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Rejection Sensitive Dysphoria: How to Identify It and Heal


A couple navigates rejection sensitive dysphoria.

Rejection sensitive dysphoria (RSD) is a social phobia involving a fear of rejection. People diagnosed with attention-deficit hyperactive disorder (ADHD) often express RSD. People living with other emotional disorders like Social Anxiety Disorder experience RSD as well.

You or a loved one could display symptoms of rejection sensitive disorder, extreme emotional sensitivity, and pain. This article will tell you everything you need to know to have a better idea about RSD.

Symptoms of Rejection Sensitive Dysphoria to Look Out For

RSD sufferers think minor emotional rejection equates to intense disapproval. The thought of displeasing others can cause emotional pain and panic for people with ADHD.

This can manifest in the following ways:

  • Overthinking interactions with (or intentions of) other people
  • Obsessive thought patterns
  • Easily becoming embarrassed
  • Emotional outbursts
  • Avoidance of social situations
  • Depression and anxiety
  • Perfectionism
  • Overvaluing criticism or rejection as catastrophic

Studies of RSD report that people with these symptoms have “preexisting expectations of rejection.” This gets in the way of a traditional response to social cues.

People with ADHD Often Experience Rejection Sensitive Dysphoria

Unfortunately, RSD is a newer concept researchers are still exploring. RSD is still not detailed in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Many people with ADHD exhibit emotional dysregulation. A study concerning children and high-school-age young people with ADHD displays this.

Causes of Rejection Sensitive Dysphoria

Peer rejection or emotional neglect in early life links to anxiety and trouble with emotions. Early trauma can also make any already present emotional illness harder to cope with. Environmental exposure to lead, maternal drug use, and premature birth can also cause ADHD.

Research acknowledges that adults with ADHD present different symptoms than children with ADHD; a difference that requires adjusted coding and diagnosis. Scientists will explore adult ADHD and how it manifests (including through RSD). This will create new information that can contribute to how we see, treat, and understand the condition.

Treatment of Rejection Sensitive Dysphoria

Mental illness and emotional dysfunction are often ongoing factors in a person’s life. They can benefit from treatment from a mental health professional.

Other ways to cope with RSD and other similar conditions can include:

  • Securing a prescription to regulate your emotional responses (NEVER take medical action without speaking to your doctor first)
  • Working with a psychotherapist to evaluate your patterns of behavior and ability to deal with rejection
  • Redirecting your anxious, worried energy with breathing exercises, grounding, journaling, or taking short walks

Speak to a mental health professional about how to calm your thoughts and emotional reactions. They can also help your brain redefine safety.

Rejection Sensitive Dysphoria Can Affect Your Entire Life

These behaviors and fears can stand in the way of your decisions and goals. It can make even the most mundane activities, for most, stressful. This can include something as small as dropping a can of food in the grocery store.

Someone with RSD would feel horrible about doing this. They might fixate on this negative event, worrying about the judgment of others in the store. Their nervous system can fight against them.

Nurturing personal relationships while experiencing symptoms of RSD can be much more difficult. It can be very hard for people with RSD and ADHD (and other mental health conditions) to foster closeness. This is necessary for a friendly or intimate relationship.

RSD Cannot Hold You Prisoner Forever

If your ADHD and related RSD is preventing you from living your life, you can do something about it. It is understandable that you could feel overwhelmed by this idea, but you can do this.

You deserve a happy life that centers your behavioral and emotional health. Professional guidance can allow you to stabilize and restructure your life.

You can:

  • Evaluate the impact of trauma
  • Establish routines
  • Identify triggers for your RSD
  • Learn positive self-talk
  • Lean on your community for help

Comforting a Partner Suffering from Rejection Sensitive Dysphoria

Working with your partner to strengthen your communication and bond is important. Rethink how you value each others’ needs, too. Rejection sensitive dysphoria itself produces a feeling of isolation that can keep your partner from expressing themselves or experiencing closeness.

They might have trouble with sex and anxiety or don’t share their thoughts with you when they think they are experiencing rejection.

If your partner is stuck thinking about a comment, their first instinct wouldn’t be to share it with you. Instead, they would likely spend time blaming themselves and reliving the exchange.

Tell Them Their Feelings Are Important to You

To help your loved one, acknowledge their feelings. Keep in mind how their brain might perceive certain interactions. Learn about the differences in how your brains work. Doing this can encourage a deeper connection and reduce negative symptoms.

Offer Them an Ear

Let your partner vent their frustrations, so they know they’re not alone. This can even allow them to work through their feelings and ADHD symptoms by hearing their thoughts out loud.

Consider Triggers to Better Avoid Negative Responses

If you know your partner does best in small-group situations, don’t try to guilt them into coming to a party with you. Make sure your partner leaves the house having a plan for how to react to negative emotions.

Have them carry a small journal or stim toy. Social media and mental health are not always conducive. Brainstorming other techniques together, to distract from obsessive spirals and fixation, can help relieve distress in your partner and provide support.

Attending Couples’ Therapy Can Bring You Closer

Individual counseling can help you understand your own thoughts and behaviors. You can also attend sessions with your partner geared toward strengthening your relationship.

Couples’ therapy can also allow you to speak to a neutral third party. This party will have professional knowledge of behavior and the mind. Your therapist or counselor can help you with your rejection sensitive dysphoria.

Take the first step toward better understanding your brain. Explore our services.

Modern Intimacy is a group therapy practice, founded by renowned Psychologist and Sex Therapist, Dr. Kate Balestrieri. This inclusive blog is designed to provide a wealth of information and resources for mental health, relationships, and sexuality. Subscribe today to get the latest information from our expert contributors from all around the world.


Author Bio

Dr. Kate Balestrieri is a Licensed Psychologist (CA, FL, IL + NY), Certified Sex Therapist, Certified Sex Addiction Therapist, and PACT III trained Couples Therapist. She is the Founder of Modern Intimacy. Follow her on TikTok and IG @drkatebalestrieri and the Modern Intimacy team on IG @themodernintimacy.



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