What is Rejection Sensitive Dysphoria? Rejection Sensitive Dysphoria Symptoms, Causes, and Treatment.

Rejection Sensitive Dysphoria (RSD) is an intense emotional response to perceived rejection, criticism, or failure, often associated with ADHD.

What is Rejection Sensitive Dysphoria?

Struggling with rejection? It’s common to feel confused, sad, or even angry. But if those emotions become overwhelming and uncontrollable, you might be dealing with “rejection-sensitive dysphoria” (RSD). Studies show that people with ADHD are more likely to experience RSD. Find out more about this phenomenon and how to cope.

What is RSD ADHD?

Rejection Sensitive Dysphoria (RSD) is a complex emotional condition that often coexists with Attention-Deficit/Hyperactivity Disorder (ADHD). It involves intense emotional responses and sensitivity to perceived rejection or criticism, leading to profound distress and dysphoria. Rejection Sensitivity Dysphoria can significantly impact an individual’s emotional well-being and quality of life. We will explore Rejection Sensitive Dysphoria, its symptoms, underlying causes, and available treatment options.

Linking ADHD and Rejection Sensitivity

Uncover the significant evidence linking attention deficit hyperactivity disorder (ADHD) to rejection sensitivity disorder (RSD). Understand how individuals with RSD overreact to criticism or rejection, impacting their emotional well-being. With RSD being more prevalent in those with ADHD, it is crucial to grasp the profound consequences it can have on their daily lives. Controlling emotional responses to rejection becomes challenging for those struggling with ADHD and rejection-sensitive dysphoria. To help these individuals manage their emotions and relationships effectively, it is essential to delve deeper into the connection between these two conditions.

What’s The Difference Between Rejection Sensitivity Disorder and Rejection Sensitive Dysphoria?

RSD and rejection sensitivity share a close connection but exhibit subtle differences. To grasp these distinctions, we must first understand the concept of emotional dysregulation.

Emotional Dysregulation arises when the brain struggles to manage emotional signals effectively. As individuals mature, their brains typically learn to regulate these signals, akin to adjusting the volume on a TV to a comfortable level. However, emotional dysregulation implies that the emotional signs remain unmanageably high, like a TV stuck at a disruptively loud volume. This condition leads to:

  • Feeling overwhelmed.
  • Uncomfortable.
  • Even distressed.

Emotional dysregulation can manifest in various states, particularly those impacting brain structure and information processing. It is commonly associated with personality disorders, mood disorders, and more.

In Emotional Dysregulation and Rejection Sensitive Disorder, rejection sensitivity and RSD can involve emotional dysregulation. People with rejection sensitivity may experience:

  • Intense anxiety.
  • Negative emotions before expected rejection.
  • Struggle to interpret non-positive interactions as anything other than rejection.
  • React with strong emotions such as anger, extreme sadness, or severe anxiety.

While these experiences are also possible with RSD, there’s an additional layer. Individuals with RSD describe overwhelming emotional pain, setting it apart from rejection sensitivity.

Rejection Sensitive Dysphoria Symptoms

Although there is no formal diagnosis for Rejection Sensitive Dysphoria (RSD), those who suffer from RSD generally show the following symptoms:

  • Strong People-Pleasing Tendencies.
  • Heightened Feelings of Embarrassment and Self-Consciousness.
  • Low Self-Esteem and Frequent Self-Doubt.
  • Sudden Outbursts of Physical Emotions, such as Anger, Tears, and Sadness.
  • Engagement in Negative Self-Talk.
  • Difficulty in Managing Emotional Reactions.
  • Feeling Drained by Relationship Management.
  • Sudden Shifts in Behavior, Such as Becoming Quiet, Moody, or Displaying Signs of Depression or Anxiety.
  • Avoidance of Certain Tasks or Social Interactions Due to Fear of Disapproval or Rejection.
  • Striving for Perfection to Prevent Any Possibility of Failure.

These symptoms could negatively affect a person’s well-being and quality of life.

The We Level Up Mental Health Centers can help empower families affected by rejection-sensitive dysphoria and their loved ones with powerful therapy & coping strategies. Call today for a free RSD assessment.

Rejection Sensitive Dysphoria (RSD) is an intense emotional response to perceived rejection, criticism, or failure, often associated with ADHD.
Rejection Sensitive Dysphoria (RSD) is an intense emotional response to perceived rejection, criticism, or failure, often associated with ADHD.

If rejection fills you with overwhelming sadness and uncontrollable emotional pain, you may be experiencing rejection-sensitive dysphoria (RSD). Experts say that individuals with attention deficit hyperactivity disorder (ADHD) are more likely to be affected by this condition.

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We Level Up Rejection Sensitivity Dysphoria Treatment Center Tips and Strategies

Overcome RSD at home. Maintain a journal where you can write down your thoughts and emotions related to RSD triggers and experiences. This can provide an outlet for your feelings, help you identify patterns, and gain insight into your reactions.

RSD Rejection Sensitive Dysphoria Fact Sheet

Rejection Sensitive Dysphoria Definition

Rejection Sensitive Dysphoria (RSD) is not an officially recognized diagnosis but is often used in the context of attention deficit hyperactivity disorder (ADHD). It refers to an extreme emotional sensitivity to perceived rejection, criticism, or disapproval, resulting in intense and often overwhelming emotional responses.

Key Characteristics:

  • Emotional Intensity: Individuals with RSD experience emotions intensely, mainly when they believe they are being rejected or criticized.
  • Self-Doubt: RSD often leads to feelings of self-doubt, low self-esteem, and persistent negative self-talk.
  • Mood Instability: Sudden and intense mood swings, such as anger, sadness, anxiety, or shame, can occur in response to perceived rejection.
  • Social Challenges: Managing relationships can be draining due to the fear of disapproval, leading to avoidance or withdrawal.
  • Fear of Failure: Some individuals may engage in perfectionistic behaviors to avoid rejection or criticism, which can negatively impact their lives.

Causes: The exact causes of RSD are not fully understood, but it is believed to be related to ADHD and possibly influenced by genetic factors. RSD may be associated with structural and regulatory differences in the brain, particularly in how it processes social rejection.

Examples: RSD triggers include workplace criticism, social exclusion, romantic relationship issues, academic struggles, online criticism, parental disapproval, and fear of failure.


  • Awareness and Education: Understanding RSD and its triggers can be the first step in managing it.
  • Medication: In some cases, medication prescribed for ADHD may help alleviate RSD symptoms.
  • Psychotherapy: Therapy, such as cognitive-behavioral therapy (CBT), can provide coping strategies and emotional regulation techniques.
  • Support: Building a support system and seeking help from friends, family, or support groups can assist in managing RSD.

Learn More About Rejection Sensitive Dysphoria Download PDF Below

Rejection Sensitive Dysphoria Statistics

Rejection Sensitive Dysphoria (RSD) is a psychological phenomenon that has gained recognition and attention in recent years, particularly in the context of Attention-Deficit/Hyperactivity Disorder (ADHD). While there is limited research specifically focused on RSD, understanding the prevalence and impact of this condition can provide valuable insights into the experiences of individuals who struggle with emotional hypersensitivity and fear of rejection.

  1. Prevalence of Rejection Sensitive Dysphoria: Estimating the overall prevalence of RSD is challenging since it is not recognized as a distinct diagnosis in the DSM-5. However, it is commonly associated with ADHD, which has its prevalence rates.
  2. Co-Occurrence of RSD and ADHD: Research suggests that RSD frequently coexists with ADHD, with some studies indicating that up to 99% of individuals with ADHD may experience symptoms of RSD.
  3. Impact of RSD on Mental Health and Functioning: While specific statistics on the impact of RSD are limited, anecdotal evidence and clinical observations indicate that RSD can significantly affect an individual’s emotional well-being, social interactions, and overall quality of life.
  4. Gender Differences in RSD: Some evidence suggests that RSD may be more prevalent in females with ADHD than males. However, further research is needed to understand the gender differences in RSD clearly.

8.7 Million

In 2019, the number of visits to physician offices with attention deficit disorder as the primary diagnosis was 8.7 million.

Source: NIMH


Approximately 9.5% of American adults, ages 18 and over, will suffer from a depressive illness (major depression, bipolar disorder, or dysthymia) each year.

Source: NIMH


The heritability of ADHD, estimated to be around 70-80%, further supports the notion that genetic factors play a substantial role in its development.

Source: NIMH

Let’s work together to reduce the devastating toll rejection-sensitive dysphoria can take on individuals and their loved ones. Please continue reading for more and contact We Level Up mental health specialists to get answers for your situation.

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What are the Causes of Rejection Sensitive Dysphoria?

Those with ADHD and RSD often experience heightened emotional sensitivity and reactivity.
Those with ADHD and RSD often experience heightened emotional sensitivity and reactivity.

According to experts, the exact cause of rejection sensitive dysphoria (RSD) remains uncertain. However, it is suspected to be related to the brain’s structure and shares similarities with the causes of ADHD.

Research has shown that social rejection, even when unclear or ambiguous, triggers brain activity similar to that associated with physical pain. Individuals with ADHD have distinct patterns of internal communication regulation in their brains compared to those without ADHD. Specifically, the brain regions responsible for filtering and regulating signals are less active in people with ADHD. This reduced filtration of brain activity can lead to difficulties in processing sensory information, making individuals with ADHD more susceptible to feeling overwhelmed by loud sounds, bright lights, or sudden environmental changes. Consequently, the brain’s inability to regulate pain-like activity may explain why rejection is significantly more distressing and painful for those with RSD.

Furthermore, ADHD has a genetic component, often running in families, and RSD, closely linked to ADHD, is also likely to have a genetic connection.

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Rejection Sensitive Dysphoria Examples

Examples of rejection sensitive dysphoria (RSD) may include:

  1. Workplace Rejection: Feeling devastated and demoralized after receiving critical supervisor feedback makes it challenging to focus and continue working.
  2. Social Rejection: Being deeply hurt by a friend’s offhand comment or feeling excluded from a social event, leading to avoidance of social situations.
  3. Romantic Rejection: Experiencing overwhelming sadness, self-doubt, and anxiety after a romantic partner breaks up or expresses dissatisfaction.
  4. Parental Disapproval: Reacting strongly to parental disappointment or disapproval, resulting in emotional distress and an intense desire to seek their approval.
  5. Academic Rejection: Struggling to cope with poor grades, literary criticism, or not meeting personal expectations, which can lead to emotional outbursts and avoidance of school-related tasks.
  6. Online Criticism: Feeling profoundly hurt and angry when reading negative comments or criticism on social media, possibly prompting a solid emotional response or even withdrawal from online platforms.
  7. Perceived Neglect: Believing that friends or loved ones neglect you, even if the evidence is minimal, leads to self-isolation or aggressive behavior.
  8. Fear of Failure: Experiencing paralyzing anxiety and avoidance behavior when facing tasks or challenges to prevent potential failure.

How to Deal with Rejection Sensitive Dysphoria

RSD often leads to behavioral and mental health challenges from a deep-seated fear of rejection. In children with ADHD and RSD, this fear can result in low self-esteem, anxiety about failure, and severe social anxiety. These challenges may impact their school performance, hinder the formation of friendships, and potentially increase the risk of developing a personality disorder.

In adulthood, individuals with RSD are more susceptible to experiencing conditions like anxiety, depression, and loneliness. People with RSD often tend to avoid situations with uncertain outcomes, which can affect their career prospects, social relationships, and romantic pursuits.

How Long Does RSD Last?

There is limited research on the duration of RSD. Some individuals may outgrow ADHD as their brains develop, which could lead to the resolution of RSD. For those who continue to live with ADHD into adulthood, RSD might persist as a lifelong concern. Nonetheless, early diagnosis and appropriate treatment can help individuals adapt and effectively manage RSD, potentially minimizing its impact on their lives.

What’s the Outlook for RSD?

RSD itself is not inherently dangerous, but it is associated with conditions that can pose risks. Anxiety and depression are common comorbidities, potentially increasing the risk of self-harm or suicidal thoughts.

When to Seek Emergency Care

If you or someone you know experiences thoughts of self-harm or suicide, it is crucial to seek immediate help. Contact one of the following resources for assistance:

  • National Suicide Prevention Lifeline (United States): This helpline supports individuals dealing with suicidal thoughts or impulses. Dial 988 to reach this lifeline.
  • Local crisis lines: Mental health organizations like We Level Up FL Mental Health Treatment Center in your area may offer resources and crisis support. Look for local crisis lines if you are struggling with self-harm or thoughts of suicide.
  • 911 (or your local emergency services number): In cases of immediate danger related to self-harm or suicide, call 911 or your local emergency services number. Operators can assist in crises, dispatching first responders to provide immediate help.
Rejection Sensitive Dysphoria (RSD) is an intense emotional response to perceived rejection, criticism, or failure, often associated with ADHD.
Rejection Sensitive Dysphoria (RSD) is an intense emotional response to perceived rejection, criticism, or failure, often associated with ADHD.

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How Is Rejection Sensitive Dysphoria Treated?

There’s no specific cure for Rejection Sensitive Dysphoria (RSD). Still, various therapies and medications commonly used for ADHD and other mental health conditions can be beneficial in managing intense emotional responses.

Medications that may be considered include:

  • Alpha-2 receptor agonists are prescription ADHD medications such as guanfacine (Intuniv) and clonidine (Kapvay). They work by stimulating brain receptors that enhance the processing of emotional signals.
  • Stimulant medications: Prescribed drugs like amphetamine (Adderall) and methylphenidate (Ritalin) help boost the function of neurotransmitters, the chemical messengers responsible for transmitting signals between brain cells. This can improve communication skills and the processing of incoming messages.
  • Monoamine oxidase inhibitors (MAOIs): Typically used to treat depression, MAOIs have also shown promise in reducing sensitivity to rejection. However, it’s important to note that they cannot be used with certain commonly prescribed ADHD medications and specific foods like aged cheese or meat, as they can lead to dangerous spikes in blood pressure. Consult your doctor before using MAOIs off-label for RSD.

In addition to medications, psychotherapy, particularly cognitive-behavioral therapy (CBT) and talk therapy, can be valuable in addressing rejection sensitivity. These therapeutic approaches can enhance your understanding of emotional responses and help you develop healthy habits. You’ll learn techniques like active listening, seeking clarifications, and managing impulsive reactions to avoid intense emotional outbursts. Over time, psychotherapy equips you with tools and coping strategies to maintain dynamic control in various social situations.

Are you looking for effective ways to manage rejection sensitive dysphoria (RSD)? Treatment options include medications like alpha-2 receptor agonists and stimulants, cognitive behavioral therapy, and talk therapy. These resources can assist you in regulating your intense emotional reactions, developing coping strategies, and enhancing your overall emotional well-being. Take the initiative to explore these treatment options and empower yourself to lead a more balanced and fulfilling life. Get help. Call We Level Up now.

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  1. What’s rejection sensitive dysphoria?

    Rejection Sensitive Dysphoria (RSD) is an intense emotional response to perceived rejection, criticism, or failure, often associated with ADHD.

  2. Can you have RSD without ADHD?

    While Rejection Sensitive Dysphoria (RSD) is commonly associated with Attention-Deficit/Hyperactivity Disorder (ADHD), individuals can experience RSD without being diagnosed with ADHD. RSD can occur as an independent condition and may be present in individuals who do not meet the criteria for ADHD.

  3. Rejection sensitive dysphoria autism, is there a link?

    While there is no direct link between rejection sensitive dysphoria (RSD) and autism, some individuals with autism may experience RSD as part of their broader emotional challenges. RSD is more commonly associated with attention deficit hyperactivity disorder (ADHD). If you or someone you know is dealing with RSD in the context of autism, it’s essential to seek support from healthcare professionals who specialize in autism and related conditions.

  4. Is rejection sensitive dysphoria real?

    While it’s not an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), many individuals with ADHD report experiencing these intense emotional reactions. The experiences of RSD are real to those who feel them, even if it’s not a formal diagnosis.

  5. How Is Rejection Sensitive Dysphoria Diagnosed?

    Your doctor, counselor, or licensed therapist might not know much about RSD or think it’s something else because it’s not an actual medical condition, and there isn’t much study to back it up.

    But suppose you already have ADHD or another mental illness. In that case, your doctor may notice the pattern of behavior related to rejection sensitivity and connect it to other problems you are having.

Watch Journaling to Improve RSD. Top Mental Health Tips That Work.

Search We Level Up FL Rejection Sensitive Dysphoria, Symptoms, Causes, & Treatment Resources
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  2. Bedrossian L. Understand and address complexities of rejection sensitive dysphoria in students with ADHD. Disability Compliance for Higher Education. rejection sensitivity adhd related articles
  3. Dodson WW. Emotion regulation and rejection sensitivity (https://chadd.org/wp-content/uploads/2016/10/ATTN_10_16_EmotionalRegulation.pdf)Attention. Oct 2016.
  4. Dodson WW. How ADHD Ignites Rejection Sensitive Dysphoria (https://www.additudemag.com/rejection-sensitive-dysphoria-and-adhd/)ADDitude. 2017, Feb 7. adhd rejection sensitivity related articles
  5. Eisenberger NI, Lieberman MD, Williams KD. Does rejection hurt? An FMRI study of social exclusion (https://pubmed.ncbi.nlm.nih.gov/14551436/)Science. 2003;302(5643):290-292.
  6. Gao S, Assink M, Cipriani A, Lin K. Associations between rejection sensitivity and mental health outcomes: A meta-analytic review (https://pubmed.ncbi.nlm.nih.gov/28841457/)Clin Psychol Rev. 2017;57:59-74.
  7. Poggi A, Richetin J, Preti E. Trust and Rejection Sensitivity in Personality Disorders (https://pubmed.ncbi.nlm.nih.gov/31264030/)Curr Psychiatry Rep. 2019;21(8):69. Published 2019 Jul 1. define rejection sensitive dysphoria related articles
  8. Zimmer-Gembeck MJ, Nesdale D. Anxious and angry rejection sensitivity, social withdrawal, and retribution in high and low ambiguous situations (https://pubmed.ncbi.nlm.nih.gov/22583003/)J Pers. 2013;81(1):29-38.