Imagine a nail jabbing at a shiny blue balloon.
Pop!
That’s what rejection can feel like for someone with attention deficit hyperactivity disorder, one TikTok creator told his audience: an explosion of emotions.
The clip, which has nearly 300,000 likes, is one of thousands of posts about “rejection sensitive dysphoria,” or R.S.D.
The term is rarely used by clinicians. You won’t find it in the manual to diagnose and classify mental health conditions. But references to R.S.D. have percolated online, especially on social media.
And for some people with A.D.H.D., the concept hits home.
What is rejection sensitive dysphoria?
R.S.D. describes an intense emotional reaction to rejection, teasing, criticism or the perception that you have failed.
Erin Ryder, 24, a teacher in the metro Detroit area with A.D.H.D, said that R.S.D. gave a name to the “extremely emotional” way she reacted to feeling dismissed.
“I just immediately go to: ‘This is the end of the world,’” she said.
When her boyfriend recently asked to postpone their plans after a long workweek, she said, negative thoughts flooded her brain and she obsessed over why he had canceled. Later, she realized her response was over the top. But in the moment, she said, “I just flipped.”
Where did the term come from?
Rejection sensitive dysphoria was popularized by Dr. Bill Dodson, a psychiatrist who spent his career treating people with A.D.H.D — but he clarified that he didn’t coin the phrase.
“Believe me,” he said. “I would not have come up with such a terrible, tongue-twisting name.”
He borrowed the term from older literature on atypical depression and adapted it to describe a phenomenon that he says he has observed in thousands of his patients.
Dr. Dodson first publicly discussed R.S.D. at a 2010 A.D.H.D. conference. Since then he has created 12 criteria to define R.S.D., chatted about the concept on podcasts and written about it extensively.
What’s the difference between R.S.D. and rejection sensitivity?
Rejection sensitivity is the tendency to overreact to perceived criticism.
It is most associated with mood disorders and personality disorders, said Dr. Erick Messias, the chair of the department of psychiatry and behavioral neurosciences at the Saint Louis University School of Medicine. Rejection sensitivity may also surface after trauma, he added.
Dr. Dodson believes that R.S.D. is distinct from rejection sensitivity, based on his decades of clinical experience, and also that it is an issue specific to patients with A.D.H.D.
With R.S.D., Dr. Dodson says, someone isn’t just sensitive to perceived criticism, they are also highly critical of themselves because they believe they have fallen short.
In addition, when they are teased, criticized or rejected, their mood changes “instantaneously,” he said, and they will suddenly feel depressed or full of rage. This is where the word “dysphoria” comes in, meaning a state of feeling very unhappy, uneasy or dissatisfied.
What do other clinicians think?
Although Dr. Dodson’s ideas have become popular online, some mental health professionals remain skeptical. But even experts who doubt the term aren’t surprised that some patients with A.D.H.D. identify with it.
Dr. Max Wiznitzer, a pediatric neurologist at Rainbow Babies and Children’s Hospital in Cleveland, noted that people with A.D.H.D. are often diagnosed with mood disorders — and they are also prone to symptoms like outsized emotional reactions.
And other clinicians, like Lindsay Blass, a psychologist in Westport, Conn., said they saw value in the phrase because it expressed just how gutting criticism can be for some people.
“You’re not just disappointed,” Dr. Blass said. “You’re devastated. And other people don’t necessarily understand why it’s that intense.”
To avoid the hurt, Dr. Dodson said his patients with R.S.D. often become perfectionists, people pleasers or overly risk averse. “People will arrange their entire being around preventing that pain,” he explained.
What can you do to ease rejection sensitivity?
There is no established pharmaceutical treatment for rejection sensitivity. Dr. Dodson said when his patients appeared to have R.S.D., he often prescribed drugs known to reduce anxiety — but that they didn’t work for everyone.
Therapy has been shown to help. Here are some expert-backed coping strategies for anyone who is especially troubled by rejection.
Acknowledge your sensitivity: Simply reminding yourself that you tend to react strongly to perceived rejection can be a good way to gain perspective. You may see that your interpretation of a situation isn’t grounded in the facts.
Consider exposure therapy: If you find yourself avoiding certain experiences because of a fear of rejection, you can work with a therapist to gradually expose yourself to the things you find uncomfortable, and build your confidence along the way, said Dr. David W. Goodman, an assistant professor of psychiatry at the Johns Hopkins School of Medicine.
Give the benefit of the doubt: The person you’re speaking with might not have negative intentions. Sometimes it can help to seek clarity. Dr. Blass recommended saying something like: “I know I have a tendency to assume the worst, but things feel a little off and I’d like to figure out what’s going on.”
“It’s not necessarily that they’re out to get you,” she said.
