Rejection Sensitive Dysphoria: What it is and How Therapy Can Help
Most people feel hurt by rejection or criticism, but for some, the reaction is more intense. When even small amounts of disapproval, rejection, or critical feedback feel overwhelming or even unbearable, it may be a sign of Rejection Sensitive Dysphoria (RSD).
RSD is not an official diagnosis, but it is a well-recognized pattern of experiences and behaviors, particularly among people with ADHD and trauma histories. The term “dysphoria” means intense unhappiness or discomfort, and in this case it refers to emotional pain triggered by real or perceived rejection or criticism, or even the perception of being left out.
What RSD Feels Like
People with Rejection Sensitive Dysphoria often describe:
Emotional pain from real or perceived criticism, rejection, or failure
Quick, overwhelming reactions such as sudden sadness, shame, or anger
Difficulty regulating emotions, leading to outbursts or withdrawal
Perfectionism or people-pleasing, in an effort to avoid disappointing others
Avoidance of challenges due to fear of failure or rejection
These reactions can feel instant and consuming—like an “emotional allergic reaction” to criticism. Some people describe feeling aware in the moment that their emotional experience is “illogical,” but unable to shake the feeling of intense negativity and reactivity.
Why RSD Happens
While we don’t know for sure what causes it, research and clinical experience suggest RSD may be linked to:
ADHD and executive function deficits – making it harder for some people to regulate intense emotions once they’ve been set off.
Early life experiences – growing up in environments with high criticism, inconsistent validation, or rejection may make people more sensitive to perceived slights.
Neurological differences – some people may be wired to experience emotional reactions more intensely and quickly than others.
How RSD Affects Daily Life
Rejection Sensitive Dysphoria can affect many areas of life, including:
Relationships – withdrawing or lashing out when feeling rejected, even unintentionally.
Work or school – avoiding opportunities due to fear of criticism, or struggling to handle feedback.
Self-esteem – internalizing rejection as evidence of being “not good enough.”
Decision-making – hesitating to take risks or pursue goals out of fear of failure.
What You Can Do If You Struggle with RSD
Notice the triggers – becoming aware of situations that spark intense reactions is the first step.
Pause before reacting – try grounding or breathing exercises to give emotions a chance to settle.
Challenge “all-or-nothing” thinking – rejection doesn’t mean you are unworthy; criticism doesn’t mean you are failing.
Practice self-compassion – remind yourself that sensitivity is not weakness—it’s a sign of deep care.
Communicate needs – letting trusted people know about your sensitivity can foster understanding.
How Therapy Can Help with RSD
Therapy can be a powerful tool for people with rejection sensitive dysphoria. It can help by:
Building awareness of RSD patterns and how they affect relationships, work, and self-image
Developing emotional regulation skills, such as mindfulness and grounding techniques
Challenging negative self-beliefs that amplify shame and rejection fears
Strengthening resilience to criticism and perceived rejection
Exploring deeper roots—including past experiences of invalidation or trauma
Rejection Sensitive Dysphoria can feel isolating, but you’re not alone. With support, you can learn to manage the intensity and adjust your response. Therapy provides a safe and supportive environment to untangle these intense feelings and develop new ways of relating to yourself and others, as well as tools for coping in the moment and space for long-term healing.
