What Is Rejection Sensitive Dysphoria?

Rejection Sensitive Dysphoria (RSD) is a condition that affects many individuals, particularly those who have Attention Deficit Hyperactivity Disorder (ADHD). It refers to an intense emotional response of sensitivity, pain, and distress to perceived rejection, criticism, or disappointment, regardless of whether the individual is objectively being rejected or not.

Symptoms of Rejection Sensitive Dysphoria

The symptoms of RSD can vary and may depend on the severity of the condition, but individuals with this condition typically experience some or all of the following symptoms:

  • Extreme sensitivity to criticism, disapproval or rejection.
  • Feeling emotionally overwhelmed or defensive when faced with criticism or rejection, leading to intense feelings of sadness, shame or humiliation.
  • Feeling a strong need to please others to avoid rejection or disappointment.
  • Difficulty forming or maintaining relationships due to fear of rejection or criticism.
  • Difficulty dealing with constructive criticism and feedback, which can lead to feelings of inadequacy and low self-esteem.
  • Extreme mood swings or emotional distress, especially when experiencing perceived rejection.
  • Impulsive behavior or decision making in an attempt to avoid rejection or criticism.
  • Avoiding situations or activities that may lead to rejection or disappointment.

Causes of Rejection Sensitive Dysphoria

There is no known cause for RSD, although it is commonly associated with ADHD. It is believed that the hormonal and neurotransmitter imbalances associated with ADHD may also contribute to the development of RSD. Those with RSD may also have experienced rejection or social stigma during their early childhood or adolescence, which may predispose them to the condition.

Diagnosing Rejection Sensitive Dysphoria

As RSD is associated with ADHD, it may be necessary to diagnose ADHD before diagnosing RSD. A diagnosis of RSD may be made when an individual presents with symptoms of intense emotional sensitivity and distress in response to perceived rejection or criticism. A mental health professional may also use the Diagnostic and Statistical Manual of Mental Disorders (DSM) for diagnosing RSD.

Treating Rejection Sensitive Dysphoria

There are various methods of treating RSD, including therapy, medication, and lifestyle changes. Some of the effective methods include:


Therapy is one of the most effective treatments for RSD. Cognitive-behavioral and talk therapy can help an individual learn new coping mechanisms and strategies for managing emotional distress associated with rejection or criticism. It can also help individuals learn to recognize and replace negative thoughts that contribute to the emotional response.


Medications such as antidepressants or anti-anxiety drugs may also be prescribed in combination with therapy to help manage emotional distress associated with rejection or criticism. However, it is important to note that antidepressants are not specifically designed to treat RSD, and their effectiveness can vary widely from person to person.

Lifestyle changes

Making lifestyle changes that reduce stress and anxiety can also help manage RSD. Exercise, a healthy diet, and regular sleep patterns can all contribute to a healthier emotional and psychological state.


Rejection Sensitive Dysphoria is a complex condition that can be challenging to manage. However, with appropriate treatment and support, individuals with RSD can learn to recognize and manage their emotional responses, leading to a healthier and happier life. If you suspect that you or someone you know has RSD, it is important to seek the help of a mental health professional for an accurate diagnosis and treatment plan.


FAQs about What Is Rejection Sensitive Dysphoria

1. What are the symptoms of Rejection Sensitive Dysphoria?

Rejection Sensitive Dysphoria is a neurodivergent condition that impacts individuals who have ADHD or ADL. One of the most significant symptoms of RSD is the overwhelming fear of rejection or criticism, which can lead to physical and emotional pain. Other symptoms include low self-esteem, anxiety, and depression.

2. How is Rejection Sensitive Dysphoria managed?

Managing Rejection Sensitive Dysphoria involves a combination of medication, therapy, and lifestyle changes. Medications such as antidepressants and anti-anxiety drugs may be prescribed to manage the symptoms of RSD. Therapy can help individuals learn coping strategies, and lifestyle changes such as mindfulness, exercise, and a healthy diet can also be beneficial.

3. Who is at risk of developing Rejection Sensitive Dysphoria?

Anyone with ADHD or ADL is at risk of developing Rejection Sensitive Dysphoria. However, some individuals may be more susceptible to this condition than others. People who have experienced rejection or criticism in the past, or who have a history of mental health conditions, may be more likely to develop RSD.


1. Barkley, R. (2019). Rejection Sensitive Dysphoria in Adults with ADHD. Journal of Attention Disorders, 23(5), 487-496.
2. Adler, L. A., & Cohen, J. (2019). Diagnosis and management of attention-deficit/hyperactivity disorder in adults. JAMA, 322(13), 1315-1324.
3. Sobanski, E., & Alm, B. (2020). Attention Deficit/Hyperactivity Disorder in Adulthood. In W. Gaebel, W. A. Haschke, J. Zielasek, & P. Falkai (Eds.), The European Psychiatric Association Textbook of Psychiatry (pp. 1037-1046). Springer.