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ADHD Chatter PodcastThe Science of Rejection Sensitive Dysphoria (RSD) | Dr James Kustow
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WHAT IT’S REALLY ABOUT
Dr James Kustow Explains Rejection Sensitivity in ADHD and How to Manage It
- Dr Kustow describes RSD as an emotional tsunami of shame, anxiety and anger, with looping thoughts, a fight-or-flight surge and a crash afterwards, which he links to the failing inhibition or 'brakes' in ADHD.
- He says masking, people pleasing, perfectionism and avoidance are protective shields against criticism that also block connection, and that careful vulnerability in safe settings is part of healing.
- For triggers such as family gatherings, alcohol, loneliness, work and romantic relationships, he recommends advance visualization, humor, clear boundaries, grounding, state changes and calm conversations after the moment has passed.
- He expects RSD to be studied and to be recognized as a symptom cluster under emotional dysregulation rather than a standalone diagnosis, and he cautions that evidence on suicide risk, sex differences and paranoia is anecdotal or his own gut feeling.
- His three tips for managing RSD are to learn about and share awareness of it, to practice prevention through self-care and daily regulation, and to use in-the-moment strategies.
IDEAS WORTH REMEMBERING
5 ideasRSD is a physical and mental surge, not just hurt feelings
Dr Kustow describes shame, anxiety or anger, looping thoughts and dissociation alongside an adrenaline surge, a racing heart and tightened muscles, followed by exhaustion.
Weak inhibition helps explain RSD
He says that with the brakes not working, a fleeting thought is latched onto and snowballs, so a neutral comment can spiral into catastrophe.
Masking protects but also isolates
He says people mask, people please and perfect to avoid criticism, yet the shield inhibits connection and leads to burnout, so the aim is a balance between too thick and too thin.
Prepare for known triggers and don't argue in the heat of the moment
He suggests visualizing the response in advance, using humor or a clear non-angry boundary, grounding when triggered, and explaining ADHD sensitivity to the person later when calm.
Repairing after a flare-up means owning it without excusing it
He recommends being settled first, framing the conversation, and apologizing and explaining rather than excusing, which he says discharges your responsibility.
WORDS WORTH SAVING
5 quotesI describe it as an emotional tsunami.
— Dr. James Kustow
The shield is there to protect you, but it also inhibits connection. The flip side of the shield, when you protect yourself too much, you don't connect. Vulnerability equals connection.
— Dr. James Kustow
And actually, the aim is to feel comfortable and content and secure and enough without any of your achievements.
— Dr. James Kustow
Everything's about balance. I don't know any answer to any question that involves personal development or growth when it doesn't involve someone having to get the balance, reestablish a better balance.
— Dr. James Kustow
Sensitivity is neither a good thing or a bad thing, but it needs to be managed.
— Dr. James Kustow
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SPEAKERS
Dr. James Kustow
guestPsychiatrist and medical doctor (Harley Street), author focused on adult ADHD and related emotional dysregulation such as rejection sensitive dysphoria.
Alex Partridge
hostPodcast host of ADHD Chatter who interviews experts and shares personal experiences of living with ADHD.
High quality AI-generated summary created from speaker-labeled transcript.
