RSD First Aid: 3 Steps for When Rejection Feels Like Physical Pain

If you are in the middle of a wave right now, skip everything below and go straight to the tool.

→ Start the First Aid protocol

What this tool is

Three steps I teach adult ADHD patients for the moments when a criticism, a short reply, or a subtle tone change triggers a surge that feels like actual physical pain. This is not treatment. It is a pause toolkit for that surge.

The three steps:

  • The 90-Second Pause — with a real timer, so you don't act during the flood
  • Fact-Check, Don't Mind-Read — three prompts to separate what happened from what your brain added
  • Body Reset — because you cannot think your way out of RSD; you have to change body state

How it works:

  • Everything runs in your browser. Nothing is sent to any server.
  • No login. No account. No email.
  • No data collection, storage, or logging. When you close this tab, everything you entered is gone.
  • Print or save at the end if you want a physical copy — nothing is auto-saved.

Design choice: Medical content about your own emotional state should not be tracked, stored, or sold. Not by me. Not by anyone.

Who this is for

  • Adults with diagnosed or suspected ADHD who experience RSD episodes
  • Adults who resonate with the description on the main RSD explanation page, even without a formal diagnosis
  • Partners, parents, and family of adults with RSD who want to understand the protocol
  • Clinicians who want a structured tool to share with patients between sessions

What this tool is not

  • Not a diagnostic assessment for RSD or ADHD
  • Not a replacement for proper clinical treatment
  • Not appropriate as your only support if RSD episodes are frequent, severe, or affecting your ability to function
  • Not appropriate during acute suicidal ideation — if that is where you are right now, please call the Tele MANAS helpline (14416) in India, or go to your nearest emergency room

Before you start

If this is your first time here and you are not currently in the middle of an episode, please read through the full protocol once before you need it. First aid tools work best when you have practiced them in calm moments and can access them automatically when overwhelmed.

If you are in the middle of an episode, skip the reading and start directly at Step 1.

RSD First Aid Sheet

Step 1 of 3

Step 1 — The 90-Second Pause

RSD floods in 0-90 seconds. Your job right now is only to surf the wave.

Do not reply. Do not explain. Do not quit the group.

01:30
I've already paused — skip to Step 2
While the timer runs:

After the wave passes

If you have used this worksheet and the wave has started to lift, a few notes for the coming hours:

  • Rest. Emotional dysregulation episodes are metabolically expensive. Your body has just spent significant energy on threat response.
  • Eat something. Blood sugar dips make the rumination component of RSD substantially worse.
  • Do not make major decisions in the next few hours. Whatever felt urgent during the wave will feel less urgent tomorrow.
  • Consider a brief journal entry about what triggered it. Patterns emerge over weeks. This is useful data for you and, if you have one, your psychiatrist.

When to seek help

If RSD is frequent, leads to people-pleasing that exhausts you, causes you to avoid opportunities, or has you using alcohol, cannabis, or scrolling to cope — please talk to a psychiatrist near you.

This sheet is educational coping. Not diagnosis. Not treatment.

The main RSD explanation page has more detail on what to expect from a proper evaluation and the specific treatment approaches that help.

If you are in Delhi NCR, I see adult ADHD patients at Umang Mind and Brain Clinic. If you are elsewhere in India, look for an adult psychiatrist with specific interest in ADHD.

About the author

Dr. Sidharth Sood is a super-specialist in Addiction Psychiatry, trained at the All India Institute of Medical Sciences (AIIMS), New Delhi. He practices at Umang Mind and Brain Clinic and consults across Delhi NCR. His clinical work focuses on ADHD, addictions, and disorders of impulse, reward, and control.

Decoding impulse, addiction, and the brain.

For consulting, corporate wellness programs, media requests, and speaking engagements: connect on LinkedIn.

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RSD First Aid Sheet v1.0 · July 2026. Content is educational and does not constitute personalized medical advice.