What is Rejection Sensitivity Dysphoria…and Do You Have It?

Rejection hurts. Whether it’s getting turned down by your crush, being criticized by your boss, or getting picked last for the basketball team at school, getting rejected sucks. Most of us are able to shake it off and move on with our lives. For some people, however, being rebuffed—or simply perceiving rejection—can trigger severe emotional reactions. This is called rejection sensitivity dysphoria (RSD).


People with RSD experience an overwhelming emotional response to real or perceived rejection, criticism, judgment, or being left out. They may lash out in anger, dwell on negative thoughts, feel hopeless, think they’re a failure, or feel their self-esteem plummet. Their moods may drop so rapidly and dramatically, it can feel like major depression and can lead to suicidal thoughts and behavior.

As a result of these intensely distressing feelings, people with RSD tend to avoid social situations, become perfectionists, develop an extreme fear of failure, and adopt people-pleasing attitudes. Because the symptoms and consequences associated with RSD are similar to those seen in many other mental health conditions, it is often overlooked or misdiagnosed.


RSD is real, and it can affect anyone, but it is more commonly seen in people who have:

  • Anxiety: People with anxiety are generally more sensitive to criticism, and they tend to be people pleasers. Prior to the pandemic, over one-third of Americans struggled with anxiety. Now with the threat of COVID-19, economic losses, social unrest, and greater uncertainty, well over 50% of people are feeling anxious.
  • ADD/ADHD: Scientists have found a strong connection between people with attention-deficit disorder (ADD) / attention-deficit hyperactivity disorder (ADHD) and RSD. In fact, it is estimated that almost all ADD/ADHD sufferers also experience hypersensitivity to rejection. ADD/ADHD is a brain-based disorder that is associated with an array of behavioral and emotional symptoms, including short attention span, distractibility, poor impulse control, irritability, being easily stressed, and a sense of insecurity. ADD/ADHD tends to amplify emotions, including those related to rejection.
  • Autism: Autism spectrum disorder (ASD) is a brain disorder characterized by social communication problems, abnormal social skills, and learning and behavioral issues. People with ASD often have trouble understanding social cues and difficulty recognizing and expressing emotions. Combined with heightened sensory reactions, this adds up to extreme hypersensitivity to criticism.

Research in Clinical Psychology Review has also found that people who are highly sensitive to rejection are at increased risk of depression, borderline personality disorder, and body dysmorphic disorder.


According to brain imaging research in Social Neuroscience, people with higher levels of rejection sensitivity experience activation in specific regions of the brain when looking at faces displaying disapproval.

At Amen Clinics, which has built the world’s largest database of functional brain scans related to behavior, people who are hypersensitive to rejection tend to have overactivity in certain regions of the brain, such as the basal ganglia (the brain’s anxiety center) and anterior cingulate gyrus (the brain’s gear shifter). Too much activity in the basal ganglia is associated with heightened anxiety. When there is hyperactivity in the ACG, it is linked to getting stuck on negative thoughts and worries, like “I’m going to say the wrong thing and everybody will laugh at me.”


How can you tell if you have RSD? Only a professional who performs a comprehensive examination including functional brain imaging and lab tests to help identify possible root causes for your symptoms can give an accurate diagnosis. However, if you recognize yourself in the following traits, it’s worth investigating RSD further with an integrative neuropsychiatrist.

  • Overwhelming emotional reactions to any form of rejection
  • Extremely sensitive to the mere possibility of rejection, fear of failure
  • Perfectionism, or setting higher standards for yourself than for others
  • Quickly feeling intense shame and guilt when your actions don’t live up to your expectations
  • Lashing out with anger or rage in response to criticism, judgment, or exclusion
  • Social withdrawal as a way to avoid rejection
  • Approval-seeking behavior
  • Low self-esteem, or needing validation from others
  • Overreact or misinterpret facial expressions


If you’re struggling with rejection sensitivity, here are 5 strategies that can help.

1. Don’t believe every stupid thought you have.

If you get stuck on thoughts—such as, “I messed up and gave the wrong statistic during my work presentation, now everybody thinks I’m stupid”–you can stop the loop by challenging your thoughts. Learn to kill the ANTs (automatic negative thoughts) that make you feel rejected. Ask yourself if your thoughts are really true and talk back to them. This is especially true if you have suicidal thoughts. Many people have thoughts of taking their own life, but they don’t act on them. One study in 2008 found that over half of all college students had suicidal thoughts during their lifetime. Suicide is a permanent solution to a temporary feeling. And if you hurt yourself, you’re teaching your kids that this is how grown-ups solve problems.

2. Learn the 18-40-60 rule.

If you’re overly sensitive, remember this. When you’re 18, you think everybody is judging you, and you care deeply about what they think of you. When you reach 40, you no longer care what anybody thinks about you. Once you hit 60, you realize nobody has been thinking about you at all because most people only think about themselves.

3. Accept that teenage children will reject you.

You may feel hurt when your teen pushes you away, but this is a normal part of life. During adolescence, teens have the psychological tasks of creating their own identity separate from their parents and developing independence. Accepting this fact of life can help you cope with the rejection.

4. Stay connected.

Isolation and loneliness are not good for people with RSD. Rather than retreating from people, find ways to stay connected.

5. Take care of your brain.

Fueling your brain with healthy foods, healthy behaviors, and healthy thinking patterns can help you handle criticism in a healthier way.

Rejection sensitivity dysphoria, ADD/ADHD, anxiety, autism, and other mental health issues can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time.

At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, remote clinical evaluations, and video therapy for adults, children, and couples. Find out more by speaking to a specialist today at 888-288-9834. If all our specialists are busy helping others, you can also schedule a time to talk.


  1. I’m wanting my husband to get a brain scan ?
    I’m already your patient

    Comment by Ryan Goddard — August 21, 2020 @ 3:45 AM

  2. This is so informative thank you Amen clinic.

    I am in South Africa and I have a private practice as a psychological counsellor. What is described in the article describes the problems i have seen in my own life and life of clients, what i love is that Dr AMEN provides ways a person can deal with their issues.

    Comment by Lerato — August 21, 2020 @ 3:47 AM

  3. Very helpful. i’m 67, so yes, people probably are only thinking of themselves.

    Comment by judi — August 21, 2020 @ 6:52 AM

  4. I learned something new today with this article. Thank you for information that adds to understanding about reasons for certain thoughts and behaviors.

    Comment by Denise Caruselle — August 21, 2020 @ 6:57 AM

  5. I definitely have it. What supplements should i take. I was seen in the Reston Office in Feb. (i think)

    Comment by Barbara Klestzick — August 21, 2020 @ 7:00 AM

  6. This sounds exactly like me. I am 76 years old, was married 51 years and now a Widower. For all those years I was able to cope reasonably well with my insecurities. My wife was wonderful. She was able to cope with my problems even though I was diagnosed with an Identity Disorder at 33 and in my early sixties a Schizotypal Personality Disorder, shortly after Schizophrenia with paranoia. I have been seeing a therapist for 14 years now and I’m better, but since my wife died with ALS I have been struggling to be more involved at church. All I ever needed was my wife, but she is gone now. My new therapist, as well as my late wife, believes I am suffering from Aspergers Syndrome. I felt rejected as a child and can not remember my early years including Grade School. My memory seems to be intact from age 12-13 on, but I don’t remember Elementary School at all. I don’t know where I went to school for the first 7 years.

    Comment by Terry Hopkins — August 21, 2020 @ 7:34 AM

  7. This is great stuff—literally decades ago, I published on ” emotional sensitivity” which seems to be the same thing as this rejection sensitivity dysphoria ( Is this in DSM-5?? ) and teachers have spoken to me countless times about students who ” shut down ” when criticized or given feedback about their work- Some college students seem to be able to handle criticism ( Musicians, athletes, drama majors ) but other students absolutely go berserk when they do not get an ” A” on a paper and seem extremely distraught and agitated. SO, I thank you for bringing this to the general public ( and especially teachers who have to deal with this. ) I tend to suspect that gifted kids are also somewhat over-sensitive to criticism or feedback- since most of their lives have been filled with approval and a lot of positive rewards and reinforcements . Again, thanks for sharing this !

    Comment by Michael Shaughnessy — August 21, 2020 @ 7:52 AM

  8. I have Inattentive ADHD and I struggle with this so badly! It’s worse than the ADHD itself.

    Comment by Cal — August 21, 2020 @ 8:35 AM

  9. Hello Ryan, thank you for reaching out. We’d be happy to contact you directly and assist in getting you information for your husband to be seen for a SPECT scan.

    Comment by Amen Clinics — August 21, 2020 @ 8:41 AM

  10. I’ve dealt with these type thoughts and triggers my whole life, effecting all aspects of my life and relationships and to see a name for this as a real thing is so validating!!! My struggle is I am isolating and wanting to avoid relationship more than ever at 51 due to the toll it takes on me. How do I change this, versus just forcing myself to reject the thoughts, which doesn’t really work well… the irrational triggers are the problem?

    Comment by Tonya Pixley — August 21, 2020 @ 9:34 AM

  11. I just ran into this article while reading my morning emails. That’s me and explains a lot about my family. I’m 78, a widow with one married daughter. Since my husband’s death, I feel like a new person, but in a good way. I long ago realized nobody was really thinking about my quirks more than I was. Everyone should read this article. Thank you.

    Comment by Bonnie Lowry — August 21, 2020 @ 10:13 AM

  12. So helpful! Thank you!

    Comment by Marty — August 21, 2020 @ 12:53 PM

  13. This is the first time, I hear about RSD, and I have it since I was a teenager and is been a long time.
    Thank you for the insight, I do not think I can overcome this disorder on my own, and will require a professional to help me.

    Comment by Sonia — August 21, 2020 @ 2:35 PM

  14. Never heard of this before, but it sounded exactly like my son, who has been to the NYC and Atlanta Amen Clinics, last time about 5 years ago. I forwarded it to him and he agreed. He’s 26 now and basically paralyzed with inaction. What to do?

    Comment by Nancy Ross — August 21, 2020 @ 3:30 PM

  15. I definitely have had this issue. I wont bore anyone with how I have discovered how to cope, but what I have found that has been the most helpful is taking a chance and trusting in Jesus. Meditating on Scripture and truly putting my trust in His Word. Someone mught discount this, but it has been the ONLY way I can say I have managed not to be paralyzed by fear of what other think of me. I was rejected a lot as a kid. We might be zeros to this world but with Jesus the one, we are 10s, 100s and 1000s! 🙂

    Comment by Bianca — August 21, 2020 @ 5:59 PM

  16. RSD is not a risk factor for BPD. You do not develop BPD. It isn’t a mental illness. It is a personality disorder. RSD is also a result of BPD. Those with BPD feel all negative emotions intensively. They are in serious emotional pain. And to add to it they generally have separation anxiety/fear of abandonment.

    Those with RSD should be evaluated for BPD, because BPD affects many other aspects of life. Both the sufferer and their loved ones will benefit greatly from the skills that are taught in DBT/CBT, which is the treatment for BPD.

    Comment by Natasha Millikan — August 22, 2020 @ 3:15 AM

  17. Good article but not so good solutions. I can’t think them away it’s stronger than me.

    Comment by Sherry Rock — August 22, 2020 @ 4:11 AM

  18. This is such a relief for me. Lately I have felt this with family and I know that I’m not too sensitive or that I am reading the situation incorrectly. My husband doesn’t support me in my feelings which makes it that much more difficult. I’ve had your brain scans and was diagnosed with PTSD. Have followed your prescriptions and work on myself every day. It’s hard sometimes. But with your help I am so relieved knowing that I do have alegitimate suffering. Not that I want to admit it but that I’m not alone, there is a reason and I can heal this with proper remedies. YaY! Thank you AGAIN for YOU!🙏💝🎁

    Comment by Anne — August 22, 2020 @ 7:24 AM

  19. Thank you for this wonderful article. Came at exactly the moment I needed to hear. Encouraged me to recognize and then to work on being less reactive.

    Comment by Peg Ugolilck — August 22, 2020 @ 8:57 AM

  20. This was truly helpful & fascinating info. While I believe that many of us have some degree of sensitivity towards criticism , I would think that for abuse victims-who received onslaughts of those repeated negative messaging, Criticism can also be overwhelming & very triggering…

    Comment by Susie — August 22, 2020 @ 1:17 PM


    Comment by JEANNE ELSTER — August 22, 2020 @ 8:16 PM

  22. Extremely helpful article. As a parent outreach coordinator, this is really valuable information for parents of teens with ADHD a nd Autism diagnosis.

    Comment by Jan — August 23, 2020 @ 11:03 AM

  23. After reading your article about RSD I realize that is one of my many problems. I have been diagnosed with ADD (maybe ADHD) , OCD, depression, and as I read this article I discovered I also have RSD, perfectionism, quick to anger when criticized, I also have cut myself off from anyone except for my children and grandchildren and those that serve a purpose in my life, ex: Doctors coworkers, hair dresser, etc. I have tried to discount my negative thoughts but it only works for a short period of time. When I’m out in public in a position when I must interact with others I come across as happy but it is very emotionally draining after the situation is over. Anything I have done in my past that turned out negative is way more worse in my mind than it actually was. I like another person said, have very little memory of my youth. I’m 66 years old. I don’t have many specific memories of my life. Some that are vague but not as many as what other people have. It’s been a very difficult life since all of my siblings and parents have passed away. They held my memories and when they told stories it was like a new experience for me. But then I ended up forgetting the story again. I want to remember but I just can’t seem to do it. I have been blessed with a wonderful husband of 48 years that accepts me for who I am but I honestly don’t know how or why he’s stuck around.

    Comment by Brenda Oliver — August 23, 2020 @ 11:45 AM

  24. Wow there is a lot of informative info on this site. Its one thing to read but another to get your other half to seek treatment. I half been co habitating with my boy friend for 7 yrs now and I have seen almost every kind of mental issue from bipolar to narsisist to bursts of rage to regecting his family to ocd to loud and obnoxious behavior. I dont know if im living with jeckel or hyde. We have all told him he needs help but he thinks we are stupid and need help. His dad was the same way and died of alseimers disease. How do you help someone like this?

    Comment by Patti — August 24, 2020 @ 8:53 AM

  25. So the brain has a tolerance for rejection scenarios interesting I didn’t know that

    Comment by cathyann dee — August 24, 2020 @ 12:28 PM

  26. This is exactly what my son is going through. He left his job as he couldn’t take it anymore back in Feb. now in Sept. he still isn’t working and is so focused on neg. thinking that he is stuck in inaction and guilt from his past.He sleeps most of the day. Trying to help him with getting him to join organizations and job applications. Hard to live with someone who is stuck in a grove of neg. thinking. Even with consistent talk therapy, he will continue with the same talk after agreeing with what you say. He’s a recovering alcoholic substitute it with smoking. He’s been self medicating to hide from himself for 20 yrs. Thank you for this article. Others don’t understand and just criticize.~jan

    Comment by Janice Benedict — September 2, 2020 @ 4:43 AM

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