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

Rejection Sensitive Dysphoria triggers intense emotional reactions to rejection or criticism. Learn the signs and tips to manage it effectively.

Rejection hurts. Whether it’s getting turned down by a potential love interest, being criticized by your boss, or getting picked last for your company softball team, 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 sensitive dysphoria (RSD).

For some people, however, being rebuffed—or simply perceiving rejection—can trigger severe emotional reactions. This is called rejection sensitive dysphoria (RSD).

WHAT IS REJECTION SENSITIVE DYSPHORIA?

Rejection sensitive dysphoria is a form of emotional dysregulation. Although it is not classified as a mental disorder, it can be highly disruptive in daily life.

People with rejection sensitive dysphoria 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 rejection sensitivity are similar to those seen in many other mental health conditions, it is often overlooked or misdiagnosed.

WHO’S AT RISK FOR REJECTION SENSITIVE DYSPHORIA?

RSD is real, and it can affect anyone, but it is more commonly seen in people who have one or more of the following three mental health conditions:

  1. 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. Those numbers have since increased.

According to the American Psychiatric Association’s 2024 mental health poll, 43% of Americans reported feeling more anxious than the year before. Some of the top anxiety-inducing issues reported in 2024 were the economy, the presidential elections, and gun violence.

  1. ADD/ADHD:

    Research has found a strong connection between people with attention-deficit hyperactivity disorder (ADHD)—also known as attention-deficit disorder (ADD)—and RSD. In fact, it is estimated that almost all ADHD sufferers also experience hypersensitivity to rejection.

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. Having ADD tends to amplify emotions, including those related to rejection.

  1. Autism:

    Autism spectrum disorder (ASD) is a neurodevelopmental 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. Emerging research suggests that people with autism may experience greater rejection-induced social pain, which can then lead to psychological distress.

Other research has found that people who are highly sensitive to rejection are at increased risk of depression, borderline personality disorder, and body dysmorphic disorder.

REJECTION SENSITIVE DYSPHORIA IN THE BRAIN

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. Single photon emission computed tomography (SPECT) scans performed at Amen Clinics show that these areas include:

  • Basal ganglia (the brain’s anxiety center)
  • 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.”

DO YOU HAVE REJECTION SENSITIVE DYSPHORIA?

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

5 HELPFUL TIPS IF YOU’RE HYPERSENSITIVE TO REJECTION

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 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.

  1. 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.

  2. 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.

  3. Stay connected.

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

  4. 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.

We're Here To Help

Rejection sensitive dysphoria, ADD/ADHD, anxiety, autism, and other mental health conditions can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.

American Psychiatric Association. American Adults Express Increasing Anxiousness in Annual Poll; Stress and Sleep are Key Factors Impacting Mental Health. May 1, 2024. https://www.psychiatry.org/news-room/news-releases/annual-poll-adults-express-increasing-anxiousness

Ginapp, Callie M et al. “”Dysregulated not deficit”: A qualitative study on symptomatology of ADHD in young adults.” PloS one vol. 18,10 e0292721. 12 Oct. 2023, doi:10.1371/journal.pone.0292721

Lin, Xinxin et al. “Autistic traits heighten sensitivity to rejection-induced social pain.” Annals of the New York Academy of Sciences vol. 1517,1 (2022): 286-299. doi:10.1111/nyas.14880

Gao S et al. Associations between rejection sensitivity and mental health outcomes: A meta-analytic review. Clinical Psychology Review, Volume 57, November 2017, Pages 59-74. https://doi.org/10.1016/j.cpr.2017.08.007

Burklund, L. J., Eisenberger, N. I., & Lieberman, M. D. (2007). The face of rejection: Rejection sensitivity moderates dorsal anterior cingulate activity to disapproving facial expressions. Social Neuroscience, 2(3–4), 238–253. https://doi.org/10.1080/17470910701391711

ABC News. More Than 50% of College Students Felt Suicidal. November 5, 2008. https://abcnews.go.com/Health/DepressionNews/50-college-students-felt-suicidal/story?id=5603837

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