Rejection Sensitive Dysphoria
Rejection Sensitive Dysphoria (RSD) is an ADHD (and Autism)-specific trait. It's characterized as an immense fear or anxiety of social rejection, judgment, embarrassment, and criticism [1]. Simply the perception or though of any of these things can send a person with RSD in a downwards spiral of self-doubt, panic, and depression.
RSD typically develops in early childhood, when the ADHD child experiences bullying [2] and/or harsh discipline from authority figures for behaviors or traits related to their ADHD. One study found that children with ADHD hear approximately 20,000 more negative words from authority figures by the age of 12 than do neurotypical children. In this case, "negative words" would be things like:
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Why is your room so messy?
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You're so unorganized.
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You need to stop interrupting.
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Sit down and be quiet!
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Why are you always late?
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You forgot your homework at home again?
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You're the only one still talking!
Because of our exposure to negativity from authority figures and possible bullying from peers, we develop RSD - some more severe than others. RSD can manifest as:
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Excessively worrying about something you said or did a long time ago
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Having panic attacks before socializing
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Taking constructive criticism as a personal attack
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People-pleasing to the point of exhaustion, even for people we don't know very well
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Assuming strangers dislike us before we ever even speak to them
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Feeling like you're always being watched and judged by others
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Avoiding asking for help for fear of judgement or embarrassment
I conducted a survey to see just how many people with ADHD have anxiety about these things and compared it to their experience with bullying in childhood and as an adult, when they were diagnosed with ADHD, and if/when they were diagnosed with ADHD. You can find the results below.
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Survey Demographics
Number of participants: 636
Participants with a confirmed ADHD diagnosis: 404
Participants without a diagnosis, but suspect ADHD: 232
Figure 1: Ages of Survey Participants at the time of their official ADHD diagnosis. Of the 636 participants, 404 (63.52%) reported a confirmed diagnosis by a medical professional. Of those 404 respondents, the most common age group reported at the time of diagnosis was 21-23 years old (13.86%), followed by 18-20 years old (13.37%) and 24-27 years old (11.63%). 27.72% of the participants with confirmed diagnoses reported their diagnosis before the age of 18.
Severity of RSD-Related Anxiety
In the Rejection Sensitive Dysphoria Survey conducted by What in the ADHD? in July 2021, there were eight scenarios given to participants for them to rank. The scale was to subjectively measure their anxiety in a given situation by choosing "3" (Severe Anxiety), "2" (Moderate Anxiety), "1" (Some Anxiety), or "0" (No Anxiety). The scenarios chosen were selected on the basis of common situations in which people with ADHD experience anxiety to some degree, such as receiving criticism or being disagreed with, either by a friend or a stranger on the internet. Below, there is a summary bar graph that ranks the eight scenarios based on the average Anxiety Rating given by all 636 participants (Figure 2). Following Figure 2 are eight pie charts, each giving the breakdown of individual rankings for each of the eight scenarios (Figures 3-10).
Figure 2: Average Severity of RSD-Related Anxiety Among People with ADHD in Eight Specific Scenarios. 636 participants ranked the above scenarios on a scale of 0 (no anxiety) to 3 (severe anxiety). The average score for each scenario was calculated and plotted alongside the others. As a whole, participants ranked "Receiving Criticism from a Teacher or Boss" as the scenario that prompts the most severe anxiety, with a rating of 2.53. This was closely followed by "Attending a Party Alone" (2.46) and "First Day of School or Work (2.42). The scenario that prompted the least anxiety for participants was "Noticing my Written Error (Typo) on a Public Platform" with a rating of 1.4.
Figure 3: Anxiety Among People with ADHD After Noticing Their Own Written Error on a Public Platform. Participants were prompted with the following scenario: You notice that you made a typo on a public post on social media a few hours after posting it. Of the 636 participants, the most popular rating was "1" or "some anxiety" at 37.7%.
Figure 4: Anxiety Among People with ADHD After Being Blocked on Social Media. Participants were prompted with the following scenario: You notice that you were unfollowed, unfriended, or blocked on social media. Of the 636 participants, the most popular rating was "2" or "moderate anxiety" at 29.6%
Figure 5: Anxiety Among People with ADHD After a Disagreement with a Stranger Online. Participants were prompted with the following scenario: A stranger on social media replies to one of your post in a confrontational manner and disagrees with what you said. Of the 636 participants, the most popular rating was "2" or "moderate anxiety" at 34.0%
Figure 6: Anxiety Among People with ADHD After a Disagreement with a Close Friend or a Family Member. Participants were prompted with the following scenario: A close friend or family member disagrees with something you said. Of the 636 participants, the most popular rating was "2" or "moderate anxiety" at 38.0%.
Figure 7: Anxiety Among People with ADHD While Waiting to be Selected for a Team. Participants were prompted with the following scenario: You're waiting to be chosen by a team leader among a pool of others (example: dodgeball). Of the 636 participants, the most popular rating was "3" or "severe anxiety" at 41.4%.
Figure 8: Anxiety Among People with ADHD on Their First Day of School or Work. Participants were prompted with the following scenario: It's your first day at a new school or a new job. Of the 636 participants, the most popular rating was "3" or "severe anxiety" at 56.6%.
Figure 9: Anxiety Among People with ADHD While Attending a Party Alone. Participants were prompted with the following scenario: You're attending a party alone and you do not personally know anyone else in attendance. Of the 636 participants, the most popular rating was "3" or "severe anxiety" at 61.2%.
Figure 10: Anxiety Among People with ADHD While Receiving Constructive Criticism from a Teacher or Boss. Participants were prompted with the following scenario: You're receiving constructive criticism meant to be helpful to you from a teacher, boss, or supervisor. Of the 636 participants, the most popular rating was "3" or "severe anxiety" at 63.5%. In addition to having the most "3" ratings among participants, this scenario also had the least amount of "0" ratings, with only 4 participants reporting "no anxiety" in this scenario.