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Rejection Sensitive Dysphoria (RSD): Definition, Related Disorders, & How to Get Help

Published: November 15, 2021 Updated: June 29, 2022
Published: 11/15/2021 Updated: 06/29/2022
Headshot of Nicole Arzt, LMFT
Written by:

Nicole Arzt

LMFT
Headshot of Rajy Abulhosn, MD
Reviewed by:

Rajy Abulhosn

MD
  • What Is Rejection Sensitive Dysphoria?Definition
  • Symptoms of Rejection Sensitive DysphoriaSymptoms
  • Effects of Rejection Sensitive DysphoriaEffects
  • What Causes Rejection Sensitive Dysphoria?Causes
  • Rejection Sensitive Dysphoria TreatmentTreatments
  • Final Thoughts on Rejection Sensitive DysphoriaConclusion
  • Additional ResourcesResources
Headshot of Nicole Arzt, LMFT
Written by:

Nicole Arzt

LMFT
Headshot of Rajy Abulhosn, MD
Reviewed by:

Rajy Abulhosn

MD

No one likes rejection, but rejection sensitive dysphoria (RSD) refers to an intense sensitivity to real or perceived criticism, rejection, or disapproval. This condition can impact anyone; however, people with depression, personality disorders, attention-deficit/hyperactivity disorder (ADHD), or autism may be more prone. RSD also correlates with low self-esteem, perfectionistic tendencies, and an excessive desire to belong with others.

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What Is Rejection Sensitive Dysphoria?

Mental health professionals have examined the effects of rejection for many years.1 Although it isn’t an official DSM-5 diagnosis, rejection sensitive dysphoria entails emotional sensitivity caused by criticism or negative feedback. In some cases, failing to meet one’s own expectations can also trigger RSD symptoms.

ADHD & RSD

People with ADHD are at an elevated risk for RSD. This is because ADHD affects emotional regulation, and events like teasing, rejection, or disappointing others can trigger an exaggerated negative reaction.2 The pain often feels automatic and consuming; it can be so distracting that it causes people to become submissive, withdraw, or avoid taking necessary social risks.

Symptoms of Rejection Sensitive Dysphoria

RSD symptoms range from mild to severe, and they often fluctuate based on context. They can  mimic mental health symptoms of social anxiety disorder, PTSD, BPD, bipolar disorder, and depression. People with RSD typically meet the criteria for one or more mental health conditions.

Symptoms of rejection sensitive dysphoria include:

  • Low self-esteem
  • Heightened fear of failure
  • Unrealistically high expectations for self
  • Feelings of helplessness or hopelessness
  • Needing constant approval or validation from others
  • Becoming aggressive or confrontational in new situations
  • Feeling anxious around new people
  • Assuming people don’t like you
  • Avoiding social settings
  • Perfectionistic tendencies
  • Becoming spiteful or vindictive after being rejected

Effects of Rejection Sensitive Dysphoria

RSD symptoms tend to be brief, but they can be intense and consuming for both the individual and their loved ones. Many times, people with RSD attempt to control their behavior via people-pleasing tendencies. They hope that, by going along with what others say or do, they can avoid the risk of rejection. However, people-pleasing requires immense energy and self-control, which can exacerbate more anxiety.3

Sometimes, people with RSD might avoid social settings or situations altogether. For instance, they might reject others before they can be rejected themselves, similar to what might be observed in someone with social anxiety disorder or avoidant personality disorder.4 However, people with RSD become upset and angry when rejected (or when facing the possibility of rejection). Those with social anxiety disorder feel anxious about social interactions and its subsequent risks.

What Causes Rejection Sensitive Dysphoria?

There isn’t a single variable that causes RSD. Instead, multiple risk factors can increase one’s likelihood of experiencing the condition. First, research shows that a history of early childhood neglect or abandonment can undoubtedly affect personality development. If a child doesn’t feel adequately loved by their caregiver, feelings of self-devaluation and inadequacy can emerge and persist well into adulthood.5

Additionally, repeated experiences of rejection (breakups, divorce, friendship issues, getting fired from a job) can trigger more fear of rejection. Over time, a person may internalize the idea that they are somehow doomed to rejection. That mindset can be the catalyst for an unfortunate self-fulfilling prophecy.

Finally, untreated mental health issues can aggravate RSD. As a result, they may feel like something is profoundly wrong with them, and this distorted belief may perpetuate problems with rejection.

Rejection Sensitive Dysphoria Treatment

Proper treatment begins with an appropriate medical evaluation. Because RSD correlates with many other conditions, it’s important for a qualified healthcare professional to screen and rule out any other explanations. While there isn’t a specific cure, successful treatment tends to be multifaceted and may include a combination of therapy, medication, and lifestyle changes.

Therapy

Therapy can be highly beneficial for treating RSD. For example, cognitive behavioral therapy (CBT) helps individuals identify negative beliefs about rejection and reframe them into healthier, realistic thoughts. Similarly, this therapy focuses on increasing healthy behavioral strategies for managing triggers and responding to difficult stimuli.

Dialectical-behavior therapy (DBT) can also be helpful. DBT focuses on improving emotional regulation and interpersonal skills. Individuals can learn how to integrate distress tolerance to reduce reactivity to adverse events.

When looking through a qualified directory of therapists, it’s important to choose a therapist who understands the emotional struggles associated with rejection. Even if someone doesn’t advertise working with RSD, consider looking at those who specialize in social anxiety disorder, depression, or ADHD,

Medication

There are currently no FDA-approved medications for RSD. However, medications for specific conditions like ADHD, bipolar disorder, or depression may reduce emotional reactivity and feelings of sensitivity. Therefore, these medications can inadvertently decrease the impact of RSD.

All medications have their risks and benefits. Similarly, they each have various side effects and potential interactions. If you believe you might have RSD, consult with your primary care physician (PCP) or psychiatrist for a medication evaluation.

Lifestyle Changes

Making a few lifestyle changes can reduce the impact of RSD and its associated symptoms. For example, integrating more mindfulness can help you feel more “in control” of your thoughts and reactions. Meditating can provide a sense of relief if you feel overwhelmed or upset.

Likewise, it’s essential to ensure you take care of your physical and emotional well-being. For instance, being hungry or tired may exacerbate your stress response. Prioritize eating a healthy diet, exercising regularly, following a consistent sleep schedule, and spending time with positive social support.

Final Thoughts on Rejection Sensitive Dysphoria

While rejection sensitive dysphoria can be frustrating, recovery is possible. Rejection will still hurt — that’s normal! — but seeking treatment can make the situation feel more bearable. It can also allow you to live a more fulfilling, meaningful life.

Additional Resources

Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for referrals by the companies mentioned below.

BetterHelp (Online Therapy) – Build your self-esteem with the help of a therapist. BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $60 per week. Complete a brief questionnaire and get matched with the right therapist for you. Get Started

Online-Therapy.com (Yoga Classes & Therapy) – Engage in activities that make you feel good about yourself! The Online-Therapy.com standard plan includes a weekly 45 minute video session, unlimited text messaging between sessions, and self-guided activities like journaling. Recently, they added instructional Yoga videos. Get Started

Headspace (Meditation App) – Mindfulness and meditation can change your life. In a few minutes a day with Headspace, you can start developing mindfulness and meditation skills. Free Trial

Choosing Therapy’s Directory – Find an experienced therapist who can help you work towards your ideal self. You can search for a therapist by specialty, availability, insurance, and affordability. Therapist profiles and introductory videos provide insight into the therapist’s personality so you find the right fit. Find a therapist today.

Choosing Therapy partners with leading mental health companies and is compensated for referrals by BetterHelp, Online-Therapy.com, and Headspace

For Further Reading

  • How ADHD Ignites Rejection Sensitivity Dysphoria
  • ADHD and Coping With Rejection
  • Why Rejection Hurts so Much – and What to Do About it
  • MentalHealth.gov
5 sources

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • Rejection sensitivity and disruption of attention by social threat cues (2009, December). Journal of Research in Psychiatry. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771869/.

  • Rejection sensitivity and disruption of attention by social threat cues (2009, December). Journal of Research in Psychiatry. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771869/.

  • Why It Doesn’t Pay to be a People-Pleaser (2016, August). Greater Good Science Center. Retrieved from: https://greatergood.berkeley.edu/article/item/why_it_doesnt_pay_to_be_a_people_pleaser.

  • What is Social Anxiety Disorder? Symptoms, Treatment, Prevalence, Medications, Insight, Prognosis. Social Anxiety Association. Retrieved from: https://socialphobia.org/social-anxiety-disorder-definition-symptoms-treatment-therapy-medications-insight-prognosis.

  • Childhood abandonment/adult rage: The root of violent criminal acts(1992). American Journal of Forensic Psychology. Retrieved from: https://psycnet.apa.org/record/1993-18067-001.

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Headshot of Nicole Arzt, LMFT
Written by:

Nicole Arzt

LMFT
Headshot of Rajy Abulhosn, MD
Reviewed by:

Rajy Abulhosn

MD
  • What Is Rejection Sensitive Dysphoria?Definition
  • Symptoms of Rejection Sensitive DysphoriaSymptoms
  • Effects of Rejection Sensitive DysphoriaEffects
  • What Causes Rejection Sensitive Dysphoria?Causes
  • Rejection Sensitive Dysphoria TreatmentTreatments
  • Final Thoughts on Rejection Sensitive DysphoriaConclusion
  • Additional ResourcesResources
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