Nobody enjoys rejection. But when it results in overwhelming and persistent emotional pain, you might be living with rejection sensitive dysphoria.
Rejection can sometimes make you feel unwelcome, unappreciated, or undesired. These are all natural emotional reactions to someone pushing you away.
With rejection sensitive dysphoria (RSD), though, these feelings can be magnified, resulting in intense emotional and physical distress.
But this doesn’t have to be permanent, and there are a few ways for you to manage symptoms and feel better.
The word “dysphoria” means dissatisfaction or uneasiness. It’s the opposite of euphoria.
In mental health, dysphoria refers to a generalized state of unhappiness, hopelessness, or feeling unwell.
Rejection sensitive dysphoria isn’t a formal diagnosis. It’s a name given to an intense feeling of unhappiness and emotional overwhelm resulting from rejection and criticism.
“It is a condition where a person is extremely sensitive to rejection, both real and perceived,” says Brian Wind, PhD, the Chief Clinical Officer at JourneyPure in Nashville, Tennessee.
You may react intensely to someone saying “no” to you or excluding you from a given situation, for example. But you could also interpret general comments or behaviors as rejection, even when they’re not meant this way.
This is part of living with RSD. It causes you to see events through a filter, making them appear dimmer or darker than they truly are. It’s not you, it’s the filter.
“This can result in extremely low self-esteem and low mood, and [cause people] to externalize their feelings as anger, withdrawal, low mood, or rage,” he notes. “The person may also feel rejection from comments or interactions that most people would consider to be mild or slight.”
Is RSD exclusive to ADHD?
No. Rejection sensitive dysphoria isn’t exclusively associated with attention deficit hyperactivity disorder (ADHD) or any other condition.
Anyone can experience RSD. However, it’s often considered a type of emotional dysregulation (ED) commonly seen among people living with ADHD.
While not yet recognized as a formal symptom of ADHD in the United States, ED is a fundamental part of diagnosing the disorder throughout the European Union.
Emotional dysregulation refers to a challenge one experiences when trying to manage mood and emotions.
Symptoms often include:
- low tolerance to frustration
- a short temper
- mood fluctuations
- emotional overwhelm
- outbursts
These symptoms are often associated with RSD, too. In fact, some experts believe emotional dysregulation and RSD are closely related.
“Some researchers think that there is a link because, for people with ADHD, stimuli trigger the central nervous system differently,” Wind explains. “As a result, they may perceive rejection differently and react impulsively or inappropriately.”
Living with ADHD may also lead to more experiences of rejection, which may then promote hypersensitivity to it, adds Wind.
This doesn’t mean RSD is exclusive to ADHD, however.
A literature review of 75 studies suggests there may be moderate links between RSD and other mental health conditions, such as depression and bipolar disorder.
What does RSD feel like?
RSD isn’t about being “thin-skinned” or being a “drama queen.” You’re experiencing genuine, intense pain as a result of feeling rejected.
RSD can be very unique to you.
It can feel like a surge of hurt and despair, possibly accompanied by physical discomfort.
You may feel the urge to cry or act out in anger.
You may want to “quit it all” in a second or become unmotivated to pursue something you’re typically passionate about.
You could also feel a knot in your stomach or feel nauseous. You may experience strong pangs in your chest or notice an increase in your heart rate.
For some people, RSD can feel like receiving a physical injury.
RSD isn’t included as a diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). This is the go-to reference manual for many mental health professionals.
But this doesn’t mean that RSD isn’t real or that what you’re experiencing isn’t authentic or valid.
While the DSM-5 is an important clinical reference tool in the United States, it tends to focus on conditions that are backed by extensive research and empirical studies.
There are many emerging, understudied conditions and symptoms that aren’t yet included in the DSM-5. These conditions, like RSD, are acknowledged and treated by mental health professionals in clinical settings.
Without defined diagnostic criteria, it may be challenging to determine whether what you’re experiencing is RSD or a symptom of another mental health condition, though.
How you experience RSD may also be specific to your current situation.
Potential signs of RSD may include:
- persistent emotional or physical distress when facing real or perceived rejection, criticism, or teasing
- feelings of anxiety when you feel disliked or not accepted by others, even if you don’t know them
- a need for approval or validation and frustration when you don’t receive it
- sense of hopelessness, particularly when perceiving rejection by someone
- fear of failure and social rejection
- a sense that you’re not liked by others, in general
- low self-esteem based on how you feel others relate to you
- social withdrawal
- thoughts of self-harm
- negative self-talk
- thought rumination
- relationship challenges
- defensiveness
- emotional outbursts
“The causes are not yet well understood, but RSD may be linked to a history of rejection and neglect in early childhood, or a family history of mental health issues,” says Wind.
Kimberly Perlin, a clinical social worker in Towson, Maryland, notes that other factors can contribute to RSD severity, such as living with undiagnosed ADHD or experiencing past trauma.
“If you have a history of trauma, you have a hypersensitive polyvagal nervous system that can cause one to react more strongly to perceived threats and criticism,” she explains.
Perlin also says genetics and modeling behavior after a parent’s emotional dysregulation may also contribute to RSD.
“Parents also can genetically pass on or personalize their child’s learning struggles, and that can also lead to a person’s hypersensitivity to criticism,” she explains.
Treating RSD may depend on its severity and its underlying causes, such as ADHD or trauma.
Your mental health team may recommend a tailored treatment approach involving:
- medication for underlying conditions and symptoms
- psychotherapy
- outside support networks
This depends on what they believe is causing your RSD. The treatment will vary according to your specific needs.
In addition to professional efforts, you can try to manage rejection sensitive dysphoria by:
- Learning more about RSD. Learning how to recognize its symptoms may help you acknowledge and anticipate intense emotional responses.
- Focusing on a supportive environment. By removing and avoiding people or situations that may hurt you, you can help limit the number of times you’re exposed to rejection and negativity.
- Teaching those around you. Educating friends and family about RSD can help them be more understanding if you have an emotional reaction to something they say or do.
- Letting the thoughts pass. Practicing mindfulness can help you acknowledge thoughts and feelings but not dwell on them.
- Delaying responses. Waiting a few moments can give you time to evaluate whether your reaction is proportional to the situation.
- Practicing self-care. Adopting relaxation and stress-relief strategies can help you manage feelings of discomfort from RSD. Some anxiety-calming exercises may also help with RSD.
Experiencing strong emotional reactions doesn’t always mean you need to see a specialist. Although, reaching out for support can become a powerful tool in your wellness journey.
However, when rejection results in excessive pain or impacts your relationships and sense of self, a mental health professional may be able to help you explore what you’re experiencing.
Speaking with someone can also be beneficial if RSD is occurring alongside other symptoms such as anxiety or depression.
Having RSD can mean experiencing exceptionally strong emotional reactions to perceived or real rejection. These feelings can cause physical distress and can impair different aspects of your daily life.
Though often associated with ADHD, RSD can affect anyone and may be present alongside other mental health conditions, like depression.
RSD is manageable, though. A mental health professional may help you create a plan that addresses the cause of your symptoms and how you experience them.