Rejection Sensitive Dysphoria: What Is It & How to Deal With It

Do you often feel like you are constantly under pressure? Do you avoid trying new things due to fear of failure? Are you in a constant state of panic in your relationships? Is your anxiety unbearable? Do you often feel depressed and alone, and like you are constantly rejected by friends, family, or your spouse or partner? If you identify or relate to any of the above questions, then you may suffer from Rejection Sensitive Dysphoria, or RSD.

Rejection Sensitive Dysphoria is a relatively common yet little known emotional disorder that can cause heightened anxiety levels, depression, and negatively impact relationships.

If you believe you suffer with RSD, you aren’t alone. Read on to learn more about what Rejection Sensitive Dysphoria is, the most common symptoms, and how to live with it.

What is RSD or Rejection Sensitive Dysphoria?

So, what exactly is Rejection Sensitive Dysphoria (RSD)? This particular mental condition involves extreme emotional sensitivity that most often revolves around criticism or rejection. RSD is often sparked by emotional pain or anxiety triggered by the perception that an individual is being rejected.

The key word here is perception. An individual with RSD might feel like he or she is being rejected or criticized, but the situation may not really exist. This is also known as a self-fulfilling prophecy. An individual with a self-fulfilling prophecy believes that something is true, and even acts as if it was true. A person will anticipate a particular outcome to a situation, and this expectation changes his or her emotional behavior. As a result, an individual will set him or herself up to receive the feedback that he or she expects, which only reinforces the belief.

RSD is also commonly triggered by a sense of failure, or falling short of meeting his or her own personal expectations or the expectations of others.

Rejection Definition

Before we get too far into the science behind RSD, let’s first define rejection, dysphoria, and rejection sensitivity, and how all three relate to RSD.

According to Merriam-Webster dictionary, the definition for “rejected” is “a: to refuse to accept, consider, submit to, take for some purpose, or use; b : to refuse to hear, receive, or admit.”

Dysphoria Definition

The word “dysphoria” is actually Greek for “difficult to bear”. The definition of “dysphoria” is “a state of unease or generalized dissatisfaction with life.”

Dysphoria often causes or accompanies other mental illnesses. For example, extreme stress, grief, anxiety, toxic relationships or other environmental issues can all cause dysphoria. Some common types of dysphoria include gender dysphoria or hysteroid dysphoria.

Rejection Sensitivity

Humans need to form close bonds with other humans. However, some internal, as well as external, factors can threaten relationships. These factors can set off psychological alarms in an individual with RSD. Some individuals have a higher sensitivity to these issues than others.

In some cases, people may sense threats and overreact to them unnecessarily, or the threats may not exist at all. Rejection sensitivity, or hyperacute rejection is a self-defense mechanism that one uses to protect him or herself from rejection. Hyperacute rejection often stems from social rejection by parents, spouses, friends, or loved ones. As a result, this false sense of rejection can carry through a person’s life, and wreak havoc on relationships and overall mental health.

RSD & ADHD: Is There a Connection?

Although RSD can impact any individual, RSD cases are more common in people with attention-deficit hyperactivity disorder, or ADHD. RSD typically triggers the hypothalamic-pituitary-adrenal axis, or (HPA), which is the body’s stress system. This is because the nervous system in many people with ADHD immediately responds to a sense of rejection. This ultimately leads to rejection sensitivity.

As a result, people with ADHD are often seen as “weak” or “overly sensitive”. This is because emotional responses hurt them more than people without ADHD.

Furthermore, some studies show that in addition to people with ADHD, RSD is also common in people with asperger’s syndrome or asperger’s disorder.

What Are the Symptoms of RSD?

Rejection-sensitive dysphoria sufferers often endure various depressive symptoms. Some of the most common symptoms include the following:

  • Overreacting
  • Experiencing a meltdown or mental breakdown
  • Easily angered or generally short-tempered
  • Loss of self-esteem
  • Increased or extreme anxiety
  • Suicidal thoughts
  • Loss sight of desires and goals
  • Avoiding social relationships
  • Struggling with relationships
  • Developing eating disorders
  • Avoiding challenging or competitive situations
  • Social withdrawal and detachment

Other Symptoms

RSD sufferers are often easily embarrassed, anxious, and are generally good at hiding their sensitivities. RSD sufferers’ random episodes of emotional outbursts or anger can often be confused with other mental issues. Some of these mental conditions can include bipolar disorder; a personality disorder or borderline personality disorder, particularly in passive-aggressive people; post-traumatic stress disorder; obsessive compulsive disorder (OCD) or even Alzheimer’s Disease.

However, when comparing RSD sufferers with bipolar disorder, episodes of depression, anxiety, and/or anger are often brief. These emotional outbursts associated with bipolar disorder sufferers are often triggered by events rather than emotional cycles.

There is also a fine line between RSD and atypical depression. Atypical depression causes severe symptoms, such as weight gain, loss of interest in social relationships or social withdrawal, severe fatigue and suicidal thoughts.

Yes, there are many RSD questions that remain unanswered. Can people without ADHD also experience rejection sensitive disorder? Although most people with ADHD or even adult ADHD also suffer with RSD, studies and research also who that RSD is learned and genetic.

How To Treat RSD or Rejection Sensitive Dysphoria

Many people with ADHD or adult ADHD find comfort in knowing that there is a name for extreme rejection sensitivity. In almost 100 percent of cases, rejection sensitivity is an unknown part of ADHD. Although it has proven to be genetic, childhood or adult trauma can make it worse. The more people with RSD understand the condition, they better they feel.

So, how do people with RSD treat or live with the condition? Like any mental illness or disorder, there are medications available. Guanfacine is the most common type of medication used to help treat RSD symptoms. Although guanfacine was originally designed as a blood pressure medication, studies have shown that it can also help relieve RSD symptoms.

For example, a study performed by Harvard University showed that increasing the guanfacine medication dosage achieved a 40 percent higher response rate.

Psychotherapy, such as cognitive-behavioral therapy treatments is another treatment option. However, many psychologists and experts believe there are better treatment alternatives. This is because RSD emotions often take over so suddenly and overwhelm the mind. As a result, it can take time for someone with RSD to calm down after an episode.

Suffering with RSD might seem hopeless. However, there are some things you can do on your own to help treat and deal with RSD:

  1. Stay On Top of Emotions. It can be incredibly difficult, but try to stay ahead of your emotions. For example, if you feel a breakdown coming on, then try to process your emotions rationally. Let go of your false sense of perfectionism. RSD sufferers should also remember that whatever is causing them to feel rejected or emotional might not really exist.
  2. Get the Right Diagnosis. As we mentioned above, RSD can be confused with other mental illnesses and mood disorders. If you are experiencing even a handful of depressive symptoms or RSD symptoms, then be sure to get a firm diagnosis. This will allow you to take the necessary steps to understanding and treating your mental disorder.
  3. Seek Professional Help. There is nothing wrong with speaking with a licensed counselor or psychologist about your emotions. A licensed mental health counselor or professional can also educate you on how to best cope with extreme sensitivity, rejection sensitivity, and adult ADHD.
  4. Reduce Overall Stress. Keeping stress levels low will ultimately reduce mental breakdowns, emotional outbursts, and severe sensitivity. RSD and adult ADHD are more manageable when individuals make a solid effort to take care of themselves physically and mentally.Engaging in enjoying activities and healthy habits can help manage emotions, anxiety, and moods. For example, regular exercise, hobbies, and eating a healthy diet are all small yet effective ways to help.
  5. Medication. As we briefly explored above, there are different medications available to help curb extreme emotional sensitivity, depression, anxiety, and feelings of rejection. For example, a medication like guanfacine is commonly prescribed to individuals with RSD or adult ADHD. However, there are a number of natural approaches that you can take to control your emotions.

Living With RSD

All in all, living with RSD can be a challenge, but individuals can still live a happy, healthy, quality life. Once individuals understand the condition, and gain perspective about what RSD is, how it affects them, and their “trigger” factors, they can begin to take strides to help gain control over their emotions.


author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings

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