I discovered something called Rejection Sensitive Dysphoria (RSD). If you google it, the first page will show pages that talk about it in relation to ADHD.

What is it about ADHD that causes "nearly everyone with" it to have RSD?

Someone might say that ADHD people would not be sensitive to rejection because they have too many thoughts unless they're hyperfocused on such rejection.

RSD sounds like something related to anxiety rather than attention deficiency or hyperactivity. So someone may suspect that RSD belongs to people with anxiety, depression, bipolar or people with a personality disorder like borderline or narcissistic rather than to people with ADHD. I really can't think of a connection between RSD and ADHD.

  • $\begingroup$ I personally don’t know if it’s true or not, but I have ADHD and the conclusion of RSD answers a lot of questions I’ve had. In fact it was while researching for answers that I discovered the term and my wife agrees that it makes sense. The only other thing that I can add is that countless times, in all aspects of human endeavor, one person will come up with answers that are only later agreed upon. $\endgroup$ – user19437 Jun 2 '18 at 13:02

Upon closer examination, it appears that Rejection Sensitive Dysphoria is a term that was coined by Dr. William Dodson to describe the phenomenon of rejection sensitivity in ADHD sufferers. It does not appear to be a 'valid' term, in the sense that there is no DSM definition. In fact, it seems that Dodson himself is the only one to have used the term. Dodson specializes in adult ADHD, and so it makes sense that the only articles associated with the term would pertain to ADHD.

As for the phenomenon of rejection sensitivity itself, note the definition of dysphoria as follows: "a state of feeling unwell or unhappy; a feeling of emotional and mental discomfort as a symptom of discontentment, restlessness, dissatisfaction, malaise, depression, anxiety or indifference."

In a broader sense, these are issues associated with chemical imbalances -- as is ADHD. One could even describe ADHD as its own dysphoria. It is also quite common for other disorders to coexist alongside ADHD, particularly anxiety, depression, obsessive-compulsive disorder and bipolar disorder. This -- coupled with the fact that children with ADHD often find themselves socially isolated -- may be responsible for a higher prevalence of rejection sensitivity in those with the disorder.

The following is an edit by the OP, Jack Bauer.

Dodson likely did not coin the term RSD, but he might have been the first to use it with ADHD. It has been used in relation to borderline people: 1 2 3 4 5

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    $\begingroup$ Sydney Maples, thank you, but I think Dodson did not coin the term. I'm going to edit some links I found. $\endgroup$ – Jack Bauer Dec 23 '15 at 20:55
  • $\begingroup$ Hi Sydney Maples. I edited the post to include some links. In what way exactly does social isolation lead to rejection sensitivity? $\endgroup$ – Jack Bauer Dec 23 '15 at 21:03
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    $\begingroup$ @JackBauer, from what I understand, Dodson used a relatively unknown (and unverified) term from one source and applied it to ADHD. Because the term was rather unknown before (note that the links you referred to all link back to one author -- the same author Dodson presumably took the term from), it makes sense that 'reviving' it in the context of ADHD would be the reason why it is almost always associated with ADHD upon searching for the term online. $\endgroup$ – Sydney Maples Dec 24 '15 at 1:01
  • $\begingroup$ @JackBauer Since 1996, the definition of rejection sensitivity has been the "tendency to anxiously expect, readily perceive, and overreact to social rejection". The idea here is that the expectation of rejection seems to promote rejection sensitivity. Naturally, expectation would be higher in those who are socially isolated. This is something you could read more about online (so as to prevent this comment chain from getting too long). I'd suggest looking at Karen Horney's research, or modern research on how bullying or social isolation affects ADHD sufferers. $\endgroup$ – Sydney Maples Dec 24 '15 at 1:03
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    $\begingroup$ Okay then thank you @SydneyMaples $\endgroup$ – Jack Bauer Dec 26 '15 at 3:01

You might want to look at
Bondü, R. & Esser, G. Eur Child Adolesc Psychiatry (2015) 24: 185. https://doi.org/10.1007/s00787-014-0560-9

The authors found fairly compelling evidence of a latent construct of rejection sensitivity associated with ADHD in a large (>1200) German sample of adolescents. This existed independently of another interesting construct, justice sensitivity, which is also higher in young people with ADHD.

As to whether or not there is an overlap between rejection sensitivity and what Donald Klein described in 1979, it is possible. However, it seems that many authors from the 1980s onward have believed that Klein's groups were probably people with Borderline Personalities or a variety of bipolar spectrum problems. Klein seems to have found good treatment results with MA0-inhibitors, which are often used off-label for ADHD. So, perhaps he was unknowingly tapping into a subgroup of ADHD patients.

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    $\begingroup$ Welcome and thanks for the substantive answer. I'm gonna point out however that the paper you highlighted also says that a (prior) small pilot study in adults with ADHD did not find higher rejection sensitivity. $\endgroup$ – Fizz Jan 7 '18 at 6:56
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    $\begingroup$ Excellent point. Thanks.Clearly, we need more research and perhaps it will be forthcoming soon. I will try to post any preliminary results we find. $\endgroup$ – Bill McCown Jan 27 '18 at 17:30
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    $\begingroup$ Bill McCown, I could cry tears of joy. Justice sensitivity sounds like a VIA-version/positive psychology-version of rejection sensitivity like when Daenerys was diagnosed with justice. :') $\endgroup$ – Jack Bauer Apr 2 '18 at 6:22

Dodson distinguishes "RSD" from social anxiety in that the latter begins as an anticipatory fear and is generally lessened upon social interaction whereas the RSD flare-ups begin as in-the-moment perceptions of an important social rejection and have emotional consequences that unfold from there. (See this slideshow and accompanying video.)

I do not believe that the sensitivity would result from social isolation. I am not sure we know that social isolation prevails for people with ADHD, but Dodson and the Dr. below believe that rejection sensitivity does. You'll find any number of studies indicating the strong evidence for genetic influence on ADHD in families (see this, that, and the other).

While Dodson seems to be the only one to use this term with ADHD, Gabor Mate, in his book Scattered, makes basically the same connection between ADHD and intense pain on perception of attachment rejection. He even goes so far as to suggest that hypersensitivity is the actually genetic component that predisposes certain infants/children to develop ADHD.

  • $\begingroup$ Thank you Cole. What is the relevance of the "You'll find any number of studies" sentence? $\endgroup$ – Jack Bauer Apr 2 '18 at 2:44

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