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Rejection Sensitivity

What It Means to Have Rejection Sensitive Dysphoria

Linked with ADHD and neurodivergence, but also trans-diagnostic.

Key points

  • Neurodivergent individuals receive a disproportionate level of criticism, rejection, and misunderstanding.
  • Rejection sensitive dysphoria describes a stronger than expected reaction to criticism.
  • While often associated with ADHD, research suggests this is likely a trans-diagnostic condition.

As a therapist, I have seen the effects that being a neurodivergent youth in America's often non-affirming school system had on kids. Failing grades on completed assignments forgotten at home. Bullying from peers after asking what others viewed as stupid. And chastising from teachers for things like talking out of turn.

Even in my own life as a neurodivergent person, I can remember how it felt to see my name almost permanently marked on the blackboard for reasons such as "not following directions" while simultaneously not knowing what the direction was or how I wasn't following it. These experiences affect kids, maybe contributing to the higher-than-expected school dropout rates among youth with ADHD (Fried and colleagues, 2016).

I had also seen the pain of adults with ADHD living in non-affirming spaces who often, although giving their best work, seemed to be chased by a sense of not living up to their potential. Still, when I first heard about rejection-sensitive dysphoria, I felt skeptical. I wondered how this was different than low self-esteem or depression. After familiarizing myself, I'm more open.

What is Rejection-Sensitive Dysphoria?

While not listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, rejection-sensitive dysphoria describes a pattern of strong reactions to rejection and criticism, particularly among neurodivergent people. It is a term often used within communities of neurodivergent communities to describe their concerns, yet is not well understood within academic circles (Lord and colleagues, 2022).

Emotional dysregulation and sensitivity are common among neurodivergent people. Some believe that there may be a neurological reason that people with ADHD in particular may be more sensitive to criticism, however, research is still lacking in this area.

At least one research study has examined correlations between reward sensitivity, depressive symptoms, and rejection sensitivity finding that depressive symptoms were highly associated with rejection sensitivity and that rejection sensitivity is associated with a blunted response to social rewards (Pegg and colleagues, 2021).

Neurodivergent people experience a disproportionately high level of criticism. In a qualitative study examining experiences of criticism and rejection-sensitive dysphoria among adults with ADHD, a thematic analysis showed that many found understanding as a mediator in how this was received (Beaton and colleagues, 2022). In an often non-neurodiversity-affirming world, much of what is criticized relates to neurodivergent traits. For example, someone might be honestly doing their best to listen to a friend but zone out. This inattention might be part of their ADHD; however, the friend assumes that the other friend just doesn't care, calling them "selfish."

As a person tries repeatedly to change these behaviors, they can be left feeling that there is something wrong with them. Education on neurodiversity and trends toward giving each other the benefit of the doubt could make a difference.

Still, research has also suggested that rejection sensitivity is unlikely to be exclusively a phenomenon in neurodivergent people. Rather it may represent a trans-diagnostic difficulty (Lord and colleagues, 2022), which may have a particular presentation in neurodivergent people.

What Can Be Done?

While research specific to psychotherapy on rejection-sensitive dysphoria is lacking, psychotherapy has long been effective in improving relationships with self and others. Interpersonal psychotherapies such as mentalization-based therapy that have already been shown helpful in improving relationship quality in individuals with other diagnoses associated with sensitivity such as borderline personality could also be candidate treatments for individuals wanting to work on their struggles might be particularly useful.

Of potentially greater importance, from a community perspective, education on neurodiversity and creating more neurodiversity-affirming spaces could foster understanding, thereby decreasing the repeated negative experiences of criticism received by neurodivergent people. In addition, psychoeducation on neurodiversity for the individual and meeting neurodivergent peers may help a person gain a greater sense of self-acceptance while understanding how their brain works best. In the case of rejection-sensitive dysphoria among neurodivergent people, intervention may be less about treatment than about acceptance, appreciation, and celebration of different ways of thinking.

To find a therapist, visit the Psychology Today Therapy Directory.

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Beaton, D. M., Sirois, F., & Milne, E. (2022). Experiences of criticism in adults with ADHD: A qualitative study. Plos one, 17(2), e0263366.

Fried, R., Petty, C., Faraone, S. V., Hyder, L. L., Day, H., & Biederman, J. (2016). Is ADHD a risk factor for high school dropout? A controlled study. Journal of attention disorders, 20(5), 383-389.

Lord, K. A., Liverant, G. I., Stewart, J. G., Hayes-Skelton, S. A., & Suvak, M. K. (2022). An evaluation of the construct validity of the Adult Rejection Sensitivity Questionnaire. Psychological Assessment, 34(11), 1062.

Pegg, S., Arfer, K. B., & Kujawa, A. (2021). Altered reward responsiveness and depressive symptoms: An examination of social and monetary reward domains and interactions with rejection sensitivity. Journal of affective disorders, 282, 717-725.

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