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As you’re getting ready for a big night out with your best group of friends, you start hearing the texts come through. One person is sick. The other forgot about a school function. It’s just not a good night. Can we reschedule?
If your first instinct is to spiral into despair or big feelings of anger or failure, instead of acknowledging your disappointment and moving on with a change in plans, you might be experiencing rejection sensitivity dysphoria, or RSD (also known as rejection sensitive dysphoria).
That intense reaction to a perceived rejection, criticism, or failure—crying or having emotional outbursts above and beyond what a situation might call for—can feel overwhelming, says Caroline Fenkel, DSW, LCSW, and chief clinical officer at Charlie Health. Rejection hurts for everybody, but for those who might experience RSD, it’s something much more than hurt feelings.
“RSD can feel like an emotional ambush—sudden and hard to control,” Dr. Fenkel says.
How can you tell if you’re experiencing RSD, and what are the most effective ways to manage it? In this article, you’ll discover exactly what RSD is (and what it isn’t), its strong connection to ADHD, and the treatment options available to help you cope.
What Is Rejection Sensitivity Dysphoria?
Rejection sensitivity dysphoria (RSD) is not the same as the everyday rejection sensitivity that most people experience from time to time. As social beings, we naturally crave connection and acceptance, so it’s normal to feel hurt when, for example, you don’t land the job you were hoping for. You might feel disappointed, mope around, or even shed a few tears—but eventually, you move on. What sets rejection sensitivity dysphoria apart is the “dysphoria” itself—a profound sense of unease or dissatisfaction that feels impossible to escape.
“When we experience RSD, we’re not thinking, ‘Oh man, I didn’t get the job, and it’s appropriate to feel upset,’” explains Kate Hanselman, a psychiatric mental health nurse practitioner at Thriveworks. “Rejection sensitivity is common and healthy, but RSD takes it to an extreme—turning the emotional response up to 11. It feels earth-shattering and overwhelming, far beyond what would be considered a typical reaction.”
This heightened emotional intensity is a hallmark of rejection sensitivity dysphoria and underscores why it’s so challenging for those who experience it.
RSD is widely acknowledged by many clinicians, but it is not officially recognized as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM). While more research is needed to fully understand RSD, the term was first introduced by William Dodson, MD, a leading expert in ADHD.
Dr. Dodson theorized that RSD is closely linked to ADHD, suggesting that individuals with RSD may exhibit specific behaviors when they perceive rejection, including:
- Sudden emotional outbursts: These can range from anger or rage to intense sadness, often manifesting as sobbing episodes.
- Negative self-talk and thoughts of self-harm: Individuals may internalize rejection and engage in harsh self-criticism.
- Avoidance of social situations: Fear of criticism or rejection can lead to withdrawal from social interactions.
- Relationship difficulties: The heightened sensitivity to perceived rejection can strain personal relationships.
The Connection Between ADHD and Rejection Sensitivity Dysphoria
Understanding rejection sensitivity dysphoria (RSD) starts with grasping the concept of emotional dysregulation, a common challenge for individuals with ADHD. Emotional dysregulation refers to difficulty managing and controlling emotional responses in an appropriate way. For example, someone experiencing emotional dysregulation might have an angry outburst or meltdown over a situation that others perceive as minor, and they may struggle to return to a calm emotional state afterward.
This difficulty stems from the unique way the brains of people with ADHD function. The amygdala, the part of the brain responsible for regulating emotions, tends to activate more intensely, leading to stronger and often impulsive emotional reactions. Additionally, the prefrontal cortex, which helps interpret and express emotions, functions differently in individuals with ADHD. As a result, their emotional responses can be more intense and harder to moderate compared to those without ADHD.
The link between ADHD and RSD is well-documented. Dodson reports that one-third of his adult patients reported RSD as “the most impairing aspect of their personal experience with ADHD.”
Hanselman adds that early-life experiences may also play a role in developing RSD. Children who are neurodivergent—such as those diagnosed with ADHD—often face challenges like frequently getting in trouble at school or having a hard time forming friendships due to emotional dysregulation. These repeated experiences of rejection can heighten sensitivity over time.
“If you’ve had that experience a lot, you’re much more likely to be sensitive to rejection,” Hanselman says. “You’ve probably already experienced a lot of it.”
Can You Have Rejection Sensitivity Dysphoria Without ADHD?
Yes, while RSD as a concept came from ADHD research, people who have social anxiety or depression can also experience the same symptoms of RSD. However, it’s most prevalent among people who are neurodivergent.
“I really only hear it described in terms of neurodivergence, but it could also describe someone with a social phobia or social anxiety disorder,” Hanselman says. “I think normally we see it with ADHD, because a lot of ADHD people externalize their emotions instead of experiencing them mostly internally.”
Signs and Symptoms of Rejection Sensitivity Dysphoria
How can you tell if you’re experiencing rejection sensitivity dysphoria (RSD)? While RSD isn’t a formal diagnosis, it is often considered a symptom associated with other conditions, like ADHD. Because of this, it’s crucial to consult with a therapist or mental health professional to better understand your experiences and determine the underlying condition that may require treatment.
If you suspect you might be dealing with RSD, here are some common signs and what an episode of RSD might look and feel like.
1. Physical discomfort
Imagine you’re at a party and tell a joke that falls flat—no one laughs. While most people might brush it off with humor (“Guess I won’t quit my day job for stand-up!”), you feel an intense physical reaction. Your heart races, you start sweating, and you desperately look for the nearest exit. This disproportionate response to a minor social misstep is a hallmark of RSD.
“People often describe RSD as feeling physically painful, like a punch to the gut or an immediate flood of shame and despair,” Dr. Fenkel says.
2. Low self-esteem
Picture this: you’re excited about a first date, but at the last minute, your date cancels due to a family emergency, promising to reschedule. While others might take this at face value, you immediately feel humiliated and spiral into thoughts like, “No one will ever want to go out with me.” You replay the perceived rejection endlessly in your mind, accompanied by relentless negative self-talk. This persistent self-criticism is a strong indicator of RSD.
3. Acting defensively
Your boss points out a small typo in your report so you can fix it. Instead of calmly addressing the mistake and moving on, you lash out, blaming others who contributed to the project or dwelling on feelings of inadequacy.
People with RSD often have disproportionate responses to mild criticisms. “Anger is a secondary emotion, so it often masks others,” says Alexandra Cromer, a licensed professional counselor at Thriveworks. “This kind of interaction at work highlights the negative automatic thought pattern that says, ‘I’m not good enough.’”
4. Avoiding social situations
People with RSD often avoid circumstances that can lead to feelings of rejection, which means that they often withdraw and isolate themselves.
5. Intense emotional pain
Even minor slights or situations—like someone forgetting to reply to a text—can trigger overwhelming feelings of sadness, worthlessness, or despair in those with RSD. These emotions are deeply painful and difficult to shake. “Your body interprets these moments as an evolutionary threat,” Cromer says, “and you shut down completely.”
How Do You Heal Rejection Sensitivity Dysphoria—in the Moment and Long Term?
If you’re experiencing symptoms of RSD, it’s important to seek help from a therapist to figure out its root cause, whether it’s ADHD or another mental health condition. In the moment of an RSD episode (or shortly after), you can also try these coping strategies:
1. Practice self-compassion
Try to be kind to yourself, or at the very least, remain neutral, Cromer says. Acknowledge that you’re doing the best you can. Maybe you’re not thinking in the most effective way, but if you give yourself a little grace, you can start coming out of the thought spiral you’re in.
2. Write down a few notes about your day
“Notice what you’re noticing,” Cromer says. This record of your thoughts and experiences—particularly what you found hurtful or triggered strong emotions—will help lay the groundwork with your therapist. Be as specific as you can about what you’re feeling.
3. Try simple grounding techniques
Grounding exercises can help calm your nervous system and bring you back to the present moment. For example, practice box breathing: inhale for four seconds, hold your breath for four seconds, exhale for four seconds, and repeat several times. This technique can slow your heart rate and help you feel more centered.
Another option is to engage your senses by making mental lists, such as four things you can see and four things you can hear, or by recalling your five favorite movies. These activities disrupt negative thought patterns and provide a mental reset. “These are basic but effective coping tools for managing big emotions,” Hanselman says.
4. Start cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT)
Therapy is a proven strategy for managing rejection sensitivity dysphoria (RSD), though there’s no one-size-fits-all solution, Dr. Fenkel says. “Cognitive behavioral therapy (CBT) is a great tool for challenging the harsh inner narrative that tends to show up after rejection, because it teaches you to reframe your negative thoughts,” she says. “Dialectical behavior therapy (DBT) adds another layer by giving people skills to regulate intense emotions in the moment.”
5. Explore other treatment options with your therapist
Social skills training can boost confidence and reduce the likelihood of misinterpreting social cues, which is often a challenge for those with RSD. This training focuses on improving communication and building stronger relationships in social settings.
Depending on your diagnosis, your therapist may also recommend medication. Stimulants or alpha-agonists, commonly prescribed for ADHD, can help with emotional regulation, Dr. Fenkel says.
Clinician CliffNotes (The TL;DR)
RSD is not a diagnosis on its own. It’s a symptom of a mental health condition that a therapist can help uncover. There are plenty of ways to cope with RSD and help yourself face rejection without spiraling into intense emotional pain.
“Above all, self-compassion is critical,” Dr. Fenkel says. “Learning to treat yourself with the same kindness you’d offer a friend can be a game-changer when you’re navigating the emotional landmines of RSD.”
