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.
What Is Rejection Sensitive Dysphoria (RSD)?
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.
RSD vs. Rejection Sensitivity
Rejection sensitivity is a common trait that involves being sensitive to rejection. In itself, it is not an indicator for a clinical issue, however it can be linked to ADHD, depression, and RSD. RSD is not currently a clinical diagnosis, however it is marked by distinct emotional pain caused by rejection.
ADHD & RSD
People with attention-deficit/hyperactivity disorder (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, post-traumatic stress disorder (PTSD), borderline personality disorder (BPD), bipolar disorder, and depression. People with RSD typically meet the criteria for one or more mental health conditions.
Symptoms of rejection sensitive dysphoria can include:
- Low self-esteem
- Being easily embarrassed
- Heightened fear of failure
- Unrealistically high expectations for self
- Feelings of helplessness or hopelessness
- Needing constant approval or validation from others (i.e., being an approval addict)
- 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
- Thoughts of self-harm
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), whereas 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 issues 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 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.
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.
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.