ADHD Chatter
The Psychiatrist Who Discovered RSD: "RSD Dies When You Do THIS!" | Dr. William (Bill) Dodson
03 Feb 2026
Transcript generated automatically by AI and may contain errors.
Chapter 1: What is Rejection Sensitive Dysphoria (RSD) and how is it experienced?
This for me is very surreal. It's not every day I get to speak to somebody who coined one of the most used, recognisable, yet, I think, painful acronyms in ADHD history. ADHD royalty. I truly believe you are. I was saying just before we started, I got my diagnosis two and a half years ago, and your work was one of the first I dived into. So on a personal note, thank you ever so much.
My pleasure.
Chapter 2: Why did Dr. Dodson coin the term 'RSD'?
Thank you.
Let's start off, Bill, with a simple but probably not an easy question about rejection sensitivity dysphoria, and I'll refer to it as RSD from this point on. And then perhaps we'll build up to some more advanced and specific details about RSD. But to start with, what is RSD and how is it experienced?
RSD is a phenomenon that I first noticed because I'm a practitioner, I'm not a researcher.
Chapter 3: Is RSD a lonely experience for those who suffer from it?
And so when you sit with a thousand people and you hear the same thing, coming from every single one of them, you may not know that it's important. I mean, what it is, but you know that it's important. And so I have to give all the credit to my patients because they were the ones who described it to me.
And what RSD is, is an exquisite sensitivity to the perception, doesn't have to be real, the perception that someone has withdrawn their love, approval, or respect. And I mean, nobody likes being criticized. Nobody likes being rejected. But for people who have an ADHD-style nervous system, it is catastrophic.
In fact, that's why the name of it includes the word dysphoria, which is literally Greek for unbearable. And so it's...
Chapter 4: How does RSD relate to emotional dysregulation?
It's like sort of other people's experience of rejection, only it is suddenly hit. It goes from zero to 100 in the blink of an eye. It's incredibly painful. It's physically painful. You'll see people clutch their chest or hunch over or grimace because it's not just emotionally painful. It's physically painful as well.
Chapter 5: What is the darkest side of RSD?
One of the other odd features of it is that people cannot describe what the pain is like. It's wordless. I always think of it as having been so primitive it came before there were words. But people can describe the intensity of it. And so they use words like, it's awful, it's terrible, unbearable, catastrophic, overwhelming. And the person can't just keep going.
It knocks them to their knees instantaneously. And so that's one of the problems is that it hits so suddenly, so completely that most people can't see it happening in advance and bring up all the stuff that they learned in cognitive behavioral treatment or dialectical behavioral treatment. You just get slammed with it.
People report feeling totally cut off from their surroundings, totally cut off from everybody else, just a profound loneliness. and that they've been cast out from everybody, every place that they know. I feel totally bereft. It's an awful, awful feeling. It then will continue an unknown period of time. It can be minutes, it can be days.
But during that time, there's really nothing much that you can do. You just have to let it run its course. One of the most important things I found that people need to know up front is that it will end. Most people, when they're in an episode of RSD, have the conscious fear, this is never going to end.
Chapter 6: Can RSD be comparable to PTSD?
I'm going to be in torment forever. So letting people know that every time it does come to an end, you will survive it, is just extremely unpleasant.
Chapter 7: How does RSD impact romantic relationships?
Whether or not it's only seen in ADHD is unknown. Now, we did some research last year. We're turning the numbers on to try and answer that question. So talk to me in six months. I'll be able to give you at least the preliminary of the results. But for right now, in my own practice...
When I asked sort of a screening question for RSD, somewhere around 90% to 95% of people say, oh, my God, yes, you've been following me around my entire life. It's not, well, no, it's wow. And about half of the people who say no come back later and say, well, yeah, I sort of lied to you. It just caught me by surprise and I panicked and masked it and all that.
The screening question that I use in my practice for the last 15 years is look back over your entire life, just as well as you can. Have you always been much more sensitive than other people you know to rejection, teasing, criticism, or your own perception that you've failed or fallen short? The vast majority of people with ADHD identify with that strongly.
And I was actually surprised just how strongly. After the first time I actually put something on the Internet, there were, within six months, more than 100 sites on Instagram talking about it. There were chat groups on Reddit. In fact, the one on Reddit said, received more involvement and comments and things like that than any other topic in ADHD in their history.
Chapter 8: What tools and strategies can help stop RSD?
So I was surprised at how many people identified with it worldwide. I mean, literally from around the world.
You've perfectly described the debilitating feeling that comes with RSD, and I think everyone listening or watching will relate to that. When I see someone who has dedicated so much of their career towards a particular topic, I always question and wonder where that passion and motivation comes from. Why did you coin the phrase RSD? Where did that interest start for you?
At the very beginning, when I was listening to people, I recognized that what they were describing was something from way back in my own training. that was called rejection sensitivity dysphoria. And at the time, it was a part of the very first research on treatment-resistant depression. In fact, it was the hallmark symptom of treatment-resistant depression.
And the treatment of choice then and now were the monamine oxidase inhibitor antidepressants, anti-anxiety medications, which, by the way, worked beautifully for ADHD as well. And so, as I said, that's what Paul Winder was describing.
And because the current state of affairs in ADHD have been allowed to languish for so long, and they lack so much, back 15, 20 years ago, I went back and started over again from the beginning, and that's the work of Paul Winder and Frederick Reimer, who originally described the syndrome. And they described it very much the same way I approach RSD.
They were psychiatrists in Salt Lake City, Utah, who sat with thousands of hyperactive children and wrote down the patterns that they saw. And that's how we got our first diagnostic criteria. They were It was called the Winder-Reimer criteria, then the Utah criteria, and finally it went into the DSM-2. And it replaced minimal brain dysfunction.
Bill, do you think that following on from that, are people with ADHD, are they born more sensitive to rejection or is it a consequence of exposure to nasty comments? The answer is yes.
It's both. ADHD itself is a genetic, biologic, neurologic condition. You're born with it. You'll die with it. It's lifelong. It's how you're wired. And that statement is always one of the big disappointments for most of my patients who hope that someday it's going to go away and they're going to be neurotypical. Doesn't happen. On your 18th birthday, they don't give you a nice wrapped-up present.
Oh, goody, just what I always wanted, a new nervous system. It doesn't happen. So it's, you know, you're there, deal with it. So... It is genetic. And you can also tell because it responds so well to two different classes of medication. So in psychiatry, in the medications of psychiatry, we generally lump them into two groups. One are the neurologic-biologic predispositions to certain conditions.
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