RSD and Rejection Sensitivity Therapy for Adults with ADHD
I don't treat RSD as a symptom to manage.
I treat it as one of the central things keeping ADHD adults stuck in lives that don't actually fit them.
We work on the in-the-moment piece, the somatic flooding, the spiral. And we work on the quieter piece. The part that's been running the show.
What you will get is a therapist who already knows the terrain. Who understands that the reason none of it stuck wasn’t that you needed better tools. It’s that shame was running the show underneath all of it.
Therapy here starts with that. The shame, The self-concept built from years of being misunderstood, the grief of late diagnosis, the exhaustion of masking. We address the thing that’s actually keeping you stuck. The skills come after. They always work better that way.
You replayed a two-sentence email for three hours last night. You turned down something you actually wanted because you already knew how it would feel if it didn't work out. You smoothed something over with a friend that didn't need smoothing because the silence felt like proof of something.
This is what people are calling RSD. Rejection Sensitive Dysphoria. And if you have ADHD, you probably already know the word. You just haven't found anyone who treats it like the thing it actually is.
Rejection sensitivity is the broader experience. The heightened radar for any sign that someone is pulling away, disappointed, annoyed, done with you. RSD is the acute version. The one that hits your body like a physical event. For a lot of ADHD adults, both are running at the same time.
Most therapy treats either one as something that happens after a rejection. Someone says the wrong thing, your nervous system blows up, and you process the aftermath in session the next week.
That version is real, but it's not the whole picture—and for a lot of ADHD adults, it's not even the most expensive part.
The harder version is the one that shows up before the rejection ever happens. The version that quietly makes decisions for you. The job you didn't apply for. The friendship you let go cold. The thing you wanted to ask for and didn't. The version of you that you stopped letting other people see, somewhere around age eleven, because it cost too much the last time.
The work isn't only about what to do when RSD hits. The work is about the years of small choices you've already made to avoid it, and what those choices have cost you.
Shame before rejection, not after. that's the part most people miss.