What is Rejection Sensitivity Dysphoria?

If you've ever felt that criticism or rejection hits you like a physical blow - leaving you devastated, ashamed, or furious - you might be experiencing what's known as Rejection Sensitivity Dysphoria, or RSD.

The Basics

Rejection Sensitivity Dysphoria (RSD) describes an extreme emotional response to perceived rejection, criticism, or failure. The term was coined by Dr. William Dodson, a psychiatrist who has specialised in ADHD for over 25 years, to describe a pattern he observed in many of his patients.

The word "dysphoria" comes from the Greek word meaning "unbearable" - and that captures the intensity of the experience. While everyone feels some discomfort with rejection, people with RSD describe it as:

What Triggers RSD?

RSD can be triggered by actual rejection, but it's often triggered by perceived rejection - situations that feel like rejection even when no rejection was intended. Common triggers include:

• Constructive criticism or feedback (even well-meaning)
• A short text message from someone who usually writes more
• Someone seeming distracted or quiet around you
• Not being invited to something (even accidentally)
• Making a mistake in front of others
• Sensing that someone might be disappointed in you
• Fear that you've let someone down

How Does RSD Feel?

People describe their RSD experiences in vivid terms. Common descriptions include:

"It feels like being punched in the gut. My brain goes blank, my body paralyzes, and I can't think of anything except what just happened."

"Even a small criticism from my boss can send me spiraling for days. I replay it over and over, convinced I'm about to be fired."

"It's like having an emotional sunburn. Even a light touch - a slight comment, a neutral expression - feels incredibly painful."

Two Common Response Patterns

When RSD is triggered, people typically respond in one of two ways (or sometimes alternate between them):

1. Internalising (Turning Inward)

• Sudden, intense shame or self-criticism
• Feeling worthless or unlovable
• Shutting down or withdrawing
• Depression-like symptoms that come on suddenly
• Ruminating for hours, days, or longer

2. Externalising (Turning Outward)

• Sudden anger or rage at the perceived rejection
• Defensive reactions
• Blaming others
• Impulsive responses you later regret
• Pushing people away before they can reject you

RSD and ADHD

RSD is particularly common in people with ADHD. Dr. Dodson estimates that up to 99% of teens and adults with ADHD experience RSD, with about one-third finding it the most challenging aspect of their condition.

The link between ADHD and RSD isn't fully understood, but researchers believe it's related to:

• Dopamine differences: The ADHD brain processes social reward differently, making approval feel less satisfying and rejection feel more painful
• Emotional dysregulation: ADHD affects the brain's ability to regulate emotional responses
• Years of negative feedback: Many people with ADHD have received more criticism throughout their lives, creating heightened sensitivity

Is RSD a Real Diagnosis?

Here's where it gets complicated. RSD is not currently listed in the DSM-5 (the diagnostic manual used by mental health professionals). This doesn't mean the experience isn't real - it absolutely is - but it does mean:

• It's not an official diagnosis you can receive
• Some clinicians are unfamiliar with the term
• Research is still catching up to clinical observations

What is well-researched is "rejection sensitivity" (without the "dysphoria"), which describes heightened sensitivity to social rejection. The research on rejection sensitivity aligns closely with what Dr. Dodson describes as RSD.

What Can You Do About It?

The good news is that RSD can be managed. Effective approaches include:

• Medication: Alpha-2 agonists (like guanfacine) can help reduce emotional reactivity. Stimulant medications for ADHD can also help by improving overall emotional regulation.
• Therapy: CBT, DBT, and other therapeutic approaches can help you develop coping strategies and challenge distorted thinking patterns.
• Self-understanding: Simply knowing that you have RSD and that it's neurological (not a character flaw) can be incredibly validating and helpful.
• Practical strategies: Grounding techniques, pause-and-check practices, and building a support system.

You're Not "Too Sensitive"

If you've spent your life being told you're "too sensitive" or "overreacting," learning about RSD can be transformative. Your experience is valid. The intensity of your emotions isn't a choice or a character defect - it's how your brain is wired.

Understanding this is the first step toward managing it better. You can learn to anticipate your triggers, develop coping strategies, and build a life that accommodates your sensitivity rather than fighting against it.