A wave of online discussion and emerging expert commentary has thrown the spotlight on a little-known but deeply felt emotional response that many people with attention deficit hyperactivity disorder (ADHD) are now recognizing as a shared experience: rejection sensitive dysphoria (R.S.D.). Although not officially classified in psychiatric manuals, R.S.D. is described as an intense or overwhelming reaction to actual or perceived criticism, rejection, or failure—a feeling likened to a “balloon popping” by TikTok creators and capturing the imagination of millions on social media platforms source.
Why does this matter for Thai readers? As awareness and diagnosis of ADHD continue to rise in Thailand, both among children and adults, understanding the emotional dimensions that often accompany this neurodevelopmental condition is crucial for patients, families, and educators. In Thai culture, which highly values social harmony (ความกลมเกลียว), saving face, and mutual respect, those living with ADHD often face additional layers of shame and isolation when their emotional responses set them apart. The rise of R.S.D. as a topic among Thai netizens reflects changing attitudes and a growing willingness to talk about mental health challenges.
Rejection sensitive dysphoria first gained popularity among ADHD communities through the work of Dr. Bill Dodson, a psychiatrist who has treated thousands of patients with ADHD. Although he did not coin the term, Dr. Dodson borrowed the concept from earlier research into atypical depression and outlined specific criteria to help define and identify R.S.D. Since 2010, he has spoken and written extensively about it, describing how it goes beyond ordinary sensitivity to criticism. According to Dr. Dodson, while many people with mood or personality disorders may exhibit rejection sensitivity, R.S.D. is unique to ADHD: “With R.S.D., someone isn’t just sensitive to perceived criticism—they are also highly critical of themselves, and their mood can change instantaneously, often to depression or rage,” he explains source.
Others in the medical community remain more skeptical. Thailand’s own psychiatric associations have yet to formally recognize R.S.D., and international experts like Dr. Erick Messias, chair of Psychiatry at Saint Louis University, view rejection sensitivity as a common component of various mood disorders, not exclusive to ADHD. Nevertheless, clinicians such as Dr. Lindsay Blass consider the term helpful because it “expresses just how gutting criticism can be for some people,” especially those with ADHD, who may already be vulnerable to social exclusion or misunderstanding.
The symptoms of R.S.D. manifest as powerful and sometimes disproportionate emotional responses. Erin Ryder, a young teacher with ADHD, recounts how a minor canceled appointment from her boyfriend led to spiraling negative thoughts and emotional overwhelm—an experience she only later realized was much more intense than the situation warranted. Similar stories abound in Thai support groups and on social media, where young adults share stories of social anxiety, avoidance, and self-doubt following relatively minor social setbacks.
Coping with R.S.D. presents real challenges and requires a blend of self-awareness, therapy, and, occasionally, medication. However, there is no specific pharmaceutical treatment for R.S.D.; clinicians typically prescribe standard anxiety-reducing medications, with mixed results. Cognitive-behavioral strategies emerge as particularly effective. Dr. David Goodman, an assistant professor at Johns Hopkins, suggests “exposure therapy”—working gradually with a therapist to reduce the fear of rejection by exposing oneself to uncomfortable scenarios. Experts emphasize reframing negative assumptions and advocating for open communication: “I know I have a tendency to assume the worst,” Dr. Blass recommends patients say, “but things feel a little off and I’d like to figure out what’s going on.”
In Thailand’s hierarchical society and tight-knit families, rejection—whether by peers, teachers, or colleagues—can sting even more acutely. Children and adults with ADHD often describe struggling to meet the high standards set by parents or schools, with failures bringing about feelings of shame (ความละอายใจ) and loss of face both personally and within the family. Such dynamics can quietly amplify the effects of R.S.D., driving individuals towards perfectionism, avoidance, or even depression—a trend recognized by both Thai mental health professionals and international scholars source.
Historically, Thai culture has handled sensitive emotions with a strong emphasis on kreng jai (เกรงใจ)—the desire not to cause trouble or impose on others. For Thais with ADHD and R.S.D., this cultural attitude might push them to internalize pain, hide struggles, or avoid seeking help. However, the increasing presence of mental health discourse online, the work of Thai psychologists, and public education campaigns are gradually changing the landscape. Notably, the Ministry of Public Health has launched initiatives to reduce stigma and expand access to counseling services for youth, including those dealing with the emotional challenges linked to ADHD source.
As awareness spreads, schools and families in Thailand are encouraged to recognize the emotional components of ADHD, not just the behavioral aspects. Inclusive classrooms, social-emotional learning programs, and teacher training on neurodiversity can create safer spaces for students vulnerable to rejection and its consequences. For adults, workplace wellness programs and peer support groups—some now available online—offer routes to connection and self-advocacy.
Looking ahead, as more research emerges and dialogue around R.S.D. becomes mainstream, Thai mental health policy faces a dual challenge: expanding professional understanding beyond traditional diagnoses and making targeted support for emotional sensitivity an integrated part of ADHD care. Thai researchers might look to international collaborations or launch studies to better understand how R.S.D. manifests in local contexts, potentially leading to culturally adapted interventions.
For Thai readers dealing with intense reactions to criticism or rejection—and for their families or teachers—practical steps are within reach. Acknowledge these feelings without self-blame. Practice reframing automatic negative thoughts: is the criticism truly personal, or a misunderstanding? Seek support from a trusted friend, teacher, or therapist, and encourage open conversations about emotional needs at home and work. Schools and organizations can foster empathy by including neurodiversity and emotional resilience in their health curricula. And perhaps most importantly, recognize that deep emotional pain in response to rejection is not a weakness, but a real experience—one that can be managed and, with time, better understood by all.
Sources:
- New York Times: What Is ‘Rejection Sensitive Dysphoria’?
- PubMed: The Relationship Between ADHD and Emotional Dysregulation
- Department of Mental Health, Ministry of Public Health Thailand: DMHP Initiatives