Rejection-Sensitive Dysphoria (RSD): What It Is and How to Cope
- Kaitlyn Boudreault
- Jul 3, 2024
- 9 min read
Updated: Jun 6
Experiencing rejection is a universal part of life. You will encounter it at some point, whether it arises in friendships, romantic relationships, or the workplace.
While these situations can lead to uncomfortable emotional and physical sensations, most people can manage and cope with these feelings.
However, for some individuals, rejection triggers an intense emotional and physical pain that is challenging to handle, a phenomenon known as rejection-sensitive dysphoria (RSD), , often rooted in rejection sensitivity.
RSD may lead to heightened emotional outbursts, negative self-talk, rumination, and withdrawal from social situations.
Typically, we think of ADHD in terms of inattention, impulsivity, and hyperactivity, but ADHD and emotional dysregulation frequently co-occur, especially in those also experiencing RSD
If you identify with the traits of RSD, a virtual ADHD coaching session or neurodiversity-affirming therapy may provide valuable support.
Read on to discover more about RSD, its connection to ADHD and other neurodivergence, and effective strategies for coping with rejection.
Table of Contents
Understanding Rejection
Types of Rejection
Impact of Rejection
Coping with Rejection
Moving Forward
What Is Rejection-Sensitive Dysphoria?
Rejection-sensitive dysphoria (RSD), referred to as hysteroid dysphoria in Europe, is not an officially recognized diagnosis, but it often occurs alongside other conditions.
It is characterized by a brain-based symptom primarily linked to neurodivergence, such as ADHD. RSD manifests as a heightened emotional response to rejection or criticism, stemming from emotional dysregulation in ADHD and other conditions.
The term “dysphoria” originates from ancient Greek, meaning difficult or unbearable. This indicates that rejection can evoke severe emotional reactions and physical pain.
Interestingly, these emotional and physical responses can occur not only in direct response to real rejection but also to imagined scenarios of rejection. Even ambiguous remarks, like a simple “OK” in reply to an email, can lead someone with RSD to worry that they did something wrong.
While everyone feels negative emotions in response to rejection, those with RSD experience feelings in an exaggerated manner that can be difficult to control. The emotional response tends to be disproportionate to the situation, and RSD can disrupt a person's work or school life, relationships, and overall well-being.
Individuals experiencing RSD often grapple with feelings of inadequacy, low self-esteem, depression, and anxiety. In an attempt to avoid rejection and its associated traits, you may engage in behaviours such as people-pleasing and perfectionism.
Rejection-Sensitive Dysphoria vs. Sensitivity to Rejection
Your brain comprises various regions that serve distinct functions. As you mature, your brain gains the ability to integrate signals from these regions to manage your emotions effectively.
However, for individuals experiencing emotional dysregulation, this integration does not occur, leading to overwhelming emotions you cannot manage.
While everyone may feel hurt by rejection, RSD symptoms are markedly more intense and disruptive than general rejection sensitivity.
Both involve emotional dysregulation, but dysphoria refers specifically to the extreme, often unbearable emotional pain found in RSD.
Whereas individuals with rejection sensitivity might feel anxious or defensive, those with RSD may experience deep shame, physical discomfort, and intense emotional pain over even minor incidents.
History of Rejection-Sensitive Dysphoria and Its Associated Emotional Dysregulation
RSD is closely related to emotional dysregulation in ADHD, a concept that dates back decades.
Dr. Paul Wender emerged as a pioneering figure in the study of emotional dysregulation and its relationship to ADHD in the 1960s and beyond.
He was among the first to recognize that emotional dysregulation is a pervasive and impairing trait of ADHD. Initially, he referred to this phenomenon as atypical depression due to societal misunderstandings at the time.
Subsequently, society came to realize that Dr. Wender was referring to RSD in ADHD individuals. Once neglected, emotional dysregulation and RSD are now gaining recognition as important features of ADHD.
In the 1990s, researchers further elaborated on the subject, with Dr. William W. Dodson coining the term "rejection-sensitive dysphoria."
He utilized this term to illustrate how some of his patients experienced extreme mental and emotional distress due to mere perceptions of rejection. Currently, many ADHD and other neurodivergent individuals identify with these intense responses to rejection.
What Triggers Rejection-Sensitive Dysphoria?
The intense emotional and physical responses associated with rejection-sensitive dysphoria often stem from rejection sensitivity, which can be triggered by:
Abandonment by a loved one
Teasing
Criticism
Real or perceived rejection or disapproval
Self-criticism, perfectionism, or negative self-talk
These triggers can lead to various traits, manifesting either externally or internally. When internalized, the response may resemble a sudden bout of depression, which can include suicidal thoughts. Conversely, when emotions are externalized, they may result in outbursts of anger or rage.
What Causes Rejection-Sensitive Dysphoria?
Experts have yet to determine the exact cause of RSD.
Some theories suggest that it relates to brain areas that process rejection, failure, and criticism, primarily the amygdala and prefrontal cortex. The amygdala governs emotional responses, while the prefrontal cortex controls higher cognitive functions.
As you mature, your brain ideally develops in a manner that helps you manage your emotional responses more effectively.
However, for those with ADHD and emotional dysregulation, the emotional center (amygdala) may override cognitive control (prefrontal cortex), leading to overwhelming painful emotions.
The resulting emotional dysregulation, characterized by the inability to manage negative emotions, is closely tied to RSD.
Researchers also believe genetics may play a role in rejection sensitivity. Individuals with familial histories of mental health conditions or neurodivergent traits may be more susceptible to rejection sensitivity.
Further research is necessary to explore the relationship between genetics and RSD.
Common RSD Symptoms and Traits
Experiences of RSD can differ greatly among individuals. However, the hallmark of RSD is intense emotional pain resulting from real or perceived rejection or criticism.
Those affected might find it challenging to articulate their experiences, as RSD feels distinct from other types of emotional pain. Individuals often describe RSD as akin to having an open wound.
Everyone experiences rejection, but the RSD symptoms are often described as:
Becoming easily embarrassed when criticized in public
Low self-esteem
Persistent fears of rejection
Physical discomfort, such as a heavy chest or tight stomach
Trouble controlling emotions in response to rejection (real or perceived)
Rumination and perseveration
Defensive reactions to rejection, including anger or aggression
A sudden onset of depression or anxiety following rejection
Neglect of self-care and potential burnout
Negative self-talk and thoughts of self-harm
These RSD traits often create a negative feedback loop. Individuals may resort to behaviors to limit rejection, which can include people-pleasing or striving for perfection to avoid criticism.
Unfortunately, rejection can still occur regardless of these efforts since no one can achieve perfection consistently. Consequently, individuals experiencing RSD might react negatively to being rejected, subsequently engaging in these behaviours again.
What Is ADHD, or Neurodivergence?
ADHD is a neurodevelopmental and neurodivergent condition, diagnosed through a comprehensive ADHD assessment.
“Neuro” pertains to the nervous system, while “divergent” signifies a deviation from "typical" brain functioning.
Consequently, ADHD individuals brains develop differently, and you may process information differently, including through the traits of inattention, impulsivity, and hyperactivity, which can benefit from ADHD coaching.
In addition to inattention and impulsivity, ADHD and emotional dysregulation often go hand-in-hand. Many individuals with ADHD report challenges with managing emotions, especially in high-stress or socially vulnerable situations.
These emotion-based traits could include "ADHD waiting mode," where an individual feels overwhelmed while waiting for something.
There are numerous other forms of neurodivergence, including neurotypes like anxiety, Tourette syndrome, depression, learning disabilities, and autism.
Is Rejection-Sensitive Dysphoria a Symptom of ADHD?
RSD is not officially recognized in the DSM-5 as a symptom of ADHD. Several challenges complicate the acknowledgement of RSD in the context of ADHD.
Firstly, the DSM-5 criteria for ADHD are primarily tailored to elementary school-aged children, leaving a gap in understanding for those over the age of 16 (Pliszka, 2007).
Moreover, the criteria often overlook emotional aspects, cognitive styles, relationships, and sleeping issues while concentrating on behavioral traits.
Over the past decade, ADHD emotional dysregulation and RSD have become more widely studied. Despite a growing body of knowledge, RSD still lacks recognition in the DSM-5. This may be due to RSD not being universally present in individuals with ADHD and the challenges involved in measuring it.
Nevertheless, though RSD is not recognized, in 2019, emotional dysregulation, which shares many characteristics with RSD, was acknowledged by the European Union as one of the six facets of ADHD. Studies indicate that 35 to 70% of people with ADHD experience emotional dysregulation.
Consequently, ADHD individuals may respond to emotions differently than neurotypical individuals, with even minor criticism triggering severe emotional reactions.
Despite the strides in research and understanding, further advocacy is needed to formally recognize emotional dysregulation and RSD as core facets of ADHD in the DSM-5.
Can Rejection-Sensitive Dysphoria Occur with Other Neurodivergence?
Just as with ADHD, research on the relationship between rejection-sensitive dysphoria and other forms of neurodivergence is limited.
However, there is some recognition that RSD may be prevalent among various neurodivergent individuals, including autism, learning disabilities, depression, bipolar disorder, and complex PTSD (CPTSD).
Further investigation is needed to uncover the reasons behind this association.
Can You be diagnosed with Rejection-Sensitive Dysphoria?
RSD is not officially recognized as a standalone condition, nor can it be diagnosed using the DSM-5.
Clinicians may suspect RSD based on your traits in conjunction with the presence of neurodivergence.
They will evaluate your responses to rejection and assess past or present experiences of harsh criticism.
The traits of mood disorders and other mental health conditions often overlap with those of RSD, complicating the identification of RSD.
Therapy and Coaching Support for RSD and Emotional Dysregulation
While there is no cure for RSD, it can be managed effectively. Many individuals benefit from neurodivergent emotional support systems that validate their lived experiences rather than pathologizing them.
Management strategies can vary based on individual needs and may include a blend of medications, coaching, and lifestyle adjustments.
Medications
Medications play a vital role in managing the traits of RSD. Currently, there are no specific medications approved for RSD treatment. Instead, healthcare providers may prescribe medications approved for related conditions, such as anxiety, depression, or ADHD.
Off-label prescribing can also occur, where medications are used for purposes other than their original approval.
For instance, centrally acting alpha-agonists, like clonidine (Kapvay) and guanfacine (Intuniv), initially developed for treating high blood pressure, are potential options for managing RSD due to their effects on ADHD. Other medications, including stimulants and anti-anxiety medications, may also be prescribed by a doctor off-label for RSD.
Neurodiversity-affirming therapy
Counselling is another valuable approach to treating RSD, helping you process and manage emotions connected to RSD while developing coping strategies for episodes.
Therapists can assist you in identifying specific triggers and understanding effective emotional management techniques.
Counselling may also address identity aspects subject to societal criticism, such as sexual orientation, recognizing that societal rejection can trigger RSD signs.
Working with a provider trained in neurodiversity-affirming therapy ensures that interventions focus on accommodations and self-understanding, rather than 'fixing' neurodivergent traits.
Therapy may take the form of a number of therapy modalities, including those that target attachment style, such as International Family Systems and Dialectical Behavioral Therapy. You can prepare for your initial therapy session by using our how-to guide.
Lifestyle Changes to Cope With Rejection Sensitivity
For neurodivergent individuals, coping with rejection can feel like navigating an emotional rollercoaster. However, there are proactive lifestyle changes that can help.
Techniques for stress management, mindfulness meditation, breathing exercises, restless sleep, and proper nourishment can be instrumental. Here are some suggestions gathered from neurodivergent individuals:
Reinforce your strengths: Acknowledge your positive traits and celebrate your accomplishments. Reward yourself for achievements to build confidence.
Use positive affirmations: Employ affirmations and mantras to counteract negative thoughts associated with RSD.
Validate your emotions and practice self-compassion: Let yourself feel your emotions and practice self-compassion, recognizing your feelings are valid.
Shift focus: Each day, recognize one good thing and one bad thing. Try to concentrate on the positive while acknowledging and holding space for the negative.
Find supportive people: Reach out to people in your life that uplift you and help build your confidence to counteract negative feelings.
Distractions: Engage in activities or use items that bring comfort, such as a fidget spinner or calming music.
Focus on glimmers: If you are facing challenges with rejection, focus on what gives you joy.
FAQ
Is rejection-sensitive dysphoria a symptom of ADHD? RSD is not officially listed in the DSM-5 as an ADHD symptom, but many individuals with ADHD experience its traits, including intense emotional pain from rejection.
What are common signs of RSD? Signs include sudden emotional pain, fear of criticism, people-pleasing, emotional outbursts, and depression after rejection.
How do you treat rejection-sensitive dysphoria? RSD is often managed through therapy, ADHD coaching, medication for emotional regulation, and lifestyle adjustments such as mindfulness and affirmations.
Book a Free Consultation With Blue Sky Learning
Are you a neurodivergent individual experiencing RSD and seeking the support of a virtual rejection-sensitive dysphoria coach or therapist?
Blue Sky Learning is here to assist you, with a dedicated team of coaches and therapists providing free consultations to determine whether they are the right fit for you.
Book a free 20-minute consultation with a member of the Blue Sky Learning team by emailing hello@blueskylearning.ca or following the link below.
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