What Is Rejection Sensitive Dysphoria?

Medically Reviewed by Smitha Bhandari, MD on May 02, 2023
5 min read

Most people don’t like rejection. Be it in a romantic relationship, a friendship, or at work, it’s common to have negative, unpleasant feelings creep up. It can often range from confusion and sadness to rage. But usually, you’re able to manage your emotions rather quickly.

But suppose the same rejection causes you to have significantly heightened, intense negative feelings, and severe emotional pain that’s difficult to control. In that case, you might have what experts call rejection sensitive dysphoria (RSD). Studies show you’re more likely to have it if you have attention deficit hyperactivity disorder (ADHD).

RSD doesn’t have an official set of symptoms and isn’t a formal medical diagnosis. But doctors and therapists often use the term when they notice exaggerated reactions connected to an official behavioral condition like ADHD. 

The word “dysphoria” stems from an ancient Greek word that translates to intense feelings of pain or discomfort. People who experience RSD don’t handle rejection well. In fact, they find it hard to describe what they feel and often use words like “unbearable” or “devastating.” It could cause you to develop a serious fear of rejection, too. 

Research on who develops RSD and how it’s linked with ADHD is still unclear. That’s because it's hard to measure rejection. But Eugene Arnold, MD, a psychiatrist and behavioral health specialist at Ohio State University, believes people with ADHD are more likely to show symptoms of RSD due to differences in brain structure. 

For people with ADHD, the frontal lobe of the brain, which controls your ability to pay attention, language, social skills, impulse controls, judgment, and problem-solving, works slightly differently. This might cause you to miss or not pay attention to certain social cues or details, or not collaborate well within a team. 

You might “lack insight” into how this might affect others around you and interpret unclear conversations as a form of rejection, being teased, or as criticism. 

This could trigger overwhelming feelings of confusion, failure, betrayal, pain, and sadness. And you might find it difficult to regulate your emotions and control them as quickly as others without ADHD might. 

Mental health conditions and mood disorders could also be linked with RSD. But experts need to conduct more studies on RSD to better understand it.

While RSD is not an official diagnosis, people with RSD are likely to:

  • Be strong people-pleasers
  • Feel more embarrassed or self-conscious
  • Have low self-esteem and self-doubt
  • Display sudden outbursts of physical emotions like anger, tears, and sadness
  • Engage in negative self-talk
  • Have difficulty managing their reactions
  • Find it draining to manage relationships
  • Suddenly become quiet, moody, or show signs of depression or anxious feelings

In some cases, the fear of disapproval or rejection from others could cause you to avoid certain tasks and responsibilities or withdraw from social interaction. 

On the other hand, you might try to achieve perfection to avoid any chances of failure in the first place. This could take a toll on your overall quality of life.

Experts don’t fully understand the cause yet. But some believe the structure of your brain might have something to do with it. 

The parts of the brain that process and respond to and manage acts of rejection, failure, emotional awareness, and negative messages are called the amygdala and the prefrontal cortex. 

They're located at the front of the brain and cause children, teens, and young adults to lose their temper and become frustrated or upset. Usually, these parts of the brain get better at processing signals as you get older. You’re able to rein in feelings and keep them organized and under control so that you can interact with your surroundings and meet your goals. 

But for some people with psychological or behavioral conditions, your brain might not regulate these signals properly. Instead, it might make negative emotions too painful to bear and overwhelming to manage or keep in check. This leads to what experts call “emotional dysregulation.”

Besides the brain’s physical structure, some experts think genetics might play a role. Especially because ADHD, which is closely linked to RSD, runs in families. But experts need to further study RSD and its links to mental health conditions.

Since RSD isn’t an official medical condition and there’s limited research to support it, your doctor, counselor, or licensed therapist might not know much about it or mistake it for another condition.

But if you’ve already been diagnosed with ADHD or another mental health disorder, they might recognize the pattern of behavior around rejection sensitivity and associate it with other issues you have. 

There’s no specific cure or treatment for RSD. But certain medications and therapies used to treat ADHD and other mental health conditions could help you regulate your intense emotional responses. 

Medications that might help include:

Alpha-2 receptor agonists. Prescription ADHD drugs like guanfacine (Intuniv) and clonidine (Kapvay) are designed to activate brain receptors that improve your brain’s ability to receive and process emotional signals. 

Stimulant medications. Prescription drugs like amphetamine (Adderall) and methylphenidate (Ritalin) stimulate certain chemical messengers (neurotransmitters) that shoot signals between different brain cells. This helps your brain to process incoming messages and improves communication skills. 

Monoamine oxidase inhibitors (MAOIs). This class of drugs is often used to treat depression. But it’s also been known to improve your sensitivity to rejection. But you can't take this drug along with other commonly used ADHD medications and certain foods like aged cheese or meat. It can cause your blood pressure to shoot up to dangerous levels. 

Check with your doctor before you use the drug off-label for RSD.

Besides drugs, Arnold notes that psychotherapy such as cognitive behavioral therapy and talk therapy can help with rejection sensitivity, too. This form of therapy could help you gain insight and awareness into your emotional responses. 

It can help you build good habits such as listening to the other person, asking for clarifications, or waiting or taking time to think of a response rather than having an intense emotional outburst. It might also improve your impulse control. 

Over time, psychotherapy can help you build tools or coping strategies to control your emotions and keep them in check in various social situations.

If you or someone you know has a mental health crisis and are thinking about harming yourself or others, call 988 for the National Suicide Prevention Lifeline for emergency help. You can also call 911 or head to the nearest hospital for medical attention.