What is Rejection Sensitive Dysphoria?
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What is Rejection Sensitive Dysphoria?



According to this study published by the American Journal of Psychiatry, emotional dysregulation and Rejection Sensitive Dysphoria (RSD for short) often accompany neurodevelopmental conditions like Attention-Deficit Hyperactive Disorder (ADHD).


Although many people with ADHD experience RSD, it still is not currently recognized by the Diagnostic and Statistical Manual of Mental Disorders. Because of this lack of recognition, there’s still a lot about RSD that’s unknown and misunderstood.


For those who want to learn more about this condition, some common questions are answered below, complete with information about how RSD affects those who have been diagnosed with ADHD and other disorders.



Table of Contents

(click on a question to be directed quickly)

What is Rejection Sensitive Dysphoria?
What causes Rejection Sensitive Dysphoria?
How does Rejection Sensitive Dysphoria affect your life?
How is RSD related to ADHD?
How do you treat Rejection Sensitive Dysphoria?







What Is Rejection Sensitive Dysphoria?


RSD is a condition characterized by severe emotional sensitivity and pain. These feelings are triggered when the person senses that they’re being rejected.


If someone with RSD feels that they’ve received criticism or rejection (especially if it comes from someone important in their life), they may take that rejection (real or perceived) harder than the average person. They might experience a strong emotional response, emotional outburst, or overreaction.


People with RSD may also have other mental health conditions like Attention-Deficit Hyperactivity Disorder, autism, or mood disorders like depression or anxiety. However, one does not have to have another diagnosis to deal with RSD.




What Causes RSD?

When a person with RSD has a strong emotional reaction to feeling rejected, a lot of factors contribute. The following are some of the most well-known influences on those with RSD:


  • Facial Expressions: People with RSD experience more dramatic changes in their brains when they’re met with a facial expression that they associate with rejection or criticism.
  • Attention Bias: People who deal with RSD tend to pay more attention to and look out for signs of rejection than others. This is known as attention bias, and it causes them to be more aware of when someone might be rejecting or criticizing them.
  • Misinterpretations: People with RSD are more likely to misinterpret people’s actions or responses and assume that they are signs of rejection or dislike.


Researchers and mental health professionals don’t know exactly what causes RSD and the issues listed above. However, these situations and conditions may play a role in someone developing extreme sensitivity to feelings of rejection:


  • Childhood Experiences: Those who experience rejection, neglect, or abuse as children are more likely to experience rejection sensitivity as adults. This may occur because these people had to learn from an early age to be aware of signs of rejection so they could keep themselves safe.
  • Biological Vulnerability: Some people may be more genetically predisposed to rejection sensitivity. This is particularly true if they experience other conditions like social phobia, insecure attachment style, or symptoms of ADHD.


Does my partner have rejection sensitive dysphoria




How Does RSD Affect Your Life? 


People with RSD are more likely to be people-pleasers than those who aren’t overly sensitive to rejection. Because these people are so worried about being rejected or disliked, they may work extra hard to try and appease others so they can feel more confident, loved, and respected.


People-pleasing behaviors can present themselves in a variety of ways. For example, some researchers have found that men who had high levels of rejection sensitivity would pay more money to be part of a group that had rejected them compared to men with lower levels of sensitivity. The study’s female participants also showed similar behaviors when they were rejected by a potential romantic partner.


RSD can have physical implications, too. Psychologists have showed that rejection-sensitive gay men experienced a more rapid progression of HIV compared to those who had low levels of rejection sensitivity.




How Is RSD Related to ADHD?


From children with ADHD to adults with ADHD, those who struggle with this condition are more likely to experience RSD than those who do not. Experts are not 100 percent sure why this is, but they suspect the following issues contribute:


  • In people with ADHD, stimuli trigger the central nervous system differently. This can change the way they perceive and respond to feelings of rejection, causing them to take these feelings more seriously and personally.
  • People with ADHD may be more likely to experience rejection and criticism compared to their neurotypical peers. This can cause them to be more aware of it and look for signs of it in the future.





How Do You Treat RSD?


Some medications can minimize the effects of RSD, including these:


  • Guanfacine (brand name Intuniv) and clonidine (brand name Kapvay), both of which lower blood pressure and can help those with RSD to feel calmer.
  • Tranylcypromine (Parnate), which treats inattention, impulsiveness, and emotional dysregulation associated with ADHD.


Along with medications, working with a therapist or mental health professional can also improve the coping skills of those with RSD. Regularly attending therapy gives them a chance to practice managing their emotions in positive, productive ways when they’re met with real or perceived rejections.


Therapists and counselors may also recommend stress management techniques, including lifestyle practices like eating well, sleeping well, and practicing meditation. These tactics teach people with RSD how to self-regulate and help them feel more in control of their emotions.







Berenson, K. R., Gyurak, A., Ayduk, Ö., Downey, G., Garner, M. J., Mogg, K., … & Pine, D. S. (2009). Rejection sensitivity and disruption of attention by social threat cues. Journal of research in personality43(6), 1064-1072.


Burklund, L. J., Eisenberger, N. I., & Lieberman, M. D. (2007). The face of rejection: rejection sensitivity moderates dorsal anterior cingulate activity to disapproving facial expressions. Social neuroscience2(3-4), 238-253.


Cole, S. W., Kemeny, M. E., & Taylor, S. E. (1997). Social identity and physical health: Accelerated HIV progression in rejection-sensitive gay men. Journal of Personality and Social Psychology, 72(2), 320–335.


Downey, G., & Feldman, S. I. (1996). Implications of rejection sensitivity for intimate relationships. Journal of personality and social psychology70(6), 1327.


Jin, M. J., Jung, W., Hyun, M. H., & Lee, S. H. (2018). Effect of behavioral inhibition system and childhood emotional neglect on serotonergic activity, negative affect, and rejection sensitivity in non-clinical adults. Plos one13(11), e0207746.


Romero-Canyas, R., Downey, G., Reddy, K. S., Rodriguez, S., Cavanaugh, T. J., & Pelayo, R. (2010). Paying to belong: When does rejection trigger ingratiation? Journal of Personality and Social Psychology, 99(5), 802–823.


Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry171(3), 276-293.




Disclaimer: ALL IN Therapy Clinic aims to improve people’s lives. We do this through providing effective mental health counseling by passionate professionals. Inspired by this, we write content for your own education. Also, our content is researched, cited, reviewed, and edited by licensed mental health professionals.  However, the information we provide is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Additionally, it should not be used in place of the advice of a qualified healthcare provider.






Written and reviewed by

Dr Kyle Zrenchik, PhD, ACS, LMFT

Dr. Kyle Zrenchik is the Co-Founder of ALL IN, the Creator of the Couples Erotic Flow model for treating sexual issues in individuals and couples, Designer of the Deep Dive programs at ALL IN, and is one of the most well-respected couples counselors in the Twin Cities.

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