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ADHD

ADHD and Rejection Sensitivity Dysphoria

How to overcome the pain of criticism and finally feel good enough.

Key points

  • Rejection sensitivity dysphoria (RSD) is a common condition co-existing with ADHD.
  • Those with RSD are extremely sensitive to criticism, often holding on to negative words or actions made towards them for months, or even years.
  • An ADHD-RSD combination is difficult to overcome, but some strategies include focusing on one's strengths and practicing self-compassion.

Do you ever feel so devastated by the criticism from a friend, teacher, boss, relative, or co-worker that you keep repeating what they said to you over and over? Is it really tough for you to rebound after feeling left out by your friends or saying something you regret?

You, like many other emerging adults, may struggle with rejection sensitivity dysphoria (RSD), a common condition co-existing with ADHD but not a formal diagnostic category.

Rejection sensitivity dysphoria refers to intense feelings related to the belief that you’ve let other people down, embarrassed yourself, failed at something, or made a serious, unfixable mistake and, as a result, people pull back their support, love, or respect. RSD causes extreme emotional pain that plagues both children and adults — even when no actual rejection has taken place.

People with RSD struggle with letting go of past hurts and/or rejections and experience heightened emotional sensitivity. They may hold onto unkind words or actions directed towards them for months or years.

If you have RSD, you just can’t seem to shake off critical comments from others and believe at some level that you deserve them. You think you’ve fallen short and, with your exquisite sensitivity, no matter what anyone else says, you just can’t bounce back. It’s especially tough to recover from personal criticism or rejection.

Because many older teens and adults with ADHD may already experience a feeling of otherness, they often already feel like they are at a disadvantage and often internalize negative voices. Living daily in this one-down position intensifies RSD and exacerbates shame.

Identifying rejection sensitivity dysphoria

Signs of RSD include:

  • Struggle with low self-worth or self-esteem
  • Easily embarrassed or ashamed
  • Quick to anger or blow up when perceiving a rejection or getting hurt by someone
  • Sets high expectations that are difficult to meet
  • Experiences social anxiety and relationship challenges
  • Sees themselves as a failure when they disappoint others
  • May consider self-harming behaviors
  • Anticipate rejection in new situations

In a society that is overly focused on social media where we can compare ourselves to others 24/7, people with ADHD frequently judge themselves and come up short. With the ADHD-RSD combination, your negative thinking combines with exquisite sensitivity to make it harder to bounce back and stay resilient.

Reducing the effects of rejection sensitivity dysphoria

Here are five tips to help you work with rejection sensitivity and reduce its tumultuous effects, whether you need a little reassurance or you're helping a friend or loved one who is struggling.

1. Reinforce strengths.

What everyone needs to remember is that simply having RSD does not make you a human who is weak or incapable. You are just wired to feel things more intensely and replay unpleasant interpersonal interactions over and over. RSD is linked to social insecurity.

A helpful tip is to consistently nurture your strengths and focus as much as possible on what you love to do and what you do well. Pay attention to your positive efforts: Write down three good (or good enough) things that happened each day before bed. This will help you see things from a new perspective and shift from negative self-talk.

2. QTIP — Quit Taking It Personally!

Many older teens and emerging adults with ADHD struggle to separate when a statement is directed specifically at them or when it's something more general. You take things personally that may not be personal.

Practice taking a pause before responding to a question or answer by saying "That's a good question/comment. Let me think about it." Or ask for some time after an unpleasant interaction by saying, “I’ll get back to you about this.” Then you can better assess what's being said.

Remind yourself that other people can say thoughtless or hurtful things sometimes which are more about them than you. Consider the source of the statement. Plus you may perceive a rejection that’s not there or is unintentional. Check things out before coming to a conclusion, maybe by asking a neutral person if they heard what you did.

3. Manage big feelings effectively.

Ivanko_Brnjakovic/iStock photo ID:1249336570
Source: Ivanko_Brnjakovic/iStock photo ID:1249336570

Folks with ADHD struggle with emotional regulation — the ability to cope effectively with the tidal waves of big feelings inside. Intense anger, hurt, and sadness frequently accompany RSD and, in combination with ADHD, increase volatility. You may lash out at others or you might withdraw for periods of time. Either way, these reactions can be harmful over extended periods of time.

Use my action plan called "Stop, Think, Act" to create and apply effective coping strategies. Pre-arranged tools such as time apart, relaxation techniques, or other healthy self-soothing activities like going for a run, doing yoga, listening to music, or talking with a friend are the best way for dealing with overwhelming emotions.

4. Treat yourself with compassion.

It can be extremely difficult to live with RSD and ADHD. You’re wired more sensitively and you feel things deeply. Your inner critic is probably very active. It takes a painful situation or someone’s unkind words and magnifies and repeats them. You may get into an overfocus loop and drop into a shame spiral, unable to forgive yourself for your role in whatever happened.

Practice self-compassion. We all make mistakes and learning from them is how we grow. When things don’t go the way you’ve hoped, take the time you need to regroup. Talk to and treat yourself the way you would approach a third-grader with a skinned knee instead of scolding.

It may seem corny but having a few phrases to counter those negative thoughts reduces their power. Learning to soothe yourself without shame is the key to resilience when living with ADHD and RSD.

5. Plan and post positive self-talk phrases.

Positive self-talk is critical for building confidence and quieting your inner critic. Developing a few self-statements of encouragement (affirmations) will assist you in reducing all that noise. Initially, pay less attention to solving a problem and concentrate more on supporting yourself.

Take a few minutes now and brainstorm some ideas for positive self-talk phrases. Write them down and post these on your bathroom mirror, on the dashboard of your car, on your computer, and in a note on your phone. One a day, preferably in the morning, read your Post-its or set an alert on your phone to do this to check them when you’re eating breakfast. Starting your day with self-compassion can remind you of who you really are and protect you when feelings of doubt creep in.

Natalya Sambulova/iStock photo ID:1215170133
Source: Natalya Sambulova/iStock photo ID:1215170133

Some ideas for these phrases might be:

  • "I'm stronger than I think."
  • "My mind is uniquely wired and creative."
  • "I can make a mistake and be a good person."
  • "I can get hurt and bounce back.”

People with ADHD and RSD need to feel the loving presence of caring friends and family. Surround yourself with these folks and spend time with them. You don’t need a posse: A few dependable allies works just fine. You can practice your social skills in a safe context, increase your self-esteem and learn to enjoy connecting with others. Most of all, you’ll nurture your resilience.

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