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Rejection Sensitive Dysphoria – More than being too “sensitive”

Rejection affects individuals in different ways. Not everyone gets over it quickly or easily. Some people experience what’s known as rejection sensitive dysphoria (RSD).

RSD is associated with ADHD and autism and can significantly impact an individual’s life. People with RSD strongly react to either perceived negative judgments and criticism or actual judgments and criticism. It can be distressing and affect the individual for some time after the event. These judgments and criticism are often disproportionate to what has occurred. It can affect the individual both emotionally and physically.

Rejection Sensitive Dysphoria - More than being too "sensitive"


Rejection sensitive dysphoria is an extreme response to actual or perceived rejection. Most people may experience sadness, disappointment, or frustration after experiencing rejection. But with RSD, rejection or criticism can be overwhelming and distressing. Individuals who have experienced or do experience RSD sometimes anticipate rejection or avoid situations of past perceived rejection. They may dwell on their rejection throughout the day, causing further doubt and distress.

It can even be physically painful. Social rejection activates the same parts of the brain as does physical pain, and the experience of each can have many similarities on a brain scan. Individuals who experience RSD may also:

  • Experience panic attacks.
  • Experience emotional deregulation.
  • Be critical of themselves, and think they are not “good enough”
  • Be risk adverse in social settings.
  • Experience school refusal.
  • Have difficulty receiving criticism in an employment setting.
  • Feelings of shame and embarrassment.
  • Feelings of despair.
  • Outbursts of rage or anger.

The risks

Up to 99% of teens and adults with ADHD are more sensitive than usual to rejection. And nearly 1 in 3 say it’s the most challenging part of living with ADHD. RSD can be depilating and have long-term impacts on education, employment, and relationships.

How do you diagnose RSD?

RSD is not a mental health condition in the DSM-5. There are no written criteria to determine whether you “officially” meet a diagnosis for RSD. But you may have a strong suspicion if you recognise yourself in several of the characteristics below:

  • Low self-esteem, or self-esteem, depends entirely on what others think of you.
  • Feeling like you are not good enough.
  • Social isolation, trying to avoid anticipated rejection.
  • Frequent anger or rage outbursts towards family or friends you feel may have been critical of you or your behaviour.
  • Frequent feelings of guilt or shame.
  • School refusal, feeling like you are not smart enough.
  • Struggle to hold employment, struggle to take on board advice because you perceive it as criticism.
  • Dwelling or obsessing on the likely hood of others talking about you behind your back.

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