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Rejection Sensitive Dysphoria (RSD): How It Impacts You?

Rejection Sensitive Dysphoria (RSD)

Rejection Sensitive Dysphoria (RSD): How It Impacts You?

Written by:

Umar Javed



Suppose you have just received an email notification. It is from the HR of the company that you have recently interviewed with. You are sure to get this job after your amazing performance in the series of interviews. However, when you open your email, it starts with ‘We are sorry…’

How would you feel at that moment? Probably, sad and dejected. But, you will overcome this minor setback within a few hours to days and go about your daily life as if nothing has happened.

However, this is not the case for people suffering from rejection sensitive dysphoria (RSD), which show exaggerated emotions when they face or fear rejection. RSD is commonly linked with attention deficit hyperactivity disorder (ADHD) and other mental health problems. Let’s explore this topic in detail.

The emotional discomfort and unwanted mental symptoms can be managed. Consult a doctor today!

What is Rejection Sensitive Dysphoria?

Rejection sensitive dysphoria is defined as a psychological state that increases your sensitivity and decreases tolerance to rejection, criticism, or taunting. The fear of rejection can be real or perceived, and it can cause despair among sufferers.

The word ‘dysphoria’ originated from the Greek word ‘dysphoros’ meaning ‘hard to bear’. Hence, people suffering from RSD are more at risk of emotional instability when faced with rejection or criticism.

Contrary to some beliefs, this condition is real and its symptoms may occur in anyone from time to time.

Causes of Rejection Sensitive Dysphoria

Experts have not pinpointed any specific cause of RSD; rather, multiple factors are associated with the development of rejection sensitivity. Some of the common risk factors include:

  • Past history of multiple rejections
  • Neglect as a child from parents
  • Overly critical parents
  • History of abuse as a child
  • Bullying in school
  • Relationship problems with a partner

RSD can result due to any one of them or a combination of factors. Additionally, rejection sensitivity has been linked to many mental health problems including:

  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Autism
  • Bipolar Depression
  • Major Depressive Disorder (MDD)
  • Psychosis
  • Anxiety Disorders
  • Phobias
  • Obsessive Compulsive Disorder (OCD)
  • Acute Stress Disorder
  • Posttraumatic Stress Disorder (PTSD)
  • Body Dysmorphic Disorder
  • Avoidant Personality Disorder

The scientific community is demanding more research on neural mechanisms [1*] that control social behaviors for a better understanding of psychological conditions. According to the proposed hypothesis, enhanced rejection sensitivity may contribute to developing mental health issues, and decreasing it may eventually treat the core psychological problems.

What Are the Signs and Symptoms of Rejection Sensitive Dysphoria?

People with extreme sensitivity to rejection may show a wide range of specific characteristics. Here is what rejection sensitive dysphoria feels like:

  • Constant people-pleasing attitude due to fear of rejection
  • Setting unrealistic expectations for themselves and others
  • Getting easily embarrassed even due to trivial reasons
  • Having frequent emotional outbursts when facing rejection or criticism
  • Avoiding social situations to evade any criticism
  • Degrading personal achievements and low self-esteem
  • Experiencing marked anxiety and feelings of hopelessness
  • Having thoughts of self-harm in extreme cases of rejection

Although RSD symptoms can mimic other mental health problems, they are usually brief and subside without any medical intervention.

Contact a doctor if emotional instability interferes with your daily life.

Rejection Sensitive Dysphoria and ADHD: What Are the New Insights?

RSD is not a recognized mental health condition nor a symptom of ADHD, according to the new edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). However, researchers believe that the emotional component of ADHD should be included in the diagnostic criteria as many patients with ADHD face emotional outbursts.

In this aspect, the European Consensus [2*] has updated the diagnostic criteria for ADHD and has included emotional dysregulation as one of the important aspects. Emotional dysregulation is a broader term compared to RSD.

People with ADHD are more prone to react negatively when criticism or rejection is thrown at them. They may become people pleasers and present an image of themselves that is not real, or they may go into their shelves and avoid any interactions that can result in criticism or judgment. On the other hand, RSD may also propel ADHD sufferers to overachieve in their line of work. Such an aim to go the extra mile in achieving perfection in their tasks results from the constant looming fear of criticism.

What rejection sensitive dysphoria feels like

Can Rejection Sensitivity Dysphoria Lead to Mood Disorders?

RSD is not exclusive to ADHD. Other mental health problems, especially mood disorders, are linked with it. These mostly include depression [3*] and bipolar disorder which heavily affect a person’s mood, substantially disrupting their daily lives. Patients may become more sensitive as the problem goes on longer.

A person may react to rejection by becoming sad, and if this sadness persists, it can become a full-blown mood disorder if the other necessary diagnostic criteria are met. Therefore, it is important for you to consult a mental health specialist if you are experiencing prolonged sadness or extreme sensitivity to rejection.

Increased sensitivity to rejection and criticism might be a symptom of a mood disorder. Get your symptoms examined by an expert.

How Does Rejection Sensitivity Affect Different Areas of Life?

Among different spheres of life, rejection sensitivity affects romantic relationships [4*] the hardest. RSD not only causes hypersensitivity to rejection but can also make you expect rejection even before a relationship starts. As a result, people with RSD are more cautious about going into relationships, and even if they are into one, they become overly cautious about their behaviors with their partners. It leads to an unstable relationship paradigm that continues to break romantic partnerships unless RSD is sorted out.

Another area of life where RSD impacts individuals significantly is their work or studies. During their academic career, they may pass up on courses of their interest that are considered difficult and hinder their progress. As far as the workplace is concerned, employees with high rejection sensitivity may show aggressive, avoidant, or peer-pleasing behaviors. They may put in extra hours and 110% to complete their task to perfection, or they may avoid taking on new assignments and projects to avoid any criticism. They may also show an aggressive attitude towards fellow workers if they point out any error in their work or personality.

How is Rejection Sensitive Dysphoria Tested?

There are no standardized tests to evaluate RSD because it is not yet considered a separate mental health condition. We have created a set of self-assessment questionnaires that can help you gauge your sensitivity levels. However, this RSD test should not be substituted for assessment from a trained mental health professional.

1. Do you set abnormally high expectations of yourself to seek validation from others?
2. Do you experience intense anger or dejection when your feelings are hurt?
3. Do you refrain from social situations to avoid interacting with others?
4. Are you easily embarrassed by even the smallest things or gestures of others?
5. Do you overanalyze remarks passed by others about you?
6. Do you avoid jobs or other career opportunities out of fear of rejection?
7. Do your family or friends comment about your overly sensitive behavior?
Rejection Sensitivity was associated with increased attention bias or sad faces after rejection but not inclusion.
8. Do you frequently experience problems in romantic relationships?
9. Do you take more time to finish a project to avoid even minor mistakes to evade any criticism?
10. Do you consider yourself your harshest critic?
11. Do you have an ADHD diagnosis or have experienced other mental disorders?
Test Results
A Maximum Total Score = 22
0-7 Normal Sensitivity
8-10 Mild Sensitivity
11-14 Moderate Sensitivity
15-22 Severe Sensitivity

Note: This is designed to give you a general idea about your rejection sensitivity levels. For an accurate assessment and diagnosis, consult a mental health specialist.

Get suitable medications from a certified doctor and get ongoing support during your treatment.

What is the Treatment of Rejection Sensitive Dysphoria?

As it is not a standalone diagnosable medical condition, there are still no set treatment guidelines to manage rejection sensitive dysphoria. The treatment is suggested based on one’s medical history and the severity of the symptoms. The following treatment methods are currently applied to people with RSD.


ADHD medications reduce hyperactive and impulsive behaviors; they may also help with RSD symptoms. Stimulants like Ritalin and Adderall work well in this regard; however, clinicians have found certain other ADHD drugs more useful in managing rejection sensitivity.

  • Guanfacine (Intuniv). It is a medication commonly used to treat high blood pressure and is also approved by the FDA to treat attention deficit and hyperactivity disorder (ADHD) in children and adolescents. It works by activating alpha-2A receptors in the brain, which helps to regulate attention and behavior. Therefore, it is believed to be effective in managing rejection sensitivity.
  • Clonidine (Kapvay). It is also an alpha-2A agonist that is used for ADHD and high blood pressure treatment. It works exactly like guanfacine to bring emotional control to people with rejection sensitivity. If one drug doesn’t work for someone, it is possible to switch to the alternatives.
  • MAOIs (Monoamine oxidase inhibitors). These are older antidepressants that can be used to treat emotional dysregulation associated with rejection sensitivity. They work by stabilizing the neurochemicals like serotonin and dopamine in the brain. Common examples are phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate).

Note: These drugs can cause side effects and should only be used under the guidance of a qualified doctor.

Self-help tips work better if used along with psychotherapy or medications. Get personalized help at MEDvidi.

Effects of Rejection Sensitive Dysphoria

Mental Health Therapy

Psychological therapies that are employed to manage ADHD are also useful to combat rejection sensitivity.

  • Emotional therapy (EFT). Emotionally-focused therapy, or EFT, is based on the concept that human emotions are derived from human needs and can be manipulated with different techniques to overcome problematic emotional conditions like rejection sensitivity.
  • Cognitive behavioral therapy (CBT). It is the most widely used therapy that helps tackle various psychological issues. It focuses on changing irrational thoughts and behaviors, which in the case of rejection sensitivity, are extreme emotional outbursts when facing or fearing rejection.
  • Family therapy. Since RSD affects relationships, involving the partner and other family members can be a viable solution to overcoming rejection sensitivity. In such scenarios, family therapy is recommended by the therapist.

Therapies help to manage RSD in the long term by educating patients about their emotions and behaviors and how to change them during sessions with a qualified therapist. However, they are less effective in managing rejection sensitivity in the short term than medications.

Self-help Strategies

  • Calm yourself: Emotional sensitivity can result in exaggerated responses to potentially harmful situations. You can relax in such scenarios by practicing certain breathing exercises. Take a deep breath through your nose and hold it for a few seconds. Now, exhale slowly through your mouth with pursed lips. Keep doing this until you are no longer in a hyper state.
  • Move away: Just drifting away from your triggers may help to lower your sensitivity. Also, it is a good strategy to apply until your sensitivity has been lowered to acceptable levels via professional treatment.
  • Express your feelings: Family and friends always provide a safety cushion to lay on when it comes to psychological issues. Expressing your feelings and emotions makes them understand what you are going through and how they can best help you.
  • Maintain a balance: Balance is key in life whether it comes to diet, exercise, work, sleep, or social interactions. It can help to optimize your physical and mental health. So, try to find the right balance in your life where you can manage all your activities without being overwhelmed.
  • Get tested for ADHD and mood disorders: If you have been experiencing rejection sensitivity for a long time, there are high chances that an underlying mental health condition might be the real cause. So, it is best to get a professional mental health online assessment from a specialists in longstanding RSD.

Final Words

Rejection sensitive dysphoria, although not a recognized mental health condition yet, is commonly seen in people with ADHD and other psychological disorders. It causes exaggerated responses when dealing with rejection and criticism, leading to problems, especially in relationships and workplaces.

There are a number of strategies to deal with this condition, but the best course of action is to get help from a mental health expert if you are facing emotional dysregulation. Medical professionals at MEDvidi are trained in helping people going through psychological and emotional problems. You don’t have to deal with this alone; reach out to us for personalized online care.


+4 sources
  1. Next up for psychiatry: rejection sensitivity and the social brain. (2021)
    Source link
  2. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. (2018)
    Source link
  3. Rejection Sensitivity and Depression: Mediation by Stress Generation. (2014)
    Source link
  4. Effects of rejection intensity and rejection sensitivity on social approach behavior in women. (2020)
    Source link
Written by:

Umar Javed


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Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of experts strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers
in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.