Picture this: You’re back in high school. You’re in the cafeteria, and you notice two classmates eating lunch at a nearby table. One of them looks at you, laughs, and then whispers something to her friend. How would you interpret this situation?

Without fail, all of my female clients reply, “They are laughing at me.”

This painful thinking pattern – sensitivity to rejection – is etched into our brains, a pattern that arguably developed for an evolutionarily adaptive purpose. It’s also a pattern that appears to be much more amplified in the female ADHD brain.

Rejection Is an Existential Threat

According to neuropsychiatrist Louann Brizendine, M.D., author of The Female Brain (#CommissionsEarned), girls’ brains are “machines” that are “built for connection.” From infancy, girls respond more to the cries of other babies and gaze longer at faces compared to boys.

Unlike men, who are physically larger and stronger, women have historically needed other people and social connections to ensure their own safety and that of their offspring. The female brain, Brizendine posits, likely tuned into the potential for social rejection as an evolutionarily protective function.

So great is the fear of exclusion among women that it informs bullying behaviors. Peer relationship research shows us that, unlike males, who engage in more physical forms of bullying, females generally rely on more relational or reputational methods, such as excluding another girl from their social group, spreading rumors, or saying something mean directly to the victim’s face. In other words, we toy with other females’ emotions by threatening exclusion from an early age because that is really what we fear the most — being rejected and alone.

The ADHD Brain and Emotional Reactivity

The amygdala, which Brizendine describes as the brain’s “emotional gatekeeper,” is where fear and anger are initially processed. Once the amygdala detects a threat — real or perceived — that information is sent to the hypothalamus. The hypothalamus then heightens the uncomfortable fight-flight sensations (e.g., faster heartrate and breathing) we experience when we are anxious or angry. The amygdala also sounds the alarm to the prefrontal cortex (PFC), the executive functioning center of the brain, which then decides whether and how to react.

And here lies the pivotal point where the differences between girls with and without ADHD come to light. Our ADHD brains, prone to greater emotional flooding, crank up the volume on the aforementioned process. Our fear of exclusion is amplified. We interpret a situation as threatening when it likely isn’t.

Regardless, our brains get carried away with the threat. The alarm bells of “danger” ring, ring, and ring. We struggle to regulate, and, due to poor executive functioning, we struggle to respond effectively. There’s a reason psychiatrists Edward Hallowell, M.D., and John Ratey, M.D., describe the ADHD brain as a Ferrari equipped with bicycle brakes.

The way those of us with ADHD experience rejection is so unique that there’s a term for it: rejection sensitive dysphoria (RSD). Psychiatrist William Dodson, M.D., notes that some of his patients with RSD even describe feeling physical pain – as if they’ve been stabbed in the chest – as a response to rejection.

I can attest to this; after I got into an argument with someone very close to me, I sobbed in my husband’s arms and could only say, “It hurts.” Yes, I was hurting emotionally. But I was also in literal, physical pain. The female brain’s propensity to relay intense emotions into actual physical sensations is not lost on me. Feelings of emotional pain can register as physical pain responses for us, according to Brizendine.

As women, but especially as women with ADHD, our brains are wired to scan for rejection at every turn. Yes, this probable evolutionary adaptation – developed for protection – is turbocharged under ADHD. Yes, RSD and emotional reactivity are the excruciating result. But our sensitivity and ability to feel deeply, dare I say, has its advantages, too.

Fear of Rejection, RSD, and ADHD: Next Steps

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