Living with ADHD - The Reality Check (Part 3)

Chapter 3: The invisible wound that shapes everything - rejection sensitive dysphoria.

In Parts 1 and 2 of this series, we established that ADHD isn’t a free pass to be a knobhead, and that direct communication works better than hints when one brain processes information differently. But there’s a particular aspect of ADHD that complicates every conversation, every interaction, and every moment of feedback - rejection sensitive dysphoria (RSD). And it’s the challenge that nearly nobody talks about honestly.

The shelf incident is one of the most readily available examples when explaining what living with my RSD actually feels like. I’d promised to install a simple shelf in one of the girl’s bedrooms approximately two months earlier. The shelf sat there, still in its packaging, a daily reminder of my good intentions and poor follow-through. Around it orbited a constellation of other unfinished projects scattered throughout the house - the outside wall that needed rendering which I was getting someone to sort,  the kitchen cupboard door that needed rehanging, the bathroom we would get redone, eventually. 

When Amanda finally mentioned it - not angrily, not even particularly critically, just a straightforward “Are you planning to put that shelf up, or should I just ask Eleanor’s dad?” - I heard something completely different. My brain translated her reasonable question into a devastating indictment of my entire character: “You’re useless. You can’t finish anything. You’re a disappointment. Why did I marry someone so fundamentally incompetent?”

I exploded and started on everyone else. Amanda angrily responded with something that’s stuck with both of us: “I don’t know where I am with you. It’s either walking on eggshells or all out affection. There’s no middle ground.”

Not this time but sometimes I shut down completely. Withdraw into despondency, spending the next three hours in what we call “the rejection cave” - that emotional space where I’m physically present but emotionally unreachable, convinced that everyone thinks I’m worthless.

She was right. My rejection sensitivity creates an emotional landscape with no temperate zones - only extremes. Either I feel completely secure in our relationship and respond with warmth and openness, or I feel utterly rejected and respond with defensive withdrawal or over-apologising. There’s no mild disappointment in my emotional vocabulary, no gentle criticism, no neutral feedback. Everything feels life-or-death.

This chapter isn’t about excusing that pattern. As we established in Part 1, explanation isn't an excuse. Instead, it’s about understanding what rejection sensitive dysphoria actually is, how it affects ADHD relationships, and what the messy reality looks like when you’re trying to build a partnership with someone whose brain interprets neutral comments as emotional warfare.

What RSD Actually Is (And Why It Matters)

Most people think rejection sensitive dysphoria is just another term for “being too sensitive.” It’s not. RSD is a neurological phenomenon where ADHD brains experience emotional pain from perceived rejection with an intensity that’s completely disproportionate to the actual situation.

Dr. William Dodson, who’s done extensive work on RSD, describes it as,

 “extreme emotional sensitivity and emotional pain triggered by the perception - not necessarily the reality - of being rejected, teased, or criticised by important people in your life.” Dr William Dodson

The key word there is “perception.” My brain doesn’t need actual rejection to trigger RSD. It just needs to interpret something as rejection, and suddenly I’m experiencing emotional pain as real and intense as physical injury.

When Amanda asked about the DIY job, she wasn’t rejecting me. She was asking a practical question about household maintenance. But my ADHD brain didn’t process it that way. It went straight to catastrophic interpretation: she thinks I’m useless, she regrets marrying me, she’s going to leave, I’ve failed as a partner.

This isn’t voluntary. I can’t talk myself out of feeling rejected any more than I can talk myself out of feeling pain when I stub my toe. The emotional response happens before rational thought can intervene.

Neuroscientist Dr. Russell Barkley explains that ADHD brains have difficulty with emotional regulation - the ability to modulate emotional responses appropriately to situations. When you combine poor emotional regulation with heightened sensitivity to rejection, you get RSD. It’s not a character flaw; it’s a neurological reality.

“Emotions in persons with ADHD are much less regulated than in persons without ADHD. The emotions are not different, just far more intense and longer-lasting.” Dr Russell Barkley 

But where it gets complicated is that understanding how RSD is neurological doesn’t eliminate my responsibility for how I respond to it. The initial emotional response might be involuntary, but what I do with that response is still my choice.

When I withdraw into the rejection cave for three hours instead of communicating about what’s happening, that’s a choice. When I respond to Amanda’s feedback with defensive anger instead of asking for time to process, that’s a choice. When I over-apologise to the point where she feels like she can’t give any feedback without triggering an emotional crisis, that’s a choice.

The philosopher Søren Kierkegaard wrote about the distinction between immediate passion and reflective response. RSD might create immediate passionate responses, but I still retain the capacity for reflection and choice about what comes next.

Amanda’s Side of the RSD Experience

Living with someone who has RSD isn’t just challenging - it’s emotionally exhausting in ways that most relationship advice never acknowledges. Amanda has had to develop an almost psychic ability to predict which comments might trigger my rejection sensitivity whilst maintaining her own authenticity and right to express needs.

“The eggshells thing is real,” Amanda tells me. “Not because you’re deliberately difficult, but because I genuinely don’t know how you’re going to interpret anything I say. The same comment that you’d laugh off one day might send you into the rejection cave the next.”

This unpredictability creates what psychologist Harriet Lerner calls “emotional labour” - the invisible work of managing another person’s emotional state. Amanda finds herself constantly running calculations: Is this the right time to mention the unfinished DIY? Is he in the right headspace to hear feedback about the social calendar? Will this comment trigger his rejection sensitivity?

The phrase “walking on eggshells” gets overused in relationship advice, usually as a warning sign of abuse. But Amanda’s experience isn’t about fear - it’s about exhaustion. She’s not afraid of me; she’s tired of the emotional management required to navigate my RSD whilst still expressing her own needs.

And then there’s the flip side - the “all out affection” Amanda mentioned. When I’m not triggered, when I feel secure in our relationship, I’m warm, present, and emotionally available. But the contrast between those two states is stark. It’s like living with two different versions of the same person, never quite knowing which one will show up.

“Sometimes I just want to be able to say something straightforward without having to consider whether it’s going to send you into an emotional spiral,” Amanda admits. “I’m not trying to criticise you. I’m not rejecting you. I just need to talk about the stuff that needs doing.”

The cognitive dissonance Amanda experiences is profound. She knows intellectually that my RSD isn’t personal - it’s neurological. But living with the emotional impact of it feels very personal. When I explode irrationally after a neutral comment, it’s hard for her not to feel punished for daring to express a need.

Dr. Sue Johnson, developer of Emotionally Focused Therapy, talks about “protest behaviours” - the ways people signal distress in relationships. My RSD-driven explosion is a protest behaviour, but Amanda experiences it as rejection too. My oversensitivity to rejection creates actual rejection of her attempts to communicate.

This is where the accountability piece from Part 1 becomes crucial. Amanda has adapted her communication style to work with my RSD (as we discussed in Part 2), but that adaptation can’t mean she loses her voice entirely. There’s a line between accommodation and silencing, and RSD constantly threatens to push us across it.

Amanda is still learning about RSD. I recently heard her use the phrase “rejection sensitive dysphoria” in conversation - a sign that she’s trying to understand the neurological reality rather than just experiencing its impact. She’s learning to work around potential triggers before things become explosive. But she’s learning through trial and error, not following some expert playbook.

The RSD Patterns That Shape Everything

Rejection sensitive dysphoria doesn’t just affect individual moments - it creates patterns that shape entire relationship dynamics. In our relationship, several specific RSD patterns have emerged over the years.

The DIY Avoidance Pattern

My procrastination on DIY jobs isn’t just about executive dysfunction (though that plays a role). It’s partly about RSD-driven fear of failure. If I don’t attempt the job, I can’t fail at it. If I don’t fail, I can’t face rejection or criticism for failing.

But of course, not doing the job creates its own criticism. Amanda’s reasonable frustration with unfinished projects triggers the very rejection I was trying to avoid. It’s a perfect anxiety loop, powered by RSD.

The irony is that I’m perfectly capable of doing these tasks. When I solo travel, I manage everything myself without issue. But at home, where the stakes feel higher because Amanda’s approval matters more, the fear of failing in front of her becomes paralysing.

The Work Rejection Bleed

When I experience rejection or criticism of my work - a blog revision request, a proposal rejection, not being asked to speak at an event when others (less qualified in my opinion!) are - it doesn’t stay at work. My RSD brain interprets professional setbacks as fundamental evidence of my worthlessness, and that emotional state comes home with me.

Amanda has learned to recognise the signs: I’m quieter than usual, more defensive, quicker to interpret neutral comments as criticism, engrossed in scrolling or working on my phone. She’s had to become fluent in reading whether my emotional state is about our relationship or whether I’m bleeding work rejection into home life.

“Sometimes you come home already in the rejection cave,” Amanda observes. “And then I’m navigating your emotional state without even knowing what triggered it.”

This bleed effect means that Amanda often bears the emotional consequences of rejections that have nothing to do with her. My ADHD brain doesn’t distinguish well between professional and personal rejection - it all hits the same neurological panic button.

The Apology Spiral

Earlier in this series, I mentioned that I’m prone to over-apologising - saying sorry even when things aren’t my fault, just to restore peace and keep the peace. This is RSD in action. The emotional pain of perceived conflict or disapproval is so intense that I’ll apologise for anything to make it stop.

But excessive apologising creates its own problems. When I apologise for things that aren’t my fault, it puts Amanda in an impossible position. She can either accept apologies for things she wasn’t even upset about, or reject my apologies and risk triggering more RSD.

“Sometimes your apologising feels manipulative,” Amanda admits, “even though I know that’s not your intention. It’s like you’re forcing me to reassure you that everything’s fine when I’m actually trying to have a difficult conversation about something that isn’t fine.”

The over-apologising also dilutes the meaning of apologies. When I apologise for everything, my apologies for things that actually warrant them lose their significance. It becomes emotional noise rather than genuine accountability.

And yes, this pattern gets abused sometimes. People learn that triggering my apologising reflex can short-circuit difficult conversations. It’s easier to let me spiral into excessive apologies than to push through to genuine resolution. But that’s a trap for both of us - it feels like peace, but it’s actually avoidance.

The Intimacy Paradox

RSD profoundly affects intimacy in ways that most ADHD relationship advice never addresses (don’t worry, I’m not going fully intimate here!). Physical and emotional intimacy require vulnerability, but vulnerability feels terrifying when your brain interprets every neutral signal as potential rejection.

I find myself constantly scanning Amanda for signs of disapproval or rejection. A slight change in tone, a momentary distraction, a neutral facial expression - all of these can trigger my RSD brain to wonder if she’s pulling away, if she’s disappointed, if I’ve done something wrong.

This hypervigilance is exhausting for both of us. Amanda can’t just exist in a neutral emotional state without me interpreting it as rejection. She has to actively signal acceptance and approval to prevent my RSD from spiralling.

“Sometimes I’m just tired,” Amanda says. “Not tired of you, not disappointed in you, just tired. But you need constant reassurance that my tiredness isn’t about you.”

The intimacy paradox is that RSD makes me crave constant connection and reassurance whilst simultaneously making genuine connection more difficult. I need Amanda to prove she’s not rejecting me, but that need itself creates distance between us.

The Accountability Tension

This brings us back to the central theme of this series: ADHD explains behaviour, but it doesn’t excuse it. RSD is real, neurological, and involuntary in its initial response. But I’m still accountable for how I manage it and how my management (or lack thereof) affects Amanda - and others around me to be fair.

Amanda has every right to mention unfinished DIY jobs. She has every right to give feedback about our social calendar, our household management, or any other aspect of our shared life. My RSD doesn’t eliminate her right to express needs or concerns.

The philosopher Martha Nussbaum writes about the “capabilities approach” to relationships - the idea that healthy partnerships require both people to maintain their capabilities for autonomous functioning. When my RSD requires Amanda to constantly manage my emotional state, it diminishes her capabilities.

“To be a good human being is to have a kind of openness to the world, an ability to trust uncertain things beyond your own control, that can lead you to be shattered in very extreme circumstances for which you were not to blame," and "What are people actually able to do and to be?"” Martha Nussbaum 

“I started to lose myself,” Amanda reflects. “I was spending so much energy managing your rejection sensitivity that I forgot I had my own needs and perspectives that mattered.”

This is where boundaries become crucial. Amanda has had to establish limits around what she will and won’t accommodate regarding my RSD. She’ll adapt her communication style to work with my brain (as discussed in Part 2), but she won’t silence herself entirely. She’ll give me space to process when I’m triggered, but she won’t accept hours of withdrawal as punishment for raising legitimate concerns.

These boundaries aren’t harsh - they’re healthy. They maintain Amanda’s agency whilst acknowledging my neurological reality. But establishing and maintaining them requires ongoing work from both of us.

I’m responsible for developing strategies to manage my RSD rather than expecting Amanda to prevent all triggers. I’m responsible for communicating when I’m in the rejection cave rather than just withdrawing. I’m responsible for working on distinguishing between perceived and actual rejection.

Amanda is responsible for maintaining her own voice and needs whilst adapting how she communicates them. She’s responsible for recognising when her exhaustion with my RSD is building up and addressing it before resentment takes root.

Neither of us is responsible for fixing the other, but we’re both responsible for working on ourselves whilst supporting each other’s growth.

What Actually Helps (And What’s Still Messy)

Most advice about managing rejection sensitivity falls into two unhelpful categories: either “just stop being so sensitive” (which is neurologically impossible) or “your partner should never say anything that might upset you” (which is relationally impossible).

The reality is messier than either of those options, and messier than most relationship advice acknowledges.

What I Try To Do:

Compose myself - When my RSD is triggered, I withdraw or explode. There’s no formal protocol, no agreed timeframe, no structured approach. I just have to compose myself however long that takes. Sometimes it’s twenty minutes. Sometimes it’s three hours. Amanda has to wait it out, not knowing whether I’ll emerge in ten minutes or half a day. Oftentimes, it’s the other way around too - Amanda withdraws. 

It’s not ideal. I don’t announce “I’m having an RSD response” or set a timer or any of the things relationship experts recommend. I just… disappear into the rejection cave until I can function again.

Try to recognise it afterwards - After I’ve calmed down, I can sometimes look back and see what happened. “Ah, that was RSD, not actual rejection.” But this is retrospective analysis, not in-the-moment awareness. I can’t stop the spiral while it’s happening. I can only understand it after the damage is done. I have to be careful not to spiral back into rejection when I acknowledge this false rejection though! (I am a nightmare!)

What Amanda’s Learning:

Work around it before it explodes - Amanda is still learning about RSD. She’s picked up the phrase, started understanding the concept, and tries to navigate around potential triggers before things become explosive. But she’s learning through experience, not expertise. She gets it wrong regularly (and that’s ok).

Be specific when she can - “The shelf needs to go up” works better than “You never finish anything.” Amanda knows this intellectually, but remembering to apply it in the moment - especially when she’s frustrated - is harder than it sounds.

Hold boundaries whilst managing explosions - Amanda has learned that she can’t silence herself to prevent my RSD. But holding that boundary whilst also trying not to trigger an emotional crisis is exhausting work. She’s still figuring out how to maintain her voice without detonating my rejection sensitivity.

What We’re Both Doing:

Accepting the messiness - We don’t have elegant solutions. RSD still derails conversations regularly. I still shout without warning. Amanda still has to calculate whether expressing a need is worth the potential RSD spiral. We’re not nailing this. We’re navigating it imperfectly, with more failures than successes. But we’re both trying, which has to count for something.

The Growth That’s Actually Happening

When I was first diagnosed with ADHD and learned about RSD, I hoped understanding it would somehow make it manageable. That awareness would create control.

It hasn’t worked that way.

The RSD is still just as intense. I can recognise the pattern after the fact - I can look back and think “ah, that was RSD, not actual rejection” - but in the moment, it feels just as devastating as it always did. The emotional pain is just as real, just as overwhelming, just as immediate.

What’s changed isn’t the intensity of RSD but my ability to understand it retrospectively. I’m better at the post-mortem than the prevention. I can analyse what happened after I’ve emerged from the rejection cave, even if I can’t stop myself from entering it in the first place. Amanda’s growth is different. She’s learning the language around RSD, understanding it as a neurological reality rather than just a frustrating pattern. As I said, she recently used the phrase “rejection sensitive dysphoria” in conversation - proof that she’s trying to understand rather than just endure. It’s also helping us navigate our kids too as there are definitely traits in them that we are working through. (NB: I have to fight on a daily basis not to feel guilty that my kids have some of my ADHD traits, diagnosed or not yet. It perpetuates my sense of rejection and powerlessness but I am having to accept that I cannot control everything and whether this is or isn’t the case, isn’t entirely my fault!)

But understanding hasn’t made it easier for Amanda to live with. She still walks the tightrope between expressing her needs and avoiding my RSD triggers. She still bears the emotional labour of managing my potential reactions. She still experiences exhaustion from the constant calibration required.

I return again to Viktor Frankl who wrote about finding meaning in suffering - the idea that we can’t always control what happens to us, but we can control how we respond to it. My RSD creates suffering for both of us, but we haven’t found some beautiful meaning in it. We’ve just learned to recognise it for what it is, which is progress even if it’s not transformation.

This doesn’t mean RSD has become easy or manageable. Just last week, a work rejection sent me into a two-day emotional spiral that affected our entire household. Amanda couldn’t say anything without potentially triggering more RSD. The girls asked if I was upset with them. It was messy and difficult and exactly as hard as it always is.

But we recovered. We talked about what happened once I’d emerged. Amanda expressed her frustration with having to manage my emotional state for two days. I acknowledged that my withdrawal affected everyone, not just me. We didn’t solve anything, but we named the reality of what had occurred.

The shelf in the girls’ bedroom? I finally installed it three weeks after the conversation that triggered this chapter. Not because we’d developed some brilliant RSD management strategy, but because enough time had passed that I could face the task without the paralysing fear of failure.

The Reality Check

Living with RSD in a relationship is hard. There’s no getting around that. It creates real challenges that require ongoing work from both partners. It means difficult conversations are more difficult, criticism feels more painful, and vulnerability feels more dangerous.

And we haven’t cracked it. We don’t have a system that works elegantly. We don’t have strategies that prevent RSD spirals. We don’t have the kind of communication protocols that relationship experts recommend. What we have is ongoing navigation of something difficult. Amanda is learning to understand RSD whilst still maintaining her voice. I’m learning to recognise RSD patterns retrospectively whilst taking responsibility for the impact of my withdrawals. Neither of us is doing this perfectly. We’re both doing it imperfectly, together.

The key is maintaining the balance we’ve emphasised throughout this series: understanding RSD as a neurological reality whilst refusing to let it become an excuse for poor behaviour. Adapting communication and expectations whilst maintaining boundaries and accountability. Working with ADHD whilst still demanding effort and growth from both partners.

Amanda and I haven’t perfected this. We probably never will. But we’ve built a relationship that can withstand my RSD without either of us losing ourselves in the process. That’s not despite the RSD - it’s through learning to navigate it together with honesty about how messy it actually is.

Most relationship advice presents tidy solutions to complex problems. But RSD doesn’t have tidy solutions. It has ongoing navigation, imperfect strategies, and the commitment to keep trying even when it’s hard. That’s less satisfying than a neat list of techniques, but it’s more honest about what living with RSD actually requires.

1. RSD isn’t “being over sensitive” - it’s neurological - The pain is as real as physical pain. Understanding this changes how both partners approach it, but doesn’t eliminate the intensity or unpredictability.

2. The eggshells vs affection dynamic is exhausting - Partners of people with RSD carry invisible emotional labour without elegant solutions. Acknowledge this reality without pretending there’s a way to eliminate it entirely.

3. Composition takes however long it takes - There’s no structured time-out or formal protocol. The person with RSD withdraws until they can function again. The partner waits. It’s messy and imperfect.

4. Retrospective recognition isn’t prevention - Getting better at understanding RSD after the fact doesn’t mean being able to stop it in the moment. Progress looks like awareness, not control.

‍5. Learning is ongoing, not mastered - Partners are still figuring out RSD through trial and error, not following expert playbooks. Getting it wrong regularly is part of the process.

6. Over-apologising creates its own problems - Even when it comes from RSD fear, excessive apologising can become manipulative and dilute genuine accountability. Recognising the pattern doesn’t automatically fix it.

Real progress looks like navigating RSD imperfectly together, not developing elegant solutions that prevent all spirals. Commitment to trying matters more than perfect execution.​​​​​​​​​​​​​​​​ So, until there are better solutions, we just have to accept the messiness and navigate it carefully.