Living with ADHD: Understanding Rejection Sensitivity

Written by Dr Kaleem Baig, Consultant Psychiatrist at UMID Healthcare.

If you or someone you care for has Attention Deficit Hyperactivity Disorder (ADHD), you might have noticed that it's not just about struggling to pay attention or feeling fidgety. There's often an emotional side to ADHD that can be really tough to deal with, and it's something that doesn't always get the attention it deserves. One of the trickiest bits is something called Rejection Sensitive Dysphoria, or RSD for short. Don't worry if you've never heard of it before – we're going to break it down for you and explore how it relates to ADHD.

What's RSD when it's at home?

Imagine feeling absolutely crushed when you think someone's criticised you or given you the cold shoulder. That's RSD in a nutshell. It's like your emotions are turned up to eleven, and even the smallest hint of rejection feels like a punch to the gut. People who experience RSD often say it's like being in emotional agony or feeling stabbed in the heart. Sounds a bit dramatic, doesn't it? But for those going through it, it's all too real and can have a massive impact on their day-to-day life.

The word 'dysphoria' comes from Greek and means 'hard to bear', which is spot on when you think about how overwhelming these feelings can be. It's not just about feeling a bit down or upset – it's an intense, all-consuming emotional response that can be triggered by even the tiniest perceived slight or criticism.

How does RSD tie in with ADHD?

Now, you won't find RSD listed in the official diagnostic manual for ADHD, but doctors and researchers reckon it's a common part of the ADHD experience. It's like an unofficial symptom that many people with ADHD know all too well. Here's why RSD and ADHD often go hand in hand:

1. Brain wiring: ADHD brains are a bit different, especially in the areas that help manage emotions. The prefrontal cortex, which is like the brain's control centre, doesn't always work in the same way as in people without ADHD. This can make it harder to keep feelings in check, especially when things get stressful or socially challenging.
2. Social antenna on overdrive: People with ADHD often pick up on social cues more intensely. It's like having a super-sensitive radar for what others think of you – which can be exhausting! This heightened sensitivity means you might be more likely to notice (or think you notice) when someone's not happy with you, even if that's not actually the case.
3. It's really common: Studies suggest that almost all adults with ADHD struggle with managing their emotions to some degree, with about a third experiencing severe RSD symptoms. That's a lot of people feeling these intense emotions on a regular basis!

How many people are we talking about?

While exact numbers are a bit tricky to pin down (after all, RSD isn't an official diagnosis), research suggests that between 30% and 50% of folks with ADHD deal with significant RSD symptoms. That's potentially millions of people worldwide feeling these intense emotions! It's worth noting that the numbers might vary depending on things like age, other mental health conditions, and how severe someone's ADHD symptoms are.

When RSD meets other mental health challenges

RSD doesn't always come alone. It can often show up alongside or even contribute to other mental health issues. It's like a domino effect – the intense emotions from RSD can set off a chain reaction, affecting other areas of your mental health:

• Depression and anxiety: The constant emotional rollercoaster of RSD can leave you feeling down or on edge. Imagine feeling like you're constantly walking on eggshells, worried about upsetting someone or being rejected. Over time, this can wear you down and potentially lead to depression or anxiety.
• Social anxiety: RSD might make you want to avoid social situations altogether, just to dodge potential rejection. You might find yourself turning down invitations or avoiding new experiences because the fear of rejection feels too overwhelming.
• Borderline Personality Disorder (BPD): While they're different things, RSD and BPD can look similar in some ways, especially when it comes to fear of rejection and intense emotional responses. It's important to get a proper diagnosis if you're concerned, as the treatments can be quite different.

Can RSD be treated?

The good news is that there are ways to manage RSD, even if it's not officially recognised as a separate condition. Here's what might help:

1. Medication: ADHD meds can help take the edge off emotional reactions. They work by balancing out the chemicals in your brain, which can help you feel more in control of your emotions.
2. Talking therapies: Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT) and other similar approaches can teach you tricks to cope with intense emotions and challenge negative thought patterns. It's like learning to be your own emotional detective, figuring out what triggers your RSD and how to handle it.
3. Mindfulness and relaxation: Learning to be more aware of your emotions and practising relaxation techniques can help you stay calmer in tricky situations. This might involve things like meditation, deep breathing exercises, or even just taking a moment to check in with yourself regularly.

Does RSD affect everyone the same way?

Interestingly, RSD might show up differently depending on whether you're a bloke or a lady. Of course, everyone's different, so these aren't hard and fast rules, but here's what research suggests:

• Women might be more likely to turn their feelings inward, leading to feelings of not being good enough. They might ruminate more on perceived failures or rejections, which can contribute to feelings of low self-esteem or depression.
• Men might be more prone to expressing RSD through anger or aggression. This doesn't mean they're feeling the rejection any less intensely – it's just that society often expects men to express their emotions differently, which can lead to these more outward displays.

It's important to remember that these are general trends, and individuals may experience RSD in their own unique way, regardless of gender.

Practical tips for managing RSD

If you're dealing with RSD, or supporting someone who is, here are some things that might help:

1. Get to know your emotions: Keep a diary or talk to someone you trust about how you're feeling. Understanding your emotions is the first step to managing them. Try to notice patterns – are there certain situations or times of day when your RSD tends to flare up?
2. Build your emotional toolkit: Learn some coping strategies like deep breathing, positive self-talk, or grounding techniques. These can be lifesavers when emotions run high. It might feel a bit silly at first, but practising these techniques when you're calm can help them become second nature when you really need them.
3. Find your tribe: Surround yourself with supportive people who get what you're going through. Consider joining a support group for people with ADHD. Sharing experiences with others who understand can be incredibly validating and help you feel less alone.
4. Challenge those negative thoughts: When you catch yourself assuming the worst, try to look at the situation from a different angle. Is there another explanation for what happened? Remember, our brains can play tricks on us, especially when RSD is involved.
5. Talk it out: Be open with your loved ones, doctors, or therapists about how RSD affects you. The more they understand, the better they can support you. Don't be afraid to educate them about RSD – many people, even some healthcare professionals, might not be familiar with it.
6. Practice self-compassion: Be kind to yourself. Living with RSD isn't easy, and beating yourself up over your emotional responses won't help. Try to treat yourself with the same kindness you'd show a good friend.
7. Set realistic expectations: Remember that managing RSD is a process. There will be good days and bad days. Celebrate the small victories and don't be too hard on yourself when things don't go to plan.

Remember...

Living with RSD can be tough, but you're not alone. Lots of people with ADHD go through similar experiences. Be patient with yourself, seek support when you need it, and don't be afraid to explore different treatment options. With the right tools and support, you can learn to manage RSD and not let it hold you back.

It's also worth remembering that while RSD can feel overwhelming, it's just one part of the complex and often brilliant ADHD brain. Many people with ADHD are incredibly creative, empathetic, and passionate – traits that can be incredibly valuable, even if they sometimes come with emotional challenges.

If you're a carer for someone with ADHD and RSD, your support and understanding can make a world of difference. By learning about RSD and how it affects your loved one, you're already taking a huge step in the right direction. Remember to take care of yourself too – supporting someone with RSD can be emotionally demanding, and it's important to look after your own wellbeing as well.

With increased awareness, ongoing research, and a supportive community, we're learning more about RSD and how to manage it every day. So hang in there – things can and do get better!

References

1. Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion Dysregulation in Attention Deficit Hyperactivity Disorder. American Journal of Psychiatry, 171(3), 276-293.
2. Barkley, R. A. (2015). Emotional Dysregulation is a Core Component of ADHD. Journal of ADHD and Related Disorders, 2(4), 201-223.
3. Surman, C. B., & Roth, T. (2011). Sleep problems and ADHD: A review of current research and insights. Current Psychiatry Reports, 13(4), 342-348.
4. Wender, P. H., Wolf, L. E., & Wasserstein, J. (2001). Adults with ADHD. Annals of the New York Academy of Sciences, 931, 1-16.
5. Philipsen, A. (2006). Differential diagnosis and comorbidity of ADHD and borderline personality disorder. ADHD Attention Deficit and Hyperactivity Disorders, 2(1), 29-38.

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Related reading: Fatigue and low energy in ADHD