Rejection Sensitive Dysphoria, Emotional Dysregulation, and ADHD: What Research Actually Says

As I started to immerse myself in online ADHD discourse, I started seeing the acronym “RSD,” which stands for “rejection sensitive dysphoria,” everywhere. YouTube videos and Substack posts provided helpful explainers about RSD, or rejection sensitive dysphoria, which was described as a symptom of ADHD. A Google image search revealed dozens of RSD infographics and checklists. On ADHD forums, people worried that their RSD would prevent them from graduating or that a partner’s RSD was going to break up their relationship. 

Curious to look into research on RSD, I hopped over to Google Scholar and searched for peer-reviewed articles about “rejection sensitive dysphoria” and ADHD.

And... I didn’t find anything.¹

That’s right. As far as I could tell, despite the official-sounding name and acronym, “rejection sensitive dysphoria” does not appear to be a scientific term.

Wait, so is RSD a real thing for people with ADHD?

Yes, RSD is totally still a real thing! It’s just not a research thing, at least so far. And it’s not an official health condition that you can be diagnosed with.

It appears that “rejection sensitive dysphoria” is a term coined by a psychiatrist, William Dodson, to describe a phenomenon he observed among his patients. The term RSD was popularized in Dodson’s 2016 article in Attention magazine. Dodson defines RSD as “extreme emotional sensitivity and emotional pain” after experiencing (or imagining) rejection, criticism, or disappointing others. 

Dodson’s 2016 article presents a lot of claims without any citations or evidence, which makes the overall introduction of RSD feel a little bit off. For instance, he says, “About a third of adolescents and adults list RSD as the most impairing aspect of their ADHD,” but doesn’t say anything about where this number came from.  

Dodson may very well have credible sources to back up his claims, but these sources aren’t mentioned in the article itself. And that seems odd.

Regardless of any missing citations, however, the reality is that the idea of RSD has blown up. According to Google’s keyword planner tool, the term “rejection sensitive dysphoria” gets between 100,000 and 1 million searches every month. Cleveland Clinic, WebMD, and Psychology Today all have RSD explainer articles. The term is ubiquitous in ADHD online spaces.

My sense is that the reason why the term RSD became so hugely popular is because it truly resonated with people. People felt validated by a clinical-sounding term that gave a name to a truly painful and common experience for them. People felt empowered by having language to discuss this pain with others. People felt less alone in their struggle when they realized that other people shared this experience too.

(By the way, if you want more on the origins of RSD as a concept, this post from Jillian Enwright does a fantastic job explaining it all.)

Okay, but are you sure there’s no research at all on rejection sensitive dysphoria and ADHD?

Well, sort of. I was unable to find peer-reviewed articles on “rejection sensitive dysphoria” and ADHD. However, as Dodson himself recently pointed out, there is quite a bit of research on emotional dysregulation and ADHD. 

In fact, in the last couple of decades, there appears to be a growing scientific consensus that the current, official triad of ADHD symptoms —inattention, hyperactivity, and impulsivity—is incomplete. Research suggests that emotional dysregulation is an important fourth symptom of ADHD, currently missing from the criteria in the DSM-V (the official list of mental health conditions used in the U.S.).

Emotional regulation is the process of managing emotions and being intentional about how emotions affect behavior. When you’re emotionally dysregulated, you may experience:

• Irritability

• Angry outbursts

• Rapid mood swings

• Feeling overwhelmed in response to everyday stressors

Rejection sensitive dysphoria could be considered one example of emotional dysregulation. In other words, while there is no research on RSD, there is lots of research on emotional dysregulation, and RSD is one way that emotional dysregulation can manifest.

Importantly, researchers have found that emotional dysregulation is especially common among women with ADHD. As I noted in last week’s post on ADHD diagnostic criteria, the current definition of ADHD is based on research on white male children, so it is perhaps not surprising that a symptom that is more common among women is missing from the current definition of the condition. Disappointing, but not surprising.

So what can I do about my RSD or my emotional dysregulation?

This is an important question that I’d love to dive into more deeply in a future post. The research I’ve read so far suggests that medications traditionally prescribed for ADHD (such as stimulants) are helpful in managing emotional dysregulation. 

Researchers also point to promising evidence that non-pharmacological interventions, like coaching and therapy, can help as well. It does appear that, at least to an extent, we can strengthen our emotional regulation skills by practicing mindfulness and accepting difficult emotions. 

To sum up, if someone came to me today saying they wanted help with their ADHD-based rejection sensitive dysphoria, I would suggest...

• Finding a qualified mental health professional for an ADHD assessment and, if appropriate, medication (if they haven’t already). This resource includes some suggestions for finding a provider.

• Finding a qualified therapist, coach, and/or meditation teacher that specializes in mindfulness or similar emotional regulation strategies.

  • If you are looking for help with healing deep emotional wounds, trauma, or recovering from depression or anxiety, a licensed therapist is likely the best choice. Psychology Today is a great resource for finding therapists.

  • If you want to work on behavior change and integrating emotional regulation strategies in everyday life, consider a coach or coaching group. The ADHD Coaching Organization Directory is one place to start looking for coaches with ADHD-specific training.

  • If you are interested in developing a dedicated meditation practice, consider a meditation teacher or meditation class.

Thank you so much for reading this post from ADHD Unpacked. I am so excited to continue exploring ADHD, productivity, and mental health with you. As always, please feel free to reach out with thoughts or suggestions for future posts! And if you enjoyed this post, I hope you’ll consider sharing it with a friend.

Stay curious,

Taylor

P.S. I’ll be taking a winter break for the next few weeks, but I’ll be back with more ADHD Unpacked in January 2024. In the meantime, happy holidays and happy new year!

1. There was one (very interesting) study in which young adults with ADHD were interviewed about their symptoms, and the interviewees themselves brought up RSD. However, I did not find any peer-reviewed studies about ADHD-based RSD itself.