“It’s Not Just in Your Head”: Understanding Rejection Sensitive Dysphoria in ADHD

By Dr Victoria Barclay-Timmis, Clinical Psychologist at Sky Psychological Services

Have you ever felt devastated by what seemed like a small criticism? Or found yourself replaying a comment over and over, long after everyone else moved on? If you have ADHD, these reactions might not be an overreaction—they may be signs of something called Rejection Sensitive Dysphoria, or RSD.

In my recent article for The Conversation, I explored this often-misunderstood emotional experience and why it matters so much for people with ADHD. In this blog post, I want to take that conversation further, especially for parents, partners, and individuals wondering, “Is this what I’ve been going through?”

(Read the full article here: What is rejection sensitive dysphoria in ADHD? And how can you manage it?)

So, What is Rejection Sensitive Dysphoria?

Rejection Sensitive Dysphoria refers to an intense emotional response to real or perceived rejection, criticism, or failure. It’s not currently listed as a formal diagnosis in the DSM-5, but it’s something many individuals with ADHD report experiencing regularly. And far from being a personality quirk, RSD has real roots in brain science.

The word “dysphoria” literally means “a state of unease or dissatisfaction,” and for those who experience RSD, this unease can become overwhelming in seconds, leading to deep sadness, shame, rage, or complete withdrawal. Therefore, it’s not about being “overly sensitive”, it’s about having a neurological vulnerability to emotional pain, particularly in the context of social rejection.

What Does the Science Say?

While the term “Rejection Sensitive Dysphoria” isn’t a formal medical diagnosis, there’s growing scientific evidence to support the neurobiological basis of this experience, particularly in people with ADHD.

Brain Imaging Research on ADHD and Emotional Regulation:

Functional MRI (fMRI) and structural imaging studies have consistently shown that people with ADHD often have differences in the structure and function of key brain regions involved in emotional regulation and threat detection:

• Amygdala: This is the brain’s alarm system, helping us detect threats, including social threats. In individuals with ADHD, the amygdala tends to be hyper-reactive, leading to heightened sensitivity to criticism, exclusion, or perceived rejection.

• Prefrontal Cortex (PFC): This part of the brain is responsible for impulse control, attention regulation, and managing emotional responses. Research shows that the PFC in people with ADHD often has reduced activity and delayed maturation, which means it can be harder to "talk yourself down" in moments of distress.

• Anterior Cingulate Cortex (ACC): This region helps regulate emotional responses and detect social errors. Some studies suggest it may be less efficient in people with ADHD, leading to increased distress over perceived social missteps or failure.

Together, these findings help explain why people with ADHD may experience emotions more intensely and find it more difficult to recover quickly after being upset, hallmarks of what many describe as RSD.

RSD vs. “Being Sensitive”

It’s important not to dismiss RSD as simply “being emotionally sensitive.” While everyone dislikes rejection, RSD reactions are often:

• Extreme – The emotional pain can feel unbearable or out of proportion to the situation.

• Fast – The response happens almost instantly, with little warning.

• Internalised – Many people turn the hurt inward, spiralling into self-criticism or shame.

• Avoidant – To prevent future pain, individuals may avoid new opportunities, social situations, or risk altogether.

For those with ADHD, this can become an exhausting cycle of masking, people-pleasing, and low self-worth.

Why Does RSD Happen in ADHD?

People with ADHD often grow up hearing that they’re “too much,” “not enough,” or “hard to manage.” Over time, this can create a deep fear of letting others down. When paired with the brain differences mentioned above, it’s a perfect storm: the brain is wired to detect threat quickly, but struggles to regulate emotions effectively.

This makes RSD not a choice, but a neurological and emotional pattern. One that deserves understanding, not judgment.

What Can Help?

The good news is that RSD is treatable and manageable, especially when approached with compassion and science-backed strategies. At Sky Psychological Services, we help individuals and families develop tools to recognise, regulate, and reframe these intense emotional experiences.

✅ Name it – Just knowing what RSD is can be incredibly validating. You’re not broken, you’re wired differently.

✅ Self-compassion – ADHD often comes with a harsh inner critic. Practising kindness toward yourself in moments of distress is essential. 

✅ EFT (Emotional Freedom Techniques) – Tapping has been shown to reduce emotional intensity quickly. We use it with many clients who experience RSD-like reactions, with positive results.

✅ Therapeutic Support – Working with a psychologist who understands ADHD and emotional dysregulation can help you develop tools to manage reactions and build resilience.

✅ Communication tools – Learning how to name your needs, express emotions, and create healthy boundaries can make a big difference in how others respond, and how you feel.

We Can Help You Get Clarity

If you’ve been wondering whether ADHD—and RSD—might be behind some of your emotional struggles, we’re here to help.

At Sky Psychological Services, we offer comprehensive ADHD assessments for children, teens, and adults. Our assessments are trauma-informed, evidence-based, and designed to give you clarity, confidence, and a way forward.

Whether you're seeking diagnosis, support strategies, or just a safe place to unpack your experience, Sky Psychological Services is here to assist.

📅 Contact [email protected] to learn more about ADHD assessment and support options.

📰 Read more in my article for The Conversation: What is rejection sensitive dysphoria in ADHD? And how can you manage it?