Feeling profound pain from criticism or rejection in ADHD is not uncommon, but there are ways you can cope.
When you’re being criticized or rejected, do you have an intense reaction and feel like you can’t control your behavior? Do you experience extreme emotional pain that feels physical?
If you live with attention deficit hyperactivity disorder (ADHD), it’s understandable to sometimes be more sensitive to criticism. Some people with ADHD are faced with judgment and blame for their behaviors.
People around you might not understand the condition. They might encourage you to just “try harder” or label you as “lazy” or “unmotivated.”
These types of comments can be hurtful when you live with ADHD. Your first instinct may be to react negatively, but there are ways you can cope and respond more calmly.
If you live with ADHD and find that you’re more sensitive to criticisms and critiques, then you might be experiencing rejection sensitive dysphoria (RSD).
RSD is “a near ubiquitous experience for ADHDers,” says Joel Schwartz, PsyD, an ADHD clinical psychologist in San Luis Obispo, California.
“So much so that I think it should be part of the diagnostic criteria,” Schwartz adds.
Currently, RSD isn’t listed as an official symptom in the current version of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), but it’s real all the same.
At her therapy practice in Texas, Adrienne Clements estimates that RSD affects about 90% of her clients with ADHD.
Her clients don’t use the phrase rejection sensitive dysphoria, but once they explore the issue underlying their avoidance, perfectionism, social anxiety, or fear of failure, this term precisely explains it, says Clements.
What RSD really looks and feels like
(Video) What is RSD?
What RSD really looks and feels like
“An RSD episode feels like being hit by a tsunami of emotion out of nowhere,” says Clements, an educator and consultant passionate about supporting therapists to become more inclusive and neurodiversity-affirming.
One minute, she says, you’re feeling fine, and then a rejection trigger hits and you’re completely overwhelmed.
“The amygdala — the emotional command center of our brain — gets hijacked and the fight, flight, or freeze response takes over the body,” Clements explains.
This response looks different in every person. For Schwartz, it’s “a deep pain in the center of my chest, anxiety in multiple systems, flushed face, and a desperation to take some kind of action to undo whatever it is that caused the RSD.”
For others, Clements says, an RSD episode may look like:
- instant rage or anger with blaming others
- all-consuming sadness and withdrawal, even triggering suicidal ideation
In some cases, RSD can be so extreme it’s misdiagnosed as a mood disorder or personality disorder, says Clements.
Schwartz describes RSD as taking “the deepest shame you’ve ever felt and double it, and then doubl[ing] it again. And then once more. And then stick a knife in your chest and twist it. That begins to approximate it.”
“Although I’m being hyperbolic, it really isn’t that far from the experience,” he says. “It is an exquisitely deep shame and trauma reaction that can literally feel like physical pain at times.”
Once an RSD episode is over, people tend to experience more shame about what happened, leaving them feeling even worse, adds Clements.
According to Clements, RSD signs and symptoms may include:
- extreme emotional sensitivity when you think you’re being rejected or are rejected
- overwhelming sadness after being criticized that leads you to isolate or shut down
- an extremely harsh inner critic
- intense preoccupation with what others think of you and assuming the worst in everyday interactions
- people-pleasing or perfectionism to avoid being rejected
- fear of failure or rejection that leads to not pursuing goals or meeting new people
Of course, the intensity of symptoms can vary by episode and person.
Clements points out that in some cases, symptoms can be so intense they throw off someone’s entire day, while feelings of shame can linger for days afterward.
In other cases, RSD episodes are brief and quickly resolved.
Clements says that it all depends on the person’s:
- specific triggers
- window of tolerance at that moment
- coping tools
- support needs at that time
“The heaviness of RSD can have some profound impacts on people’s lives,” says Clements. She and Schwartz note that RSD may lead to:
- burnout, where the simplest tasks feel insurmountable and just getting up and starting the day feels like too many steps
- relationship ruptures, if you lashed out during an episode
- shame about your sensitivities, which might lead to feeling humiliated, self-judgment, and distress
- problems at work
- social isolation
- depression, or worsening of depression
- suicidal ideation
Support for suicidal thoughts
If you’re considering self-harm or suicide, please know you’re not alone, and there is help available right now. You can:
- Call a crisis hotline, such as the National Suicide Prevention Lifeline at 800-273-8255
- Text “HOME” to the Crisis Text Line at 741741
- Call or text the Postpartum Support International Help Line at 800-944-4773 (#1 Español, #2 English).
- Call The Trevor Project if you’re LGBTQIA+ and under 25 years old at 866-488-7386, text START to 678678, or chat online 24-7
- Call the Veterans Crisis Line at 800-273-8255, text 838255, or chat online 24-7
- Use Befrienders Worldwide, an international crisis helpline network, to help you find a local helpline
- Call 321-800-DEAF (3323) or text HAND at 839863 for the DeafLEAD Crisis Line
Everyone’s RSD triggers are unique, but according to Schwartz, they often fall into these categories:
- Being criticized for something you can’t control, like missing something your spouse said because you haven’t yet transitioned from your task.
- Being rejected or thinking you’re being rejected, like not hearing back from a friend you texted.
- Not living up to your own expectations, like forgetting something important at the store, feeling ashamed and angry with yourself, and saying “Why can’t I do the things others can do!?”
(Video) How to Deal with Rejection Sensitivity
Research on RSD is scarce. Some ADHD specialists believe RSD is natural and brain-based, and only medication — such as guanfacine (Intuniv ER) and clonidine (Catapres) — makes a difference.
In her practice, Clements has also seen other medications — such as bupropion (Wellbutrin) — reduce the intensity of RSD.
Both Clements and Schwartz believe that RSD is a trauma response.
“ADHDers grow up with constant negative feedback from peers, teachers, and parents,” says Schwartz. “It is the death of a million paper cuts. You learn on a deep level that everything about you is wrong, and your sense of interpersonal and personal security is threatened by these mistakes.”
As such, trauma-focused therapies may be helpful, like:
- somatic experiencing
- eye movement desensitization and reprocessing therapy (EMDR)
- internal family systems (IFS)
- neuroaffective relational model (NARM)
Schwartz has heard from many that Brainspotting — a type of talk therapy using fixed eye positions to help you process trauma — can also be helpful, but it needs more research.
In Clements’s experience, dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT) can also help in coping with RSD.
In general, she says, “navigating RSD usually takes a multi-modal approach and there’s no one silver bullet.”
Whether you’re receiving treatment or not, there are practical strategies you can use during and after an RSD episode.
Label what’s going on
You might tell yourself, “This is my RSD. I know it’ll pass,” which Schwartz says has been helpful for him. He’s also made a deal with himself not to act in the midst of intense RSD.
“If a few days go by and I still want to act, then I’ll do it,” he adds.
Unhook from unhelpful thoughts
When working with her clients and going through her own RSD, Clements uses an ACT technique called defusion.
Defusion creates distance between you and your thoughts, so you can see them for what they are, says Clements. It’s “words in our head” versus absolute truths or laws you have to obey.
According to Clements, during an RSD episode, you can try to:
- Label your thoughts as thoughts, such as: “I’m having the thought that I’m the worst person ever and everyone hates me.”
- Use a silly voice for the thoughts, such as a cartoon character like SpongeBob or Mickey Mouse, so “it’s a lot easier to take an unhelpful thought less seriously.”
- Play around with thoughts that come through as images, such as changing the image’s colors, slowing or speeding it up, adding funny background music, or adding a silly voice-over.
Use a distraction
Which distractions are helpful may depend on the severity of your reaction. For example, when her reaction is intense, Clements’s go-to distractions are:
- splashing cold water on her face or putting ice on the back of her neck to return to the present moment
- using a strong scent, like an essential oil, to distract her amygdala, since olfactory senses are close to it in the brain
When her reaction is more manageable, Clements might:
- play with her dogs
- spend time outside
- watch a show that brings her joy
- seek support from a loved one
Pick activities that specifically work for you
When picking calm-inducing activities, do what works best for you — which might be different from conventional advice. As Schwartz notes, “For many ADHDers, things that are calming or lowering stimulation may actually be activating for us.”
In other words, instead of deep breathing practices, you might feel calmer engaging in intense exercise or rocking out to complex or heavy music — something that Schwartz says “helps me like nothing else.”
Let the other person know
Because episodes can be all-consuming, Clements suggests telling loved ones that you’re experiencing one and can’t communicate until it’s passed.
Try to ask for what you need, such as:
- alone time
- a hug
- an ice pack to self-soothe
Use self-compassion
“We can’t get out of an RSD episode the same way we got in it: with criticism,” says Clements. Instead of further feeding your inner critic, use compassionate self-talk to help you cope, such as:
- telling yourself “that really hurt, may I try to be kind to myself?”
- giving yourself a hug
If you find self-compassion feels out of reach, consider listening to a guided self-compassion meditation.
Forgive yourself
In dealing with RSD, Schwartz has found it helpful to study the social theory of disability, which “states that disability is neither good nor bad, it is a part of life that is mostly mitigated by society.”
“Instead of blaming myself or taking on the negative feelings of others, I’m able to forgive myself for having a different brain,” Schwartz says. “I see how many societal forces are at play in how people judge me and how I cannot always be accommodated.”
Schwartz adds that he recognizes there are just some things that he cannot do: “And that is OK and not on me to fix — it’s on all of us to be accommodating and make room for different ways of being in the world.”
Many people with ADHD experience RSD — an intense emotional reaction to being criticized or rejected. While RSD is not always clinically recognized, it’s real and powerful.
There’s still a lot we don’t know about rejection sensitivity dysphoria, so more research is needed. Experts speculate that RSD may be innate and brain-based, or stem from trauma. Or, perhaps a complex combination.
Helpful ways to manage may include medication, trauma-focused therapies, and coping strategies.
If your loved one has ADHD, try to be extra gentle, patient, and supportive. As Schwartz notes, “You have no idea how much [criticism] hurts and how much we are already doing it. If we are having a hard time, come help and give us love. Let us know we are OK when we cannot perform as neurotypical people can.”
FAQs
Do people with ADHD have rejection sensitivity? ›
Most people who have ADHD are also very sensitive to what other people think or say about them. This is sometimes called rejection sensitive dysphoria (RSD), which is not a medical diagnosis, but a way of describing certain symptoms associated with ADHD.
Are people with ADHD more sensitive to criticism? ›Almost all teens and adults with ADHD are more sensitive than others to perceived criticism, and nearly a third report that this is the most difficult aspect of ADHD to live with.
Why does rejection hurt so much ADHD? ›Rejection sensitive dysphoria (RSD) is when you experience severe emotional pain because of a failure or feeling rejected. This condition is linked to ADHD and experts suspect it happens due to differences in brain structure.
How do people with ADHD cope with rejection? ›Practice self-compassion. We have all experienced (and will continue to experience) rejection and hurt in life. When things don't go the way you hope, take time to regroup, and treat yourself like you would a child with a skinned knee — with care and kindness.
What disorder is sensitive to criticism? ›People with avoidant personality disorder are very sensitive to anything critical, disapproving, or mocking because they constantly think about being criticized or rejected by others. They are vigilant for any sign of a negative response to them.
Are people with ADHD easily offended? ›We're extremely sensitive to disapproval, rejection, and criticism. We might interpret a colleague's reaction to something we proposed as criticism, disapproval, or even insult, when none was intended. We tend to react self-defensively, or worse, angrily. Rejection sensitivity is extremely common in people with ADHD.
How do ADHD people react to criticism? ›ADHD makes us more sensitive to criticism. Often, our first instinct is to respond defensively or angrily to outside comments that feel like disapproval. But adults with attention deficit disorder (ADHD or ADD) should know that doing so could sacrifice learning opportunities and the respect of others.
What is an ADHD meltdown? ›ADHD meltdowns are sudden outbursts of frustration and anger that seem to come out of nowhere. If your child is struggling to control their emotions, there are ways to help them. For children with attention deficit hyperactivity disorder (ADHD), impulsivity can present in many ways.
Do people with ADHD struggle to Empathise? ›As we've discussed, unfortunately, many people with ADHD tend to have a lack of empathy. This can be addressed, though, through identifying and communicating about each other's feelings.
Do all people with ADHD have rejection sensitive dysphoria? ›It makes a difference knowing what it is, that they are not alone, and that almost 100% of people with ADHD experience rejection sensitivity. After hearing this diagnosis, they're relieved to know it's not their fault and that they are not damaged.
Do people with ADHD have trouble forgiving? ›
It's my experience that adults with attention deficit hyperactivity disorder (ADD/ADHD) are kindhearted and would give the shirt off of their backs to strangers in need. But being so giving has its limits — even in the ADHD world, particularly when it comes to forgiving.
Do people with ADHD live in denial? ›Denial may follow the period of relief that often accompanies diagnosis. At first you might deny the reality of having ADHD, or accept it superficially, or continue to question whether you have it. Even if you admit to having ADHD, you have not yet integrated it in a meaningful way that will help you adjust.
What do people with ADHD struggle with the most? ›In adults, the main features of ADHD may include difficulty paying attention, impulsiveness and restlessness. Symptoms can range from mild to severe. Many adults with ADHD aren't aware they have it — they just know that everyday tasks can be a challenge.
Do people with ADHD have trouble loving? ›Due to differences in the ADHD brain, you can shift focus even more quickly, causing you to seem to lose interest in your partner or your relationship suddenly. During the early stages of a relationship, the partner affected by ADHD can focus intensely on the romance and the new partner.
What do people with ADHD find difficult? ›People with ADHD can find it difficult to suppress impulses, which means they may not stop to consider a situation, or the consequences, before they act. If you're looking after a child with ADHD, you may find this advice helpful.
Why do I react so badly to criticism? ›When we receive negative feedback, we root into our “emotional brain,” which bypasses our “thinking brain.” The “emotional brain” (also known as the limbic system) is where our databank of triggers and past emotional memories are stored.
Why do I get so hurt by criticism? ›It hurts because we are human. We experience pain when others point out our weaknesses and our faults. Often, our critics go for the jugular, attacking the areas where we are the most insecure. This augments the pain.
Why do I react strongly to criticism? ›Researchers believed some individuals were more sensitive to criticism than others due to a cognitive bias that led them to interpret ambiguous information negatively, rather than in a neutral or positive manner.
Do people with ADHD say hurtful things? ›People with untreated ADHD may have a tendency to speak before they think and often say things that are considered rude, either because of how they were said or their content. This is related to a lack of impulse control and can often be improved with medication or mindfulness training.
Does ADHD make you rude and disrespectful? ›Sometimes, people living with ADHD may behave in ways that come off as rude or disrespectful. These behaviors can stem from challenges with self-control, executive functioning, and self-stimulating actions. How you perceive their behavior often depends on your understanding of ADHD symptoms.
What does an ADHD shutdown look like? ›
Differences in emotions in people with ADHD can lead to 'shutdowns', where someone is so overwhelmed with emotions that they space out, may find it hard to speak or move and may struggle to articulate what they are feeling until they can process their emotions.
How do ADHD people act in arguments? ›Emotional outbursts. People with ADHD may be more prone to these outbursts, which can lead to hurt feelings and arguments. They may also struggle to discuss issues calmly and be more likely to lose their temper.
What is the behavior of a person who has ADHD and gets upset? ›Impulsive behavior: People with ADHD may have trouble controlling their impulses, causing them to act in socially inappropriate ways when they feel anger. Hyperactivity: People with ADHD often have trouble sitting still.
How do people with ADHD struggle with emotions? ›People who have ADHD frequently experience emotions so deeply that they become overwhelmed or “flooded.” They may feel joy, anger, pain, or confusion in a given situation—and the intensity may precede impulsive behaviors they regret later.
What does a Neurodivergent meltdown look like? ›What does an 'autism meltdown' look like? Some signs that a loved one is having or nearing a meltdown may include: being irritable, which can include shouting or physical aggression. fidgeting or stimming more (repetitive movements or noises)
What does ADHD overwhelm feel like? ›Becoming easily overwhelmed and distracted can sometimes be hallmark symptoms of ADHD. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, people with ADHD might experience symptoms like: restlessness. difficulty focusing.
What does an ADHD episode feel like? ›Adult ADHD Symptoms
Trouble focusing on a task. Feelings of restlessness. Organization problems. Feeling easily frustrated.
ADHD and narcissistic personality may share some behavioral similarities, but they're different conditions. Attention deficit hyperactivity disorder (ADHD) and narcissistic personality disorder (NPD) are different mental health diagnoses yet in some instances, behaviors may look similar.
Is ADHD linked to narcissism? ›Attention deficit hyperactivity disorder (ADHD) and narcissism are two completely separate conditions, but both can affect an individual's relationships, work or school life, and ability to function in society. People with ADHD tend to be impulsive and may have difficulties with organization and paying attention.
Are people with ADHD more emotionally sensitive? ›Emotional sensitivity in ADHD may present as passionate thoughts, emotions, and feelings more intense than anyone else. Their highs are higher, and their lows are lower than the average person. People with ADHD experience stronger emotions, whether positive or negative.
Do ADHD meds help with rejection sensitive dysphoria? ›
ADHD medications: Ritalin (Ritalin) and dextroamphetamine-amphetamine (Adderall) are particularly successful in controlling the basic symptoms of ADHD. They may also aid in the treatment of RSD.
Does ADHD medication help with rejection sensitive dysphoria? ›ADHD medications: ADHD medications, such as methylphenidate (Ritalin) and dextroamphetamine-amphetamine (Adderall), are highly effective in managing the core symptoms of ADHD. They may also help with RSD.
Do ADHD meds help with rumination? ›ADHD medication can help children and adults with ADHD approach their challenges and symptoms with more ease, one of which may be ruminating thoughts. So, medication for ADHD may aid with negative thought patterns, and help you get things back on track.
Do people with ADHD hold grudges? ›This is why people with ADHD can often hold grudges against people, companies and locations; memories of an injustice or disservice can linger for a while, which can cause all sorts of other problems such as low moods and irritability.
Does ADHD hold grudges? ›This includes the primary ADHD symptoms plus trouble shifting attention, being stuck on negative thoughts and behaviors, holding grudges, excessive worrying and being argumentative. People with over-focused ADD tend to need a strict routine. It is often seen in families with addiction problems.
What is the life expectancy of someone with ADHD? ›He also found that if ADHD persisted to young adulthood, the reduction in healthy life was nearly 13 years and was over 11 years in total life expectancy.
Why is living with someone with ADHD so hard? ›In fact, the relationship failure rate is twice as high for individuals with ADHD. The ADHD-affected relationship can be very challenging due to common ADHD symptoms such as persistent distractibility, inattention, forgetfulness, physical and mental restlessness, along with impulsive behavior and/or speech.
What are the weaknesses of people with ADHD? ›All types of ADHD may include weaknesses in executive functioning. Thus, children with ADHD are more likely to have problems getting started on things, and have difficulty with planning, problem-solving, and time management.
What it's like to have ADHD as a grown woman? ›Women with ADHD face the same feelings of being overwhelmed and exhausted as men with ADHD commonly feel. Psychological distress, feelings of inadequacy, low self-esteem, and chronic stress are common. Often, women with ADHD feel that their lives are out of control or in chaos, and daily tasks may seem impossibly huge.
Why do so many successful people have ADHD? ›Why Are There So Many Successful People with ADHD? It is known that people with ADHD have specific strengths, as a result of their brain functioning difference. They are more spontaneous, creative, energetic, intuitive, imaginative, and inventive.
Do people with ADHD talk to themselves? ›
In his own investigation, he found that others with ADHD tend to get carried away in their hyper self-talk, while those without ADHD sometimes report not even being aware of any self-talk or internal dialogue (what he refers to as being hypo-neuro-vocal).
What does untreated ADHD look like in adults? ›Untreated ADHD in adults can lead to mental health disorders like anxiety and depression. This is because ADHD symptoms can lead to focus, concentration, and impulsivity problems. When these problems are not managed effectively, they can lead to feelings of frustration, irritability, and low self-esteem.
What age is ADHD hardest? ›The symptoms may peak in severity when the child is seven to eight years of age, after which they often begin to decline. By the adolescent years, the hyperactive symptoms may be less noticeable, although ADHD can continue to be present.
What are things people with ADHD are good at? ›People living with ADHD may have a variety of skills and abilities beyond those of their neurotypical counterparts. These may include hyperfocus, resilience, creativity, conversational skills, spontaneity, and abundant energy.
Why is my ADHD getting worse as I get older? ›As people age, they may face more challenges in their lives. This can include things like entering into new stages of development, such as adolescence or adulthood; increased stress levels; and competing demands on time, such as work and family responsibilities. These challenges can worsen ADHD symptoms in some people.
Do people with ADHD have sensory sensitivity? ›Clinicians working with people with ADHD view hypersensitivity, both physical and/or emotional, as a common comorbid condition. “[People with ADHD] often are hypersensitive in one of the sensory domains: sound, touch, or smell,” says Ned Hallowell, M.D., author of Driven to Distraction (#CommissionsEarned).
Do people with ADHD not want to be touched? ›Many people with ADHD experience a physical hypersensitivity to a variety of things, including touch. Being hypersensitive may mean that stimulation of their genitals might be uncomfortable or even painful in someone with ADHD. This sensitivity may also extend to other senses as well.
Do ADHD kids feel rejected? ›Rejection can impact kids with ADHD more intensely than their peers. Kids with ADHD can feel rejected even when it was nothing personal. There are ways to help your child get better at coping with rejection.
What does ADHD overstimulation feel like? ›Overstimulation is a state of feeling overwhelmed by the situation you are in. This might take the form of physical or emotional discomfort and feeling like your brain is frozen or you're unable to think or process anything that's happening.
Do people with ADHD lack empathy? ›As we've discussed, unfortunately, many people with ADHD tend to have a lack of empathy. This can be addressed, though, through identifying and communicating about each other's feelings. If you see a disconnect between ADHD and empathy in your child or in your spouse, don't give up hope.
Are people with ADHD Empaths? ›
In fact, some people with ADHD have trouble reining in their empathy. They might call themselves empaths, as I explain below. Stimulant medication often helps them, too. It's all about the self-regulation: not over-doing, not under-doing, but finding the middle ground.
Why do people with ADHD struggle with intimacy? ›The attentional and emotional self-regulation challenges that can exist for partners with ADHD can interfere with experiential intimacy in several ways. First, the partner with ADHD may be distracted within the experience, missing the moment together.
Do ADHD kids feel remorse? ›Since kids with ADHD typically have trouble managing their emotions, their feelings of remorse may be more intense than for other kids. That feeling of “beating themselves up” over what they've done may also last longer for them than for kids who don't have ADHD.
Are people with ADHD disagreeable? ›This deficiency in the emotional reward could be an additional problem for some people with ADHD. These individuals would find tasks not only more difficult but also less satisfying, reducing their motivation to achieve. They might also be more moody and disagreeable.