Rejection Sensitivity Dysphoria (RSD) is a term that describes an extreme emotional reaction to perceived rejection, criticism, or failure. It’s a topic I’ve been working on with some clients recently, particularly those with ADHD, as RSD can be a significant barrier to their emotional and social well-being. While not an official diagnosis, RSD is recognised by many professionals and researchers as a major factor in the emotional health of people with ADHD and related conditions.
What is Rejection Sensitivity Dysphoria?
RSD is characterised by severe emotional pain that can be triggered by real or imagined rejection, criticism, or even a sense of falling short of one’s own expectations. A minor comment or piece of constructive feedback might feel devastating to someone with RSD, leading to intense feelings of shame, anger, or sadness.
Dr. William Dodson, a psychiatrist specialising in ADHD, coined the term to describe this phenomenon, explaining that it represents a type of emotional dysregulation unique to ADHD. People with RSD might avoid certain situations, overreact to perceived criticism, or engage in people-pleasing behaviours as a way to cope with their fear of rejection. Research has shown that RSD shares similarities with other psychological phenomena, including social anxiety and aspects of borderline personality disorder, where rejection is seen as a severe threat to the self (Liebke et al., 2018; London et al., 2007)
How Does RSD Manifest?
Some of the main ways that RSD manifests include:
- Emotional Outbursts or Meltdowns: A perceived slight can cause a person to react with disproportionate anger or sadness. They might withdraw or become very self-critical, feeling unworthy or inadequate.
- Avoidance of Social Situations: People with RSD may avoid group activities, networking events, or situations where they fear criticism or social rejection. This avoidance can significantly impact their professional and personal lives.
- People-Pleasing Behaviours: Some may go to great lengths to gain approval or avoid conflict, which can lead to burnout and resentment.
For example, I recently worked with a client who has ADHD and experiences severe RSD. She shared how a lack of communication from her team for an upcoming event led her to feel excluded and undervalued. Despite her logical understanding that it was a simple oversight, her emotional response was overwhelming, triggering thoughts of quitting the event altogether. This is a common response in RSD: either overcompensating to avoid rejection or withdrawing completely.
The Science Behind RSD: What Research Says
The roots of RSD are complex and often linked to early attachment patterns and social interactions. One study found that adolescents with high rejection sensitivity experienced increased anxiety and depressive symptoms, highlighting the long-term impact of this heightened emotional sensitivity (Fontana et al., 2018)
Another study explored how rejection sensitivity in individuals with borderline personality disorder led to heightened responses to social acceptance or rejection, further complicating their interpersonal relationships (Liebke et al., 2018)
Interestingly, research also indicates that rejection sensitivity can influence one’s social networks over time, leading to fewer close relationships and increased social isolation. This was noted in a study by Lazarus et al. (2016), which looked at the impact of rejection sensitivity on long-term social outcomes, demonstrating that untreated RSD can have significant consequences on a person’s social world.
Managing RSD: Strategies That Work
Given the emotional intensity of RSD, traditional coping strategies might not always be effective. However, some approaches have been found helpful:
- Cognitive Behavioural Therapy (CBT)
CBT helps individuals identify and challenge the negative thoughts that trigger emotional pain. For example, when my client felt excluded, we worked together to reframe her thoughts: instead of “They’re ignoring me,” she practiced telling herself, “They might be busy, and it’s not a reflection on my value.” - Self-Compassion and Mindfulness
Practicing self-compassion—treating oneself with the same kindness and understanding that one would offer a friend—can be a powerful tool for managing the self-criticism that comes with RSD. This aligns with research showing that individuals who engage in self-compassion tend to have better emotional regulation and lower levels of anxiety (Eisenberg et al., 1989) - Developing Assertive Communication Skills
Assertiveness training helps individuals express their needs and boundaries without fear of rejection. By learning to communicate clearly and confidently, they can reduce the likelihood of misunderstandings and emotional overreactions. - Medication and Professional Support
For some, ADHD medications or mood stabilisers can help manage the emotional dysregulation associated with RSD. Working with a therapist who understands ADHD and RSD can also provide specialised support and coping strategies.
Moving Forward: Understanding and Acceptance
Rejection Sensitivity Dysphoria can make everyday interactions feel like navigating a minefield. But understanding this condition—and acknowledging its impact—can be the first step toward managing it effectively. My experience with clients such as the one I’ve mentioned in this article has shown me that while RSD can feel overwhelming, it is possible to develop a healthier relationship with these emotions through the right combination of therapy, self-compassion, and support.
If you resonate with what I’ve described, know that you’re not alone. There are resources and professionals who can help guide you through the process of building resilience and coping with rejection sensitivity. With the right strategies, RSD doesn’t have to control your life.
References
- London, B., Downey, G., Bonica, C., & Paltin, I. (2007). Social causes and consequences of rejection sensitivity in adolescents. Journal of Research on Adolescence, 17(3), 481–506. doi:10.1111/j.1532-7795.2007.00531.x(
- Fontana, A., De Panfilis, C., Casini, E., Preti, E., & Ammaniti, M. (2018). Rejection sensitivity and psychopathology symptoms in early adolescence: The moderating role of personality organization. Journal of Adolescence, 67, 45–54. doi:10.1016/j.adolescence.2018.06.001(
- Liebke, L., Thome, J., Hauschild, S., Bungert, M., Defiebre, N., Lis, S., et al. (2018). Difficulties with being socially accepted: An experimental study in borderline personality disorder. Journal of Abnormal Psychology, 127(7), 670–682. doi:10.1037/abn0000372
- Eisenberg, N., Fabes, R. A., Miller, P. A., Fultz, J., Shell, R., Mathy, R. M., & Reno, R. R. (1989). The relations of sympathy and personal distress to prosocial behavior: A multimethod study. Journal of Personality and Social Psychology, 57(1), 55–66. doi:10.1037/0022-3514.57.1.55