OMG Are You Mad at Me?

ADHD and Rejection Sensitivity

By Jordan Mayfield, LSCSW, LCAC

Most individuals experience emotional distress after feeling a sense of rejection. However, research has shown that some individuals are significantly more negatively impacted by the rejection of others or the perceived rejection of others. This can result in the person lashing out toward others who have slighted or offended the individual which can result in a self-fulfilling prophecy of people distancing from or avoiding them.

The feeling of rejection is qualified as experiencing:

· Criticism

· Betrayal

· Active disassociation

· Passive dissociation

· Being unappreciated

· Being teased (Psychology Today).

Some people in the mental health community have advocated for a diagnosis of Rejection Sensitive Dysphoria to be included in the Diagnostic and Statistical Manual (DSM) but not enough research currently exists to support (or negate) its inclusion. Research that does exist shows that perceived rejection activates a person’s fight or flight response resulting in physiological arousal including changes in “blood pressure, decision-making, and emotions” (Psychology Today). A person with rejection sensitivity will interpret “benign or mildly negative social cues… as outright rejection. They may disregard more logical explanations” resulting in increased internal and external conflict (Psychology Today).

The most common diagnosis linked to rejection sensitivity is ADHD. It is one of the hallmark characteristics of ADHD individuals. Treating ADHD symptoms adequately can lesson or eliminate rejection sensitivity but not always. While specific diagnostic criteria do not exist for rejection sensitivity, these are some probable symptoms:

· High sensitivity about the possibility of rejection

· Overly high standards for oneself

· Feeling easily triggered toward guilt or shame

· Isolating oneself in a preemptive strike not to be rejected

· Aggressive or rageful behavior toward those who have been perceived to have slighted the person

· Frequently feeling an uncomfortable physical reaction due to “not fitting in” or being misunderstood

· Self-esteem that is mostly dependent on what others think, and rises and falls accordingly

· Frequent and intense ruminating after an interaction (Psychology Today).

Rejection sensitivity can often look like a mood disorder. There can be a “sudden change from feeling perfectly fine to feeling intensely sad” which can include suicidal thinking and ideation (ADDitude). The emotional response can also be external in which the person expresses “instantaneous rage at the person or situation responsible for causing the pain“ (ADDitude). And unfortunately for the rejection sensitive person, these mood episodes often push people further away, reinforcing their sensitivity and worry.

Current research shows that 100% of people with ADHD also struggle with rejection sensitivity. And it is important to note that it is not caused by trauma (although trauma can compound the symptoms). Individual therapy has not been proven particularly effective for rejection sensitivity as the symptoms come on “suddenly and completely overwhelm the mind and senses” (ADDtude). For those with ADHD, the frontal lobe of the brain which manages impulse control and judgment works differently than in a non-ADHD brain. A sense of rejection could “trigger overwhelming feelings of confusion, failure, betrayal, pain and sadness” after having been uncertain or misinterpreted “unclear conversations as a form of rejection, being teased, or as criticism” (WedMD).

Medication management has been proven effective in its treatment of ADHD and associated rejection sensitivity. In conjunction with therapy, individuals can learn mindfulness strategies to help assess a situation more accurately, coping strategies to help with emotional regulation and communication skills and reduce cognitive distortions such as personalization which help promote the rejection narrative in the person’s brain.

If you struggle with rejection sensitivity, Science of the People has outlined some tips to help:

1. Don’t assume rejection, look for alternative explanations.

2. Instead of basing your self-esteem on how others view you, try attaching your self-esteem to something intrinsic.

3. Journal on rejection.

4. Reframe how you perceive rejection.

5. Shift your awareness with acceptance.

6. Expose yourself to rejection (to reduce your reactivity and build your confidence in handling it successfully).

7. Work with your limiting beliefs on rejection.

8. Heal old wounds.

Feeling rejected hurts. We as humans rely on social connection and acceptance to live a happy and fulfilling life. Not having one of our most fundamental needs met, or having it feel precarious can be very distressing. If you struggle with rejection sensitivity, I encourage you to try some of these recommendations and speak with a mental health provider for more personalized help. You are worth it.