“RSD is real. It’s embodied. It’s deeply impairing. We know this anecdotally, even if formal science is catching up.”

This is how Dr. James Kustow, a leading UK-based psychiatrist who specializes in adult ADHD, described rejection sensitive dysphoria in his June 2026 ADDitude webinar, “RSD Coming Into Focus: Rejection Sensitive Dysphoria in ADHD Brains.”

While not a formal diagnosis, RSD — a unique and impairing form of emotional dysregulation that causes extreme distress (even physical pain) in response to real or perceived rejection — is an underexplored phenomenon that many people with ADHD say is not just central to the condition, but integral to explaining the course of their lives.

Here are our takeaways from Dr. Kustow’s deep-dive into RSD, including how to manage emotional overwhelm in the moment.

RSD Is a Body-Brain Response That Can Last for Days

RSD is an intense and rapid emotional and physiological reaction to real or perceived criticism, teasing, exclusion, or disapproval. There is always a trigger to an RSD “attack,” whether the trigger is a comment, the look on a person’s face, or just the perception of someone’s criticism or disapproval.

[Free Download: Understanding Rejection Sensitive Dysphoria]

Chest tightness, facial flushing, and knots in the stomach are just some ways RSD shows up in the body, along with an unbearable feeling of collapse. Distress can be internalized as low mood and anxiety or externalized as rage. Once in full motion, distress can be difficult to stem, lasting minutes, hours, and sometimes even days.

RSD can feel “almost like a nervous system seizure or assault,” said Dr. Kustow, who noted that episodes follow a predictable pattern: trigger → body sensation → meaning-making → emotional response → behavioral response → RSD is reinforced.

Uncertainty appears to be a major precursor to RSD. Neutral but ambiguous situations (like an e-mail from your boss asking to meet) activate the threat-response system, moving the nervous system into a hypervigilant state.

Nature vs. Nurture: What Causes RSD?

Two theories may explain why RSD appears to be part-and-parcel of ADHD.

• People with ADHD are more likely to experience micro-rejections and small “t” traumas over their lifetimes that accumulate into shame, feelings of inadequacy, and hypervigilant monitoring for signs of rejection.
• Differences in brain-body physiology — dysregulated threat-response systems, altered pain appraisal, differences in inhibitory control — may make ADHD brains more sensitive to rejection.

Factors that can aggravate RSD and increase its risk include substance misuse, a history of trauma, and impulsivity.

[Read: How Does RSD Really, Actually Feel?]

RSD Shapes Personality and Identity

RSD causes “identity-level pain,” according to Kustow. It can shape a person’s entire approach to life, which is why it’s important to pay attention to this body-brain phenomenon.

Many people with ADHD commonly adapt to RSD by seeking safety through chronic self-abandonment, perfectionism, and avoidance. That can look like people-pleasing to the point of losing one’s identity, overworking to exhaustion and burnout, isolation, and missing out on life. These patterns fuse into the person’s identity, making them especially difficult to break out of.

“Many people might think these are character flaws, but they are much better interpreted as nervous system survival strategies,” Kustow said.

The Power of the Pause

Use the following strategies to promote real-time regulation and gradually reduce RSD’s impact on daily life:

• Pause. Buy yourself time when you’re triggered. Avoid sending that text or physically remove yourself from the situation when possible. Come up with scripts you can say or do on autopilot while your body and mind process.
• Name what’s going on internally.
• Opposite action. Engage rather than withdraw, for example.
• Interrupt the story you’re telling yourself about the situation.
• Boost your emotional resilience. Prioritize sleep, exercise, and nutrition. Streamline your life and reduce exposure to triggers when possible (like social media).
• Consider therapy and medications to support emotional dysregulation.
• Talk to loved ones about how to support you during RSD attacks.

For more RSD insights and strategies, watch Dr. Kustow’s full webinar at additu.de/061126

Rejection Sensitive Dysphoria and ADHD: Next Steps

• Read: 7 Surprising Signs of RSD
• Self-Test: Do You Have RSD?
• Read: “I Can’t Handle Rejection. Will I Ever Change?”

ADDITUDE IS HUMAN
Artificial intelligence does not create or edit any written content published by ADDitude. Our editorial team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

It’s weird looking at my childhood photos. I seem so happy, so full of life. But I don’t remember feeling happy. Mostly, I remember feeling ashamed that I could never meet my teachers’ and my parents’ expectations.

Why Am I So Angry?

I tried to be the good kid, the good student, the good friend. Nothing ever went according to plan. Report cards pointed out the many ways in which I failed as a student. I was too late, too messy, too much. I was also not enough. I didn’t apply enough effort. I didn’t have enough willpower.

“Jesse is too emotional,” teachers said, and it was hard to argue with this. I felt emotions intensely and expressed them with the same ferocity. My classmates were quick to notice. No child wants to be labeled a crybaby, so I learned to hide inside the one emotion that seemed acceptable for boys: anger.

[Read: Crashing Out? How to Calm Down When You’re Angry]

Anger wasn’t weak, right? Anger felt strong. I could ball up my fists and fight in anger. When I got angry, no one called me a crybaby.

How Blame Becomes Shame

My frequent angry outbursts got me into trouble. It was clear that something was wrong. But instead of investigating the root of my behavior, teachers and administrators made me out to be the troublemaker. That blame became shame. And I carried it around with me like a heavy backpack. Each time I did or said the wrong thing, or forgot about another important task, or didn’t meet expectations, the backpack grew heavier. It weighed me down.

That shame didn’t diminish with age. Any time my actions didn’t line up with expectations, more shame was shoveled into the backpack. My bosses would tell me, “You’re the only person I’ve ever had trouble with. I just don’t know what to do with you.”

[Read: ADHD and the Epidemic of Shame]

I didn’t know what to do with me either. I tried to cover my faults by working harder, working longer, working later. I continued to fall short and burn out.

A Clarifying Diagnosis

When I was finally diagnosed with ADHD as an adult, it all made sense. I finally understood why my actions and intentions rarely synced up. But I couldn’t shrug off the heavy shame. The backpack was still there, weighing me down.

Yet trying to remove and unpack it didn’t feel like an option. After so many years, it felt like a part of me.
Then I realized the truth: The shame in my backpack never should have been mine. It was created by people who just didn’t understand ADHD.

Toxic Shame and ADHD: Next Steps

• Read: Life Is Too Short for Shame
• Download: Rein In Intense ADHD Emotions
• Read: Neutralize Chronic Shame by Understanding Its Source

Jesse J. Anderson is the author of Extra Focus: The Quick Start Guide to Adult ADHD. He is the host of the podcast ADHD Nerds.

ADDITUDE IS HUMAN
Artificial intelligence does not create or edit any written content published by ADDitude. Our editorial team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

Alex Partridge had already founded and sold UNILAD and LADbible, two United Kingdom-based news and entertainment sites, when an ADHD diagnosis changed the course of his life. At age 34, and with new clarity, the social media pioneer turned his focus to a new startup: the ADHD Chatter podcast, on which he interviews experts and celebrities about the condition.

In 2025, that project led him to write a book — part memoir, part self-help — called Now It All Makes Sense. Partridge, now 37, recently published a second book, Why Does Everybody Hate Me? In it, he describes living with rejection sensitive dysphoria (RSD), the intense emotional pain triggered by real or perceived criticism, and he offers strategies to cope.

Q: Why did you write a book about RSD? What do you want people to know about RSD?

I want readers to see the damage RSD does to people’s lives — you’re making decisions dictated by a fear of being criticized, you’re putting everyone else’s needs ahead of your own, and/or you’re overworking to protect yourself from criticism to such an extent that you’re exhausted. Some people with RSD avoid starting a business or stepping out the door because it feels safer to hide.

[Free Resource: Understanding Rejection Sensitive Dysphoria]

RSD is the hardest part of ADHD. It’s the most crippling, disabling, and debilitating, and it’s often an unspoken component. I wanted to try to shine a light on it because if you’re living with it and you don’t know where your mood swings come from or why a comment can completely derail your day, you just think you’re crazy.

With RSD, the intense emotional pain you’re experiencing isn’t a direct response to the words that someone — a boss or a partner — made today. Their comment just snapped your nervous system back to a place where it feels the compounding effects of the many, many nasty comments you got as a kid with ADHD about how different you are, how you’re too much or not enough, or too dramatic.

Q: How do you manage RSD today?

I still feel intense sadness when someone criticizes me, but I understand now that RSD is causing this. I name it Dave the Dragon. I now know the pain is real, but the source of that pain isn’t. Naming it helps to alleviate that intense emotional response. If you don’t put that pause between the trigger of RSD and your response to it, it can quickly escalate into bad outcomes. You can scream, “I want a divorce!” You can storm out of the office shouting things to your boss or colleagues that there’s no coming back from. And that explosive rage or sadness is the source of huge shame and anxiety.

[Get the ADDitude eBook on RSD]

Q: What advice do you have for partners of people with RSD who want to raise a sensitive issue?

If you’re the partner of someone who is suffering with RSD, approach a sensitive conversation with curiosity rather than judgment. Plan a time and place for the conversation so the person with RSD can prepare for it. Maybe every Friday at 6 p.m. you sit as a couple and spend an hour sharing what you wish were different in the relationship or about how something was handled. Save your comments for that planned time, in that controlled setting. People with RSD can prepare by putting systems in place to reinforce their scaffolding. When a combative conversation or comment comes as a surprise, that’s when the damage can be done.

How to Handle Criticism: Next Steps

• Watch: “Easing Rejection Sensitivity for Black Women with ADHD”
• Self Test: Rejection Sensitive Dysphoria in ADHD Brains
• Read: “ADHD Criticisms That Shattered Us… and the Words That Healed”

Carole Fleck is Editor-in-Chief at ADDitude magazine.

ADDITUDE IS HUMAN
Artificial intelligence does not create or edit any written content published by ADDitude. Our editorial team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

Q: I am a people-pleaser who averts all conflict. I make sure my husband gets what he wants before he even has a chance to ask for it. How can I exit this destructive loop?

Living with a compulsive need to please others and avoid conflict can be emotionally exhausting. To achieve a healthier balance in your relationship, follow these seven steps.

7 Steps to Stop People Pleasing

1. Identify Root Causes

People-pleasing behavior often stems from fear of rejection, low self-esteem, or past experiences in which you felt emotional safety hinged on pleasing others. Perhaps you had to fulfill your parents’ demands, no matter how unhealthy, or risk harsh punishment and emotional upheaval. Or maybe you have experienced rejection by your parents, peers, or their adults whose impossible standards you felt you couldn’t reach. Meeting with a therapist can help you explore and understand the root causes of your people-pleasing behaviors and develop solutions for overcoming them.

[Read: “It’s Not People-Pleasing. It’s Self-Abandonment.”]

2. Set Boundaries

Self-respect grows as you practice setting healthy boundaries and prioritizing self-care. This doesn’t mean you care less about your family; it means you care enough about yourself to make sure your needs are being met. Start with minor requests, learn to say no, and express your desires.

3. Speak Up

Have an honest conversation with your husband and family about how you feel. Express your desire to change. A supportive partner will understand and help you with this transition. Effective communication can also prevent misunderstandings and resentment from building up.

4. Challenge Negative Thoughts

Compulsive people-pleasers often harbor negative thoughts and self-criticism. Ask yourself if your fears are based on proven facts or speculation. Cognitive behavioral techniques can be particularly helpful in reframing negative thinking patterns.

[Read: How CBT Dismantles ADHD Negativity – Cognitive Behavioral Therapy Overview]

5. Develop Assertiveness Skills

Being assertive means expressing your thoughts, feelings, and needs directly and respectfully. This can be challenging if you’re used to avoiding conflict, but there are many books, workshops, and therapies to help you build these skills. Participating in role-playing scenarios with a therapist or trusted friend can also help.

6. Practice Self-Compassion

Be kind to yourself as you work through these changes. It’s normal to make mistakes and revert to old patterns occasionally. Instead of beating yourself up, acknowledge your progress and remind yourself that change takes time.

7. Prioritize Mutual Respect

Healthy relationships are built on mutual respect and understanding. When you and your husband contribute equally to the relationship, this creates a more satisfying partnership and reduces your pressure to constantly please.

Breaking free from the cycle of people-pleasing and avoiding conflict is not easy, but with patience, self-awareness, and support, it can be done.

Stop People Pleasing & Set Boundaries: Next Steps

• Read: Stop Prioritizing Everyone Else
• Self Test: How Resilient Is Your Relationship? A Quiz for ADHD Couples
• Free Download: Friendship Guide for Adults

Stephanie Sarkis, Ph.D., is the author of Healing from Toxic Relationships: 10 Essential Steps to Recover from Gaslighting, Narcissism, and Emotional Abuse.

ADDITUDE IS HUMAN
Artificial intelligence does not write or edit any content published by ADDitude. Our team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

April 19, 2026

People with ADHD are more likely than their neurotypical peers to take positive and prosocial risks as well as negative risks, according to a new study in the Journal of Attention Disorders.¹

The study marks the first research to explore the prevalence of positive or prosocial risk-taking behaviors in an adult ADHD population. “The vast majority of risk-taking research focuses on negative and undesirable outcomes,” the study authors write. “And thereby often neglects a potential positive side of risk-taking behavior.”

The researchers explored the contributions of ADHD characteristics as well as depression, anxiety, and stress to risk-taking behavior in all its forms. Prosocial risks are defined as risky behaviors that may lead to positive outcomes, performed for the benefit of someone else, such as advocating for a vulnerable group, intervening in a fight, or attending a protest. Positive risks are defined as risky behaviors that may lead to positive outcomes performed for one’s benefit, such as adventurous travel, trying out for a performance or sports team, or public speaking.

ADHD symptoms were associated most strongly with negative risk-taking but also with positive and prosocial risk-taking to a lesser extent. ADHD characteristics appeared to contribute more to risk-taking behaviors of all kinds than did anxiety, depression, and stress. As the participants’ age increased, their likelihood of taking negative and positive risks decreased.

Additionally, researchers found that, “All three forms of risk-taking were interrelated, suggesting that a higher reported likelihood of one type coincided with increased likelihoods of the others.”

In the correlational study, 611 Dutch participants completed surveys about their likelihood of engaging in negative, positive, and prosocial risk-taking behaviors. Participants also completed a questionnaire that measured symptoms of ADHD as well as depression, anxiety, and stress.

Further research is needed, write the study’s authors, since the association between ADHD traits and positive or prosocial risk-taking is likely multi-factorial and, “may be influenced by a variety of factors, including internalizing conditions.” Still, they conclude: “These insights may contribute to a more nuanced understanding of ADHD, with potential implications for fostering positive self-concept, promoting acceptance of the condition, and supporting adaptive coping strategies.”

The Upside of Risk Taking: Upstanders and Advocates

The ability of many individuals with ADHD to demonstrate the courage of their convictions, high levels of empathy, and a passion for justice has long been observed. “If managed correctly, a healthy dose of frustration and sadness regarding inequities can be useful,” says Marcy Caldwell, Psy.D., in the ADDitude article “Why ADHD Brains Can’t Just Ignore Unfairness.” “The world needs individuals who are committed to making a positive difference in the lives of others.”

ADDitude readers have shared many such accounts of altruism. “My daughter has a strict sense of what’s right and has no problem telling someone when they’re in the wrong,” says Rebecca, an ADDitude reader, in the article, “What I Would Never Trade Away.” “Right now, as her mom, it drives me insane at times, but I know it’s a true superpower.”

Another reader named Karen shares a similar reflection: “My daughter always watches out for the ‘little guy.’ If someone is getting picked on or bullied, she will step up and have their back.”

Stories of individuals with ADHD taking risks with unfortunate results are all too common, but there are many stories of risks that yield benefits in relationships, personal growth, and business.

“I was bored by work in the ’70s and saw a newspaper ad for a volunteer nursing job in Yemen,” says Susan, an ADDitude reader in the United Kingdom. “I didn’t know anything about it or even where Yemen was, but I applied, got the job, and spent two amazing years there.”

“Risk-taking. Impulsivity. Sensation seeking. Hyperfocus. Curiosity. We associate these traits and qualities with some of the most successful, trailblazing entrepreneurs of our time, writes Linda Roggli, PCC., in “Entrepreneurship and ADHD: Fast Brain, Fast Company.” “In some ways, the ADHD traits most commonly associated with challenges are the same ones lauded by successful entrepreneurs.”

Source

¹Fuermaier, A. B. M., Dong, H., Pollak, Y., Braams, B. R., & Dekkers, T. J. (2026). ADHD Characteristics Are Linked to Divergent Risk-Taking Behaviors. Journal of Attention Disorders. https://doi.org/

Dopamine is the neurotransmitter most often associated with ADHD, but the condition is about far more than a single chemical deficiency or a set of symptoms.

“ADHD is not one chemical in the brain. It’s how these chemicals interact with each other,” said Gregory W. Mattingly, M.D., a psychopharmacology instructor at The Washington University School of Medicine and Past President of APSARD, during his ADDitude webinar, “The Brain Chemistry of ADHD.”

Here, explore highlights and fascinating insights about the ADHD brain (and its treatments) from Dr. Mattingly’s free webinar.

The Big 3 (And Then Some)

ADHD is associated with dysregulation of three key neurotransmitters:

• Dopamine supports focus and motivation and is implicated in reward.
• Norepinephrine helps with alertness, cognitive processing, and working memory.
• Serotonin regulates mood, emotion, anxiety, sleep, and circadian rhythm — all areas of struggle for people with ADHD.

Stimulant medications have focused almost exclusively on raising dopamine and norepinephrine levels in the brain. Newer ADHD medications, however, are also targeting serotonin, and researchers are still understanding how other neurotransmitters (like GABA and glutamate, the brain’s brakes and gas, respectively) can be targeted in ADHD treatment. “If the brain is overexcited, maybe I need to slow it down by modulating GABA,” Mattingly commented.

[Read: Unraveling a Tangle of Confusion Over ADHD Medications]

The Serotonin Effect

Between one-third and two-thirds of adults with ADHD take at least one medication on top of their ADHD prescription(s) — most commonly something to address anxiety, depression, or mood instability. That is, many adults are taking a medication that modulates serotonin in addition to ADHD medication.

This reality has led to a lot of interest in developing medications that address the emotional aspects associated with ADHD — anxiety, emotional frustration, overarousal, etc. — not sufficiently addressed by stimulants on the market today. Viloxazine (Qelbree), already approved for ADHD, is one such option: It modulates both norepinephrine and serotonin and has shown effectiveness not just for core ADHD symptoms but for associated anxiety and mood symptoms as well. Additional medications that raise dopamine, norepinephrine, and serotonin simultaneously are currently in development (e.g., Centanafadine).

“Get ready and hang on because we’re going to have more medicines that modulate serotonin,” Mattingly said.

Our Understanding of ADHD (and its Treatments) Continues to Evolve

It’s encouraging that new medications for ADHD are targeting emotional dysregulation, a feature of the condition that has been overlooked for far too long. It’s the latest development in our ever-evolving understanding of ADHD as a whole-person, whole-life condition — a relatively new concept in ADHD research.

[Read: ADHD at the Center — A Whole-Life, Whole-Person Condition]

Regarding research on Mydayis, for example, an amphetamine released in 2017, Dr. Mattingly noted that it was one of the first studies to consider how ADHD medications affect adults outside of school and work.

“This triple-beaded formulation helped not just with work performance and school performance, but it helped with making friends, getting along with others, being able to parent kids, modulate emotions,” Mattingly said.

And our understanding of how medications target core symptoms is evolving as well. For years, for example, the prevailing assumption was that stimulants improve attention, making it easier to attend to tasks. But researchers recently discovered that stimulants raise the perceived value of tasks that would otherwise feel unrewarding. “It’s helping that signal-to-noise ratio, being able to stay motivated… engaged with something,” Mattingly said.

ADHD Treatment Protects the Brain in the Long-Term

Treating ADHD isn’t just about addressing current symptoms, but about protecting the brain from the consequences of ADHD’s secondary issues, from anxiety and depression to insomnia.

“An untreated ADHD brain becomes a less connected ADHD brain, which decreases our resiliency and increases our frustration, emotional frustration, and other things,” Mattingly said, emphasizing the importance of holistic treatment — that is, medications and healthy lifestyle habits, from sufficient sleep to consistent exercise.

Watch Dr. Mattingly’s full webinar at additu.de/040826

The ADHD Brain: Next Steps

• Read: Serotonin Dysregulation Is the Common Denominator in Most ADHD Comorbidities
• Read: Stimulant, Non-Stimulant, or Both? Combination Therapy for ADHD
• Read: Emotional Dysregulation Improved with ADHD Medication Use

ADDITUDE IS HUMAN
Artificial intelligence does not write or edit any content published by ADDitude. Our team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.