The Party Pooper: Thoughts on Rejection Sensitivity

When I first read about rejection-sensitive dysphoria and ADHD, it was like I suddenly found a missing piece of the puzzle in the cushions of my mind’s sofa.

Dr. William Dodson coined the term:

Rejection sensitive dysphoria (RSD) is extreme emotional sensitivity and pain triggered by the perception that a person has been rejected or criticized by important people in their life. It may also be triggered by a sense of falling short—failing to meet their own high standards or others’ expectations.

For me, it explained a lifetime of increasingly intense reactions to rejection, both perceived and quite real, as well as the fear of it happening again. Rejection sensitivity makes it difficult to develop new friendships or romances. It can make criticism of our work, professional or personal, utterly unbearable. And often, it all turns back in on ourselves and our perceived shortcomings.

We’re all social creatures to a greater or lesser extent. Some of us need time to recharge after social engagements, but we still crave community. And some of us just plain suck at intermingling with neurotypical folks.

Yet, we keep trying. We keep striving to make friends or find love. And some of those relationships fail, so we fall back into a pit of despair and self-recrimination.

It’s like there’s a tree with the sweetest, juiciest, golden apples we’ve ever tasted, but it’s surrounded by an electric fence. Of course we’re going to try and get to those apples. We may even create ways to get over the fence safely. But of course, we’re still going to occasionally get shocked.

Sadly, many people eventually stop caring about the golden apples because they get sick and tired of being shocked.

That is the real tragedy.

Photo of a Golden Delicious apple tree, although, in my mind's eye, I wanted them to be actual golden apples. Not solid gold, mind you. Just shimmering, golden skin. These are just yellow. Bo-ring.
Keep reaching. They’re worth it.

It’s critical that people who are rejection sensitive not give up on relationships. Friendship and love are vital for our emotional well-being. We all deserve loving, healthy relationships. And not just because they make life brighter; social relationships can affect your physical health. It’s part of the social determinants of health.

If RSD is real, then it’s the greatest obstacle for people with ADHD to finding meaningful relationships. Dr. Dodson’s definition of RSD is something I’ve personally experienced, so I wanted to understand it better.

But to my surprise I cannot find any peer-reviewed research on RSD.

In my search, I did find three articles specifically about ADHD and rejection sensitivity (if anyone has better luck, please let me know). I’ll share everything I’ve found in the next post because those three studies are fascinating and shine some light on Dr. Dodson’s concept.

But RSD does not seem to be have been studied at all.

The reason I want to focus on the research is that, although RSD seems to be a genuine phenomenon among people with ADHD, there’s isn’t much research on what causes it or how it can be effectively treated clinically.

At this point, it’s important to take stock of what we actually know. Otherwise, unfounded claims find their way into common discourse. For instance, while researching on RSD, I came across a dissertation that includes the following:

Screenshot from a dissertation that claims "Nearly everyone with ADHD suffers from some form or level of Rejection Sensitive Dysphoria" and includes a references to Matteson. This is followed by the definition previously provided of RSD.

Does “nearly everyone” with ADHD suffer from RSD? Maybe. Maybe not. I’ve read references to how ADHD is both heterogeneous and is on a spectrum like autism. How many people do or don’t have rejection sensitivity is completely unknown.

But the dissertation includes a reference to Matteson, which leads to this article on RSD. That article includes five sources, of which three are Dr. Dodson and two are not about ADHD.

A list of Sources which include three articles by Dr. Dodson about ADHD and/or rejection sensitive dysphoria. Another one is titled "Rejection Sensitivity, Irrational Jealousy, and Impact on Relationships" and the last is "Rejection sensitivity and symptom severity in patients with borderline personality disorder."

Other searches reveal similar circular references.

And if you just Google the term, you’ll find numerous examples of thinly sourced or unsourced claims regarding RSD, including WebMD, which includes authoritative declarations without a single reference. For example:

Screenshot of WebMD with the subheader "How Is RSD Treated?" It first suggests two brands of drugs: Intuniv and Kapvay, which are for lowering blood pressure. It also says "Therapy can help with other symptoms of ADHD, but it doesn't do much for RSD." Finally, it recommends stress management, eating right, sleeping well, and yoga or meditation.

I’m not going to link to it, but this is WebMD, one of the top sources that pops up when you search for rejection-sensitive dysphoria. And it’s based on … what?

Now, could this advice help? Maybe. But in response to the self-reported anguish of RSD-like symptoms, we need answers, not best guesses. What happens when someone is eating right, sleeping well, doing yoga and meditating when some major, unexpected rejection happens and they’re still left in the shadows? Who do you blame? WebMD?

No, you blame yourself.

And deciding to start a new drug therapy is an important decision, especially using ones intended to lower your blood pressure. I’m not a doctor, so if it’s standard practice to recommend off-label uses for unresearched syndromes, then I’m deeply interested in understanding the process better, since this impacts me personally.

Until then, it seems a little reckless to give medical advice with such limited understanding.

The earliest reference I could find to RSD on the internet was from this 2006 article in Psychiatric Times and it’s by Dr. Dodson. The article is about office-based interventions for ADHD, but RSD is mentioned in a discussion of how practitioners should approach assessing employees with ADHD. He includes tips for not triggering RSD by having a friendly and welcoming staff that will “offer soft drinks and snacks in a relaxed and informal settings.”

I wholeheartedly agree. If you want me at my best, please offer me drinks and snacks in a relaxed and informal setting.

Fiji, perhaps?

Photo of a hammock between two palm trees on the beach in, what I am led to believe, is Fiji.

What caught my eye about this section, though, is how Dr. Dodson describes the resulting response to rejection as “affective storms.”

First, I had to look up what “affective” means.

Once again, Dr. Dodson’s description rings true with my experience. I’ve most definitely experienced affective storms in response to rejection throughout my life, just a dedicated dark cloud of intense despair. Oddly, Veronica (my wife) says that when I get upset about something it’s like a dark cloud crosses my face.

I believe that recognizing this phenomenon is important; simply knowing that I share RSD symptoms with so many people who have ADHD matters. It makes me feel less like an emotional freak. There’s something there, we just need more research to understand it better.

I honestly don’t know what to make of the fact that Dr. Dodson has recognized RSD as early as 2006, yet there’s such a paucity of research and data on it. But the cautious optimist in me (who frequently does battle with my inner cynic), believes that the accuracy with which he describes our experience tells me that he’s simply ahead of his time.

Does that mean there’s nothing we can do about RSD? Absolutely not!

Although little is known scientifically, if you’re looking for sage advice on how to deal with RSD, once again, Rene Brooks has a great post for you. Also, I have found it incredibly comforting to find other people with ADHD who share our eerily common history, like on the Twitter machine.

In my view, the most important thing about RSD is that it’s finally being recognized by those with ADHD as something that reflects a painful part of our experience. And this leaves us many, many questions we should continue asking.

Is RSD inherent to ADHD? Is it a result of frequent rejection? Is it both nature and nurture collaborating on a toxic feedback loop? Do other rejection-sensitive groups (I’m looking at you, autistic fam) experience RSD?

In my search to know what we actually know about ADHD and rejection sensitivity, I spent some time digging through a bunch of existing research on rejection sensitivity and secondary issues (positive illusory bias!). There’s more and less than you might imagine.

My next post will focus largely on the three papers that have looked most closely at rejection sensitivity and ADHD. The results are fascinating.

The Rejection Sensitivity Series:


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