Adult ADHD and Rejection Sensitivity

Findings from recent research on the experiences and detrimental effects of criticism on adults with ADHD came as no surprise to anyone familiar with ADHD, but it is one of those studies that is valuable because it documents an important problem area that is too easily overlooked or dismissed. Impulsivity was the main source of reproach in relationships, such as common ADHD-related problems with missing social cues, breaching situational or group norms, and otherwise not meeting expectations in relationships.¹

These adult findings are catching up with research on what children with ADHD have faced. Such impulsivity in children with ADHD manifests as not playing by the rules of games, difficulties with waiting and turn-taking, and getting too wound up and somehow “overdoing it” in the eyes of others in ways that might be seen as off-putting. Studies of the social standing of children with ADHD show that they’re less likely to be invited to events or included in peer activities and are more likely to be actively or passively excluded by others.²

An encouraging finding from the study of adult ADHD and criticism was that there are benefits for adults with ADHD who experienced support, understanding, accommodation, and acceptance and being valued in relationships. This includes being with others who are willing to understand ADHD and bear periodic lateness for the payoffs of relationships with adults with ADHD, eyeing the flowers and not the weeds.

In the midst of the negative effects of criticism and the benefits of supportive relationships is the issue of rejection that is particularly relevant for adults with ADHD. Rejection is a topic that gets a lot of attention in the ADHD world.³ Let’s take a closer look at why rejection in relationships is such a trigger for hurt feelings and why this is a particularly unnerving issue for so many adults with ADHD.

The issue of rejection and adult ADHD is a big, important topic. This post will focus on the building blocks of the rejection issue. A follow-up will discuss what to do about it, and how to cope with it.

Belongingness and Acceptance

The desire for a sense of belongingness and some measure of acceptance is a basic human need, one of our factory settings. The demands and selection pressures of group living in early human history is the probable driving force in the development of the human capacity for self-regulation (also deemed executive functions). This capacity promoted the ability to “work and play well with others” and to seek and maintain healthy connectedness, which requires intact emotional regulation among other executive function skills.²

There are six categories of human behavior that focus on being liked:⁴

• Physical appearance (attractiveness and managing appearance, such as hair style, clothing, and adornments)
• Being liked (trying but not overdoing it)
• Achievement-related behaviors
• Conforming to norms
• Being a good social exchange partner
• Resources: Having something to offer that others need or value

The list above includes several items that are common domains of ADHD-related difficulty, such as good social exchange, achievement-related behaviors, and adherence to group norms. If the rebel in you recoils at the notion of norms and expectations, even non-conformists and mavericks have their own implicit rules for fitting in.

Most adults with ADHD have had more than their fair share of social life frustrations, including negative labels or misattributions of their symptoms, such as laziness, being unmotivated, insensitive, unreliable, and others. Such difficulties run the risk of rupturing bonds with others. Such problems include not following the rules on the playground or forgetting promises and obligations that affect your marriage or a friendship, or not doing your fair share in a work or study group. Hence, such situations can result in rejection, which has persistent, painful effects.

What Is Rejection?

Although we often say we “feel rejected,” rejection is an event that triggers hurt feelings. The most common rejection events are (not specific to ADHD):⁵

• Criticism
• Betrayal
• Active disassociation
• Passive disassociation
• Being unappreciated
• Being teased

Whether you realize it or not, we monitor and keep track of our standings with others. Elsewhere, I’ve used the financial analogy of “social capital” to convey how adults with ADHD track their relationships.^6,7 Adults with ADHD may be prone to assume that they’ve made many more “withdrawals” than they credit themselves for “deposits” with others This tendency might be an over-correction for past social snafus, frustrations, and relationship letdowns.

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But such views lead to overcompensations, such as subjugating their own needs or trying too hard to please others, such as overpromising but underdelivering on promises in an effort to pay down debts (“I know I waited until the last minute, but I’ll have our taxes done and filed by the time you get home from work, I promise!"). At the very least, many adults with ADHD describe a “one-down” or “less-than” stance, anticipating, even “bracing” themselves for the time that they will somehow disappoint someone.

The hurt feelings and other emotions start with the perception that something is not right with a relationship in the form of social anxiety, and feelings of apprehension around the person or persons. Embarrassment, guilt, and shame signal perceptions (accurate or not) to adults with ADHD that their standing in a social situation is diminishing. Jealousy and envy can be triggered at the sense that they are losing status while someone else is gaining status with a friend or in a group situation. Such status anxiety is one of the social emotions triggered in such social capital audits of relationships.⁸

Lowered self-esteem is another obvious effect of rejection. An insidious aspect of this, though, is that one’s sociometer is now more sensitive and on the lookout for signs of rejection, especially for adults with ADHD. While a degree of this awareness helps learn and improve future alliances, such self- and other-monitoring is often not a strong suit for adults with ADHD. There may be too little awareness or, conversely, exaggeration of normal critiques or feedback as signs of rejection, including emotional overreactions and blowing things out of proportion.

Such reactions are magnified by the emotional dyscontrol of ADHD, which includes difficulties up-regulating emotions, such as motivation and “feeling enough,” like doing taxes that no one wants to do, and, more to the point of rejection, down-regulating unpleasant feelings, at least to keep them proportional to a situation to promote coping and resilience.

No one likes rejection. As with many other things, the issue is that ADHD is a quantitative difference of degree insofar as the frequency and magnitude of rejection events (real or perceived) and of hurt feelings is greater for adults with ADHD.

Rejection and Adult ADHD

Rejection Sensitive Dysphoria has been proposed as a common feature of adult ADHD.³ It manifests as an overwhelming emotional sensitivity, even shutdown at perceived slights. Such stark affective reactions might be misinterpreted as evidence of a mood disorder. Adults with ADHD who have this emotional sensitivity may compensate via avoidance or people-pleasing, subjugating their needs to stay in the good graces of others.³

Seeing as Rejection Sensitive Dysphoria has also been implicated in mood, borderline personality, and other diagnoses, I’ll use the term Rejection Sensitivity (RS) to represent the sort of “once bitten, twice shy” defense by adults with ADHD — probably more like “often bitten, perpetually on-guard.”⁷ Rejection experiences due to ADHD are magnified by emotional dyscontrol that is a core feature of ADHD², which makes it more even difficult to self-soothe, rebound, and get over them.

Another way to think about RS is that it is akin to impostor syndrome — the sense that one is a fraud or incompetent in a role and will be found out and ousted in shame. Like impostor syndrome, RS is not an official “thing” but captures a pattern of experience that resonates for many people.

In terms of the recipe for RS in adults with ADHD, a parallel comes from research on distorted thoughts and depression in adult ADHD. The interplay of frustrations and failure experiences of growing up with and living with ADHD result in feelings of depression. These feelings lead to escape-avoidance coping, in turn creating more problems or “failures” and, presto, you have a vicious cycle.⁹ In a similar vein, living with ADHD creates relationship disappointments that mix with emotional dyscontrol, creating a vicious cycle of RS.