brakes… this is my life. A quality of life none of the educated professionals would want for themselves or their own daughter’s. Somehow, they deemed the frustrated, futile existence I lived wad all I could hope for. I was “born that way”. Thankfully, I never, never, ever completely gave up on myself. 18 months ago, I was formally tested for ADHD. I did not believe ADHD to be applicable to me, or even “real”. I am learning to rebuild my life, forgive myself, and others. I have stopped looking to others to tell me who I am and/or show me how to live. The meds work, I am completely without friends or family, yet I have seen in small and increasing ways daily that I have never had a better chance than I do right now. “Retirement” age right around the corner and I am flat-broke, rejected, and homeless. Yet, “dead is better” cannot be the answer for me. I now know myself, my mind, and my heart. They all finally are synched up. Thank you, Additive for the life-line you offer me. xoxo

  10. Is external rage a definitive characteristic in the RSD evaluation? Specifically, for those who internalize rage and express restrained/discrete anger, but never outward rage, in conflict/rejection scenarios, would RSD still be a fitting descriptor?

  11. I would like to point out an obviousness. It’s not not how ADHD triggers RSD. By that framing of the problem, we are skipping past the real elephant in the room. We are STILL only treating the symptoms if we approach our issues with RSD playing a secondary role!!!

    Have we become so accustomed to our work-arounds that set-up the real stumbling block as a secondary issue! Please revisit your own preconceived notions. It is bad enough when our ‘health professionals’ feign ignorance at the relevance of RSD in our lives, please don’t buy into that pack of lies so quickly, like I did for most of my life.

    I tell kids all the time “stay in school, get a real job” because I believe it could be better for them. My lack of understanding what truly needed to be address for 16 years is appalling. No wonder why I stopped and restarted stimulants so many times. They never solved the problem for me, they did a great job of distracting me from the truth.

    Highly functioning, rejection sensitive craziness. A person once described herself to me as 37 kinds of crazy. But what happens if we can zero in on that one kind that is an under pinning. Might not change the world, but highly likely will dramatically change life for those of us built this way.

    Nearly 100% they say experience RSD? Doesn’t sound like anything close to a ‘secondary’ problem does it! Yes that was not a question.

    EESWANSON

  12. I must protest at Dodson’s—and Additude’s—relentless pairing of ADHD and RSD. Without the slightest bit of evidence.

    Moreover, Dodson over-confidently asserts “the cure” — Guanfacine, Clonidine, or MAO inhibitors!

    No citations. No evidence.

    Why is Additude giving this man free reign to spin his idiosyncratic theories? These theories spread through the Internet, serving only to further confuse people with ADHD and their loved ones.

    Don’t we have enough of that?

    Please be more responsible.

    Gina Pera

    1. I have taken both MAOI’s and stimulants (separately & together). The “dangers” concerning MAOI’s are ridiculously overblown. The fact you find them so terrifying shows how uneducated you are on this type of medication.
      I discontinued therapy with stimulants years ago and stuck with the MAOI as I found them far more effective in treating my ADHD & comorbid disorders. This has also allowed me to eliminate the need for several other medications as they address all my symptoms. The only side effect I experience is insomnia, which is easily managed with the occasional use of a hypnotic.
      Additionally, MAOI’s are not neurotoxic like amphetamine.
      There is already enough misinformation about this class of drug online, and people who can potentially benefit from MAOI’s do not need this uninformed scaremongering.

      Thanks.

  13. I’ve not been diagnosed with adult ADHD Ms Pera, but the things I’ve read on this site – including articles by Dr Dobson – have resonated more strongly with me than anything the medical community has come back with over the years.

    What hasn’t resonated at all are the medically trained naysayers who don’t have the condition themselves (whatever they consider said condition to be) and who’ve insisted on “evidence”, using this as the basis to poo-poo alternative ideas, all the while sounding like every other medical professional I’ve ever heard from – and Big Pharma.

    It’s not the need for “evidence” that’s prompted forum users to respond so favourably; it’s the resounding *resonance* of the explanations of symptoms which mirror users’ experiences that has done so.

    It leads to hope, where before there was none.

    1. Oh, and btw Ms/Dr. Pera; Agnes Green didn’t “attack” you at all in her post dated 13 July.

      She politely asked why you couldn’t give credence to x,y or z, and to give forum users some credit for being able to analyse their feelings and arrive at their own conclusions, rather than blindly following what they’re told by medics.

      The only “attacking” that I’ve felt has occurred has been from (as one would expect) those in the medical/pharmaceutical industry desperately trying to dissuade forum users from taking on board anything that could draw treatment options (= $) *away* from Big Pharma…

      1. Ivan, have you actually read Dodson’s piece here? And, have you read solid books by experts that describe this phenomenon but don’t reduce it to a catchy phrase and some off-label Rx?

        Do you realize Dodson argues that, basically, it’s a slam-dunk to treat this alleged “Rejection Sensitivity Dysphoria” with MAO inhibitors? Do you know what those are? You cannot eat many common foods when taking MAOI, due to severe interactions. (Guess what? People with ADHD forget!)

        Most responsible psychiatrists and other prescribers view MAOI as “last resort” and not at all for ADHD.

        So, your anti-pharma paranoia should be better placed in reaction to that than to legitimate treatments for ADHD.

        I understand that SENTIMENTS of what Dodson writes here might resonate for you. But ADHD experts have explained the same phenomenon, without giving it the wrong name that leads to the wrong treatments—and thus even more rejection and distress.

        What Dodson is “dumbing down” is a much more complex phenomenon — and one that nothing to do with the term “Rejection Sensitivity Dysphoria.” That is a term that only he (in the entire medical community) uses to describe the phenomenon vis a vis ADHD. But now every for-profit and many ADHD coaches’ website and bloggers state it as if it were established fact. It is NOT. It is Fake News.

        It is no state secret: Left untreated/unrecognized, ADHD can lead to social isolation, feeling misunderstood, rejected, and a failure. There are three compounding phases:

        phase 1:
        Folks grow up not knowing they have ADHD (or if they do, what it really means). All they know is that the world is treating them very unfairly.

        phase 2:
        In faction, these folks develop thoughts about this world and the people in it, the people who are so harsh and mean and unfair to them.

        phase 3:
        Those thoughts form their “worldviews” and inform their emotions. They stand ready to be hurt or angered by the next action of rejection, harsh judgment, or admonition. They expect it. Because it has happened so consistently.

        It’s horrible.

        One misses social cues. One loses track of the conversation. One feels embarrassed, ashamed. Friends’ likes and dislikes or important events aren’t remembered or asked about, so friends cut things off and sometimes in an angry way, born out of hurt.

        But these folks’ thoughts about the world are skewed by lack of knowledge about ADHD, their role in these poor outcomes, and, in many cases, lack of medical treatment that can help them better function and more realistically perceive the world as not being “entirely against them.”

        Caught up with one’s own distractions and difficulties, it can be impossible to put oneself in the shoes of another person and to understand why their negative reactions or criticisms are justified. And how to make positive changes that will minimize rejection.

        Folks with untreated/unrecognized ADHD can go through life never knowing when they will slip on that imaginary banana peel. Despite the best of intentions, they find themselves the subject of criticism and tongue-lashings for their failure to remember, follow-through, show signs of caring, etc.. It’s a “high anxiety” way to go through life. “Rejection sensitive” doesn’t begin to describe it…or to describe the way out.

        Higher-order brain functions can be hampered. That includes emotional regulation, which can cause outsized responses to reactions from others, including perceived rejections. But also empathy. So, while some folks with ADHD might think they feel great empathy, they might fail to understand: They do not show it with actions and words. In fact, they might show the opposite: self-centeredness and “it’s all about me.”

        But some, in fact, don’t feel much empathy at all. It’s a dopamine thing (see link below). Low empathy can lead to a narcissistic self-involvement, where there is little concern about the impact of their behavior on others. They are always the victim. No matter what. They might make a giant mess at work or catch the house on fire but as long as their intentions were good, they feel they are treated unfairly if anyone criticizes. Again, they don’t have an objective perspective on their problematic behaviors: They grew up with ADHD and know nothing different.

        https://adhdrollercoaster.org/adhd-and-relationships/adhd-impaired-empathy-and-dopamine/

        With treatment, more “connections” are made between cause and effect. Between the behaviors required for good friendships and other relationships and the ability to display those behaviors. Between the ability to feel only one’s own emotions and empathizing with another person who has grievances against you.

        With increased empathy, the person sees that what might have previously been viewed as a “rejection” is actually more complicated.

        This is a quick attempt to explain the problem with this dangerous over-proliferation of “Rejection Sensitivity Dysphoria” as being something apart from ADHD, something that is treated differently. I write about this more extensively in my first book (Is It You, Me, or Adult A.D.D.?), including perspectives from ADHD luminaries such as Dr. Robert Brooks and Dr. J. Russell Ramsay.

        1. Rationalizing Rejection Sensitivity Dysphoria with logic and reason is great. So we have just made ourselves sensitive? So what I just read makes me think that the writer thinks we can make ourselves feel better by understanding that we really are not dealing with RSD but our own perception. That’s a load off (tongue in cheek). If those of us with these borderline severe cases could ‘work around’ our difficult to bear situations we would have. We tend to be bright people with creative solutions dealing with these things that are so often front and center.

          Glad for you that you can get such a good handle on it for yourself. This not always such an easy thing for some of us. We need help or we will go to great lengths to add to our distractability and really get ourself twisted up in a knot so we do not need to feel rejection (real or imagined). Imagine being born without an epidermis. That is an extreme example but no less applicable. When a person feels like that then great pains will be taken to avoid bumping into items that will cause such feelings.

          Who cares if there are numerous contributing factors and that we heighten the situation ourselves or not. Perception becomes the reality.

          So many want to beat up the few people that talk about RSD as a real thing. Hats off to them that they are taking a stand to describe something that is huge and extremely wide spread. Once there were few if any that talked about ADHD yet that is a reality too.

          If we can rationalize away RSD could we not rationalize away our varied situations with ADHD. Of course we can not, leaving RSD still an issue to be dealt with.

        2. Bill Dobson is a board certified psychiatrist and specializes in treating adults with ADHD for over three decades in his own clinic. Dr. Dobson’s description of RSD is his medical opinion based on practical, real life clinical experience.

          Gina Pera writes a blog, claims to be a journalist, gives talks, and admits to having no degrees that will quality her to diagnose or treat people with ADHD. She is an expert on her own opinion.

          I think I will listen to Dr. Dobson on this one.

  14. Hi, I’m Dave,from Ireland, 55 years old and sole parent to 3 still quite young ones…

    Last year my youngest son Adam, still 8 yrs old now, was diagnosed with ADHD. I spent most of last year researching ADHD and therapies, will I medicate, what is the best response.

    Like many adults/parents,I discovered what was “wrong” with me all my life, quite by accident and after hundreds of hours of research and reading all the usual Bestseller AHDH books… I had a eureka moment last December 2017 when I read about adults diagnosed as ADHD.. Like most I spent a month or two in tears of relief and regret. Relief and delight mostly. All the books dealt with the typical old story narrative of ADHD as a young male toddlers illness. In all cases they were magically cured after reaching their 18th birthday and girls just didn’t suffer from the same illness.

    Every single sentence, every single word, every single fullstop in every article by Dr Dodson, in particular, described me … Symptoms I would never in a million years have uttered to a doctor or psychiatrist as being my problems, as they were too weird, too subtle, too off the wall, but to me they were crippling, they were me… and I was a one off.

    I had the usual hyperfocus ( I called it getting in the zone, with a few drinks to get work done up to and including patent applications), zoning out ( my buddies knew I just needed a few minutes to zone out – I was happy out but needed time out – overloaded I was ), the constant simultaneous thoughts in my brain from before I opened my eyes in the morning to… I guess while I was sleeping ( I never slept more than 4/5 hours in my life and mostly blocks of 1-2 hours), the staring at people I’m talking to and being in a different world and being able to jump back enough to their talking that I could fool them that I was actually listening – I was away – far far away mostly and sometimes I’d look quickly somewhere else as I’d just notice a tarpaulin flapping on a truck a 1/4 of a mile away…

    My memory is shocking, I think lately that is’s because if you had 4 or 5 or 20 thoughts non stop and simultaneously, all your life… which one would your brain remember as being the thought for that one moment ? The name of the person you talked to for an hour and what they said and their story… or one of the very real things you were simultaneously thinking about – which one is what you were doing just then ? Which one does your brain chose ?

    Exhausting, these “normal” symptoms of ADHD, and as an undiagnosed adult living these 2 lives, the responsible one who must behave “normally” despite the screaming boredom of doing so, the genuinely very social (and seen as a very social, smart funny guy) but who craves isolation to recover, the not understanding people and why they are so rules based and seem to love these rules – what’s wrong with them ??? 🙂

    The utter kindness of ADHD, the empathy of ADHD, the love and minding of loved ones of those of us with ADHD… the absolute and overwhelming overload of thoughts and emotions of those with ADHD which cripple us, drown us, shake our heads like dogs trying to get the multiple thought out, to reduce them to one, to find calm and focus, ….. We so want to help with our kindness, our empathy and in many cases our amazing gift of insight and problem solving.

    So, Dr Dodson… every word he writes is gold.

    Fullstop.

    1. Typical ADHD, I actually forgot to elaborate on the emotional sensitivity, the rejection sensitive dysphoria ….. well, seriously these are some of those “things” I would never have thought to mention to a doctor or psychiatrist (and I didn’t and like many undiagnosed ADHD I was at one time diagnosed by a psychiatrist with Atypical Depression, in other words – no known cause, well it was ADHD and RSD and mild Aspergers and SPD, mainly the first 2 though 🙂 ).

      RSD is real, oh so real (surreal 🙂 ), sorry, I’ve felt it all my life, I’ve been that people pleaser and sometimes the tough f u but only when I could not do anymore, I’ve felt it, I felt it when it was not real, I anticipated it just to be sure I wouldn’t be blindsided by it, it is a life changer, it is horrible, it is crippling.

      Emotional sensitivity for me was always about … empathy (good but time consuming and probably related to emotional sensitivity and constantly scanning for potential problems that I should be aware of but normal people aren’t and sometimes being totally wrong as I read into something that wasn’t there – you either get this or you don’t), scanning for potential rejection, scanning for non agreement and trying to negotiate an agreement – nonsense I know now, ramping up emotionally on the suspicion or incorrect reading of a response as being an attack.. often.. strike that, 99% just a normal comment, sometimes a difference of opinion.

      Intense emotions, rejection sensitive dysphoria etc are very real and debilatating symptoms of ADHD

      1. I would also comment that if someone does not have ADHD, then they have never experienced ADHD, they have never experienced RSD. I would have no idea why they would be here exclusively to disagree with those of us who do.. why would someone do that ? What is their gain ? Is it attention seeking ? It seems such an unlikely disagreement that someone with ADHD might also have RSD… these should be just random letters to one who has neither – I suspect a troll, a hidden agenda, an undiagnosed case. I would ask that they exit and join another forum.

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