Rejection Sensitive Dysphoria, Symptoms, Causes, and Treatment

Rejection Sensitive Dysphoria (RSD) is an intense emotional response to perceived rejection, criticism, or failure, often associated with ADHD.

Rejection Sensitive Dysphoria Overview

Rejection Sensitive Dysphoria (RSD) is a complex emotional condition that often coexists with Attention-Deficit/Hyperactivity Disorder (ADHD). It involves intense emotional responses and sensitivity to perceived rejection or criticism, leading to profound distress and dysphoria. Rejection Sensitivity Dysphoria can significantly impact an individual’s emotional well-being and quality of life. This article will delve into Rejection Sensitive Dysphoria, exploring its symptoms, underlying causes, and available treatment options.

What is Rejection Sensitive Dysphoria?

Rejection Sensitive Dysphoria (RSD) is a psychological condition characterized by an extreme sensitivity to perceived rejection or criticism from others. It is commonly associated with Attention-Deficit/Hyperactivity Disorder (ADHD), although it can occur independently.

People with RSD ADHD may have an overwhelming fear of being rejected or judged, leading them to avoid situations where they anticipate criticism or disapproval. They may also exhibit social withdrawal, isolation, or a strong desire to please others to avoid rejection. This heightened sensitivity can significantly impact their relationships, self-esteem, and well-being.

Rejection Sensitive Dysphoria Symptoms

  1. Intense Emotional Responses: Individuals with RSD often experience strong emotional reactions to situations they interpret as rejection, disapproval, or failure. These emotional responses can be overwhelming and disproportionate to the situation at hand.
  2. Fear of Rejection and Criticism: There is a persistent and profound fear of being rejected, criticized, or judged by others. This fear may extend to various areas of life, including personal relationships, social interactions, and professional settings.
  3. Hypersensitivity to Rejection Cues: People with RSD are highly attuned to subtle cues or perceived signs of rejection. They may overanalyze and misinterpret others’ words, gestures, or actions, making them feel rejected even when no actual rejection occurs.
  4. Social Withdrawal and Avoidance: Due to the fear of rejection, individuals with RSD may withdraw from social interactions or avoid situations where they anticipate criticism or disapproval. They may become socially isolated or limit their participation in activities that involve potential judgment or rejection.
  5. Mood Swings and Emotional Dysregulation: RSD can contribute to rapid and intense mood swings. Individuals may experience sudden shifts between emotional states, such as happiness to sadness or calmness to anger, in response to perceived rejection or criticism.
  6. Self-Esteem Issues and Self-Criticism: RSD can significantly impact self-esteem. Individuals may have a persistent negative self-image and engage in excessive self-criticism. They may internalize perceived rejection, leading to feelings of worthlessness, self-doubt, and self-blame.
  7. Avoidance of Risk-Taking: People with RSD may avoid taking risks or pursuing goals due to the fear of potential failure or rejection. They may hesitate to try new things, express their opinions openly, or take on challenging tasks that could expose them to judgment or criticism.
Those with ADHD and RSD often experience heightened emotional sensitivity and reactivity.
Those with ADHD and RSD often experience heightened emotional sensitivity and reactivity.

ADHD Fact Sheet

Prevalence: ADHD is one of the most common neurodevelopmental disorders, affecting approximately 5-10% of children and 2-5% of adults worldwide. It is more commonly diagnosed in males than females.

Core Symptoms: The core symptoms of ADHD include inattention, hyperactivity, and impulsivity. Individuals with ADHD may struggle to sustain attention, organize tasks, follow instructions, sit still, and control impulses.

ADHD is categorized into three subtypes:

a. Predominantly Inattentive Presentation: Primarily characterized by difficulties with attention and organization.

b. Predominantly Hyperactive-Impulsive Presentation: Primarily characterized by hyperactivity and impulsivity.

c. Combined Presentation: Displays symptoms of both inattention and hyperactivity-impulsivity.

Diagnosis of ADHD: This involves a comprehensive evaluation, including interviews with the individual, parents (for children), and teachers or other relevant observers. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria are commonly used for diagnosis.

Long-Term Outlook: With appropriate diagnosis, treatment, and support, individuals with ADHD can lead fulfilling lives. Early intervention and ongoing management can significantly reduce the impact of symptoms and improve overall functioning.

Co-occurring Conditions: ADHD often coexists with other conditions such as learning disabilities, anxiety disorders, depression, oppositional defiant disorder (ODD), and conduct disorder (CD). These comorbidities can further complicate diagnosis and treatment.

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Rejection Sensitive Dysphoria Statistics

Rejection Sensitive Dysphoria (RSD) is a psychological phenomenon that has gained recognition and attention in recent years, particularly in the context of Attention-Deficit/Hyperactivity Disorder (ADHD). While there is limited research specifically focused on RSD, understanding the prevalence and impact of this condition can provide valuable insights into the experiences of individuals who struggle with emotional hypersensitivity and fear of rejection.

This article aims to explore the available statistics on Rejection Sensitive Dysphoria, shedding light on its prevalence, co-occurrence with ADHD, and its potential impact on the lives of those affected. By examining these statistics, we can better understand the scope and significance of RSD as a psychological phenomenon.

  1. Prevalence of Rejection Sensitive Dysphoria: Estimating the overall prevalence of RSD is challenging since it is not recognized as a distinct diagnosis in the DSM-5. However, it is commonly associated with ADHD, which has its prevalence rates.
  2. Co-Occurrence of RSD and ADHD: Research suggests that RSD frequently coexists with ADHD, with some studies indicating that up to 99% of individuals with ADHD may experience symptoms of RSD.
  3. Impact of RSD on Mental Health and Functioning: While specific statistics on the impact of RSD are limited, anecdotal evidence and clinical observations indicate that RSD can significantly affect an individual’s emotional well-being, social interactions, and overall quality of life.
  4. Gender Differences in RSD: Some evidence suggests that RSD may be more prevalent in females with ADHD than males. However, further research is needed to understand the gender differences in RSD clearly.

8.7 Million

In 2019, the number of visits to physician offices with attention deficit disorder as the primary diagnosis was 8.7 million.

Source: NIMH


Approximately 9.5% of American adults, ages 18 and over, will suffer from a depressive illness (major depression, bipolar disorder, or dysthymia) each year.

Source: NIMH


The heritability of ADHD, estimated to be around 70-80%, further supports the notion that genetic factors play a substantial role in its development.

Source: NIMH

Rejection Sensitivity Dysphoria Causes

  1. Neurobiological Factors: Differences in brain structure, neurotransmitter function, and neural pathways have been suggested as potential contributors to RSD. Individuals with RSD may have altered processing of emotional stimuli, leading to heightened emotional reactivity and sensitivity to rejection.
  2. Genetic Predisposition: There may be a genetic component to RSD, as studies have shown that certain genetic variations may increase the risk of developing emotional sensitivity and vulnerability to rejection. However, more research is needed to identify specific genetic factors associated with RSD.
  3. Emotional Trauma and Adverse Life Experiences: Traumatic experiences, such as repeated rejection, bullying, or significant emotional distress during childhood or adolescence, may contribute to the development of RSD. These experiences can shape an individual’s perception of rejection and increase their sensitivity to future instances of perceived rejection.
  4. Environmental Factors: Growing up in an environment where criticism, rejection, or emotional invalidation is prevalent can influence the development of RSD. High levels of stress, unstable relationships, or inconsistent emotional support may contribute to heightened sensitivity to rejection.
  5. Co-Occurrence with ADHD: RSD is commonly associated with Attention-Deficit/Hyperactivity Disorder (ADHD). The emotional dysregulation and impulsivity often seen in individuals with ADHD may exacerbate their sensitivity to rejection and criticism.

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RSD ADHD Examples

  1. Academic Challenges: A student with ADHD and RSD may experience intense fear of failure and criticism from teachers or peers. They might be highly sensitive to receiving constructive feedback or corrections on their work, leading to feelings of inadequacy and a strong desire to avoid academic tasks altogether.
  2. Social Interactions: Individuals with ADHD and RSD may struggle navigating social situations. They might constantly worry about saying or doing something wrong and fear being judged or rejected by others. As a result, they may avoid social gatherings, struggle to establish and maintain friendships or become excessively self-conscious in social settings.
  3. Perfectionism: RSD can contribute to a perfectionistic mindset in individuals with ADHD. They may set excessively high standards for themselves to avoid criticism or rejection. However, the fear of falling short of those expectations can lead to anxiety, procrastination, and difficulty initiating or completing tasks.
  4. Emotional Sensitivity: Those with ADHD and RSD often experience heightened emotional sensitivity and reactivity. They may react intensely to perceived rejection, criticism, or minor setbacks. Small conflicts or disagreements can quickly escalate into overwhelming emotional distress, leading to feelings of sadness, anger, or frustration.
  5. Impulsivity and Rejection: In the context of ADHD, impulsivity can exacerbate the challenges related to RSD. For example, a person with ADHD and RSD may impulsively interrupt others in conversations, leading to negative reactions and perceived rejection. This can further reinforce their fear of being socially rejected and increase their emotional sensitivity.
  6. Work and Career Challenges: Individuals with ADHD and RSD may struggle in professional environments. They may be susceptible to feedback or perceived criticism from supervisors or colleagues, leading to heightened stress and difficulty coping with workplace demands. This can affect their confidence, job performance, and overall job satisfaction.

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  1. Psychoeducation: Education about RSD and its association with ADHD can be empowering. Learning about the condition helps individuals understand the nature of their emotional sensitivity, recognize triggers, and develop strategies for managing their reactions.
  2. Cognitive-Behavioral Therapy (CBT): CBT techniques can be effective in helping individuals with RSD challenge negative thought patterns, develop healthier beliefs about rejection, and learn skills to regulate their emotions. CBT can also address perfectionism, self-criticism, and social skills deficits.
  3. Medication: Medication may be considered, particularly if RSD coexists with ADHD. Stimulant medications commonly prescribed for ADHD, such as methylphenidate or amphetamines, can help manage symptoms of impulsivity, inattention, and emotional dysregulation.
  4. Supportive Therapies: Various supportive therapies can complement the treatment of RSD. This may include interpersonal therapy, which focuses on improving relationships and social functioning, or psychodynamic therapy, which explores underlying emotional issues and past experiences.
  5. Coping Strategies: Learning and practicing effective coping strategies can help individuals manage their emotional reactivity. This may involve relaxation techniques (e.g., deep breathing exercises, mindfulness), problem-solving skills, assertiveness training, and stress management techniques.
  6. Lifestyle Adjustments: Adopting a healthy lifestyle can have a positive impact on emotional well-being. This includes regular exercise, sufficient sleep, a balanced diet, and engaging in activities that promote relaxation and self-care.
  7. Support Groups: Joining support groups or engaging in peer support can provide individuals with RSD a sense of validation, understanding, and connection with others who share similar experiences. Sharing experiences, insights, and coping strategies with peers can be invaluable in managing RSD.

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  1. What is rejection sensitive dysphoria?

    Rejection Sensitive Dysphoria (RSD) is an intense emotional response to perceived rejection, criticism, or failure, often associated with ADHD.

  2. Can you have RSD without ADHD?

    While Rejection Sensitive Dysphoria (RSD) is commonly associated with Attention-Deficit/Hyperactivity Disorder (ADHD), it is possible for individuals to experience RSD without having a diagnosis of ADHD. RSD can occur as an independent condition and may be present in individuals who do not meet the criteria for ADHD.

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Search We Level Up WA Mental Health Rejection Sensitive Dysphoria Topics & Resources

[1] What is ADHD? | CDC Examining ADD vs ADHD Learn More: Rejection Sensitive Dysphoria

[2] NIMH » Mental Illness ( ADD vs ADHD Review Learn More: Rejection Sensitive Dysphoria

[3] NIMH » Attention-Deficit/Hyperactivity Disorder (ADHD) ( Learn More: Rejection Sensitive Dysphoria

[4] Attention Deficit Hyperactivity Disorder – StatPearls – NCBI Bookshelf ( ADD vs ADHD Adults Review. Learn More: Rejection Sensitive Dysphoria

[5] ADHD: Reviewing the Causes and Evaluating Solutions – PMC ( ADD vs ADHD in Adults Causes. Learn More: Rejection Sensitive Dysphoria

[6] What is mental health? Evidence towards a new definition from a mixed methods multidisciplinary, international survey – PMC ( ADD vs ADHD Symptoms Learn More: Rejection Sensitive Dysphoria

[7] COMMON MENTAL HEALTH DISORDERS – Common Mental Health Disorders – NCBI Bookshelf ( ADD vs ADHD in Female Adults Learn More: Rejection Sensitive Dysphoria

[8] About Mental Health ( Learn More: Rejection Sensitive Dysphoria

[9] Information about Mental Illness and the Brain – NIH Curriculum Supplement Series – NCBI Bookshelf Learn More: Rejection Sensitive Dysphoria

[10] Effective Mood And Personality Disorder Treatment ( Learn More: Rejection Sensitive Dysphoria