Rejection Sensitivity Dysphoria with Dr. Bill Dodson (reprise)

Dec 4, 2025

Dr. Bill Dodson, a board-certified psychiatrist specializing in adult ADHD, delves deep into Rejection Sensitivity Dysphoria (RSD) and its impact on emotional health. He explains how RSD manifests in ADHD, often resulting in intense emotional pain and misdiagnosis. The distinction between RSD and social anxiety is explored, shedding light on coping strategies and the influence of childhood experiences. Dodson emphasizes the importance of medication, lifestyle adjustments, and the power of psychoeducation for self-advocacy and recovery.

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INSIGHT

Emotions Are Central To ADHD Diagnosis

Emotional dysregulation is a core ADHD feature internationally, though DSM criteria in the U.S. still omit it.
Europe added emotional dysregulation as a core adult ADHD criterion due to its real-world impact.

INSIGHT

RSD Is Triggered, Intense, And Short-Lived

Rejection Sensitivity Dysphoria (RSD) is a specific, intense subtype within emotional dysregulation tied to clear triggers.
RSD episodes are instant, short-lived, and match the perceived trigger, unlike mood disorders.

INSIGHT

RSD Causes Physical Pain And Mimics Depression

RSD produces both emotional and physical pain and can mimic a major depressive episode if internalized.
Episodes often require prevention rather than in-the-moment fixes because they must run their course.

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Emily Kircher-Morris and Dr. William Dodson have a conversation about the complexities of ADHD, in which they discuss emotional dysregulation, Rejection Sensitivity Dysphoria (RSD), and social anxiety. They talk about how RSD manifests in ADHDers, and how we can distinguish it from social anxiety. They also explore the impact of childhood experiences, the vital role of relationships, and the need for updated diagnostic criteria. This conversation was taken from a two-part series earlier in 2025.

TAKEAWAYS

Emotional dysregulation is often overlooked in ADHD diagnoses.
RSD is a specific condition affecting many with ADHD; the pain can be both emotional and physical, leading to significant life impairments.
Social anxiety is anticipatory, while rejection sensitivity is reactive; they can coexist but are distinct.
Childhood experiences can exacerbate RSD but are not the sole cause.
Medication, alongside sleep, nutrition, structure, and routine, plays a vital role in emotional regulation.
Mood disorders can manifest independently of external events, and a significant percentage of individuals with ADHD have coexisting psychiatric diagnoses.
Understanding RSD is essential for clinicians, and psychoeducation is key to self-advocacy.

Here's the research project Emily mentions in her closing thoughts.

Dr. Bill Dodson is a board-certified adult psychiatrist who has specialized in adults with Attention Deficit/Hyperactivity Disorder for the last 27 years.

In recognition of his clinical contributions to the field of ADHD he was named a Life Fellow of the APA in 2012. He was the 2006 recipient of the national Maxwell J. Schleifer Award for Distinguished Service to Persons with Disabilities.

His contributions to the field of ADHD include:

The only currently available methodology for the fine-tuning of ADHD medications.
The concept of Rejection Sensitivity Dysphoria and its treatment with medications.
The first non-behavioral theory of what ADHD is and how it can be treated successfully with an emphasis on what goes right rather than what goes wrong.

BACKGROUND READING

Bill Dodson's website, Dr Dodson's contributions to ADDitude magazine