Scientific Foundation

What is RSD? Understanding Rejection Sensitive Dysphoria in ADHD

A comprehensive guide to rejection sensitivity dysphoria: symptoms, causes, and how the RSD-RS assessment measures it.

What is Rejection Sensitive Dysphoria?

Rejection Sensitive Dysphoria (RSD) refers to an intense emotional response to real or perceived rejection, criticism, or failure. While not a formal diagnostic category, RSD is widely recognized among clinicians working with ADHD as a significant source of distress and impairment.

The phenomenon draws on the broader construct of rejection sensitivity, first described by Downey and Feldman (1996), which involves anxious expectation of, and intense reaction to, rejection. In the ADHD context, this sensitivity appears amplified, possibly due to underlying differences in emotional regulation.

Research on emotional dysregulation in ADHD (Shaw et al., 2014; Surman et al., 2013) provides strong evidence that emotional symptoms are core features of ADHD, not simply comorbid conditions. RSD-RS builds on this foundation to provide a clinically useful measurement tool.

Construct Validity

The RSD-RS is grounded in established psychological constructs:

  • Rejection Sensitivity: The anxious expectation of, readiness to perceive, and overreaction to rejection (Downey & Feldman, 1996)
  • Emotional Dysregulation: Deficient emotional self-regulation (DESR) as a core feature of ADHD (Surman et al., 2013)
  • Interpersonal Sensitivity: Heightened awareness of and reactivity to social cues

The six-domain structure was developed through clinical observation, literature review, and expert consultation to capture the full phenomenology of RSD as experienced by individuals with ADHD.

The Six Domains

RSD-RS measures rejection sensitivity across six clinically meaningful domains.

A
Trigger Sensitivity
Heightened sensitivity to perceived rejection, criticism, or disapproval. Individuals experience intense reactions to situations that others might find mildly uncomfortable or not notice at all.

Example presentations:

  • •Feeling devastated when someone seems disappointed
  • •Interpreting ambiguous situations as rejection
  • •Experiencing small signs of rejection as major threats
B
Dysphoric Pain & Shame
The intense emotional and sometimes physical pain experienced during rejection episodes, often accompanied by deep shame and feelings of worthlessness.

Example presentations:

  • •Crushing emotional pain when rejected
  • •Physical symptoms like chest tightness or nausea
  • •Feeling fundamentally worthless after criticism
C
Anticipatory Hypervigilance
Constant scanning for potential rejection signals and excessive mental energy spent predicting and preparing for possible disapproval.

Example presentations:

  • •Constantly scanning for signs others are upset
  • •Noticing tiny changes in tone as threats
  • •Feeling dread before potentially judgmental situations
D
Acute Reactivity
The immediate behavioral and emotional responses during rejection episodes, including shutdown, emotional flooding, or fight-or-flight reactions.

Example presentations:

  • •Shutting down completely when rejected
  • •Sudden anger or rage in response to criticism
  • •Mind going blank or flooding when judged
E
Recovery & Aftermath
The prolonged recovery process after rejection episodes, including rumination, reassurance-seeking, and avoidance behaviors.

Example presentations:

  • •Ruminating for hours or days after rejection
  • •Seeking excessive reassurance
  • •Avoiding situations after being rejected once
F
Functional Impact
The overall impact of rejection sensitivity on daily functioning, relationships, work/academic performance, and quality of life.

Example presentations:

  • •Avoiding opportunities due to fear of criticism
  • •Relationships affected by rejection sensitivity
  • •Work or school performance suffering

Validation Roadmap

RSD-RS is currently in the provisional validation phase. Current severity bands are based on item anchor severity (the clinical meaningfulness of response options) rather than population norms.

Phase 1: Current (v0.x)

Transparent additive scoring with total and domain scores. Provisional severity bands based on item anchors. Impairment gate for clinical significance.

Phase 2: Norms Development

As data accumulates, develop normative reference groups stratified by age, sex, and ADHD status. Convert raw scores to percentiles and T-scores.

Phase 3: Factor Analysis

Test competing factor models (6 correlated factors vs. bifactor). Confirm or refine domain structure.

Phase 4: ROC-Based Cut-offs

Derive empirical cut-offs using criterion anchors (clinician ratings, impairment thresholds). Establish sensitivity and specificity for screening purposes.

Key References

Dodson, W. (2022). Rejection Sensitive Dysphoria in ADHD. ADDitude Magazine.

Clinical description of RSD phenomenon

Downey, G., & Feldman, S. I. (1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70(6), 1327-1343.

Foundational rejection sensitivity construct

Shaw, P., et al. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276-293.

Emotional dysregulation in ADHD

Surman, C. B., et al. (2013). Deficient emotional self-regulation and adult ADHD. Journal of Attention Disorders, 17(4), 296-302.

DESR and ADHD