April 4, 2023

Why I’m Rejecting RSD (Rejection Sensitive Dysphoria)

I get bold and honest in this episode as I challenge “expert” opinion on Rejection Sensitive Dysphoria (RSD). And honestly, I’m scared you’re going to reject me for it. 

Most of us adults living with ADHD have many experiences from childhood onwards of being rejected due to our neurodivergence. We’ve grown up in families and systems that have indeed rejected us. OF COURSE this means that we’re more sensitive to rejection. 

But I reject the idea that our ADHD itself is the genetic and neurological CAUSE of our rejection issues. No. Growing up in a world that constantly rejects us is the cause of our rejection issues. 

Yet there is one published ADHD expert who claims that RSD is genetic to those with ADHD and that the ONLY treatment is medication. He says that “psychotherapy does little to help” those with rejection issues.

Well, I reject these statements as they lack the following:

  1. Any evidence at all
  2. Any mention of other supportive research
  3. Any anecdotal confirmation from real life adults living with ADHD

Rejection is real. Those of us with ADHD have experienced and do experience a lot of it. That doesn’t mean we have genetic disorder giving us rejection sensitivity and that doesn’t mean that only medication can help us improve our sensitivity.

Thankfully I’m not the only one who feels this way. Take a look in the references below and make your own best judgment based on the existing research, your personal rejection experiences, and what you know about the ADHD community.

Rejection sensitivity IS REAL, and most of us ADHDers experience it. But I reject the term RSD, and I wonder if you’d like to reject it, too? 

Be in community with kind, like-minded individuals living with ADHD and join my group coaching program, FOCUSED.

Referenced Articles:

RSD: The Feelings are Real but the Cause is All Wrong 

Dodson’s Additude Mag Article on RSD 

Medical News Today: RSD is Controversial



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Kristen Carder 0:05
Welcome to the I have ADHD podcast, where it’s all about education, encouragement and coaching for adults with ADHD. I’m your host, Kristen Carter and I have ADHD. Let’s chat about the frustrations, humor and challenges of adulting relationships working and achieving with this neurodevelopmental disorder. I’ll help you understand your unique brain. Unlock your potential and move from point A to point B.

Hey, what’s up, this is Kristen Carter and you are listening to the I have ADHD podcast. I am medicated. I am caffeinated. I am regulated, and I’m ready to roll. I am so ready to roll and really looking forward to this episode.

Today. We are continuing our deep dive on rejection sensitivity. And today we’ll specifically be talking about our SD or rejection sensitive dysphoria. But I’m really, really glad to be back with you because I’ve been dying to tell you this. I have a story.

On my episode last week, which was all about rejection sensitivity. I talked about a scenario that I created in my brain where the builder hated us. Yes, you remember that? Okay. I kid you not, I swear. This is true. I finished up recording that episode. I sent it to my editor. I looked at my phone. And what do I see? I’m not joking. There was a voicemail from the builder on my phone 100% could not even have made this up. Here’s what the message said something to the effect of “hey, Kristen, we got your submission on our website. So sorry, it took me so long to get back to you. We’ve had two guys out because they both had brand new babies. So we’ve been behind schedule.”

I mean, I literally almost fell out of my chair. Because after I had just told you about feeling so rejected by the builder and building this whole scenario in my mind around how they didn’t want to work with us. And they thought we were high maintenance and they didn’t really like us. And trying to remember that there were other possibilities besides them hating us. And bam, there was a voicemail right there from them. I just couldn’t wait to tell you I’ve been dying to tell you I feel like I’ve had to wait forever to let you know.

So I’m really, really excited to tell you that it was just a rejection scenario created by my brain that is highly highly, highly sensitive to rejection. I was not correct. My feelings were 100% valid, they deserve to be cared for. Nurtured, taken care of the feelings were real, super, super real.

But my thoughts and assumptions were not correct. Which is a huge relief. Because now like they’re coming to my house and a week and a half, and they’re gonna like do a design consultation. I’m very, very excited about that. And I’m glad that they don’t hate us. So there you go.

Now if you are like me, and you are someone who experiences a lot of rejection sensitivity, one of the most healing things that you can do for yourself is to be in community with kind, open like minded humans. And that’s exactly what my focused ADHD coaching program is all about. I want you to hear from my client, Nicole, as she talks about her experience being in focused.

Nicole 3:33
Focus, I’m obsessed with it. I’m a stay at home mom right now. So I have the opportunity and availability to listen to a lot by podcast. I have been in since the end of December. And I have listened to over 350 Private of the episodes and calls and whatever I listen all day every day except like, you know, I have two kids. So I you know, do things with them and whatever. But I listen through everything and I love it. I’ve gotten so much out of it. And I so appreciate that this is here. I have I don’t I have no I have a lot of ADHD symptoms, or whatever you would call them. But I’ve never been diagnosed or whatever. But I feel so similar and so loved and I love this community. So it’s just amazing that you’re here and just this year, I was like, Oh my God, this woman and then like a few months later, I listened to your podcast and then I was like I just was binging your podcast, your regular podcast, and I was like okay, so thank you so so much for doing this for being here and I have learned so much from you already.

Kristen Carder 4:39
Isn’t that just lovely to hear from her. Now whether or not you have an official ADHD diagnosis, you will be warmly welcomed and included in our community. Visit I have to learn more.

All right. I want to say here that if you haven’t listened to last week’s Episode called rejection sensitivity. You really need to listen to that one first, please. I’m begging you, please. Maybe you’re a brand new listener, like maybe you just searched up RSD in your podcast app. And now you’re here for the first time, which is amazing. Welcome. But I’m gonna say some stuff on this episode. And without the broader context of last week’s episode, it might make you mad. Okay, so I want I don’t want to make you mad. I want to make you happy, because I am also massively prone to rejection. So please, please, if you haven’t listened to last week’s episode, yet called rejection sensitivity, please start there.

Now in last week’s episode, we chatted about rejection sensitivity and how it is a very common experience for people with ADHD. We talked about what it is exactly why we’re prone to it. And we touched a little bit on how to deal with it. Now I want to just review a few of the main points here before we get started. First, rejection sensitivity is when we interpret benign or mildly negative social cues as signs of outright rejection.

This is very common for people with ADHD. And it often feels so so so painful that it is emotionally debilitating, like we were so debilitated by that pain, and then that informs our actions and we don’t really get anything done. So a few common ways that we cope with this is number one, we either disengage, and we don’t do anything for fear of being rejected. Or we become massive people pleasers and essentially try to please people into never rejecting us.

This is a real and valid and common experience for adults with ADHD. It may also be common among other neuro divergences. I’m not actually sure, ADHD is my area of expertise. And that’s, you know, what I’m able to speak to with credibility.

So on today’s episode, we’re going to do a deep dive on our SD rejection sensitive dysphoria, and I’m going to push back on some stuff. Okay, so, deep breaths. I’m a little scared, honestly, because I don’t want you to reject me for this episode. But I feel like it’s very, very necessary. So I’m going to move forward.

What I want to talk about today is what is RSD? And is it different from rejection sensitivity and what what are people saying about it? Okay, so our SD stands for rejection sensitive dysphoria. It appears that a doctor who was a major contributor to the development of American psychiatry named Donald F Klein, first coined this term in relation to patients with borderline personality disorder. So it seems so I’ve been able to, like find, but the person who speaks most about RSD and present day is Dr. William W. Dodson.

Now, Dr. Dodson is a board certified adult psychiatrist, and he was one of the first clinicians who specialized in adults with ADHD over 25 years ago. So I mean, you know, he’s got some ADHD chops, we got to give it to him. He is a major contributor to attitude magazine, and he’s part of all of the like standard classic ADHD organizations like add A and Chad and all the mainstream ADHD things.

He also makes really big, huge claims about RSD. And, and I struggle, so we’re going to chat about that. Okay. He makes some big claims, from what I can find he’s the only one using the term RSD. So that either makes him a hero, or it makes him an outlier in the psychiatric community and we just need to like, decide what we think.

Now I’ve combed through the books, y’all. I’ve come to the Bucks Barkley doesn’t mention RST Ramsey doesn’t mention RST Tuchman doesn’t mention RST Halliwell does mention it briefly, but when he does he quotes Datsun so he doesn’t share any of his own thoughts about it that I could find. The term RSD rejection sensitive dysphoria, as it pertains to the ADHD community seems to rest on the shoulders of one man, Bill Dodson.

I think he goes by Bill I. I’ve seen it in his like bios and stuff. So we’ll call him Bill. Dr. Bill Dotson, and it doesn’t sit great with me that that we are using a term that only one person is willing to use. It doesn’t sit well with me for a few reasons.

First, there’s no research on RST. And I understand that that doesn’t mean that RST isn’t a thing I get that the community of ADHD as will always be ahead of the research on ADHD I 100% agree with that. But there is no research on it, there is no medical consensus on RSD RST is not a recognized, you know, classified disorder. And yet one person continues to speak very authoritative ly on it without any nuance or without any acknowledgement to the complexity of it. And I will get to the real reason why I take issue with this later. But I will just give you a teaser here.

The treatments that he says, you know, are the only effective treatments. I have not seen that to be true in my experience working with 1000s of adults with ADHD. So I’ve got some issues here around around all of this. Since there is no research on RST, I am very confused as to how Dr. Dodson just speak so authoritatively on it, and why are other reputable medical publications picking up his words and just using them as fact, when they are really not backed up by anything.

So here’s kind of what I mean by that. I’m gonna give you an example. So here is an article from attitude magazine. It’s called How ADHD ignites rejection sensitive dysphoria. And here’s the first sign of the article. Rejection sensitive dysphoria. RSD is extremely emotional sensitivity and pain triggered by the perception that a person has been rejected, or criticized by important people in their life.

It may also be triggered by a sense of falling short or failing to meet their own high standards, or others expectations. That sounds great. 100% That sounds great. But the term rejection sensitive dysphoria is linked to show authority and credibility.

But where’s it linked to? Hmm, it’s linked to another attitude magazine article written by none other than William Dodson. So he’s linking to himself not to research, not to client stories, not to someone else, another professional who backs up his claims, but to himself.

Okay, here’s more of what Datsun says in this article. It can take a long time for physicians to recognize that these symptoms are caused by sudden emotional changes associated with ADHD and rejection sensitivity, while other aspects of relating to others seems typical. RSD is in fact a common ADHD symptom, particularly in adults. Okay. A separate there are SD is, in fact, a common ADHD symptom. Okay. No, it’s not. It’s it’s actually not an ADHD symptom is not it’s not a symptom of ADHD. It’s not cause it’s not in the DSM. It’s not listed anywhere as a symptom of ADHD.

Now, ADHD symptoms here in this article is linked. Oh, credibility, amazing. Take me to the place that says that our SD is in fact a common symptom of ADHD. Will we get some research? Will we get some credibility here? Oh, no. It’s another attitude magazine article talking about the symptoms of ADHD. And guess what isn’t mentioned. Rejection sensitive dysphoria?

We would wait, What? What? Because it’s not a symptom of ADHD. So why are we linking to an article that includes the symptoms of ADHD, but that does not mention rejection sensitive dysphoria. I’m just thinking that maybe attitude magazine could do better.

Doesn’t the ADHD community deserve a little better than this? I think I think we deserve better, y’all. And not because I don’t agree that massive rejection sensitivity is a thing for us. It is, of course 1,000,000% It’s a huge thing for me personally, and I see it in my clients as well. I’ve worked with 1000s I know it’s a thing. But we’ve got to do better for our ADHD community than one person quoting himself with no data, or any other person backing it up. I’m sorry, I am not. I’m just not willing to accept that on behalf of myself and on behalf of my clients.

So you see the tension, get a little bit fired up. I am still regulated. I just I would like to let you know. You can be fired up and regulated at the same time and I believe that that is where I am right now.

Our ADHD is more prone to being sensitive to rejection held to the Yes. But I for 1am going to stop using the term RST. It’s a decision that I’ve made. Just very recently. I’m going to stop personally, I’m going to stop using the term RSD. Not because it’s not a recognized medical disorder, I don’t need it to be recognized by the elite medical community in order for me to know it’s a thing.

Okay, so I know that rejection sensitivity is a thing, but I’m going to drop the term RSD. And not because there’s no research on RSD I’ve worked with 1000s of adults with ADHD, and I’ve seen rejection sensitivity be pervasive among almost 100% of us across the board. So like, there doesn’t need to be massive amounts of research on rejection sensitivity, but I’m gonna drop the term RSD. And there’s two reasons why.

First, it makes me skeptical, and it weirds me out a little bit when there are outliers, like Dodson, or another example on a completely different different topic would be Dr. Amen. That’s a whole different conversation. But like, these are definitely like people on the outskirts.

And if our SD is such a, quote, unquote, fact, why aren’t other experts and professionals talking about it? Why aren’t the other giants that we all turn to for insight and help speaking about it? So that that gives me pause?

Okay, but here’s the main reason why I’m going to no longer use the term RST. This is the most important this is the main reason I will not be using the term RST, moving forward because of what Dotson says here. Rejection sensitivity is part of ADHD.

Okay, great. Love that 100%. Now moving on, this is a direct quote, It is neurologic, and genetic. Early Childhood Trauma makes anything worse, but it does not cause RSD.

Moving on, I think that’s BS. By the way, moving on. Psychotherapy does not particularly help patients with RSD. Because the emotions hit suddenly and completely overwhelmed the mind and senses, it takes a while for someone with RSD to get back on their feet after an episode. Psychotherapy does not particularly help patients with RSD not true.

I’m sorry, there’s no evidence to back that up. He doesn’t quote anybody here. He doesn’t use any research. He doesn’t even quote his own experience with his clients. He is He is giving us no reason for this claim. And I do not believe it to be true.

In my experience helping so many people with ADHD, this has not been the truth. And it is not my own lived experience. And so if RSD is connected to these quotes on Hey, guess what, there is no hope for you and psychotherapy doesn’t help and like non medication approaches don’t help. If it’s connected with that. I reject it. I’m sorry, it’s a no.

He goes on to say there are two possible medication solutions for RST. So your non medication interventions don’t work. But don’t worry, we’ve got two meds for you. And he lists them both in the article and I’m not going to give it credibility. So I’m not going to say them here on this podcast.

It infuriates me it absolutely infuriates me because these claims are not backed up. They are not the experience of myself or my clients and they are being quoted by medical publications like WebMD and Psychology Today and all of these other places that are picking up you know, trendy RSD content and quoting Dodson that non medication interventions don’t work and so when ever someone Google’s our SD, guess what they find out they read the words this condition is neurologic and genetic. There’s nothing you can do about it. And nothing will help you except for medication. And that is absolutely bonkers to me. absolutely bonkers.

Now when I first started researching for these episodes, and you know adorably thinking that I could just do one full episode on RST and like kind of knock it out of the park. This was back in February I posted in my Slack community for my focus ADHD coaching program and here are my exact words.

I said hello, I would love to hear from you. Has your rejection sensitivity improved with any have the following adjoining focused therapy or another intervention, but not including medication. I just need a yes or no, you can feel free to share your story, but you don’t have to.

Okay. Oh, and then I put down here. I want to reiterate, I’m trying to get a feel for whether or not you’ve seen any improvement with a non medication approach. 58 People said, yes, they have seen improvement with either focused or therapy or another non medication approach. Three people said no, okay. 58 People said, Yes, three people said, No.

Now, is this like research data? Not necessarily, but it is our community’s lived experience. 58 People said, yes, my rejection sensitivity has improved through a non medication approach. Three people said, No, I have not seen any improvement with non medication approaches. I need y’all to understand that this very, like cringy basic data is more data than we’re getting from an attitude magazine article. And adults don’t really think that’s okay. I just don’t think it’s okay. I know I’m going to be blacklisted. I understand that.

This is why I have put off this topic for years is because I knew I would be going against attitude magazine, and someone who has been propped up by Chad and add a and all of those things. I couldn’t handle that. But I think I can handle it now. I’m ready. Okay, I’m ready for it.

I want to share a couple of these beautiful responses. Andrea says yes, my rejection sensitivity improved with therapy in the past and focused presently, it’s helped me to be more mindful and follow through on things that are important to me. If I don’t knock myself down, others don’t have the power to do it, either. Lisa says, yes, no therapy or meds. But focus has increased my awareness, which slows down the reaction. It really does. I’d never heard of RSD though, before focused.

Mia says yes, I think so. one more vote for mindful and self compassion. Like asking myself what painful thing is my brain making this mean about me. And then heart centered somatic support with my body and nervous system.

Alright, that’s just a couple people sharing their experience. But again, that’s more data. That’s more back up. That’s more, you know, statistical stuff than what we’ve been provided from attitude magazine.

Okay, let’s move on. I want to read you an article, or at least parts of an article that really I could have just read this for the podcast. It’s called RSD. The feelings are real, but the cause is all wrong. It’s by Gillian and right. And I’m going to link it in the show notes. And I would really love to be best friends with Jillian. So if you know her, send her my way.

She talks all about rejection sensitive dysphoria, and she kind of like lists the, you know, all of the things that we can find on the internet. Okay, Julian says the description of RSD is very real, which I totally agree with. It’s very real, as an overwhelming majority of the ADHD population can attest to it, which is why I was so drawn to exploring it and researching it in the first place.

But now I want a do over like, yes, 100% Because I’ve learned a lot more and as a result have some important things to add. Notably, the fact that RSD is attributed to ADHD and neuro divergence. And that has me thinking about this more critically, there is very little actual research done on rejection sensitive dysphoria.

Actually, there’s None.

Absolutely none.

So it’s very difficult to critique research that doesn’t exist. RSD is a term made up by William Dodson, which I think it was first used by that Klein guy, but whatever. William Dodson is the first one to link it to ADHD that I know of, to describe the experience of many ADHD patients. In fact, he claims that 99.9% of his patients experience RSD and cite it as their biggest problem, a figure for which he provides zero actual data. Thank you, Julian. I know where’s the data? Continuing with Julian’s article? Because seriously, she could have just like written scripted this podcast for me.

The primary information about RSD is available on the attitude magazine website and Dr. dotson’s own website, neither of which site any peer reviewed research. Dr. dotson’s website has zero citations and attitude mags website only sites itself. Sorry, I’m sorry. Sorry, that’s ridiculous and takes you in circles around other articles on their website. Yeah, that’s real weird.

Here’s a point here that Gillian makes that I want to just applaud. She says it’s not disordered when it’s a rational response to actual repeated rejection. So rejection sensitive dysphoria might not make sense, because it’s not actually like a disorder. It’s actually a rational response to actual repeated rejection. Research has shown, and I’m quoting her research has shown that children diagnosed with ADHD are in fact more often rejected than their peers. As many as 52% of seven to nine year old children with ADHD fall into the rejected category. Guess what, y’all? Chilean links research? I imagine. Imagine that she likes research. 52% of all 79 year old children with ADHD fall into that category. Children with ADHD are also more vulnerable to bullying and victimization. And guess what she links, more research, and many adults with ADHD described childhood experiences of rejection and bullying by peers.

Okay, and quote, cheers for Julian, thank you so much for this beautiful article. I want you, dear listener to think about your childhood.

Were you often rejected as a child?

Did you grow up in a family who thought that you should be different than you are?

Were you seen for the magical, beautiful person that you truly are? Or were you made to feel like you were the problem and like you should change that you needed to fit into your family’s box or your school’s box or society’s box. I can think of repeated times in my childhood where I was bullied, where I was rejected, where I was excluded, where I was made to feel like I was the odd person out over and over and over. 

Most notably, in seventh grade, I was kicked out of the lunch table. That’s right, the seventh grade girls sat there and they looked at me in the face, and they said, We don’t want you to sit with us anymore. And I was just like, oh, okay, like that, that is going to make you more prone to being massively fearful of rejection. And I bet if you have the emotional capacity to think through your childhood, my assumption about you is that it probably wasn’t that different from my childhood, you probably experienced massive amounts of rejection as well. 

And wouldn’t that make sense that we are then Berry, Berry scared to be rejected? Julian says, If you spent a significant part of your childhood experiencing actual rejection, criticism and bullying, it stands to reason that you would become hypersensitive to these experience. Yeah, 100%. It would make sense I’m quoting her again, it would make sense to have a more intense reactions to rejection, then someone who grew up feeling accepted and appreciated someone who had the environment and circumstances in which develop a healthy sense of self. And quote, yes, all of this 100%. 

So here’s where I’m going to wrap it up. Rejection sensitivity is 100% a part of ADHD. People with ADHD struggle with extreme emotional distress when it comes to rejection? Yes, our community deserves to be believed about this. This is our lived experience for most of us, and we deserve to be heard. But personally, I’m going to drop the term RSD I will not be using it moving forward because of what it implies. 

First, that my intense feelings of rejection are strictly genetic. Ah, that’s just telling me I’m the problem. My brains the problem? How about trying to grow up in a society that didn’t accept me? How about that, okay. 

So first, that my intense feelings of rejection are strictly genetic, I reject that 100% And that my intense feelings of rejection cannot be soothed or treated with with anything other than medication. I whole heartedly reject that 100%. 

So I will not be using the term RSD because I do not agree that it’s 100% genetic and I do not agree that it cannot at least be helped and soothed a little bit with therapy or different types of therapies and coaching. It can And I know it can I have seen that to be true. And here’s where we’re going to end listener, you get to make your own choice, I respect you 100%. 

If you like using the term RSD, and you want to continue to do so, please do it with my blessing. Absolutely. I am a person who believes that too smart, educated people can have varying opinions about one topic, and they can still respect each other. It’s okay, I respect you, whatever you decide. 

For me, personally, I’m going to be using the term rejection sensitivity. And I’m really going to be leaning into that term for kind of narrating the ADHD experience, as I see it and you get to use whatever term works for you. 

Please know that all of the articles mentioned today are listed in the shownotes. There was one other one that I absolutely love that I didn’t get a chance to mention because this is getting long, but I’m going to include that too. So if you’re a nerd like me, you can go read it. Enjoy. I will talk to you next week. Bye bye.

 A few years ago, I went looking for help. I wanted to find someone to teach me how to feel better about myself and to help me improve my organization productivity, time management, emotional regulation, you know, all the things that we adults with ADHD struggle with. I couldn’t find anything. So I researched and I studied and I hired coaches and I figured it out. And then I created focused for you. Focus is my monthly coaching membership where I teach educated professional adults how to accept their ADHD brain and hijack their ability to get stuff done. Hundreds of people from all over the world are already benefiting from this program and I’m confident that you will to go to I have for all details.

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