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Many neurodivergent people experience Rejection Sensitive Dysphoria (RSD). It can have a profound impact on someone’s working life. RSD is an intense emotional response to perceived criticism, rejection, or failure.

RSD at work can look like:

• Constant hypervigilance, e.g. constantly anticipating criticism or disapproval
• Assuming the worst from ambiguity, e.g. a short or delayed reply 
• Strong reactions to constructive feedback 
• Over-explaining or over-apologising 
• Not asking for help 
• Avoiding opportunities or promotions 

Lucy McKillop, Global brand director at Dentsu shares what RSD really feels like through a personal lens, and what it can look like at work.  

When you’re diagnosed with ADHD there’s a bedding-in period. Elation. “Oh my god, it all makes sense.” Grief. “Oh f*ck. If only I’d known sooner.” Envy. “Wait… people can sit and focus on one thing for two hours? Wild.” 

It’s easy to feel like a kinetic pinball, ricocheting from one new ADHD discovery to another. I remember the ones that blew me away. 

Body doubling. I’d been doing this with friends for years without realising there was a name for it. 
Impulsiveness. Oh. That’s why I can’t stop buying beautiful scarves I absolutely do not need. 
Being weirdly calm in a crisis, but completely overwhelmed by the simplest admin task. 
Learning what was “me” and what was my neurodivergence was a very windy road. 

When I first heard about rejection sensitivity dysphoria, I’ll admit I was suspicious. Slightly eye-rolly. Another acronym. Another thing supposedly caused by my brain wiring rather than me just being… me. But when I properly read into it, it stopped me in my tracks. 

I’ve always been described as “passionate” at work. I’ve also always felt like my work and my identity were woven together into one highly textured and fibrous cloth. I don’t mind saying out loud that connection  made me very good at what I do – passion making up for additional neurodivergent issues like dyslexia, making attention to detail when I am not passionate about something hard to achieve. But it has also meant I’ve had visceral, and for many people overly emotional, reactions to things that more measured, or resilient personalities seem able to absorb and move past without much trouble. This, I realised, is how RSD has shown up in my working life.  

So what actually is RSD? The generic search/AI definition says this: 

An intense emotional pain triggered by the perception, not just the reality, of rejection, criticism, or failure to meet expectations. Commonly experienced by people with ADHD, it can cause sudden emotional shifts such as intense sadness, shame, or rage. 

Honestly? Fair. 

A few parts of it hit particularly hard for me: 

• The fact it can be triggered by perceived rejection, not just actual rejection 

• The tendency to overanalyse neutral feedback 

• The way it can push people into people-pleasing, overworking, or emotional withdrawal 

• The intensity and speed of the emotional reaction 

I have one work memory that was probably one of the clearest RSD flare-ups I’ve ever experienced. I’d been in my job for about four years and had recently been promoted being a head of department within the overall marketing team i was working in – making me one of about five members of the senior management team. A few months later, my boss sat me down to explain a new structure to the team, he told me my closest friend at work was being promoted to Marketing Director. Brilliant news. Completely deserved. I was delighted for him. He and I had spoken at length and many times about how he should be the marketing director of our team so the first part of the new structure made sense, and sat incredibly well with me.  

Then, he told me I’d be the only one at the head-of level, from the group of five department heads reporting into him. Everyone else would still report into the CMO. 

So. I processed what he was saying, and a very short two-word phrase roared in my brain. This is a demotion. A DEMOTION.  

My body flooded with adrenaline. I rocketed out of my seat  and shouted something I won’t repeat here. I told my boss I was going to lunch and wouldn’t be coming back that day. Reader: I did not come back the next day either. It felt like every private insecurity I’d ever had about not being as capable, not being as valued as everyone else had suddenly been confirmed out loud. My skin crawled with a rageful heat and my eyes pricked with tears. 

Years later, I’m still close with both of them. We’ve talked about it. They’ve admitted mistakes were made. They know this was the starting point for me eventually moving onto a new role elsewhere. We’ve even laughed about parts of it. But when this happened I wasn’t diagnosed with ADHD yet. I’d never heard of RSD and neither had they. Hindsight, and context have been crucial in helping them and me understand why this – to a more logical and process driven brain was just a step in the road to creating a better team for everyone. But for me it was incredibly personal, and a hugely bitter pill to swallow.  

And that’s the difficult thing about RSD. Even when you understand it intellectually, the emotional experience still feels completely real in the moment, and afterwards. 

As for managing it? I honestly don’t have a perfect answer. The biggest thing that has helped me personally has been switching antidepressants. Venlafaxine, an SNRI rather than an SSRI like Sertraline which i was on for years, has helped smooth the peaks and troughs off my emotional reactions. Definitely not erasing them, but helping me breathe and curtail emotional eruptions that RSD brings with it. It gives me slightly more time between feeling something and detonating over it. It also makes the bruising and trail left by those reactions slightly lighter and easier to recover from. 

I think that’s the thing with RSD. Knowing what it is doesn’t magically fix it. But it does help you move towards understanding yourself with a bit more compassion and a bit less confusion. 

And when it does flare up? These days I try hard not to scream obscenities at my bosses when I feel big things about work situations. I am grateful for the grace my ex-colleagues and life long friends showed me in that moment even when we didn’t know the why’s of its extremity. Understanding ADHD, RSD and a bit more self-awareness have shown doing that really doesn’t help anybody. 

By Lucy McKillop

RSD at Work: Tips for managers

• Start at onboarding. Create a Manual of Me for each employee to discuss how they work best, including how they prefer to receive constructive feedback. 
• Manage consistently and transparently. Ambiguity and inconsistency could trigger RSD. 
• Welcome requests for clarification. An employee who asks questions is engaged, not difficult. 
• Give feedback regularly, not just at formal reviews. 

If you want to understand more about Neurodiversity at work, our Neurodiversity Understood for Managers training, HR Training, Neurodiversity Understood Lunch and Learns and Manager Clinics can help.