Rejection Sensitive Dysphoria (RSD), ADHD and Perimenopause: When Your Brain Tells You Lies
I’d worked really hard on something at work. Hours of it, done properly, every detail checked. Then I was off for one day, someone covered for me, and when I got back I heard them being thanked for all of it.
Anyone might feel a bit hurt by this, but my RSD took it and ran with it.
I felt sick to my stomach. I went over and over it, looking for clues as to why someone else had been praised and why my work had been ignored. By the evening, my brain had decided that nobody ever notices what I do, that maybe I wasn’t as good at my job as I thought, and that maybe I needed to leave. For the next couple of days, I felt tearful and could barely concentrate at work.
That’s the bit that’s so hard to explain to people. To anyone else, it might look like such a small thing, but inside it feels huge.
That’s rejection sensitive dysphoria, or RSD, and it’s often described as one of the things that people with ADHD struggle with most.
What is rejection sensitive dysphoria?
RSD is extreme emotional pain that comes from real or perceived rejection from others. It can be caused by the smallest thing, a short reply or a blank look across a meeting, and suddenly it can feel like the world’s ending.
It’s a deep, visceral pain, and it’s really hard to describe to anyone who hasn’t felt it. When people say, “Oh, no one likes rejection,” they’re right, but this is rejection on steroids.
Can RSD be diagnosed?
RSD isn’t something a doctor can diagnose. There’s no test and no checklist. It’s a name for an experience so many of us recognise.
What the research does show is that people with ADHD find their emotions harder to regulate than those without it (Beheshti, Chavanon and Christiansen, 2020). Research into RSD is still in its early days, which is why it’s so encouraging to see studies starting to happen. Dr Jenny Kirton at the University of Liverpool is currently researching ADHD and RSD, and the results of her study are expected next year.
Why does RSD hurt so much with ADHD?
We’re all built to care about belonging. There’s research suggesting the brain handles social pain using some of the same areas it uses for physical pain (Zhang, Zhang and Kong, 2019), which might explain why it can feel like a punch to the chest.
With ADHD, the brakes that act as a buffer don’t work as well. The emotional pain hits you like a tsunami, huge and visceral, before you’ve had a chance to brace yourself.
Years of being corrected, told off and feeling so misunderstood have an impact. Every new criticism reinforces the negative things we already believe about ourselves. It becomes one more thing to add to the list of what we’re doing wrong, what we’re not good at or why people don’t like us.
Lots of us become people pleasers as a result. We’ll do almost anything to avoid rejection, and that’s exhausting in itself. You spend all your energy trying to get everything right and be perfect, even though perfect doesn’t exist.
When you do get something wrong, it feels even harder. It only adds more proof that there’s something wrong with you, as if it’s a flaw in who you are rather than just a mistake that anyone could make.
A recent UK study backs this up. Students with ADHD described rejection as something they felt in their bodies, like feeling sick or having a tight chest, and talked about hiding it and pulling away from people to cope (Brighton and Sussex Medical School, 2026).
Looking back after a late diagnosis
For lots of women diagnosed later in life, finding out about RSD explains so much. Years of being told you’re too sensitive, or that you overreact, suddenly make sense. You weren’t too much. Your brain was feeling things at full volume, and nobody had told you why.
This can bring huge relief, and some grief too, for all the years you spent blaming yourself.
How RSD affects everyday life
RSD doesn’t just hurt in the moment. It changes how people live.
Say you’ve always wanted to have a few friends round to celebrate your birthday. For years, you’ve been too scared to ask, as the fear of nobody coming felt too big. This year, you finally find the courage. You send the invites, and slowly the replies come back. Everyone’s already busy, with so many reasons why they can’t make it.
Then the spiral starts. When anyone else invites people round, everyone turns up. Why won’t they come for me? What have I done wrong? Do they hate me? I’m obviously not popular or funny or interesting enough.
What you forget is all the times people have come along to things for you. You’ve seen other people’s plans fall through too, for real, genuine reasons, and you knew it wasn’t personal.
You can see it so clearly for someone else. When it’s happening to you, though, you go into the biggest tailspin known to man. You convince yourself that everybody hates you, that you’re boring and rubbish, and that you’re just not worth people’s energy.
It doesn’t stop at birthdays. People shut down friendships because they think they’ve misread a text. They quit jobs. They don’t apply, don’t ask and don’t post, because a ‘no thanks’ would hurt too much. Or they do or say something on impulse, and then they’re horribly hard on themselves afterwards.
For some people, the pain can feel insurmountable. If you’re struggling, you can talk to your GP during working hours. NHS 111 and the Samaritans on 116 123 are both there 24 hours a day, every day of the year, with trained people ready to listen and help.
Does perimenopause make RSD worse?
Nobody has directly researched RSD and perimenopause yet, so we don't know whether hormonal changes make RSD worse.
What we do know is that oestrogen plays a role in brain processes involving dopamine, noradrenaline and serotonin (Kooij et al., 2025). During perimenopause, fluctuating hormone levels can coincide with changes in mood, anxiety and emotional wellbeing.
For women with ADHD who already struggle with RSD, these changes might make difficult feelings around perceived rejection, criticism or disapproval harder to manage. Add in other impacts of perimenopause, such as disrupted sleep, brain fog and increased anxiety, and it isn't difficult to see why some women might feel that their RSD has become harder to deal with.
Research has also found that women with ADHD report more severe perimenopausal symptoms than women without ADHD (Jakobsdóttir Smári et al., 2025). However, this is a possible explanation for why some women might find their RSD harder to manage during perimenopause, rather than a direct link that has been established through research.
What can help with RSD?
This is a really hard one. RSD can feel so overwhelming, and what helps differs so much from one person to another, so there’s no one size fits all. RSD is something that is part of who we are and it isn’t something that can be cured or improved with medication. Finding tools and strategies are often the best way to ride the tsunami of RSD, rather than letting it engulf you.
Here are some things that can make a difference.
Name it to tame it. Learning to recognise when RSD is there, and even starting to see it coming, can act as a buffer. However small that buffer is, it helps.
Pause before you act. Sleep on it, and tell yourself you don’t have to act on this straight away. Lots of us with ADHD are very visual, so a post it note somewhere you’ll see it, reminding you to pause and that this might not be real, can really help. Go back to it later and reread the message or email with fresh eyes.
Talk it over. If you’ve got someone you trust, ask them to look at a message with you or talk it through. RSD often comes with a huge amount of shame and guilt, and saying it out loud to someone safe can take some of the weight off.
Check the evidence. How much of this is actually real? Is there any tangible proof that what you’re afraid of has happened? The pain is real, and the story attached to it often isn’t. Sometimes a simple “Is everything alright?” can save days of worrying, though whether that feels right will depend on you and the person involved.
Look at the basics. How tired you are, how hungry you are and where you are in your cycle can all affect your emotions, your energy and how you’re feeling on any given day.
Keep reminders of the good stuff. Save the lovely things people say about you, in a note on your phone, a folder or a screenshot album. On the days your brain tells you everyone hates you or you’re getting everything wrong, they’re there to remind you of the good things you’ve done and that you’re a good person.
Treatment and support for RSD
There’s no medication specifically for RSD, and no research yet on whether ADHD medication helps with it. Some research suggests ADHD medication can help a little with emotional regulation more generally, though much less than it helps with attention and focus (Lenzi et al., 2018).
If you’re on ADHD medication and in perimenopause, it’s worth asking your ADHD prescriber to review your medication. Falling oestrogen may make stimulant medication work less well, so your dose, the timing or even the type of medication might need changing (Wynchank and Kooij, 2026).
Neuroaffirming coaching or therapy, with someone who really understands ADHD, can help you recognise your triggers and early warning signs, and build strategies to manage RSD better.
What if you work with or are the manager of someone who is neurodivergent and suffers with RSD?
If you’re a manager, RSD doesn’t mean you can’t give feedback or have difficult conversations. Feedback is important, and most people with ADHD really want to know how they’re doing. It’s how it’s given that makes the difference.
Even small things matter. A message saying “Can we have a chat later?” can leave someone panicking for hours, so tell them what it’s about straight away.
Be specific. Vague comments leave an ADHD brain filling in the gaps, usually with the worst possible version. Say what’s going well, what needs to change and how you’ll support them to do it.
Give them time. Even kind, well delivered feedback can bring up big feelings. Letting someone go away, think and come back to talk about next steps can make all the difference.
RSD is one of the hardest parts of ADHD to explain, and one of the hardest to live with.
It doesn’t mean you’re too sensitive or too much. It means your brain feels rejection at full volume, and sometimes it tells you lies.
That day at work, the story my brain told me felt completely true, but looking back, I know it wasn’t. Knowing it was RSD doesn’t take the pain away, but it does help me remember that the feeling wasn’t the full picture.
So the next time RSD shows up for you, I hope you can remember that too.
References
Beheshti, A., Chavanon, M.L. and Christiansen, H. (2020) ‘Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis’, BMC Psychiatry, 20, 120. doi: 10.1186/s12888-020-2442-7.
Brighton and Sussex Medical School (2026) “It hurts in your body”: new BSMS research explores rejection sensitivity in ADHD. Available at: https://www.bsms.ac.uk/about/news/2026/it-hurts-in-your-body-new-bsms-research-explores-rejection-sensitivity-in-adhd.aspx (Accessed: 16 October 2026).
Jakobsdóttir Smári, U. et al. (2025) ‘Perimenopausal symptoms in women with and without ADHD: a population-based cohort study’, European Psychiatry, 68(1), e133. doi: 10.1192/j.eurpsy.2025.10101.
Kooij, J.J.S. et al. (2025) ‘Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease’, Frontiers in Global Women’s Health, 6, 1613628. doi: 10.3389/fgwh.2025.1613628.
Lenzi, F., Cortese, S., Harris, J. and Masi, G. (2018) ‘Pharmacotherapy of emotional dysregulation in adults with ADHD: a systematic review and meta-analysis’, Neuroscience and Biobehavioral Reviews, 84, pp. 359–367.
Wynchank, D. and Kooij, S. (2026) ‘Pharmacological management of ADHD in women across perimenopause, menopause and post-menopause’, Drugs & Aging, 43(5), pp. 385–395. doi: 10.1007/s40266-026-01291-z.
Zhang, M., Zhang, Y. and Kong, Y. (2019) ‘Interaction between social pain and physical pain’, Brain Science Advances, 5(4), pp. 265–273.
