Is This ADHD Symptom Messing With Your Sex Life?

Attention-deficit/hyperactivity disorder impacts many different aspects of life, from laundry habits to behavior at work. Another area where ADHD can pose major challenges is sexual intimacy, thanks to a condition known as rejection sensitive dysphoria, or RSD.

So what exactly is RSD, and how does it harm your sex life? Below, experts break down the concept, how it manifests and what you can do if the experience sounds familiar.

“Rejection sensitive dysphoria, or RSD, means having an intense negative emotional reaction ― often emotional pain ― to real or perceived instances of rejection, dislike or critical statements by others,” Dr. Lidia Zylowska, an associate professor at the University of Minnesota School of Medicine and author of “The Mindfulness Prescription for Adult ADHD,” told HuffPost.

“It often means being vigilant and sensitive to others’ negative reactions, trying to pre-empt them, and having difficulty shaking off the intense negative feeling triggered by feeling rejected or disliked in some way.”

RSD is not a formal designation in the DSM-5, which is the official handbook for mental health diagnoses, but the term has been popularized by psychiatrist Dr. William Dodson. As Dodson writes, this kind of extreme emotional sensitivity and pain can be triggered by someone’s perception of criticism or rejection ― or “by a sense of falling short ― failing to meet their own high standards or others’ expectations.”

RSD is particularly common in people with ADHD, as they tend to struggle with emotional regulation due to imbalanced dopamine levels and brain activity.

“One significant reason for its prevalence in ADHD is that the very nature of ADHD symptoms can lead to more frequent experiences of perceived or actual criticism and rejection,” said clinical psychologist Cristina Louk. “Impulsivity, difficulty with social cues, struggles with organization, and challenges in completing tasks can inadvertently lead to misunderstandings, critiques, or situations where individuals with ADHD feel they have fallen short.”

Many neurodivergent individuals also have a long history of being bullied. All of these lived experiences can make the brain hypervigilant to any hint of dissatisfaction. For someone with RSD, even a seemingly neutral or minor interaction can trigger a disproportionate emotional response.

“Events such as a someone being reminded to close a window, or that they forgot to put a dish in the dishwasher, or a boss requesting some edits to a report can trigger extreme emotional reactions, rage or sadness,” said J. Russell Ramsay, a psychologist who co-founded and formerly co-directed the University of Pennsylvania’s adult ADHD treatment and research program.

These feelings are swift and overwhelming, regardless of whether there’s anything negative happening in one’s present reality. A manager could be requesting a meeting to discuss positive feedback and new opportunities, but someone with RSD might immediately assume they’re being fired and start to spiral.

“Similarly, a fleeting memory of a childhood event, like being bullied or excluded, can trigger the same intense emotional pain as if it were happening in the present moment,” Louk said.

People often compare the sensation to a physical wound, like a punch to the gut, ache in the chest or crushing sensation, she added. These episodes of emotional distress can last for a few hours or even a few days ― thus affecting someone’s ability to function in daily life.

“To cope, individuals with RSD may withdraw from social situations entirely to protect themselves from potential hurt, further exacerbating feelings of isolation and low self-worth,” Louk said.

They may also take excessive steps to avoid any perceived negative reactions from others.

“People might become people-pleasers, being overly deferential to avoid negative feedback,” Ramsay noted. “They might avoid situations that they view as ‘risky’ or overcompensate by being very perfectionistic, trying to do everything right to avoid criticisms. Reactions and impulsive over-reactions can lead to arguments in relationships, including in the workplace.”

“Rejection sensitive dysphoria can significantly complicate a person’s sex life, transforming what should be an arena of connection and pleasure into one fraught with anxiety and potential pain,” Louk said. “At its core, sexual intimacy demands profound vulnerability, which directly clashes with the intense fear of rejection and criticism that defines RSD. This often leads individuals to emotionally withdraw, making it difficult to fully open up and express authentic desires or needs, ultimately creating a chasm in emotional and physical closeness.”

Another challenge is the tendency to misinterpret neutral responses as personal slights: “A partner’s momentary distraction or fatigue might be perceived as disinterest or disapproval,” Louk said, “triggering disproportionate emotional reactions like anger, sadness, or immediate defensiveness, which can quickly escalate minor issues into significant conflicts.”

She noted that this hypervigilance can lead to a self-perpetuating cycle of dissatisfaction, with performance anxiety and physical difficulties with arousal and orgasm. Individuals with RSD might actively avoid initiating sexual encounters or even general physical affection to prevent any sense of failure or rejection.

“For someone with RSD, a partner simply saying that they’re tired, or not in the mood may trigger a spiral of anxiety, fear, and shame,” said therapist Rachael Bloom. “Fear of rejection may also cause someone to prioritize their partner’s needs over their own, as they want to make sure to get it ‘right.’ It might also make someone less likely to openly share sexual preferences or desires. This lack of openness can significantly impact someone’s sexual satisfaction.”

Individuals with RSD might even sabotage their relationships to avoid potentially feeling hurt and rejected in the future. Psychotherapist and ADHD coach Terry Matlen noted that adults with ADHD often feel lingering self-doubt and insecurities from childhood and question whether their partner is even attracted to them.

“They may be overly sensitive about their looks, perhaps perceived imperfections, weight, ability to sexually express themselves, for example,” she said. “One can also shut down sexually and not enjoy the full experience as a way to avoid being rejected or criticized.”

There are things you can do ― both with a partner and on your own ― to keep rejection sensitive dysphoria from derailing your sex life.

“Educating yourselves together about RSD fosters deeper empathy and understanding, and preemptive communication about potential triggers ― perhaps establishing a ‘safe word’ for needed breaks ― can prevent escalation,” Louk said.

She also recommended reinforcing the strength of your relationship by focusing on non-sexual intimacy with shared activities and emotional connection. The positive effects can carry over into your sex life as well.

“Recognize that your automatic assumptions about how someone else sees you can be mistaken,” Ramsay advised. “Look at all the positive aspects of a relationship, including the physical relationship.”

Making an effort to understand your sensitivities and reactions can help you anticipate and prepare for them.

“The key to managing RSD is to regulate the emotions involved ― shame, guilt, fear,” said Billy Roberts, a therapist at Focused Mind ADHD Counseling. “One way to regulate emotions within a relationship is by being open about RSD. Identify when you’re experiencing RSD, and check the facts with your partner. For example, ‘I’m feeling worried that you’re mad at me. Is that true?’ You might also share that it would help if they delivered their response in a supportive manner.”

Roberts emphasized that vulnerability and honest communication foster security, which builds a better sex life.

“It is helpful to recognize what happens in the moment a feeling of rejection comes up ― how does the body reacts or tenses, what feelings or thoughts bubble up,” Zylowska said. In these moments, she recommended you try to practice calming yourself with deep breathing and self-compassion.

“Instead of thinking ‘I am not liked,’ give the benefit of the doubt ― ‘what if I am liked?’” she said. “It can be helpful to ask yourself if there is too much personalizing of a partner’s behavior ― ‘maybe their lower libido is not about me but something going on with them.’”

Try to practice being brave and honest about your preferences, even in small ways, as you have sex or talk about intimacy with your partner.

“Tell your partner of your emotional sensitivities and what words and behaviors are most troublesome,” Matlen said. “Educate your partner on RSD and how it’s related to your ADHD and that it’s not about them. And it’s important to be kind to yourself, to know that it’s part of how your ADHD brain works, and that you aren’t broken, weird, or psychologically weak.”

If you’re having issues, consider seeking professional help through individual and/or couples therapy. Don’t be discouraged if you need time to figure out the right multifaceted approach for you.

“In my practice, I treat RSD using a combination of cognitive behavior therapy, acceptance and commitment therapy and somatic therapies,” Bloom said. “People with ADHD absolutely deserve to have satisfying and authentic sex lives, and developing an awareness around certain fears and how they are impacting behavior is so important.”