No one likes to be rejected, criticised or fail. But people with ADHD feel the emotional response to these inevitable life experiences much more extremely than neurotypical people. This is known as Rejection Sensitivity disorder and is a symptom for many with ADHD. Responses from people close to them that they perceive to be negative or feelings of falling short or not being good enough in activities or situations that are important to them can feel extreme like physical pain. When this emotional response is triggered in those with ADHD it can cause them to respond with a full major mood disorder and possibly suicide ideation or intention. This can look like an immediate and very elaborate rage at the person or situation that they consider responsible for causing this pain. This change in mood can come suddenly and unexpectedly to those around them. This is not because people with this symptom of ADHD are wimps or weak but usually because they feel emotions much more deeply and much more sensitive than others.
Clinicians can often mistake these extreme mood responses from RSD as rapid cycling mood disorder or as Bipolar disorder. It may take some time for physicians to recognise that these symptoms are caused by a sensitivity to an emotional response and are associated with ADHD as often many other factors relating to others can seem the norm. However, RSD is very common among ADHD, particularly in adults. Due to the extreme feelings people have from RSD, they can begin to anticipate and avoid rejection even when it may be unlikely. This can be misdiagnosed as social phobia, having an intense fear that they may be embarrassed or humiliated in front of others.
People with ADHD struggle to express their feelings of RSD. Often describing it as terrible and an awful overwhelm and usually always triggered by a thought of a loss of respect, approval or love. Those with ADHD tend to cope with these extreme feelings by becoming people pleasers or stop trying to please at all as it becomes too risky or painful to make the effort. This can cause intelligent, capable individuals to avoid any activities that may provoke any feelings of RSD. Activities such as dating, job interviews or speaking in public both socially and professionally tend to be avoided in order to avoid the feelings of RSD.
RSD in ADHD is neurologic and genetic. Psychotherapy for RSD has had limited benefit due to the emotions hitting suddenly and the overwhelm of the mind and senses. Medication has benefited many with RSD and can be life-changing to the individual to feel relief from this debilitating symptom (Barkley, 2009). It is to be noted that not all people with ADHD have RSD.