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What Is Rejection Sensitive Dysphoria & How is it Treated? | How Does Rejection Sensitive Dysphoria Affect Your Life?

Nobody likes to be rejected, regardless of whether this rejection comes from peers, family, a crush, or coworkers. Rejection hurts, but it is an unavoidable part of our lives. While some people can quickly shake off this rejection and move on with their life, others find it challenging to deal with rejection, and the feeling of rejection can sometimes trigger an overwhelming and unmanageable emotional response. In people who get overwhelmed by rejection, this condition is sometimes known as rejection sensitive dysphoria (RSD). This condition is typically characterized by an extreme emotional sensitivity to being rejected or criticized, regardless of whether this rejection or criticism is real or perceived. While rejection sensitive dysphoria (RSD) can affect anyone, it is believed to be more common in people with autism or attention deficit hyperactivity disorder (ADHD). Read on to find out what is rejection sensitive dysphoria and how to deal with this condition.

What is Rejection Sensitive Dysphoria?

What is Rejection Sensitive Dysphoria?

Life throws all sorts of challenges our way every day. Rejection and criticism is one such challenge that we have to deal with in our lives. While some people are able to shake off rejection easily, others find that being rejected triggers an overwhelming emotional response that is difficult to manage.(1)

In such people, this feeling of being overwhelmed by rejection is known as rejections sensitive dysphoria (RSD). The condition is marked by having extreme emotional sensitivity to being rejected or criticized, regardless of whether the rejection was real or perceived.(2)

Rejection sensitive dysphoria (RSD)is a condition that can affect anyone, but it has been observed that people who have autism or those who have attention deficit hyperactivity disorder (ADHD) are more susceptible to rejection sensitive dysphoria.(3)

What are the Causes of Rejection Sensitive Dysphoria?

People who have rejection sensitive dysphoria are much more susceptible to rejection in their life, and they get easily triggered by specific situations. However, the exact cause of why some people suffer from RSD, and others do not is not fully understood.

However, it is believed that the cause of rejections sensitive dysphoria is multiple factors and not just one standalone incident.

One of the possible explanations for rejection sensitive dysphoria (RSD)is believed to be a history of neglect or rejection during a person’s early life. This rejection or neglect could either be from a parent who was neglectful or over critical, which has a profound impact on how people with rejection sensitive dysphoria (RSD)view themselves.

Due to this parental relationship, many people grow up having lower self-esteem combined with an intense fear of abandonment and rejection in their other relationships.
There are also many other situations that can cause a person to become extraordinarily sensitive to rejection — for example, being bullied or being teased by peers. Or being rejected or criticized by a romantic partner can also be a cause.

It is also believed that some people with rejection sensitive dysphoria (RSD)are genetically predisposed to the condition. Rejection sensitive dysphoria is known to pass down through families for generations. If a parent or a close relative has rejection sensitive dysphoria, then there is a high chance that you may also develop the condition.

Symptoms of Rejection Sensitive Dysphoria

Signs of rejection sensitive dysphoria are challenging to understand and quite challenging to identify for healthcare providers as well. The symptoms of this condition can sometimes also mimic the symptoms of other mental health conditions, including:

The common symptoms of rejection sensitive dysphoria include:

  • Extreme fear of failure
  • Low self-esteem
  • Avoiding social settings
  • Having high expectations for self
  • Approval seeking behavior
  • Feelings of hopelessness
  • Anxiety
  • Aggression and anger in uncomfortable situations
  • Being easily embarrassed
  • Getting angry or having an emotional outburst when they feel someone has rejected or hurt them
  • Having problems in relationships
  • Staying away from social situations
  • Withdrawing from other people
  • Sometimes thinking about hurting themselves

One difference between rejection sensitive dysphoria and other mental disorders is that episodes of rejection sensitive dysphoria (RSD) can be intense, but they do not last for very long. The symptoms of rejection sensitive dysphoria tend to trigger by emotional cycles, rather than any actual event.

How Does Rejection Sensitive Dysphoria Affect Your Life?

People with this condition are more likely to work very hard at making everyone like and admire them. Or they might even stop trying at all and opt for staying out of any situation that may involve them facing rejection or getting hurt. This social withdrawal looks very much like social phobia, which is a condition characterized by having a severe fear of being embarrassed in public.

Rejection sensitive dysphoria is also known to affect all your relationships, be it with family, friends, or with your partner. The belief that you are going to be rejected can, in itself, turn into a self-fulfilling prophecy. After all, when you start behaving differently with the people you think have rejected you, they may also sense your change in behavior and actually start neglecting you for real.

Diagnosing Rejection Sensitive Dysphoria

It is challenging to figure out if you have rejection sensitive dysphoria. Even doctors have to first rule out all the symptoms of any underlying mental health disorder before they can diagnose you with rejection sensitive dysphoria (RSD).

Rejection sensitive dysphoria is not an actual recognized diagnosis under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is why a professional diagnosis might not always be a possibility.(4)

In an attempt to assess your symptoms, you will need to consult either a psychologist, a counselor, or any other mental health professional. Your doctor will inquire about your past medical history, your family history, and your symptoms in detail. You will also need to answer a series of questions regarding how you tend to react and feel in specific situations. You may also need to fill up a mental health questionnaire.

Some of the questions your doctor may ask you include:

  1. Do you assume that no one likes you?
  2. Do you feel intense aggression or anger when someone hurts your feelings or makes you feel embarrassed?
  3. Do you feel rage or anger when you have been criticized or rejected?
  4. Do people say that you are overly sensitive?
  5. Do you always find yourself going out of the way to please people? Are you a people pleaser?

Your doctor may also inquire about any prior diagnosis of autism spectrum disorder or ADHD. If you have never been diagnosed with ADHD or other mental health conditions before, but you have the symptoms, then your doctor will recommend that you undergo screening for mental health disorders to better understand the underlying cause of your symptoms, especially your emotional reactions.

Is There Any Treatment For Rejection Sensitive Dysphoria?

Since the condition of rejection sensitive dysphoria is believed to be closely associated with ADHD and autism, your doctor is likely to recommend treatment for the underlying condition first. There is no cure for such conditions, but it has been observed that taking regular medication helps relieve the associated symptoms such as depression and hyperactivity.

Here are some treatment options for rejection sensitive dysphoria (RSD):

Cognitive Behavioral Therapy

  • Behavioral intervention helps reduce hypersensitivity, making it easier for the person to manage and deal with criticism and rejection. Your doctor is, therefore, likely to recommend psychotherapy as the first stage of treatment.
  • Psychotherapy is a traditional method of treatment that helps people cope with rejection sensitive dysphoria.
  • Cognitive-behavioral therapy (CBT) is one of the most effective methods of psychotherapy. CBT is a type of talk therapy that teaches patients coping techniques.
  • You will be taught how to resolve relationship conflicts, handle stressful situations, improve your communication skills, and overcome previous abuse or emotional trauma.


In combination with therapy, your doctor is likely to also prescribe certain medications to help relieve your symptoms.

However, there are no medications for rejection sensitive dysphoria (RSD)that have been approved by the US Food and Drug Administration (FDA), and the medicines that are typically prescribed are off-label or for other conditions.

A commonly prescribed medication for treating rejection sensitive dysphoria is Guanfacine.(5) This drug is generally prescribed for lowering blood pressure levels, but it is also known to interact with receptors in the brain to bring down the intensity of emotional responses and hyperactivity.

Lifestyle Modifications

Along with these traditional treatment plans, you will also be advised to make certain modifications to your lifestyle to help manage your emotional response to criticism and rejection.

For example, you will be advised to understand whether what you perceive to be criticism or rejection really exists or not. You will need to keep your emotions in perspective. Of course, it is going to be difficult at first to control your feelings, especially when you feel hurt. But, instead of giving in to your emotions and having an outburst, try to stay calm and rationally discuss your feeling with another person.

It will also help if you try to reduce your overall stress levels. Reducing your stress will help you more at ease and also make it easier to control your emotions.

You should try to get plenty of sleep, eating a nutritious and balanced diet, and get regular exercise. Exercise has a huge role to play in bringing down your stress levels and releasing endorphins, which are the body’s feel-good hormones.


All of us have good days and bad days, which is why having an occasional emotional response or outburst is considered to be reasonable and does not warrant you to see a doctor.

However, if you find yourself experiencing overwhelming feelings of anxiety, hurt, and rage at any time you feel rejected or criticized, then you may consider seeing a doctor. Medical intervention becomes necessary when the condition of rejection sensitive dysphoria starts having an impact on your life and your relationships.

Rejection sensitive dysphoria (RSD)can often lead to problems in romantic relationships, and it can also cause friction in your family and group of friends.

Even though rejection sensitive dysphoria has been linked with autism and ADHD, this does not mean that you cannot have the condition without the other accompanying disorders. Rejection sensitive dysphoria (RSD)can affect anyone, and symptoms tend to worsen if left untreated.

So if you find yourself feeling an overwhelming emotional response after rejection or criticism, then you should consider reaching out to a mental health professional for help.


  1. Psychology Today. (2019). What Is Rejection Sensitive Dysphoria?. [online] Available at: https://www.psychologytoday.com/us/blog/friendship-20/201907/what-is-rejection-sensitive-dysphoria [Accessed 19 Dec. 2019].
  2. Kraines, M.A., Kelberer, L.J. and Wells, T.T., 2018. Rejection sensitivity, interpersonal rejection, and attention for emotional facial expressions. Journal of behavior therapy and experimental psychiatry, 59, pp.31-39.
  3. ADDitude. (2019). Rejection Sensitive Dysphoria and ADHD: How to Get Over RSD. [online] Available at: https://www.additudemag.com/rejection-sensitive-dysphoria-and-adhd/ [Accessed 19 Dec. 2019].
  4. American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders. BMC Med, 17, pp.133-137.
  5. Sorkin, E.M. and Heel, R.C., 1986. Guanfacine. Drugs, 31(4), pp.301-336.
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:December 27, 2019

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