CIFT: Information on Rejection Sensitivity

While rejection sensitivity is not currently a listed diagnostic trait of ADHD and Rejection Sensitivity Dysphoria (RSD) is not a formal diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders - 5 (DSM-V), the relationship between heightened sensitivity to and emotional distress from exposure to real or perceived rejection and ADHD has been well established.

Rejection sensitivity is used to describe when an individual experiences more emotional dysregulation and pain than typical in response to real or perceived rejection. Rejection Sensitive Dysphoria is used when individuals’ response to real or perceived rejection is so intense it feels extreme and nearly unbearable for the individual. It is believed that the vast majority of individuals with ADHD experience some degree of heightened sensitivity to rejection.

It is currently debated whether this response to rejection is a part of the neurological condition of ADHD itself, or if it develops as secondary response to the traumas of navigating the world as a neurodivergent individual. ADHDers are exposed to drastically more negative feedback and criticism than their neurotypical peers from childhood on, often due to their struggles with impulsivity, hyperactivity, inattentiveness – all of which can contribute to an increased likelihood of missing social cues or failing to meet social norms/expectations. Many ADHDers become extremely vigilant of social missteps and work hard to hide or mask their symptoms due to painful experiences with rejection.

Regardless of how the sensitivity to rejection is formed, ADHDers often do experience rejection as actually emotionally painful. Rejection in these cases can be actually occurring or can be perceived as occurring. Rejection can come from authority figures such as parents, teachers, coaches, or supervisors, or from peers, or even from within the ADHDer themselves when they have failed to meet their own standards or expectations. Feeling rejected can be triggered by feeling excluded, criticized, viewed negatively, or by failing/performing poorly.

How individuals respond to rejection sensitivity or RSD can vary widely based on the temperament of the individual as well as on gender and cultural differences. Some individuals may experience increased defensiveness and anger and respond with aggression, some may become extremely avoidant of conflict and any environments or activities that they perceive as having an increased risk of triggering rejection sensitivity or RSD. This avoidance can sometimes look like a lack of willingness to take risks or try new things. Some individuals become highly anxious, perfectionistic, and seek high levels of academic and career achievement. They may regularly engage in people-pleasing behaviors in an effort to minimize their exposure to rejection sensitivity and RSD triggers.

Many people use a mix of strategies to cope in different situations.

People wishing to play a supportive role in the life of someone with rejection sensitivity or RSD may benefit from keeping in mind that kindness with difficult feedback makes it easier for ADHDers to receive and process needed guidance.
Additionally, people with rejection sensitivity/RSD are very sensitive to positive feedback and can feel powerfully motivated by encouragement, feeling believed in, viewed positively, praise, and having their effort being acknowledged.

Because people with ADHD and rejection sensitivity/RSD may also struggle with anxiety and emotional dysregulation/flooding, when they do manage to seek help or request accommodations, it’s important to take their communication seriously and to respond to requests with understanding, explanations, and reassurances that they are still viewed positively/neutrally as appropriate.
When possible, flexibility in expectations and reasonable accommodation may be indicated.

Resources: #

Informational Resources

Below some additional ways for anyone to learn more:

• CHAAD:

  • Rejection can be more painful with ADHD¹

• Web MD:

  • What Is Rejection Sensitive Dysphoria?²

• Cleveland Clinic:

  • Rejection Sensitivity Dysphoria³

• ADDitude:

  • Emotional Dysregulation and Rejection Sensitivity⁴

• Attitude Magazine:

  • An ADHD Guide to Emotional Dysregulation and Rejection Sensitive Dysphoria (w/ William Dodson, M.D.)⁵

• NeuroClastic:

  • Living with Rejection Sensitive Dysphoria⁶

• How to ADHD:

  • How to deal with Rejection Sensitivity⁷

Clinical References: #

Accredited and Peer-reviewed Resources

Below are peer reviewed studies for specialists (such as individuals in the mental health, medical, or teaching fields) to learn more:

• UC Davis:

  • Peer Rejection and Attention Deficit Hyperactivity Disorder Symptoms:⁸
    Reciprocal Relations Through Ages 4, 6, and 8

• US National Library of Medicine:

  • Rejection sensitivity and disruption of attention by social threat cues⁹
  • Rejection Reactivity, Executive Function Skills, and Social Adjustment Problems of Inattentive and Hyperactive Kindergarteners¹⁰

• Science Direct:

  • Rejection sensitivity prospectively predicts increased rumination¹¹

• Journal of Abnormal Child Psychology:

  • Sensitivity to Peer Feedback in Young Adolescents with Symptoms of ADHD:¹²
    Examination of Neurophysiological and Self-Report Measures
  • Peer Rejection and Friendships in Children with Attention-Deficit/Hyperactivity Disorder:¹³
    Contributions to Long-Term Outcomes

• Journal of Child Psychology and Psychiatry:

  • Evaluating chronic emotional dysregulation and irritability in relation to ADHD and depression genetic risk in children with ADHD¹⁴

• PLOS

  • Experiences of criticism in adults with ADHD:¹⁵
    A qualitative study

• Wiley:

  • Understand and address complexities of rejection sensitive dysphoria in students with ADHD¹⁶