What Is Rejection-Sensitive Dysphoria and How to Overcome It?

August 25, 2021
RSD Treatment


Since the dawn of time, one of the characteristics evident in humans is their social behavior. Even when looking at the history of early man, you’ll soon realize that humans needed to stay closer to other people in order to thrive and survive.

By banding together, humans can overcome most challenges, create effective and meaningful bonds, and forge towards a better future. In archaic times, members of the society that went against the rules were often cast out and isolated. This isolation had an incredibly negative impact on their mental and psychosocial status.

Today, the situation is no different. People still need the company of others to lead successful lives. When you face rejection or isolation, you can easily suffer from mental and physical conditions.

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One of the most common outcomes of being rejected is experiencing rejection-sensitive dysphoria. What exactly is rejection-sensitive dysphoria, how can you tell if you have it, and most importantly, how can you overcome it?

Here’s all the information you need to know about rejection-sensitive dysphoria.

1. What Is Rejection-Sensitive Dysphoria?

Rejection-sensitive dysphoria, commonly referred to as RSD, can best be described as an extreme response condition associated with pain and discomfort. RSD is often triggered when a person faces rejection or criticism from close friends, family, and people within the inner circle. Rejection-sensitive dysphoria can elicit feelings of being inadequate and inept to achieve goals or match other people’s expectations.

The term dysphoria is derived from Greece. In the Greek language, the word means challenging to bear.

While society has developed in understating rejection-sensitive dysphoria, there are still a lot of misconceptions associated with RSD. For instance, many people still believe that people who suffer from mental health conditions are often fragile and volatile. Consequently, many people believe this volatility is what leads mental health patients to act out and overreact to things like rejection or criticism.

In reality, there’s a disparity between what people believe and what is medically and scientifically proven. For example, in the case of RSD, people affected by the condition have cycles, bouts, or dysregulated emotions. Additionally, most people with rejection-sensitive dysphoria have heightened senses and levels of emotion. As such, they are able to connect with and feel negative emotions at a more robust capacity.


Rejection-Sensitive Dysphoria
Causes of Rejection-Sensitive Dysphoria


Even when looking at the common person, you’ll soon realize no one likes to be rejected. As established above, man is a very social being at the very core. Consequently, this means you need to relate with other people to have a wholesome living experience.

One way to look at the dependence of humans on relations is by investigating the impact of isolation and segregation on prisoners. In general, no one would like to be in prison. With so many dangers and perils, you would think being alone is the most preferred option in prison.

However, whenever prisoners are in solitary confinement, they report instances when they thought they were going insane. One great example to examine is that of Anthony Gay, a prisoner jailed in Illinois.

After being held in solitary confinement for some time, he allegedly started hurting himself to the point where he had to be hospitalized. This man was average in the conventional sense. However, when isolated from others, he broke down and suffered great mental health distress.

For people suffering from rejection-sensitive dysphoria, these emotions are heightened as they experience feelings on a much deeper level. For instance, people with mental health conditions such as attention-deficit hyperactivity disorder (ADHD) can have either an internalized or externalized response when facing rejection or criticism. Here’s a breakdown of what both reactions mean in relation to rejection-sensitive dysphoria:

1. Internalized Emotional Response

An internal emotional response is typical in people experiencing rejection-sensitive dysphoria. This can be typically displayed in mannerisms similar to acute depressive episodes and mood disorders. Most people can easily misunderstand these episodes. Additionally, people with an internalized emotional response often experience suicidal thoughts and, in most cases, will visualize these feelings and go as far as planning them.

The internal emotional response is triggered by feelings or experiences related to worrying or panicking. In many cases, this method or feelings approach can be misconstrued or misunderstood as mental health disorders. There are numerous instances where people with RSD have an internalized emotional response are diagnosed with mental conditions such as anxiety and depressive disorders.

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2. Externalized Emotional Response

Unlike internal emotional responses, people with externalized emotional responses are overt and can have episodes of intense reactions and outbursts emanating from rejection or criticism. Some of these overt outbursts may include suicidal thoughts and feelings, rage, anger, isolation, and physical violence.

People with an externalized emotional response can easily get in trouble with others as they are overt in their approach. There are numerous examples where such cases have led people suffering from RSD to get in trouble with the law and ending up behind bars. Externalized emotional responses can be easily misunderstood as rude or offensive.

Understanding the Fear of Rejection in RSD

In the field of mental health care and analysis, rejection is amongst the most negatively emotive feelings. It can lead to a sense and feeling of grief, shame, and immense sadness for most people.

As a result, if you have RSD, you could easily believe that no one wants you, even when that is not the case. Rejection can come from different spheres, including family, friends, colleagues, and schoolmates.

As mentioned above, you likely perceive yourself as a social being. This has been the case since time is immemorial. When subjected to feelings of rejection and criticism, many people withdraw from friends and family. This time spent in isolation only makes the condition worse. As a result, isolation resulting from RSD can easily morph into feelings of worthlessness and social anxiety. This then leads to a destructive cycle of being ostracized and getting more anxious to be around other people.

What Are the Adverse Psychological Effects of Rejection-Sensitive Dysphoria?

Long-term experiences with rejection-sensitive dysphoria can have untold effects on your psychological health and wellbeing. In recent studies, long-term RSD has been linked as a key contributor to mental health disorders such as anxiety, ADHD, and depression. Some of the apparent psychological impacts of rejection sensitive dysphoria include:


According to research, RSD affects the brain the same way traumatic events do. Long-term experience with rejection-sensitive dysphoria can easily mimic the signs of trauma and can have significant psychological impacts on your brain and life.

In the case of children, kids who experience rejection-sensitive dysphoria from their friends and family are more likely to feel inferior. Additionally, these children are most likely to perform poorly in psychical, academic, and psychosocial activities.

The same can be said for adults exposed to long-term rejection-sensitive dysphoria. Adults often lack control in their social, professional, and personal lives. In some cases, relating with others is the most laborious task for adults with RSD.


Rejection-Sensitive Dysphoria
Triggers of RSD



Data collected from various sources reveal that depression closely ties with RSD. In the case of young girls, RSD is believed to be a causative agent in the development of depressive conditions.

The same data has been replicated both in children and adults. In both these categories, those with an experience in bullying often face depression later in their lives.

When combined, RSD and depression can have adverse effects on your mental health and overall wellbeing. This can further cascade to conditions such as bulimia nervosa, anorexia, and self-harming behaviors.

Chronic Pain

Pain is one of the least desirable feelings. No one likes to be in pain. Unfortunately, rejection-sensitive dysphoria has been linked to the impact of pain on the brain. When you’re in pain, the body releases natural painkillers or endorphin hormones.

Similarly, when you’re suffering from RSD, the body releases the same endorphin hormones, leading experts to believe that RSD affects the brain and body the same way the pain does.

Unfortunately, unlike physical pain, where you can easily detect the source and curate effective measures, the brain has a difficult time identifying RSD. As a result, you could be suffering from the condition and feel pain but not know what to do about it.

Stress and Anxiety

Even to the healthiest people, rejection-sensitive dysphoria can lead to the development of chronic anxiety and unending stress. If you are unfortunate enough to be already suffering from stress and anxiety, rejection-sensitive dysphoria can profoundly affect the preexisting stress and anxiety.

The symptoms associated with stress and anxiety are most likely to worsen and get more severe, making treatment and management even harder.

Physical and Mental Abuse

As already established, there’s a close relationship between the mind and body when dealing with mental health disorders. The case is no different when examining the impact of the rejection-sensitive disorder on psychological and physical frontiers.

The more severe the degree of rejection, the more likely someone is to look for an out. As a result, many people (predominantly males) opt for destructive behavior that could harm their minds and body. 

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2. What Causes Rejection-Sensitive Dysphoria?

Victims of rejection-sensitive dysphoria are often characterized as overly sensitive to various situations, including nasty remarks, discrimination, rejection, and criticism from people within their circles or environment.

These situations can lead to emotional outbursts and impulsive behavior. Consequently, this can result in the worst reactions being triggered and the victim lacking control.

In reality, more research is needed to establish a better understanding and narrow in on the exact cause of rejection-sensitive dysphoria. However, there are several working theories on the cumulative effects that lead to the development of RSD.

One of the hypothesized potential causes of RSD is trauma and neglect, especially in the early stages of childhood. The lack of a parent’s love and care is believed to contribute significantly to severe RSD development in later stages of life.

This theory is highly thought of as the same neglect, and lack of parental care guidance can be attributed to other mental health conditions. These include depression, anxiety, and dissociative behaviors.

As a result of parental neglect, kids without a present parental figure often grow up with diminished self-esteem and an increased fear of rejection. Consequently, they isolate themselves from other people and avoid most forms of social interactions, neglect, and criticism.

Heartbreak, rejection from loved ones, and bullying have also been attributed to the development of rejection-sensitive dysphoria. Research highlights that people with a history of abusive and harmful relationships are more likely to develop RSD compared to those in successful and thriving relationships.

Borderline personality disorder has also been linked with the development of RSD. Borderline personality disorder has some similarities to RSD as difficulties in regulating emotions characterize both conditions. People with borderline personalities also experience bouts of intense emotional reactions.


Rejection-Sensitive Dysphoria
Treatment Options for RSD


3. What Are the Symptoms of RSD?

In its very nature, RSD is quite a complex condition. Since the cause is not well understood, some of the associative symptoms are hard to diagnose. Additionally, since most of the symptoms are closely related to other mental health conditions, most can be easily misdiagnosed. Some of the other conditions RSD can be mistaken for include:

  • Bipolar disorder
  • Major depressive disorders
  • Social phobia
  • Post-traumatic stress disorder (PTSD)
  • Borderline personality disorder (BPD)

The most common signs and symptoms associated with RSD include:

  • Anger
  • Anxiety
  • Aggression
  • Hopelessness
  • Social phobia
  • Fear of failure
  • Emotional outbursts
  • Low self-esteem
  • Unrealistic expectations on yourself
  • Seeking approval from others

In reality, RSD can manifest under a variety of symptoms. These symptoms may appear in unison, but more often, you get affected by cumulative symptoms.

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4. What Is the Relation between RSD and ADHD?

ADHD is a mental condition characterized by impulsiveness, hyperactivity, and inattentiveness. Most of the people who suffer from one of these conditions usually develop the other. Moreover, these two conditions can feed off each other and increase their negative implications.

People with ADHD can easily get overly emotional and feel depressed or let down when their feelings are not reciprocated. This can be viewed as one of the many overlaps between the two mental health conditions.

Additionally, these cognitive disorders can lead you to procrastinate as you wait for the perfect time to carry out a certain task. This can result in feelings of hopelessness and frustration. Over time, you may also begin to feel as though people disapprove of how you do things, which could further heighten anxiety, alienation, and depression.

According to some early research, the effects of ADHD, such as having unrealistic expectations, and a heightened level of emotional sensitivity towards criticism and rejection, can lead to the development of RSD in extreme cases, and where there’s no history of professional attention and treatment, ADHD and RSD can lead extreme lack of confidence and suicidal thoughts and actions.

Both ADHD and rejection-sensitive dysphoria can strain relationships between the affected and friends and relatives. These strained relationships can trigger anxiety attacks and various mental health conditions.

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5. How Can You Tell When You Have RSD?

Diagnosis of RSD is very challenging, and only a certified health professional can rule out whether or not you have RSD. Since RSD is not recognized under DSM-5 criteria, it becomes difficult to make a diagnosis for every individual using set criteria.

Similar to the above-mentioned signs of RSD, there’s no definitive line to how someone with the condition should act. However, there are some easily observable characteristics related to the condition. Below are some of the ways you can tell you have rejection-sensitive dysphoria:

1. You Are Always Trying to Please Other People

When suffering from RSD, your emotions and feelings are pegged on the approval of others. As a result, you may find yourself doing what others want to satisfy their needs. Over time, this can lead you to lose your sense of personality and character. Trying to please others can easily lead to depression and feeling rejected when others do not approve of your actions.

2. You Find It Challenging to Try New Things

One of the most effective ways to grow and advance is by trying new things. However, with RSD, you’ll likely be afraid to try new things as failing may lead to others’ disapproval. As a result, by trying to please others by being perfect, you could end up stuck in the same place, which then results in feelings of hopelessness and frustration.

3. You Try to Be Perfect at Everything

When you have RSD, you believe the only way to be accepted by others is by being perfect at everything you do. Since no one can be perfect at everything, trying to do so will only lead to increased stress and anxiety.


Rejection-Sensitive Dysphoria
Psychological Effects of RSD


6. Rejection Sensitive Dysphoria Treatment

While the cause of RSD is not well understood, there are certain curative and management options for people living with the condition. While the information displayed below is meant to be practically helpful, you should steer away from self-medication.

If you suspect you could be suffering from rejection-sensitive dysphoria, the best course of action is to seek professional help. Your general physician will direct you to a psychologist or other qualified experts to help diagnose the condition. If you’re found to have RSD, the doctor may recommend one or more treatment options, including:

Cognitive Behavioral Therapy

Cognitive-behavioral therapy is one of the most effective remedies against rejection sensitivity. This therapy has also been proven as an appropriate remedy in the reduction and stabilization of hypersensitivity.

Through CBT, patients can also learn various coping mechanisms to overcome RSD complications and symptoms. The approach of CBT is open conversations with a qualified therapist.


While there is no FDA-approved medication that caters to RSD, there are numerous off-label prescriptions that can help overcome the effects of RSD. These drugs can also improve coping mechanisms and improve your quality of life and interactions with others.

These medications are usually prescribed in addition to cognitive behavioral therapy sessions. Guanfacine is the most prescribed drug in combating RSD. 

Lifestyle Changes

Even without medication, it is possible to combat RSD with lifestyle changes. Practices like yoga, mindful meditations, controlling emotions, regular sleep, and exercise can help improve your coping mechanism against RSD.

These lifestyle changes can gradually improve your coping mechanisms. However, you shouldn’t dismiss the other treatment options as combining all of them increases your chances of fighting RSD.


Rejection-Sensitive Dysphoria
RSD Coexisting Conditions


7. Frequently Asked Questions Regarding RSD

These are the most asked questions on the subject of rejection-sensitive dysphoria:

1. How can you help someone with RSD?

The best way to help someone you suspect has RSD is by advising them to get professional help. There’s little help you can offer without a medical background. Additionally, you can also encourage the person to affect the lifestyle changes mentioned above.

2. What triggers RSD?

There are various factors that can trigger rejection-sensitive dysphoria. Some of the common triggers include criticism, embarrassment, rejection, heated arguments, and comparisons.

3. How long do RSD episodes last? 

While the episodes often last for about two hours, the effect can worsen if no care is taken. Seeking professional help is the only surefire way to combat RSD.

4. Can you have ADHD and RSD?

Yes, these conditions are not only closely related; some of the symptoms overlap. If you’re affected by one condition, you stand a higher chance of developing the other.

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Currently, rejection-sensitive dysphoria is not a clinically diagnosed condition. However, RSD does register as a severe condition with the accompanying impactful signs and symptoms.

Moreover, RSD is closely associated with other mental health conditions, such as autism and ADHD. If left untreated, RSD can worsen with time and can result in severe health complications. A certified professional can help you overcome RSD and provide effective remedial, treatment, and management measures.

Ultimately, there’s a need for more awareness of mental health conditions. Only with a better understanding will people know how to react or what to do. If you suspect you may develop RSD or know someone who is, it’s vital to get professional help as soon as possible. Only then can you combat the condition and lead a healthy and quality life.

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