Rejection Sensitive Dysphoria

People with Rejection Sensitive Dysphoria (RSD) experience an overwhelming, instantaneous, negative emotional reaction to even mild forms of rejection. Criticisms that other people might brush off or feel sad about for a short period feel catastrophic to a person with RSD.

People with RSD are also prone to perceiving rejection when there hasn't been any, furthering their dysphoria.

Examples of Defining Symptoms

Overall, someone with RSD is more likely to:

• Expect rejection
• Perceive rejection without hesitation
• Overreact emotionally and behaviorally to real or perceived rejection

In response to rejection (or the perception of it), people with RSD might experience the following symptoms:

• Body image issues
• Constant anticipation of a possible rejection
• Depression and anxiety
• Disproportionate emotional reaction to any rejection
• Feelings of shame and fear
• Heightened emotions and mood swings
• Low self-esteem, negative self-talk, and self-criticism
• Misreading social cues, questions, or constructive criticism
• Obsessing over the perceived rejection and replaying in the mind interactions that led up to it
• Overanalyzing social interactions
• Social isolation and withdrawal
• Tendency toward people pleasing, perfectionism, and overachieving to avoid rejection
• Thinking that others don't like them

What Does Rejection Sensitive Dysphoria Feel Like?

A qualitative study asked people with ADHD about their symptoms, and many participants reported experiencing rejection sensitivity. This is what they had to say:

• "I feel really insecure, for some reason. It doesn't make any sense because of course my friend is going to have other friends."
• "In my experience with rejection, a lot of the time it can make me self-isolate. If I feel like someone has excluded me over something trivial, I'll just push myself away further."
• "In the moment, I get completely overwhelmed, and I worry about, Oh my God, am I going to get fired because I messed up this one little thing? It's put me in some embarrassing situations where it shouldn't have been a big deal that I was getting this feedback."
• "Yes, 100% that exists in me; huge, huge fear of rejection, . . . but rejection, I guess, from teachers, very much when I didn't meet the grade and wasn't accepted into the advanced class or was separated from my peers because I was in the class that needed extra support or something."

RSD and ADHD

People with ADHD may be more susceptible to RSD, even though difficulty with emotional regulation isn't included in the current diagnostic criteria for ADHD. This could be due to differences in the brains and nervous systems of people with ADHD and other forms of neurodivergence.

Neurodivergence

Neurodivergence is when a person's brain processes and learns differently from the social norm, or what is considered "neurotypical."

In 2024, William Dodson, the scientist who coined the term "rejection sensitivity dysphoria," published a case series of patients with ADHD who displayed RSD to define RSD since it is not a validated diagnosis on its own.

In this case series, Dodson details the stories of four patients with RSD and the treatments they received. He reports that these patients' stories are consistent with over 300 other patients from his clinical practice and reports from numerous international psychiatrists. RSD has been understudied, and research on this topic is in its early stages. Dodson recommends further research to enhance its understanding.

Is RSD Unique to ADHD?

RSD is not unique to ADHD. It is also associated with other forms of neurodivergence, like ASD. Rejection sensitivity is believed to be a trait found in other mental health conditions, including:

• Bipolar disorder
• Body dysmorphic disorder
• Depression
• Personality disorders
• Post-traumatic stress disorder (PTSD)
• Social anxiety

It is not clear if RSD is a symptom of these mental health conditions or perhaps is a diagnosis on its own. Additional research may provide insight in the coming years.

Causes and Triggers

Researchers believe that RSD develops from childhood experiences of rejection, neglect, or abuse. For example, your parents might have been highly critical or neglectful, leading you to internalize these experiences into low self-esteem or abandonment issues.
Another theory is that for people with ADHD (and presumably other types of neurodivergence), RSD is a learned behavior from being rejected by others due to difficulties with social interactions.

Based on their childhood experiences, an adult may be highly vigilant to criticism and react out of proportion to a perceived rejection. Rejection can come in the form of:

• Being corrected
• Breakups
• Constructive criticism from a teacher or boss
• Friends canceling plans
• Losing a competition
• Not meeting self-imposed expectations
• Not receiving praise when expected
• Social exclusion
• Teasing

Self-Regulation

People with RSD have reported various ways to self-manage their symptoms, and better respond to rejection. Strategies include:

• • Challenge your negative thoughts and interpretations of social scenarios and replace them with more optimistic, positive interpretations.
  • Distract yourself with something new that you find interesting and can focus on in order to shift your mood.
  • Talk about your sensitivity to rejection with family and friends, and encourage them to use gentle humor to help pull you out of RSD episodes.

• Learn about rejection sensitivity dysphoria and consider how it affects people's lives. Some report that this knowledge gives them a sense of power and control over their emotional responses.

Professional Support and Treatment

Professional support from your healthcare team can also be highly beneficial for managing your RSD.

Consider seeing a psychiatrist or licensed mental health professional to find out if an underlying condition is related to your RSD. A psychiatrist can prescribe medication if it may help your symptoms. While some psychiatrists conduct therapy, some don't. In that case, therapy with a qualified mental health professional can help you develop tools to cope with RSD.

Since RSD is not an official diagnosis, there is no Food and Drug Administration (FDA)–approved medication specifically for it. However, it has been reported that off-label use of medications for people who exhibit symptoms of RSD.

Key Takeaways

• Rejection sensitive dysphoria (RSD) causes intense feelings from even mild rejection.
• People with ADHD are more likely to experience RSD.
• RSD is also found in other forms of neurodivergence, like autism, PTSD, anxiety, depression, forms of abuse, people with alcohol and substance use challenges.
• Consider the possibility that someone you know or yourself has experienced rejection sensitivity and has it affected other people in your life?