ADHD and Rejection Sensitivity

I have heard that depression is often tied to someone looking back and feeling a sense of sadness about what has happened or how they have been, whereas anxiety is the foreboding of things that possibly might come. Depression and anxiety are often cousins of each other.

The Seeds of Rejection Sensitivity

The seeds of depression and anxiety usually take root when the individual begins to condemn themselves and doubt their value to others. They have built a strong case in their mind that they are unlovable, unworthy of love or praise, and a host of negative thoughts about themselves that is truly soul-crushing. The really sad thing is that they are often wrong.

When a child is growing and developing in their early years, they are taking in the world and forming ideas and sometimes drawing conclusions about the world in which they live. They begin to develop a notion about themselves over time, regarding whether they are safe and secure or not.

Parents are the most influential, of course, and they begin to get a sense of their parents/guardians’ dependability and whether they are important to them. The children are also looking at some of their peers and gathering some indication as to what they think about them, such as whether they are likable or important to them.

They also begin to develop a sense of their capabilities, such as certain abilities like being artistic, athletic, smart, and overall capable or not in these areas. The schema that is forming in their heads is powerful and firm and likely to come to some conclusions.

This leads me to the discussion of the phenomenon of Rejection Sensitivity Dysphoria (RSD). (It should be noted that this is a relatively new concept and doesn’t have an official clinical diagnosis at present.) It’s hard enough for a child/person to develop a positive sense of themselves with the realities of their lives, let alone to be set back by an additional challenge of determining if the world is safe or accepting, when one has ADHD.

On a side note, currently Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder have no clinical distinction, so ADHD is the umbrella term. There can be many reasons why a person develops a particular sensitivity to rejection. It is likely to be several experiences where they have been told they are a disappointment to someone important, or, in some cases, failing to live up to expectations in some way.

RSD is “an intense reaction to real or perceived rejection”(Good Health, Nov. 20, 2024). The hypersensitivity to rejection can lead the person to have feelings of self-doubt and inadequacy. This often leads to someone overthinking their interactions with others and fearing they have failed in some way or embarrassed themselves. It’s been my experience and research tends to bear this out that folks with ADHD are particularly susceptible to this experience.

Why Those With ADHD Are Susceptible To RSD

When I began my career as a teacher, ADHD was a common diagnosis for children, where they were prescribed stimulants to (ironically) have a calming effect that allowed them to increase their ability to successfully do schoolwork.

The conventional wisdom of the time was that this condition would fade as a child got older and did not impact adults. This was wrong. We now know that people with ADHD as adults still struggle with the same issues as when they were young. They likely have developed a series of coping skills to mask the condition, but it is real just the same. A great number of adults are now being diagnosed with ADHD for the first time.

The nineties represented an explosion of information on how the brain works, and the good people who research the brain continue to find more and more about its functions each year. ADHD is known to “affect the regions of the brain responsible for emotional regulation, impulse control and reward processing” ( Good Health ‘24).

Studies show that dopamine and norepinephrine, both neurotransmitters, control these functions. People with ADHD show deficiencies or imbalances in these molecules. The impact of this occurrence is essentially that people with ADHD do indeed experience life differently. The term “neurodivergent” comes to mind.

This refers to people who have a brain that works differently from the average person who is labeled “neurotypical.” I say all of this to simply make the point that a person with ADHD is experiencing the world differently, interpreting the world differently, and perceiving social interactions differently to some degree. For some, it may be dramatic, and for others, somewhere else on a continuum.

When a person grows up with ADHD, they begin to suffer the consequences socially by getting frequent reprimands for not following instructions, being easily distracted during key times such as school, or frustrating parents because the behavior seems intentionally non-compliant.

This leads to self-doubt and a fear of judgment by others over whom they don’t feel much control. It’s hard enough to develop a good and balanced sense of self-esteem, but when these experiences begin to pile up, they really hurt.

The intensifying of sensitivity to rejection seems to grow into adulthood. The ruminations of self-disgust, self-frustration, and self-doubt lead to a sense that a person can hardly do anything right or be able to gain the affection of another.

The individual can become so sensitive that they may see some slight humor toward them, sarcasm, or even a slight bit of teasing as confirmation of their fears. The more they feel this, the more they will perseverate/ruminate on the negative sense of self, which could lead them into depression.

How do I know if I have RSD?

Rejection sensitivity alone is not Rejection Sensitivity Dysphoria. RSD is so strong that one can often feel it physically with tenseness in the chest or other sensations in the body due to a perceived rejection or the possibility of such. Such feelings as overwhelming feelings of shame, sadness, anger, anxiety, or physical pain are common to those with RSD. The following is a list of common experiences of those with RHD taken from the Cleveland Clinic.

Intense emotional reactions: sudden and overwhelming feelings of anger, sadness, or anxiety in response to a perceived or actual criticism or rejection

Low self-esteem: feelings of worthlessness, self-doubt, and negative self-talk

Social anxiety: fear and avoidance of social situations, especially those that could involve potential rejection or judgment

People pleasing: a strong desire to please others and avoid disapproval, often leading to neglecting one’s own needs

Perfectionism: striving for perfection to avoid potential criticism or failure

Avoidance behaviors: avoiding tasks, social situations, or new experiences due to fear of rejection

Difficulty managing reactions: struggling to regulate emotional responses to perceived slights or criticism

Physical symptoms: Some individuals may experience physical sensations like a knot in the stomach or feeling physically wounded when faced with rejection

Perceived Rejection: interpreting neutral or even positive interactions as rejection ( Clevelandclinic.org)

Ways To Manage And Treat RSD

The value of psychotherapy should not be underestimated because the voices that people have been listening to have been their own, and it has taken them to a dark place. A place they don’t know how to get out of. Being able to talk to a professional and to be heard can be such a relief and a place of safety to explore and share the inner workings of their mind.

Becoming aware of their tendency to overreact, to rejection or perceived rejection, or the possibility of rejection is useful for the client to gain some insight into themselves and why they are often miserable. A therapist can also be effective in beginning to shift the overly weighted self-condemnation to a more balanced perspective of themselves.

Helping the client to recognize that they are a valuable person to themselves, to others, and mostly to God, can change someone’s life. It’s not an instantaneous road, but it is worth the process.

If one has ADHD, medication can often be a useful tool to regulate the levels of neurotransmitters in the brain. Stimulants are still used to help, as said before, by increasing certain types of neurotransmitters that can increase activity in specific areas of the brain.

The stimulants Adderall and Ritalin can help those areas of the brain that regulate communication become more active in the individual. A physician should always be consulted to best determine what meds would likely be most advantageous.

I have found that once an individual becomes aware of the possibility of having RSD, some relatively simple steps can be applied. Since there is such a neuropathway of the person suffering from negative beliefs about themselves, I have referred to this as something like a superhighway or a six-lane freeway straight to that negativity destination. Automatic thoughts of self-doubt and negative self-assessment have worn a direct and speedy road to that part of the brain.

The part of the brain where anything positive regarding self-worth is but a two-lane country road. That part of their brain hasn’t been nurtured and requires attention. Even when there is positive feedback from somewhere, it is often rejected. So, an intentional process needs to begin by developing this pathway to counterbalance the frequently false internal narrative of the loathsome self.

It begins with the simple task of writing down some of one’s personal qualities, talents, character traits, and values. If this is hard to do, then think of what someone else would say about you to develop that list and extend it some. Don’t forget one of the key elements to this – how God values us as His children.

When overtaken by these negative thoughts, mindfulness breathing (four slow seconds in through the nose, hold for two seconds and then four seconds slowly out the mouth) about ten times to shift the mind’s attention to something else and then as you are doing this, repeat a phrase such as “I am a beautiful and wonderful person and… ( add some character qualities such as kind, generous, caring).

One might not believe it at first, but in time it will begin to sink in and through that find some peace. Or, in essence, build some more lanes to that highway. Because one with RSD is quick to determine possible rejection that is or might be happening in their mind, it is good for that person to get into the habit of pausing and counting to ten, in order to step back and re-evaluate the situation and keep themselves from diving right into the rejection pit.

A caring partner or friend can help you with this if you invite them. They can often notice a situation you are in or sense you are going down that road, and catch your attention and say something like, “Hey, take a second, mentally take a step back and reframe what is happening.” This help from a trusted partner or friend can work to form these steps into a more familiar practice.

Similarly, you can ask questions of that person like, “I just felt that person put me down, is that what you heard?” or “The way that person is looking at me makes me think they don’t like me, do you see that?” It requires some vulnerability, but it is worth it if you can begin to see things as they are, not as you imagine them to be.

This is a tough journey for folks with Rejection Sensitivity Dysphoria (RSD) because it requires re-thinking much of how one has thought about the world, of people, and mostly themselves. It will not automatically go away in time. It will require consistent attention and support. But what a relief to come into a better reality where others really do accept you and you have great value.

Next Steps

If you found this helpful, I am grateful. If you are having some struggles in life and are at a loss as to what to do, please don’t hesitate to reach out. Contact me directly (509-569-7102 or martyr@spokanechristiancounseling.com) or through the offices of Seattle Christian Counseling. If I could be of any assistance to you, I would consider that a great privilege.