Ask Dr. Saline: What is the difference between social anxiety and rejection sensitivity dysphoria (RSD)?

red peg standing apart from group of brown pegs









Dear Dr. Saline:

I am confused about something. The topic of rejection sensitivity dysphoria seems to be everywhere. But what is the difference between that and social anxiety?


From Dr. Saline

Dear DeeDee-

This is a great question! It makes sense to me that you are confused because social anxiety and rejection sensitivity dysphoria (RSD) are fundamentally related. Let’s start by defining these two conditions and explore their differences (and similarities).

Social Anxiety

young man uncomfortable among people

Social anxiety is defined as a distinct fear in one or more social situations where you are exposed to potential (negative) scrutiny from others. These worries about humiliation and rejection are persistent, often lasting six months or more and restrict your activities, interests and relationships. Studies have actually found that an estimated 12.1% of all adults experience social anxiety disorder (SAD) at some time in their lives and it’s one of the most common of all of the anxiety disorders. Researchers estimate that anywhere from one third to one half adults with ADHD live with social anxiety too.

People with social anxiety have persistent, debilitating fears that others will negatively judge them in social situations. Social anxiety is based on a fundamental disconnect between how you actually appear to others and your own exaggerated, often negative perceptions of yourself. These negative perceptions form core, false beliefs related to thinking that you are deficient in some way. Examples include “I will surely embarrass myself,” “People won’t like me,” “I am not that smart,” “I’m not much fun,” etc. Sound familiar?

The prevalence of social media makes this worse. Negative comments, teasing and bullying happen online almost instantaneously. With 24/7 access, there’s no escape. If you misspeak or do something foolish, everybody will know about it within 5 seconds. Worried about what others might think or post about them, folks with ADHD who struggle with impulsivity and reactivity become more afraid of putting themselves in novel situations and reaching out to make friends.

Rejection Sensitivity Dysphoria (RSD)

sad young woman looking at her phoneRejection sensitivity dysphoria, unlike social anxiety, isn’t a formal diagnostic category. It’s a syndrome that was named by Dr. William Dodson after years of observing traits and behaviors in his patients with ADHD. Rejection sensitive dysphoria refers to unbearable feelings of pain following an actual rejection or a belief about one. These intense feelings, directly related to emotional dysregulation, lead to an expectation that others will pull back their support, love or respect. RSD causes extreme emotional pain that plagues both children and adults– even when no actual rejection has taken place.

RSD falls under the umbrella of social anxiety because it takes these worries to the next level. Folks with ADHD and RSD may hold onto and repeat unkind words or actions directed towards them for months or years. It’s as if you just can’t seem to shake off a negative comment and, having lived for years with criticisms about being “different”, believe at some level that you deserve it. You think you’ve fallen short and, with your exquisite sensitivity, no matter what anyone else says, you just can’t bounce back. 

Struggling to let go of past hurts, people with RSD refrain from reaching out socially, managing conflict directly and feeling good enough. They not only believe their core false beliefs about deficiency are true but they also become quickly overwhelmed by tidal waves of intense anger, hurt, shame and sadness. You may lash out at others or simply withdraw to lick your wounds and hide from any chance this could happen again. This is where social anxiety and RSD overlap. 

How ADHD factors in

woman comforting another womanWhat adults (and kids) with ADHD, social anxiety and RSD need to remember is that simply living with these conditions doesn’t make you is weak or incapable.  You are just wired to feel things more intensely and replay unpleasant interpersonal interactions over and over. RSD is linked to the social insecurity inherent in social anxiety. To counteract these patterns, spend time consistently nurturing your strengths. Focus as much as possible on what you love to do and what you do well. Pay attention to your positive efforts: write down 3 good (or good enough) things that happened each day before bed. This will help you see things from a new perspective and shift from negative self-talk. 

4 tips for reducing social anxiety and RSD

  1. Identify limiting core beliefs and negative self-talk. Find evidence that contradicts or supports those beliefs. Remember that no one is judging you as harshly as you judge yourself. Talk to people in your life who love and know you best and get their perspective on all your best qualities.
  2. Recall a situation when you were uncomfortable and did something anyway. Focus on positive feelings and outcomes from this experience and build on it. Your past successes are proof that you can succeed again.
  3. Plan positive self-talk phrases and reinforce your strengths. Build your confidence and quiet your inner critic with reminders of your gifts and traits. Shine a light on your accomplishments and strengths and treat yourself with compassion.
  4. QTIP – Quit Taking It Personally. Remind yourself that you may perceive a rejection that isn’t there or someone may just be thoughtless. Consider the source and ask if this is something worth holding onto? Take setbacks in stride and shift your attention to doing what you love rather than what hasn’t worked.

People with ADHD, social anxiety and RSD need to feel the loving presence of caring friends and family. Surround yourself with these folks and spend time with them. You don’t need a posse: a few dependable allies works just fine. You can practice your social skills in a safe context, increase your self-esteem and learn to enjoy connecting with others. Most of all, you’ll nurture your own resilience and develop core beliefs related to what’s special, unique and lovable about YOU.