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ADHD Chatter Podcast

How To Manage Rejection Sensitivity - Dr. Samantha Hiew, PhD (4K)

Dr Samantha Hiew is the Founder of ADHD Girls and a neurodiversity and ADHD expert. In this episode, Samantha explains how you can deal with Rejection Sensitive Dysphoria in your personal and romantic life.

Alex PartridgehostDr. Samantha Hiewguest

Jan 22, 202443mWatch on YouTube

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CHAPTERS

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Chapter summaries

What Rejection Sensitive Dysphoria Feels Like
Alex reads a community description of RSD, and Dr. Hiew agrees it is fair. She adds that how long a reaction lasts depends on its source, with relational rejections from people who matter lasting longer.
- •Community description: small rejections feel like trash for days, with sadness or rage
- •Intensity and duration vary with the source of the rejection
- •Longer-lasting reactions tend to be relational
- •Hurtful comments from someone meaningful can resurface later
Where RSD Comes From: Attachment and Early Experience
Dr. Hiew credits William Dodson with noticing intense reactions to perceived rejection in ADHDers. She explains how neurodevelopmental differences, insecure attachment, neglect and constant negative messages can leave people without the tools to regulate emotions.
- •William Dodson observed reactions far bigger than the actual rejection
- •Research cited: fewer than 10% of ADHDers have secure attachment
- •Children rely on caregivers to learn emotional regulation
- •Negative messages about executive function and relationships add to the problem
- •Maladaptive strategies develop when emotions are never learned to be managed
Nervous System Responses and Why ADHDers Are Susceptible
Dr. Hiew describes how the nervous system holds memories and flares when triggered, particularly when ADHDers have a poor relationship with stress. Reactions can be externalized as rage or withdrawal, or internalized as depression, rumination and suicidal thoughts, and rejection from close people hurts most.
- •The nervous system carries embedded memories from the past
- •Insecure attachment makes relational injury a stronger trigger
- •Externalizing can look like rage, anger or withdrawal
- •Internalizing can look like depression, rumination and the inner critic
- •Rejection from those closest hurts most because we don't mask with them
Can Rejection Cause Physical Pain? Trauma and Masking
Dr. Hiew links the bodily pain of rejection to the posterior insula and to old wounds rather than the present moment. She says the daily adaptation and masking of ADHD can resemble post-traumatic stress in the body and leave people living for others' approval.
- •The posterior insula ensures shame and guilt are felt in the body
- •The reaction responds to an old wound, not the person in front of you
- •Trauma can be ongoing, as ADHDers constantly adapt to fit in
- •Research cited says ADHD adaptations look like PTSD in the body, though not everyone with ADHD has PTSD
- •Masking leads to giving people the version of you they like
Short-Term Tips for Managing an RSD Episode
Dr. Hiew explains that RSD puts you in an amygdala hijack and that you need to shift attention into the here and now. She suggests sensory strategies such as something icy or sharp-tasting, calling a compassionate friend, or walking in nature.
- •RSD is an amygdala hijack that cuts off the prefrontal cortex
- •Use a strong sensory focus, such as an ice shard or lemon juice
- •Using these takes planning, which is part of living with ADHD
- •Calling a compassionate friend is what she finds most effective
- •A walk in nature can also help
Long-Term Approaches: Therapy, Self-Belief and Medication
For the longer term, Dr. Hiew recommends exploring which parts of you are triggered and loosening reliance on external validation. She mentions compassionate therapy including internal family systems, and non-stimulants such as guanfacine and clonidine, which some people report helping them let rejection go.
- •Self-worth tied to achievement leaves you crumbling when criticized
- •Re-parenting yourself and building a sense of self without external validation
- •Internal family systems looks at the parts at war within
- •Guanfacine and clonidine are non-stimulants prescribed for RSD
- •Some people say they stop needing guanfacine once they've built skills
Sharing RSD with a Partner and Sensitivity as a Strength
Alex asks whether to tell a romantic partner about RSD at the start of a relationship. Dr. Hiew says it's a good idea, and frames sensitivity as a strength that comes with empathy, while noting that partners have their own challenges to contribute.
- •Tell a new partner you are a sensitive person
- •What makes us difficult in one context makes us good in another
- •ADHDers often feel empathy in the body
- •Alex notes the same traits bring spontaneity and fun
- •Partners also bring their own issues to the conversation
Managing RSD in Relationships: Maturity and Communication
Responding to a community question, Dr. Hiew explains that argument patterns differ between partners, that people can project past pain onto each other, and that both people need self-awareness and emotional maturity. She draws on Gabor Maté's tension between authenticity and attachment and says communication requires owning your own part.
- •Externalizing and internalizing partners have different processing styles
- •Partners may be reacting to unresolved pain from their own past
- •Both partners need self-awareness and emotional maturity
- •ADHDers often feel they are too much and hide parts of themselves
- •Relationships are two-way, so own your part in the pain
Responding to "Stop Being So Sensitive"
Asked how to counter being told to stop being sensitive, Dr. Hiew says she now sees it as a compliment. She describes sensitivity as an inherited trait that brings empathy and loyalty, but one that carries a responsibility to manage emotions through awareness, compassion and maturity.
- •Sensitivity means ADHDers hear, see and feel more
- •It enables empathy and loyalty that partners value
- •Great power comes with responsibility to manage emotions
- •Growth starts with awareness, compassion and then maturity
Menstrual and Testosterone Cycles and Rejection
Dr. Hiew explains how sex hormone oscillation shapes emotional resilience, with a monthly cycle for women and a daily one for men. She describes the four "seasons" of the cycle, the effects of the luteal phase, and the daily afternoon dip in testosterone, medication and blood sugar that make arguments and RSD more likely.
- •Women's hormones cycle monthly, likened to four seasons
- •Luteal phase brings poorer sleep, memory and wellbeing
- •Spain has legalized menstrual leave
- •Men's testosterone peaks in the morning and dips around 5 or 6 pm
- •Medication tapering and low blood sugar in the evening can make arguments and RSD more likely
How Alcohol and Hangovers Affect RSD
Alex describes being more prone to RSD flare-ups when hungover. Dr. Hiew confirms alcohol's effect, citing research that even a glass of wine reduces deep sleep and weakens stress tolerance the next day, and says she would rather be awkward for two hours than suffer for days.
- •Alcohol reduces deep sleep by about 20% with one glass and 40% with two or three
- •Poor sleep and depleted nutrients reduce the ability to handle stress
- •Recovery depends on protective environments and relationships
- •Alcohol often serves as a crutch for social anxiety
- •She prefers awkwardness to days of suffering
Telling RSD Apart from a Justified Reaction
Alex asks how to tell an irrational RSD flare-up from a justified response to someone being unkind. Dr. Hiew says it feels like someone else has taken over your body, with disproportionate anger sometimes aimed at innocent people, followed by shame, and that the answer is self-questioning and working on the different parts of yourself.
- •It can feel like stepping aside while someone else takes over
- •Anger may be directed at people who didn't cause the pain
- •Shame follows when harm is done to bystanders
- •Internalizing sounds like "there's no place for me here"
- •Self-questioning and integrating inner parts helps
ADHD Traits in Nature and Stress
Alex asks about a study showing ADHD struggles decrease in nature. Dr. Hiew discusses the chicken-and-egg question of stress and ADHD, saying that two weeks in nature without a phone reportedly makes traits disappear, and links stress management to RSD, which she calls emotional stress. They joke about her organizing a camping trip.
- •Chicken-and-egg question on whether stress or ADHD biology comes first
- •ADHDers often need stress to get motivated
- •Research cited: two weeks in nature without a phone makes ADHD traits disappear
- •Modern demands, many self-imposed, increase stress
- •RSD is about navigating emotional stress
Washing Machine of Woes: Rejection Special
Alex introduces his weekly segment and reads a community woe about a friend being too busy feeling like a punch in the stomach. Dr. Hiew says sensitivity to a friend's no comes from placing self-esteem outside oneself, in archetypes like the people pleaser, achiever or class clown, and suggests treating perceived rejections as learning and not taking others' choices personally.
- •The woe describes anger as a defense against painful rejection
- •Self-esteem placed outside yourself creates instability
- •Archetypes include people pleaser, perfectionist and class clown
- •Treat perceived rejection as a chance to learn and communicate maturely
- •Another person's no often reflects their own journey, not you

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