Rejection Sensitive Dysphoria, ADHD and Your Nervous System

I was talking about RSD (Rejection Sensitive Dysphoria).

The other day, in a workshop, someone asked...

Is RSD like the inner critic?

Well, I took a deep breath because I had a lot to share on that one.

RSD can sometimes feel like a dysregulating pang of anxiety and an afternoon spent catastrophising.

Other times, it's visceral, physical, and feels like you want to tear your own skin off.

Either way, it's very real and very exhausting.

 

RSD is most commonly associated with ADHD, but it isn't recognised in the DSM-5 as an official trait. However, it is one of the most commonly reported experiences among people with ADHD, but not exclusive to it.

It's a disproportionate, overwhelming response to the feeling of being rejected, criticised, or having fallen short in some way... at least by your own standards.

And you don't even need someone to actually reject you.

The perception of it is enough. Your nervous system treats it like a threat because to your brain, that's exactly what it is.

We are wired to scan for the negative, just as we're hardwired to detect danger. In evolutionary terms, being ousted from your community meant certain death.

So the brain developed a very efficient, very over-enthusiastic alarm system for anything that looks even vaguely like rejection.

But that alarm hasn't had a glow-up in several thousand years, and for some brains, it's more than a warning.

 

I went to a conference recently. A brilliant one, full of people I know and like, the kind of day that genuinely gives you all the feel-good vibes. I came home happy.

Then I tried to go to sleep, buuuuut my brain had a completely different plan.

I lay awake replaying minute by minute of the day and each and every one of my interactions, auditing them for ways I got it wrong.

Did I forget someone's name?

Did I info dump on people?

Did I say the wrong thing?

Was I too much?

Was I too loud?

On and on, every single interaction examined for evidence of where I might have got it wrong.

It took me hours to calm down, and I was a complete puddle the next day.

The thing is, I know cerebrally that none of it was true.

But knowing that and feeling that are not the same thing, and that gap is exactly where RSD lives.

 

What actually happened is that... a conference takes a lot of spoons (aka energy).

It's social, sensory and full of transitions, noise and stimulation, and as much as I love it, it's a lot.

By the time I got home, my nervous system was at max capacity.

Think of it like a bank account that's gone into the red, and when you're that depleted and under-resourced, RSD gets louder.

It creeps into the gap.

And because you're already having a big physical response, that wired-but-tired, adrenaline-crashing feeling, your brain attaches thoughts and feelings to the physical sensation and turns the volume up until those thoughts feel completely, undeniably true.

They weren't, of course. But they felt it. And that's the whole problem.

 

There is a lot of talk online about feelings being valid. And I'd push back on that, at least when it comes to RSD.

For neurodivergent people, trusting everything our feelings tell us can send us on a wild goose chase.

Because when RSD is running the show, our feelings aren't always accurate.

They reflect a catastrophised, pimped-up version of events that our brain has constructed at speed and is presenting to us as fact.

What I call a spirally moment will take you to the far reaches of possibility, and you will believe it, no matter how many times someone tells you it isn't true.

And it can get out of hand very quickly.

 

This is because the RSD response is partly physical.

The emotional signal you feel bypasses the brain's regulatory filters and hits your emotional centre at full force, without the buffer that would usually let you think your way through it.

That's why it so often feels like a physical wound, because neurologically, something close to that is actually happening.

Now if this all lands in your premenstrual phase... batten down the hatches, friends.

Oestrogen directly influences the pathways involved in emotional regulation and ADHD, and when it drops in the lead-up to your period, or fluctuates through perimenopause, the whole thing becomes even more visceral.

So the most useful shift I've found, both for myself and in working with clients, is learning to separate two things that usually get completely tangled up... the nervous system response, and the thoughts and feelings that come after it.

The nervous system response is just mechanics.

It's your body reacting to overstimulation, overload, or overwhelm.

And it is not evidence of anything.

The thoughts and feelings that land on the back of that response are your brain trying to make sense of the physical sensation, and when you're already running on empty, that process is not reliable.

Your nervous system has reached capacity and gone into the red, and RSD will absolutely try to make that mean something it doesn't.

But once you can recognise the two as separate, you have somewhere to go.

 

Now, there is one thing I want to be clear about here, because I don't want this to become another stick to beat yourself with.

This is NOT about dismissing your feelings, or using this understanding to gaslight yourself into dismissing how you feel.

Because sometimes there's a 5% truth underneath it all.

Something did sting a little, or is sitting uncomfortably. There might be a teensy tiny grain of something real trying to get your attention underneath all the noise.

What I'm saying is that the disproportionate reaction is not to be trusted.

The catastrophised, pimped-up, spirally version of events that RSD constructs at speed is not reliable intel.

But that doesn't mean there's nothing there at all. It just means you need to wait until your nervous system has come back from the red before you look for it.

 

So what actually helps?

➡️ First, find your RSD voice. It has a tone.

It sounds a particular way in your head. It's the one that tells you you're not good enough, you could have done better, you got it wrong, you're not capable, you're too much.

It feels different from your other thoughts because it's loud, nasty and devious.

It's like the inner critic's inner critic. And wildly out of control.

So name it, give it a persona.

Mine is called DeeDee, after Dexter's sister in Dexter's Laboratory (thank you, cable and cartoon network for those early 00's gems), because every time she shows up, I just hear Dexter screaming "DeeDee, NOOOO" as she heads straight for the big red shiny button of destruction in my head.

It sounds silly, but it works because it humanises the voice.

It makes it feel like something you can overcome and creates distance between you and what it's telling you, making it easier to say, "Oh, it's you again", and give it the side eye.

 

➡️ Second, interrupt the pattern before the spiral takes hold.

Three questions help with this.

You can ask these yourself, journal them, or ask a sympathetic friend to ask them for you...

1. Is this true?
2.  Is this really true?
3. And what is an alternate, and more likely, possibility?

The first two interrupt the thought.

They create a tiny bit of friction between the feeling and the story your RSD is so desperately trying to build.

The third is the actual work.

It asks you to sit with the idea that there is an equal chance of a kinder possibility also being true.

You may not believe it at first. That's OK. You don't have to fully believe it for it to help.

Simply acknowledging that another possibility exists, one that your brain hasn't catastrophised, can be enough to take the edge off.

This is a practice you build over time. Each time you come back to it, calling the voice out gets a little easier.

 

➡️ And then, once you've done that, look after your poor tattered, overstretched nervous system.

Whatever that looks like for you...

• Complete sensory deprivation
• Your favourite programme
• A breathing exercise
• A jigsaw
• A walk
• Yoga
• Hugs

Something to bring you back to what's real and present.

For a lot of us, especially those with autistic nervous systems, what helps most is taking back a sense of control, not over the RSD, but over something immediate and tangible.

What can you touch?

What can you see?

What's actually in front of you right now?

Your thoughts and feelings will calm as your nervous system does, and from there, the 5% that's actually true will be a lot easier to find.