Skip to content

By playing, you agree to uListen's Terms and Privacy Policy and YouTube's Terms of Service.

ADHD Chatter PodcastADHD Chatter Podcast

The Science of Rejection Sensitive Dysphoria (RSD) | Dr James Kustow

Are you sensitive to rejection? Does a tiny criticism cause an internalised sadness or externalised rage? Is it causing havoc in your life and relationships? Don’t worry, you're not alone, and there is a solution.

Dr. James KustowguestAlex Partridgehost
Jan 28, 20251h 19mWatch on YouTube

Summaries, chapters, transcripts, and FAQs on this page are made by uListen, not YouTube.

Great conversations run long. Their best ideas don't have to.

uListen is free on iPhone, iPad, Android, Chrome, and Claude.

See how

CHAPTERS

Jump to publisher timestamps

Chapter summaries

  1. How RSD Feels: The Emotional Tsunami

    Dr. Kustow describes RSD as an emotional tsunami marked by shame, anxiety or panic, and anger turned inward or outward. Alex shares how even neutral responses can derail him, and Kustow explains why with sunburn analogies and the ADHD "braking system" problem.

    • •Three main features: shame, anxiety/panic, and anger directed inward or outward
    • •Thoughts loop and ruminate for hours or even days
    • •Sunburn and cut-fingertip analogies for amplified sensitivity
    • •Neutral responses can trigger RSD as the mind starts playing games
    • •Weak inhibition (the brakes) lets fleeting thoughts snowball

  2. How RSD Shows Up Mentally and Physically in Patients

    Kustow explains how RSD appears in his patients, including dissociation, self-doubt, catastrophizing, and a sympathetic nervous system surge followed by a crash. He and Alex then discuss whether RSD is biologically driven or shaped by life experience.

    • •Dissociation, self-deprecation and catastrophization on the mental side
    • •Adrenaline surge, racing heart and tight muscles, then exhaustion afterwards
    • •Kustow cites William Dodson's view of RSD as a biological, neurological glitch
    • •Years of setbacks and criticism compound the sensitivity

  3. Masking, Childhood Wounds and the Stuck Inner Child

    Alex describes years of feeling "weird" and masking, and Kustow says masking protects against criticism. They discuss unprocessed trauma leaving parts of us stuck at younger ages, and how vulnerability becomes healing despite rejection sensitivity.

    • •Masking is a defense against feeling awful, via people pleasing and a "fine" facade
    • •Small-t and big-T traumas leave a charge that keeps parts of us stuck
    • •Integrating younger parts through therapy is a big piece of ADHD work
    • •Kustow found being open about his own ADHD freeing
    • •Vulnerability is countered by rejection sensitivity but helps in the right setting

  4. Handling Uncle Barry: RSD at Family Gatherings

    Alex asks how to cope when family members like a tipsy uncle trigger RSD. Kustow recommends preparing in advance, using humor or clear boundaries, grounding yourself, and discussing ADHD with the relative later rather than in the heat of the moment.

    • •Visualize in advance how you want to respond
    • •Deflect with humor or set a calm, clear boundary
    • •Ground with a state change, breathing or tapping, and a mask may be useful short term
    • •Have the ADHD conversation later, not mid-trigger
    • •Teasing is often more about the other person

  5. Alcohol, Conflict and Recovering After a Flare-Up

    Kustow explains how alcohol lowers inhibition and can set up RSD spirals, and how people with ADHD may seek stimulation through conflict. They then cover recovering after a post-Christmas blow-up, including humor, owning mistakes and apologizing honestly.

    • •Alcohol reduces self-control and ADHD already involves inhibition problems
    • •Conflict can be an unconscious way of seeking dopamine or noradrenaline
    • •Impaired working memory means most flare-ups fade within a day or two
    • •Explain ADHD and apologize without excusing the behavior
    • •Lingering reactions may point to a trauma charge

  6. Loneliness as an RSD Trigger

    Kustow says loneliness is perceived as rejection and that unstructured time lets rumination grow, especially around the festive period. He suggests adding structure, helping others, and reaching out to people who care.

    • •Lack of connection is perceived as rejection
    • •Festive periods heighten social comparison
    • •Limit unstructured time with creative projects or community involvement
    • •Reach out to caring friends rather than retreating, while balancing vulnerability

  7. Will RSD Become a Diagnosis? Studying RSD

    Kustow doesn't expect RSD to become a formal diagnosis but thinks it will be studied and recognized as a symptom cluster within emotional dysregulation in ADHD. They discuss study designs, such as the buzzer approach used by Professor Philip Asherson, combining quantitative and qualitative data.

    • •RSD likely to be treated as a symptom cluster under ADHD emotional dysregulation
    • •Hard to study but has strong face validity
    • •Buzzer study used by Philip Asherson as a model
    • •Both numbers and descriptive accounts are needed
    • •Judging whether criticism was warranted requires careful design

  8. Everyday Triggers, People Pleasing and Subtle RSD Signs

    Kustow describes interactions that trigger RSD, such as being picked last for teams and neutral comments read negatively, and links this to evolutionary threat detection and hyperfocus. They then connect RSD to people pleasing, perfectionism, avoidance and other subtle signs.

    • •Neutral or open-ended messages get interpreted as danger
    • •Hyperfocus picks up subtle facial and tonal cues
    • •People pleasing, perfectionism and avoidance are protective patterns
    • •Subtle signs include high achievement, holding back from projects and "agreeers"
    • •The shield protects but also inhibits connection

  9. Too Thick or Too Thin: Balancing the Mask and the Glass Orb

    Kustow says managing RSD is a life's mission involving resilience, prevention and in-the-moment tools, and that a mask that is too thick or too thin both cause problems. He then explains the glass orb on the table as an image of fragile sensitivity shattering under criticism.

    • •Resilience depends on sleep, nutrition, mindfulness and grounding tools
    • •Too thin a mask means getting hurt easily, too thick means disconnection
    • •Personal growth is about finding balance
    • •The thin glass orb represents fragile sensitivity and the shame of the shattering

  10. Agony Aunt: Creative Passion and Unsupportive Family

    A listener writes in about demeaning comments from a business-minded family over their wish to be an author. Kustow advises being clear and boundaried as an adult, and then describes how he found psychiatry by following his gut.

    • •Following your heart in vocation is a key to success with ADHD
    • •Be assertive that the decision is yours and avoid slipping into childhood roles
    • •Feed back your feelings clearly without anger, and you can choose not to attend
    • •Passion is felt as inner excitement; Kustow impulsively chose psychiatry on instinct

  11. RSD at Work and in Romantic Relationships

    Kustow explains how large organizations with rules and monitoring can trigger RSD, along with procrastination and misreading colleagues. He then covers misread looks with partners, using subtle signals, telling a partner you've been triggered, and state-changing or joking.

    • •Slip-ups at work evoke fear of being shamed or losing the job
    • •Procrastination and avoiding volunteering protect against judgment
    • •Neutral looks from partners can be taken personally
    • •Bring partners on board with agreed signals and say "I've been triggered"
    • •Use state change, humor and hugging to move on

  12. Sex Differences, Suicidality and Paranoia in RSD

    Kustow speculates, anecdotally, that women may internalize more and men externalize more. He says RSD can feel intense enough to raise suicide risk, and that it can bring a paranoid flavor of over-interpretation but not full psychosis.

    • •Women may internalize; men may externalize or avoid, though there's much variability
    • •Intensity may make episodes a higher-risk period for suicidality, by Kustow's gut feeling
    • •Paranoia lies on a spectrum and RSD involves over-interpreting looks and tones
    • •He wouldn't say RSD triggers full-blown paranoid psychosis

  13. Who Isn't Affected, and Whether to Trust ADHD Intuition

    Kustow says most people with ADHD experience rejection sensitivity, though autism features such as reduced theory of mind or alexithymia may make it less likely. He agrees ADHD brings heightened intuition because of reduced frontal-lobe braking, but says emotional intensity and stress can distort it.

    • •No official diagnosis for those unaffected by rejection
    • •Autism and alexithymia may reduce RSD likelihood
    • •Reduced inhibition expands the ability to sense and feel others' emotions
    • •Stress shuts down the frontal lobe and distorts perception

  14. Three Tips for Managing RSD

    Kustow offers three tips: learn about RSD and share that awareness, prevent through self-care and a daily practice like his SoSoma movement meditation, and use in-the-moment strategies such as humor, timeouts and regulation techniques.

    • •Reinterpret past episodes through understanding RSD
    • •Prevent charges building up via sleep, nutrition, limiting alcohol and mindfulness
    • •The finished SoSoma practice is a 20-minute movement meditation
    • •In the moment: humor, deflection, timeout, breathing, tapping, fresh air, talking to a friend

  15. Sensitivity as Double-Edged Sword and Closing Letter

    Asked about a positive framing, Kustow says RSD itself isn't positive but the underlying sensitivity is double-edged, drawing on his own heightened sensitivity after Lyme disease and mold toxicity. The episode closes with him reading the previous guest's three rules to live by.

    • •Sensitivity is neither good nor bad but needs to be managed
    • •His sensitivity increased after Lyme disease and mold toxicity, alongside stronger intuition
    • •Previous guest's rules: listen to knee-jerk reactions, don't beat yourself up over triggered words, celebrate small wins
    • •Alex reveals the rules were his own

Publisher timestamps

  1. 0:00Trailer
  2. 1:04Dedication
  3. 1:12How RSD feels in our bodyRead this chapter
  4. 4:18RSD visual analogies
  5. 7:05How RSD shows in your patients
  6. 18:52Tiimo advert
  7. 21:44How to manage RSD when your family triggers youRead this chapter
  8. 26:50How alcohol affects emotional regulation
  9. 29:54Some common family events that trigger RSD, and how to manage them
  10. 35:01Can loneliness be a trigger for RSD
  11. 37:21Will RSD ever be a medical diagnosis
  12. 40:59What common social interactions might cause RSD that a Neurotypical person might be able to ignore?Read this chapter
  13. 44:39Are RSD and "people pleasing" connected?
  14. 45:44Can RSD manifest in subtle ways that we don’t notice
  15. 51:14The RSD item (an orb)
  16. 52:52The ADHD agony aunt (How to manage family disagreements)
  17. 56:29How to find your passion
  18. 58:09How RSD shows up at work (and how to manage it)Read this chapter from 58:10
  19. 1:00:11Managing RSD in romantic relationshipsRead this chapter
  20. 1:03:47Does RSD present differently in different sexes?
  21. 1:05:07Can RSD get that bad that someone might want to end their life?Read this chapter
  22. 1:06:26Can RSD dip into the realm of paranoia?
  23. 1:07:43Why some people are never affected by rejection
  24. 1:08:49Should we believe everything our super sharp ADHD intuition tells us?
  25. 1:11:433 tips on how we can we manage our RSD
  26. 1:15:17Is there a reframing of RSD to be a positive thing?Read this chapter
  27. 1:18:04A letter from the previous guest (3 rules to live by)

Get more out of YouTube videos.

Read along on your phone, search it beside the video, or ask your favorite AI app what was said.

iOSAndroidClaudeChatGPTChrome