Rejection Sensitive Dysphoria (RSD)
When perceived rejection or criticism causes intense emotional pain that feels unbearable. One of the most impairing yet misunderstood aspects of ADHD.
Rejection Sensitive Dysphoria describes an intense emotional response to real or perceived rejection, criticism, or failure. The word "dysphoria" means "difficult to bear" - and that's exactly how it feels.
While not a formal diagnostic term, clinicians working with ADHD widely recognise RSD as a significant source of distress. Research increasingly shows that emotional dysregulation is a core feature of ADHD, not a separate issue.
"It's like a switch flips and suddenly everything is terrible. A small comment that wouldn't bother most people can feel like the end of the world. And it happens so fast there's no time to think."
- Adult describing their childhood RSD experiences
The Six Domains of RSD
Research identifies six interconnected ways RSD affects people. Understanding these helps recognise what your child is experiencing.
In children, this might look like:
- •Devastated by a teacher's minor correction
- •Falls apart if a friend doesn't want to play
- •Upset when not chosen for something
- •Overreacts to neutral facial expressions
In children, this might look like:
- •"Everyone hates me" after one incident
- •Deep shame that feels physically painful
- •Feeling fundamentally flawed or broken
- •Internalising criticism as proof of being "bad"
In children, this might look like:
- •Always watching for signs they've upset someone
- •Assuming people are secretly annoyed with them
- •Asking repeatedly "Are you mad at me?"
- •Avoiding trying new things in case of failure
In children, this might look like:
- •Instant meltdown when criticised
- •Sudden rage that surprises everyone
- •Complete shutdown - can't speak or respond
- •Running away or hiding
In children, this might look like:
- •Still upset hours or days later
- •Replaying the incident over and over
- •Needing constant reassurance it's okay
- •Avoiding the person or situation afterwards
In children, this might look like:
- •Won't ask for help in case they seem "stupid"
- •Avoids activities where they might fail
- •Difficulty maintaining friendships
- •People-pleasing to avoid any criticism
Emotional dysregulation is core to ADHD
Research shows emotional symptoms aren't just "comorbid" - they're part of ADHD itself. The same brain differences that affect attention also affect emotional regulation.
Dopamine affects emotional processing
The dopamine differences in ADHD brains affect not just motivation but also how emotions are processed, experienced, and recovered from.
Years of accumulated criticism
By age 12, children with ADHD receive 20,000+ more corrections than their peers. This history primes the brain to expect and react to criticism.
Impaired emotional braking
ADHD affects the brain's ability to put the brakes on emotional responses. Feelings hit fast and hard before the thinking brain can intervene.
What RSD is NOT
"Being "too sensitive""
RSD involves genuine neurological differences in emotional processing - the pain is real and intense, not a character flaw.
"Just low self-esteem"
While RSD can cause low self-esteem, it's specifically triggered by rejection/criticism. Self-esteem issues are more constant.
"Social anxiety"
Anxiety fears future judgment; RSD is intense pain from perceived rejection that's already happening. They can co-occur.
"Attention-seeking"
Children with RSD often hide their pain or react so fast they couldn't be "planning" it. The reaction is involuntary.
| Aspect | RSD (often with ADHD) | Autism |
|---|---|---|
| Primary driver | Fear of/reaction to rejection and criticism | Difficulty reading social cues can cause uncertainty and anxiety |
| Trigger | Perceived disapproval or failure | Social confusion, sensory issues, unexpected changes |
| What helps | Explicit reassurance, validation of pain | Clear communication, predictability, explaining social expectations |
Note: Many people have both ADHD and autism, so these experiences can co-occur and interact.
What Helps
Validate the pain
Say "That really hurt" not "You're overreacting." The pain is real even if the trigger seems small.
Name it
Teaching your child about RSD helps them understand they're not "broken" - their brain just processes rejection intensely.
Separate feedback from worth
Be explicit: "This one thing needs work AND you are loved and capable." Both are true.
Predict and prepare
Before situations where feedback might happen, acknowledge it might be hard and plan coping strategies.
Watch your face
Children with RSD are scanning constantly. A neutral face can read as disapproval. Show warmth explicitly.
Repair quickly
After conflicts, reconnect warmly. Don't let them sit with shame. Reassurance isn't "spoiling" them.
Private feedback
Corrections in front of peers are exponentially more painful. Find private moments when possible.
Lead with positives
Start with what's working before addressing what needs to change. The positive needs to land first.
Be explicit about not being angry
"I'm not upset with you, I just need you to..." can prevent a spiral.
Normalise mistakes
Create a classroom culture where mistakes are learning, not failure. Model your own mistakes.
Check in after corrections
A quick private "You okay?" after feedback can prevent rumination for the rest of the day.
Understand the meltdown
A child who rages or shuts down after feedback isn't being defiant - they're in pain. Respond to the pain.
Know your brain
Understanding RSD helps: "My brain makes rejection feel HUGE. That's how my brain works, not the truth."
Name it happening
Learning to say "I think this is RSD" gives some space between feeling and reacting.
Reality check
Ask: "What actually happened? What did they actually say? Is there another explanation?"
Safe person
Having someone who understands and can help reality-check when everything feels terrible.
Calming strategies
Deep breathing, movement, cold water, or other sensory regulation before the spiral takes over.
Self-compassion
Learning to say "This is hard for my brain" instead of "I'm pathetic for feeling this way."
The Most Important Thing to Remember
When a child with RSD reacts intensely to criticism or rejection, they are experiencing genuine emotional pain. The trigger might seem small, but the pain is real. Responding to the pain - not just the behaviour - is what helps them heal and learn to cope.
Want to Measure RSD?
The RSD-RS is the first standardised assessment tool specifically designed to measure rejection sensitivity in ADHD. It helps quantify RSD across all six domains and track changes over time.
Available as self-report, parent, teacher, and clinician versions for different ages.