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Researching Rejection Sensitivity and ADHD: Three Treatments to Support Your RSD

Updated: Nov 3, 2021

This article is written based on the results of the 'which ADHD topics do you want me to write about?' post on Facebook in 2020. Thank you to everyone who contributed to that post. You can find more results from that article here.


Rejection sensitivity is defined as the propensity to "anxiously expect, readily perceive, and overreact" to rejection (Ayduk et al., 2001; Normansell & Wisco, 2017). But for many of us, even before we had a definition, we understood what Rejection Sensitivity Dysphoria (RSD) was. It's the sinking feeling you might experience when you don't get a response to a text, the racing thoughts, heightened anxiety, and frustration you feel when receiving criticism or critique.


Some of you even felt like it was a more difficult part of ADHD to manage than the more commonly discussed executive dysfunction. With all this in mind, when I started researching RSD, I was totally surprised to find out that in the academic literature on ADHD, RSD is barely mentioned, let alone studied. I thought I was missing something and went back to the literature several times before finding a thesis from Webster (2018) on the experiences of ADHD adults that confirmed my suspicions.


Webster (2018) also argues that along with that omission of RSD is an omission of the potential positives of ADHDers' emotional sensitivity. For example, a participant noted that "if I find someone struggling who feels like a bit of an outsider, I will make them feel well... Because I've been that outsider and I don't want anyone else to feel like that" (Webster, 2013). Although RSD in ADHD can be difficult, it might also support empathy and a willingness to help others who experience forms of rejection (Webster, 2018).

RSD and Emotional Dysregulation

So if academics don't discuss RSD, what do they discuss? Overall, it appeared that they focus on ADHDers' struggle with emotional regulation, including all emotions, happy or sad. There are many names for it, but academics and clinicians' most common term is emotional dysregulation (ED) (Adler & Silverstein, 2018). Bunford and colleagues (2015) argue that ED should be defined as the inability to regulate emotions when they come up. ED is also associated with not being able to self soothe when experiencing heightened emotions and overall functioning in social situations in a meaningfully poorer way (L. A. Adler & Silverstein, 2018).


Historically, because ED does not occur for all people with ADHD, it has not been considered part of the diagnosis. It has not been considered at all in many cases, with more focus on executive functioning difficulties (Dodson et al., 2020; Kooij et al., 2019). But there is now a growing understanding that emotional struggles also play a big part in ADHD and that it should be included, if not in the diagnosis itself, at least as a part of the overall clinical process for ADHD (Dodson et al., 2020; Kooij et al., 2019).


RSD Treatment

So with no academic research into RSD specifically, where does this leave us in terms of treatment options? There have been several papers researching treatment for ED symptoms, so if you are looking for support for RSD, this might be a good place to start. Below I have outlined three treatment options that have been outlined in ED academic research that may be relevant to RSD. Please know that I'm a coach and academic, not a doctor, so please always consult your health professional and follow their recommendations when trying something new.


1. Medication.

There is some evidence that medication supports the regulation of ED symptoms (Adler & Silverstein, 2018; Childress & Sallee, 2015; Faraone et al., 2019). There is also some evidence medication does not support ED as well as it assists executive functioning ADHD symptoms (Lenzi et al., 2018). Below is a list of possible medications with reference to the papers that found some support for their use with ED. If you are interested in this method, please speak to your doctor or psychiatrist as the next step.

- Methylphenidate

(Marchant et al., 2011; Reimherr et al., 2020)

- Atomoxetine

(Adler et al., 2014; Childress & Sallee, 2015; Faraone et al., 2019; Schwartz & Correll, 2014)

- Amfetamine

(Adler et al., 2013; Adler & Silverstein, 2018; Childress & Sallee, 2015)


2. Cognitive Behavioural Therapy (CBT)

The other method of support discussed throughout the research was CBT (Adler & Silverstein, 2018). CBT's goal is to help you to find areas where your thoughts, feelings, and behaviours might be distorted and work to reframe them (Faraone et al., 2019). Many therapists use CBT, so finding an ADHD specialised therapist who can work with CBT might be a good move if you are interested in seeking this type of treatment.


3. Mindfulness.

Another non-medical form of treatment for ED, which was discussed in the research, is mindfulness (Cairncross & Miller, 2020; Mitchell et al., 2017). Mindfulness practices focus on helping people increase their awareness and acceptance of internal and external experiences, emotions, and thoughts (Cairncross & Miller, 2020). It can include breathing exercises and guided meditations (Faraone et al., 2019; Mitchell et al., 2015; Schoenberg et al., 2014). If you are interested in seeking mindfulness as support for RSD, finding an ADHD therapist who specialises in this can also be a helpful next step.


Overall, it appears that the research into RSD and emotions in ADHD is still sadly under-researched. Hopefully, as the importance of emotions in ADHD become more well-known, this area will start to see more studies come through. In the meantime, if you need help with RSD, these three treatment methods have been researched and found some evidence supporting their use in ED. You might find they help your RSD as well. No matter what, remember RSD is a very common experience for those of us with ADHD. You are not alone, reach out, talk to someone, and get the help you need. You deserve it.


Talk to you next week,


Skye.


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References

Adler, L. A., Dirks, B., Deas, P. F., Raychaudhuri, A., Dauphin, M. R., Lasser, R. A., & Weisler, R. H. (2013). Lisdexamfetamine Dimesylate in Adults With Attention-Deficit/ Hyperactivity Disorder Who Report Clinically Significant Impairment in Executive Function: Results From a Randomized, Double-Blind, Placebo-Controlled Study. The Journal of Clinical Psychiatry, 74(7), 694–702. https://doi.org/10.4088/JCP.12m08144

Adler, L. A., & Silverstein, M. J. (2018). Emotional Dysregulation in Adult ADHD. Psychiatric Annals, 47(7), 318–322. http://dx.doi.org.ezproxy.auckland.ac.nz/10.3928/00485713-20180607-01

Adler, L., Tanaka, Y., Williams, D., Trzepacz, P. T., Goto, T., Allen, A. J., Escobar, R., & Upadhyaya, H. P. (2014). Executive Function in Adults With Attention-Deficit/Hyperactivity Disorder During Treatment With Atomoxetine in a Randomized, Placebo-Controlled, Withdrawal Study. Journal of Clinical Psychopharmacology, 34(4), 461–466. https://doi.org/10.1097/JCP.0000000000000138

Ayduk, O., Downey, G., & Kim, M. (2001). Rejection Sensitivity and Depressive Symptoms in Women. Personality and Social Psychology Bulletin, 27(7), 868–877. https://doi.org/10.1177/0146167201277009

Bunford, N., Evans, S. W., & Wymbs, F. (2015). ADHD and Emotion Dysregulation Among Children and Adolescents. Clinical Child and Family Psychology Review, 18(3), 185–217. https://doi.org/10.1007/s10567-015-0187-5

Cairncross, M., & Miller, C. J. (2020). The Effectiveness of Mindfulness-Based Therapies for ADHD: A Meta-Analytic Review. Journal of Attention Disorders, 24(5), 627–643. https://doi.org/10.1177/1087054715625301

Childress, A. C., & Sallee, F. R. (2015). Emotional Lability in Patients with Attention-Deficit/Hyperactivity Disorder: Impact of Pharmacotherapy. CNS Drugs, 29(8), 683–693. https://doi.org/10.1007/s40263-015-0264-9

Dodson, W., M.D., & LF-APA. (2020, July 29). New Insights Into Rejection Sensitive Dysphoria. ADDitude. https://www.additudemag.com/rejection-sensitive-dysphoria-adhd-emotional-dysregulation/

Faraone, S. V., Rostain, A. L., Blader, J., Busch, B., Childress, A. C., Connor, D. F., & Newcorn, J. H. (2019). Practitioner Review: Emotional dysregulation in attention-deficit/hyperactivity disorder – implications for clinical recognition and intervention. Journal of Child Psychology and Psychiatry, 60(2), 133–150. https://doi.org/10.1111/jcpp.12899

Kooij, J. J. S., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I., Balázs, J., Thome, J., Dom, G., Kasper, S., Filipe, C. N., Stes, S., Mohr, P., Leppämäki, S., Casas, M., Bobes, J., Mccarthy, J. M., Richarte, V., Philipsen, A. K., Pehlivanidis, A., … Asherson, P. (2019). Updated European Consensus Statem