A participant in my most recent ADHD couples seminar recently made a life-changing discovery – he has suffered all of his life from Rejection Sensitive Dysphoria along with his ADHD. He wrote movingly of the impact this has had on his life.
What is Rejection Sensitive Dysphoria (RSD)?
Most adults with ADHD have an incredibly deep and painful aversion to rejection. This is not a learned behavior, but rather part of the physiology of their ADHD. It goes beyond the emotional lability* that is now recognized as a part of ADHD. With RSD, rejection is so hard to bear that those who have it build life skills around avoiding it. As you’ll see from the story below, it also greatly impacts how ADHD adults respond to those around them.
What Does RSD Look Like in Your Life?
According to William Dodson, MD, RSD encourages those who have it to compensate for the pain they feel from rejection in three basic ways – striving for perfection (nothing to reject); rejecting those who critique (move away from the pain); or intermittently raging to hurt or punish those who reject. How does this show up in your life? Here’s one man’s story:
"Last week, 23 years into a challenging and often rocky marriage with a non-ADHD partner, with 6 kids ranging from elementary school to college, with 10 years diagnosed and medicated (but not well-treated) for ADHD, and 15 months into marital and individual therapy, I stumbled on William Dodson’s ADDitude articles about Rejection Sensitive Dysphoria. They were revelatory. Through this model so much more of my life makes sense, from my childhood to now.
Every direct human interaction is impacted by my deep aversion to rejection, and every personal and private action is as well, because anything I think or do can ultimately come to light. Rejection avoidance, in the context of RSD, has been so great a motivation that I’d place it as one of the lower levels in my own Maslow hierarchy.
My general approach to personal and relational life has been to either seek perfection so there is no grounds for rejection (which I did in my youth through religious zeal and academic success, and do at work and some other environments), or throw in the towel and withdraw and people please so there’s nothing objectionable to reject (in my adult relationships after repeated moral failures burst the delusion of moral and relational perfection). And in interactions with my family, I can see how I internalize “rejection-events” as mini-depressions, and externalize them as fits of rage toward the one “rejecting” me. I use quotes because I had to use my reactions as cues to the trigger, and discover that yes, there’s a deep sense of rejection I’m feeling in those moments. Though I would have never recognized it this way without the model Dr Dodson presents. “Emotional disregulation/lability” is too general to get there, and “Shame” is really close, but not nuanced enough as to what it’s attached to. It’s the deep feeling of failure/rejection in other people’s eyes - real or perceived - so deep that avoidance of it becomes a primary motivation in life that manifests itself in so many now identifiable ways.
And for what it’s worth, this is not simply a conditioned response to being shamed as children because of other ADHD symptoms. Mine didn’t come from years and years of adults telling me I was a disappointment or a bad person. I overachieved as a kid academically to get praise and adoration from parents and teachers, despite my undiagnosed ADHD and despite having parents who saw no wrong in me ever. Even so, any negative judgment from them or any adult was so personally shame-inducing (dysphoric) that I avoided or hid failure at all costs to avoid the perceived rejection that would follow. "
What Happens to Your Relationship if you Have Rejection Sensitive Dysphoria?
RSD will contribute to volatility in your relationship because you will be more likely to misinterpret basic behaviors in a partner. For example, if your partner is quite busy, you might interpret that as a rejection and feel particularly hurt, even though there is nothing personal at all about the action. In addition, sensitivity to potential rejection is so strong that any whiff of potential disapproval or rejection might send you into one of the three types of behaviors above.
Another issue would be a greater likelihood of cover-ups and lying to avoid pain.
How To Treat Rejection Sensitive Dysphoria
There are medicinal ways to help manage RSD. William Dodson, M.D. recommends either guanfacine and clonidine in combination or MAOIs off label. See this article in ADDitude Magazine for more details.
Another good article on RSD (but without the treatment suggestions) is How RSD Derails Relationships.
*Emotional lability is when a person typicaly responds emotionally more extremely and more quickly than others might expect in the situation. It is thought to be a core characteristic of ADHD.
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Comments
Yes.. I have it. "DYSPHORIA"
I never knew I had it what you call it, but it still has an effect on me... but only under extreme circumstances. I experienced it again just recently in the breakup of my relationship. Even if cognitively I had resolved everything, it didn't matter.... it's simply being rejected that causes it... for no other reason.
Not being afraid of it.... just comes from repeated exposure. That certainly helps to not avoid it.... but I found I still had to deal with it when it comes. There's no escaping it in other words. Processing this through mentally and telling myself this makes it that much easier to move through it and not let it affect me as much. Awareness I guess is the only real medicine... and being able to recognize it different than anything else.
J
I Disagree ( with myself )
Awareness IS NOT the only real medicine, which now seems like a ridiculous thing to say. I can forgive myself for my own ignorance including much of my past posts which I just started to reread. The value, in having the ability to read what you said in the past, shows you how little you know compared to after you've learned new information and had new experiences along the way is immeasurable. It shows me at least, how far I've come.
This really just shows me that I was just scratching the surface. Not that I was completely wrong, but I wasn't completely right either. Being incomplete is a good way to say it.
I think that I am sensitive
I think that I am sensitive to rejection. This might help explain why I stayed so many years in a relationship with a person (with ADHD) despite his many behaviors that resulted in harm to me and our children.
Might be one reason
That might be one reason, though RSD would impact you across a wide range of relationships and experiences, not just one. Other reasons people stay in relationships that may not be healthy for them include: financial; low self-esteem (don't believe you deserve better); role models - from past family experiences as well as from your past romantic experiences; optimism about whether something is temporary.
I know that my own romantic history was quite complicated in that my very first relationship as a teen was emotionally abusive and I didn't have a framework at that age into which to put that behavior relative to the excitement of being connected to the BMOC. As I have ben thinking about RSD it seems it's hard to draw the line. I know I hate being rejected, and my initial desire to stay in my relationship included feelings of not wanting to go through the pain of rejection/divorce. But even though I hate being rejected and find it intensely painful to be rejected (we all do) I didn't change my everyday behavior towards everyone else (not just my partner) because of it as the man who shared his story did. He went to great lengths not to be rejected, even if there was no indication that the person he was with was intending to do so. If that makes sense.
I think I have adult ADD and RSD.
I have always been extremely sensitive towards the rejection of others much so to the point of always trying to be the people pleaser. The scholar as a kid. Etc. I also lose focus a lot. Have been lazy and mistreated my wife as of lately. I try to reason through and throw a lot of blame at her and everyone around me and have never really analyzed myself. After reading through this site, I realize I have a long ways to go and I have probably been pushing people away my entire life without even knowing it. I have job hopped, I have lied, I have also fought with alcohol abuse as well as used alcohol as an excuse. I think it's time I accepted that I have a mental illness. Only then can I work on being better. I only hope I haven't gone so far as to push away the one person who has really tried to be there for me. I really don't want to lose her,. But I don't want to have her be another person on here that hates her life and regrets being with me for so long either. I think I need serious help. Any advice would be appreciated.
Next steps
Hi, Grelden - I'm so glad you wrote. As strange as it seems, your note is actually really good news. The hardest part of possibly having ADHD is actually getting out of denial about your behaviors and your impact on others. What you wrote suggests that you are ready to start addressing your issues, which is GREAT news for you and your partner! Research suggests that those who start to manage their ADHD can make amazing progress and changes in their lives, including how you react to others, holding jobs longer, managing distraction better, managing anger better, etc. Working on ADHD issues (if you have it) can also help you change habits around lies and cover ups (over time...this isn't one of the first things to go, sadly!)
Your first steps are two - get a full evaluation so you know exactly what you are dealing with, and also to get more information about ADHD and its impact if that is what you have. There is a great deal of information at this site about ADHD so this is a good resource for you. I would in particular point you to the free ebook on treatment on my home page, as well as the treatment section and my blog posts. In addition, my couples seminar has helped many, many couples and is excellent - it would be a good option for you and your partner to take together in September.
To find someone who can do a good evaluation you should seek a psychiatrist who is familiar with ADHD. This is a better approach than just going to your GP because ADHD often goes hand in hand with other issues (you mention drinking too much - that's one of them but not the only one) and it's most straightforward if you get a feel for everything all at once. Also, if you decide to take meds, a psychiatrist can prescribe for you. I have a list of ADHD-savvy folks on my therapists page, and also have some other ideas about how to find someone below.
I applaud you for your taking a close look at yourself. It isn't ADHD that causes divorce, but denial...so your admitting that you could be a better partner in your relationship is a really important step.
Ways to find a therapist in addition to my page (start there first - they are all good)
CHADD – many CHADD chapters keep lists of professionals in their area who help those with ADHD. Look up your chapter on the CHADD website and contact them.
PsychologyToday.com – Psychology Today keeps a large list of providers that is helpful because it is sortable by zip code, specialty and health plan. Look for specialists who say they diagnose ADHD, who practice CBT or in some other way indicate that they have more than a “passing interest” in ADHD. When you call them, find out what proportion of their practice is devoted to ADHD.
GoodTherapy.org – this website has a lot of information about choosing a therapist as well as an extensive list of therapists that can be sorted geographically and by specialty. Note that to find an ADHD therapist you have to go into “Advanced Search” and choose “Inattention…ADHD” Like the PsychologyToday resource, you’ll want to make contact to verify that the person has a specialty in ADHD.
Google – You may find someone by Googling ‘adult ADHD’ or ‘ADHD couples’ and your location.
Hope this helps!
Melissa
What I've learned about RSD has been helpful
Melissa - Thanks as always for being there, the tremendous effort you put into your books, articles, posts, and conversations like this have helped me (and others) so much over the past few years.
Though I was diagnosed ADHD in early childhood (in the 60’s) I continue to discover the nuances that have influenced my life, and this article in has suddenly shone a bright light on something I’ve been struggling with.
As the man’s story you open this post with says, he was an overachiever academically and in business, always striving to be a people pleaser. I guess I’m what you call “high functioning ADHD” but it certainly doesn’t feel that way inside. Though I’ve always internalized this overachievement as a positive aspect of myself, I can see now how harmful this self-focused attitude has been, and how it has led to low self esteem so clearly associated with ADHD, constant attention on what other people think of me, avoidance, occasional addictions, defensiveness and a great deal of fear and shame.
About a year ago I first became aware of RSD, and also recently what appears to be a similar condition described in the ADDITUDE article “ADHD & Emotional Distress Syndrome: Your Truth & Tactics”. Note to the reader: EDS seems rather loosely defined, associated with emotional trauma, the term appears to have been coined by an LPC (not an MD) in a book he published in 2016 – perhaps not much science or research behind EDS, but the articles (I haven’t read the book) ring true with me nevertheless.
This situation for me has been so difficult in the past couple of years that my 34 year marriage has been near the failure point numerous times, occasionally followed by suicidal ideation, with feelings of low self esteem and hopelessness as I grapple with my repeated failures at addressing this habitual, reactive behavior pattern. Thankfully my patient wife sees so much good in our lives that she sticks with me and we’re heading in what I feel is a positive direction, supported by what I’ve learned here.
Here is a detail of my experience that may be helpful to others struggling with similar issues. It’s very difficult for my non-ADHD partner to share her concerns with me. She is such a good, empathic listener to me, but the moment she expresses anything resembling a criticism, or merely points out that I left a drawer hanging open (for the hundredth time) I immediately jump in with a rationalization, why I did this, or why ADHD made me do it. Note to readers who speak of lying – there is a neurological/psychological behavior called “confabulation” that you might want to explore.
I dearly love this woman, and empathize with her, and want to make sure she can express her feelings – which you (Melissa) so clearly emphasize in your books. But my reactive response is so automatic (RSD/EDS) I don’t see it coming, an immediate emotional hijack. It’s seems to be a limbic response (unconscious) the animal brain kicking in (fight, flight, freeze) and I can’t seem to get ahead of it. As Dodson says in the article, “emotions hit suddenly and completely overwhelm the mind and senses.” Only later in the middle of a painful fight, do I once again “wake up” and realize what I’ve done.
So many cycles of this deeply conditioned reaction, of zoning out, so many times failing, have brought me recently to the brink of true despair, hopelessness, suicidal ideations – but I’m now working my way through it. It feels like a cop-out to say I can’t intercept it, but it’s true . . . my brain just seems to “zone out” with this trigger of perceived criticism. I meditate and work hard at mindfulness yet I still fall into this trap. I’ll look into guanfacine and clonidine.
Me too. I've sacrificed any
Me too. I've sacrificed any career potential ostensibly for the good of our family but really, if I'm honest, to avoid rejection. The irony is that the frequency of freezing me out during our earlier years of marriage (a partnership with ADHD - neither of us officlally diagnosed) has sent me, in the end, to look for comfort elsewhere and my other half to follow a long-lasting hyperfocus combined with her family practice of over-dutiful religion, a failing (in my view) then passed on to our children to their detriment. My own response to being rejected frequently at a time when my hormones were raging during our early marriage was to retreat into my shell, and now I have had no physical intimacy within our marriage for years. In any case, even proper kissing was rejected at an early stage, let alone other forms of intimacy. Marriage has turned out to be a huge disappointment physically and emotionally, though not intellectually, but I am aware that I would shoulder the blame within our community if I left and doubt, frankly, if I have the skills to rebuild emotionally or socially.