EPISODE  #10 “RSD: REJECTION SENSITIVITY DYSPHORIA”

What is rejection sensitive dysphoria (RSD) and how does it affect ADHD adults? I’m diving into this topic to share how RSD feels and strategies you can use to manage your symptoms.

For ADHD folks, one of the key symptoms is RSD, and this episode shares feedback from my listeners on their experiences with RSD.

Specifically in episode 10, I’m chatting with you about:

• The definition and scientific research behind Rejection Sensitivity Dysphoria (RSD).
• How RSD differs from general Emotional Intensity and mood disorders.
• What RSD physically feels like in the body, shared by listeners.
• Coping mechanisms we pick up to cope with RSD.
• Managing your RSD symptoms using awareness, therapy, and coaching.

Listen below, stream it on your favorite podcasting app, or scroll to access the full blog post.

What is Rejection Sensitivity Dysphoria (RSD)?

RSD is an intense and emotional response caused by the perception that you have disappointed others in your life, and that, as a result, they have withdrawn their love, approval, or respect.

It is a common experience for people with ADHD.

The term dysphoria is a Greek word for unbearable, which reflects the intensity of this feeling.

The same painful reaction can occur even when you fail or fall short of your own high goals and expectations. Critically, RSD causes extreme emotional pain even when no actual rejection has taken place.

Dr. William Dodson’s research highlights the prevalence of RSD:

• 98% of adults describe RSD as an aching in the core of their being.
• 30% of adults with ADHD say that RSD is the most impairing aspect of having ADHD.

What Does RSD Feel Like?

For me, the difference between general emotional intensity and RSD is that RSD is intensely physical.

While all emotions are physical, RSD physically hurts.

I feel it in my solar plexus. I feel it in my heart. I feel it in my stomach.

It is so overwhelming, and then it comes with the emotions, particularly shame. It’s the most heightened version of a feeling that I can explain.

RSD is not depression because it is not an absence of feeling. You can appear depressed because there are so many feelings going on internally, and you feel like you’re barely hanging.

Sharing Listener Experiences on Rejection Sensitive Dysphoria

I also decided to ask my podcast listeners about their experiences with RSD.

The question: “If you have RSD, what’s your experience with it? You can tell me how it feels in your body, how long it lasts, and just anything you want to say.”

I received so many answers that were truly so relatable, and it just made me want to give all of you a hug.

Here are some of the amazing responses I received…

• “It feels like pressure at the top of my chest and in my throat for two hours. But does it ever leave? Up to a week, sometimes two. If it’s a real heartbreak, I can’t let it go.”

• “It will always be there. Stomach turns, and at least 48 hours. A cloud of doom, feeling, sadness, chest jitters, obsessive thoughts. I never knew it had a name, but I can relate. I am 52 and can remember feeling this always.”

• “It feels like a full-bodied shame. I know that’s an emotion, but it’s a sensation for me, too.”

• “It feels like my body becomes empty and numb and my mouth turns to sandpaper. It feels like any warmth that was inside me is completely drained out and I’m left cold and shaking.”

• “It feels like I’ve been slapped across the face and stabbed in the heart with a knife simultaneously. My chest hurts. I taste metal, fight-flight style. Anxiety shakes my guts. It usually takes a handful of hours to wind down because I internally fire off useless comebacks after the fact.”

• “RSD feelings go away? Oh, and lasts 5 to 10 minutes each time. The hangover after lasts longer. It’s like the end of the world is imminent. Hot, flushing through my chest and arms. A frantic feeling inside that I need to correct the situation or get the other person to approve of me. I think my brain interprets it as physical pain. In the past, I’ve cried for days. It’s usually followed by being ashamed of my response once the intensity passes.”

• “Working in corporate was rough. Anytime I got any kind of constructive criticism, I felt the tears well up. I’d try to hide it, but never succeeded. I feel embarrassed to even see the person who criticized me, if not for years, if not forever. I actually didn’t realize I had this, but it’s been my whole life that I’ve dealt with this.”

• “It’s a physical pain that radiates throughout my body. It’s in my arms, like I’ve been physically kicked in the gut. It’s been very physical though, and it lasts. Also, there’s a lot of crying. It really hurts. Like, my torso and arms have been electrocuted, followed by severe tightness and shortness of breath.”

• “Sometimes fades after 10 minutes, sometimes can last several hours. I can’t breathe when it happens. I feel so gross. Can’t explain it exactly, but I just feel so unworthy and uncomfortable after the slightest hiccup. It usually lasts two to three days. I feel it in the pit of my stomach and shortness of breath. Obviously, it doesn’t last the whole time, but that is the normal come-down for me.”

• “My face gets so hot it feels like my pores will all explode and I get shivers and tingles all around my shoulders. It lasts for as long as I will let it. I’ve started chanting “dysphoria” over and over until my brain realizes that I know it’s an overreaction. I call it the hot mayonnaise feeling, like I just feel like a glob of mayonnaise softening under heat.”

• “Oh man, it feels in my body like a heaviness that I cannot shake. It can last for a few hours or a few months, depending on the kind of rejection. If it’s a small thing, like an idea of mine was rejected, that is a couple of hours. If it’s bigger, like being rejected by someone I had a crush on, it could last for months. But it’s a constant, heavy feeling, like I’m wearing a lead coat.”

• “Nauseating, painful, hot. Almost never fully goes away. You just learn to push the memory away fast enough, so as not to re-trigger the feelings. For me, it feels like the rejection is part of a lineage of all the rejection I’ve experienced, and I feel like I’m being rejected by all those people at once.”

I’m hoping you can relate to these experiences as you hear yourself in other people and know you are not alone.

Key Characteristics of an RSD Episode

According to Dr. Dodson’s research, an RSD episode:

• Has no warning. It happens all at once, instantaneously.
• Is uncontrollable once it starts. It has to run its course.
• The mood shift is instantaneous and the painful episodes usually end quickly, often in a matter of hours, and rarely last more than a couple of hours.

RSD vs. Mood Disorders

If you are talking to a professional, it’s important to understand how RSD differs from a traditional mood disorder.

If internalized, RSD can look like an instantaneous major depressive episode. If externalized, it can present as rage directed at the person who was perceived to have “wounded” them.

This has often led to misdiagnosis of Borderline Personality Disorder.

The Unhelpful Habits We Pick Up to Manage RSD

If you’ve had RSD your whole life and didn’t know what it was, you’ve likely developed some unhelpful coping mechanisms to avoid the pain.

• People-Pleasing: You try to be so perfect that people can never be mad at you, reject you, or criticize you. This involves constantly scanning everyone you meet to keep them happy and avoid triggering an episode. This can make you forget what you want from your own life.
• Avoidance (Slacking Off): The risk of trying but failing—especially in front of people—is so painful that you avoid trying altogether (a new job, relationship, or project). These are the people who often get deemed as “lazy” in the ADHD world.
• Anticipating Rejection: You become so vigilant about avoiding rejection that you can get misdiagnosed as having a social phobia.

5 Ways To Manage Your RSD Symptoms

The key to managing your symptoms is awareness, awareness, awareness.

If you know, “Oh, this is my RSD,” you can accept it and let it run its course without telling yourself a story that you suck or that you’re unlovable.

Here’s how you can manage your symptoms:

1. Seek Trauma-Informed Therapy:

Traditional talk therapy is not always helpful with RSD because of the physical nature of the response. Find a therapist who understands RSD and is trauma-informed.

2. Explore Somatic Therapy:

Since RSD is so physical (in the body), look into bodywork treatments like somatic therapy, which focus on the mind-body connection.

To learn more about somatic therapy, check out this video…

3. Work with an ADHD Coach:

An ADHD coach, especially one with ADHD, will be practiced in helping people understand and manage RSD as a known symptom.

? Here is the group coaching program I’ve been a part of for the past 2 years – get $50 off your first month with this link.

4. Refer to Emotional Intensity Solutions:

Check out episode 8 of the You Are A Lot Podcast on Emotional Intensity Solutions.

5. Be Aware of Shame:

People with RSD are usually ashamed of their overreactions, even if internal, and they hide them. Just naming it as RSD allows you to release some of that shame.

Note: RSD can’t specifically be measured; therefore, it has trouble getting published in research. That is one of the problems with something like RSD not being mentioned in the DSM, which is what psychiatrists use to diagnose you with ADHD. 

Episode 10 Sources:

• Defining Features of ADHD That Get Overlooked (Video) – Dr. William Dodson
• An ADHD Guide to RSD (Video) – Dr. William Dodson
• Rejection Sensitivity Dysphoria – ADDitude Magazine
• Understanding RSD Download – ADDitude Magazine
• RSD Coping Strategies Toolkit – ADDitude Magazine
• Overview of RSD – Cleveland Clinic