Is Rejection Sensitive Dysphoria Real?

You may be asking yourself “what is Rejection Sensitive Dysphoria (RSD)?” Well, some individuals feel the sting of rejection much more intensely than others and have an exaggerated fear of being rejected by others around them. These people are high in a trait known as Rejection Sensitivity. Some people with Rejections Sensitivity may see cues such as a partner not answering their phone call or text message immediately as a sign of outright rejection. They may disregard more logical explanations. Such behavior may end up pushing others away creating a self-fulfilling prophecy. They may overcompensate and bend over backwards in a attempt to keep themselves in others’ good graces. Others may see those with RSD as overly perfectionistic, over-sensitive, or over-reactive to the mildest types of criticism.

Evidence suggests that sensitivity to rejections isn’t just “in their head.” Social rejection activates the same part of the brain as physical pain does. Brain imaging shows that people who have the trait of sensitivity and feel rejected may trigger physiological changes, including the fight-or-flight response, and can be physically painful. Studies also show that rejection-sensitive individuals who see disapproving facial expressions may show heightened activity in areas that influence blood-pressure, decision-making, and emotions.

The causes of rejection sensitivity are unknown, but some evidence shows that genetic factors and feeling rejected by a parent or primary caregiver as a child may play a role. Some clinicians and psychologists in the ADHD community have proposed that high levels of rejection sensitivity may be classified as RSD. Certain mental health conditions, including ADHD, are associated with high emotional reactivity and is theorized that RSD occurs with ADHD for that reason. Some adults with ADHD have severe RSD to the point that it interferes with daily life and the formation of healthy relationships. However, RSD has not been recognized by the DSM, and the concept has not been widely studied to give validated diagnostic guidelines, but it has gained attention in recent years in adults with ADHD.

Can Rejection Sensitivity Be Treated?
Certain strategies have been shown to be beneficial. Therapy, particularly cognitive behavioral therapy, may help people identify negative thoughts. Couples’ therapy can also help break out of negative cycles caused by a partner’s high rejection sensitivity. Treating co-occurring mental health conditions like ADHD and depression may provide relief as well. Simply recognizing an increased sensitivity to rejection can help people cope more effectively in some cases.

Possible Signs of RSD
Due to RSD not being in the DSM-5, there are no empirically quantifiable criteria, but according to psychologist Andrea Bonior, Ph.D., some of these characteristics can help spot an overly sensitive individual:

  • High sensitivity about possible rejection
  • Feeling easily triggered toward guilt or shame
  • Isolating themselves in a preemptive strike to withdraw from socializing with others in an attempt to avoid rejection
  • Aggressive or rageful behavior toward those who have been perceived to have slighted the person
  • Frequently feeling an uncomfortable physical reaction due to “not fitting in” or being misunderstood
  • Self-Esteem that is entirely dependent on what others think, and rises and falls accordingly
  • Frequent and intense ruminating after an interaction
  • Get easily embarrassed
  • Set high standards for themselves they often can’t meet
  • Have low self-esteem
  • Feel anxious in social settings
  • Have problems with relationships
  • Feel like a failure because they haven’t lived up to other people’s expectations

Some of the signs listed are also common in other mental health conditions and can be confused with:

  • Bipolar disorder
  • Borderline personality disorder
  • Post-traumatic stress disorder (PTSD)
  • Obsessive-compulsive disorder (OCD)
  • Depression
  • Social phobia

RSD episodes can be intense, but don’t typically last very long. Because RSD can look like other mental health disorders, it is essential that you get the right diagnosis. If you have any of these symptoms, please see a psychologist, counselor, or other mental health providers for help. We have licensed professionals here at Affiliated Family Counselors who are willing to meet with you to help any way they can. Visit our website at for more information on our providers or call us at 316-636-2888. 

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