Rejection sensitivity and rejection sensitive dysphoria (RSD)

Reviewed by Robert Bogenberger, PhD

Written by

therapist.com team

Last updated: 10/27/2025

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Have you ever felt an overwhelming wave of emotional pain when you thought someone was criticizing or rejecting you? If so, you might have been motivated by rejection sensitivity.

Rejection sensitivity is the tendency to expect, notice, and strongly react to rejection or criticism.¹ For some people, especially those with attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), this response may be particularly intense. ^2,3 Some people use the term rejection sensitive dysphoria (RSD) to refer to this state of extremely heightened sensitivity and resulting negative emotions.

What is rejection sensitive dysphoria?

Rejection sensitive dysphoria (RSD) is a more recent, informal term that’s gained popularity within ADHD communities.⁴ It describes an especially intense form of rejection sensitivity where perceived rejection causes overwhelming thoughts and emotions.

People who experience RSD often dwell on negative emotions and self-blame after feeling rejected, criticized, or excluded. These events can cause physical discomfort and a strong urge to withdraw from others. People who experience RSD may know their reaction is out of proportion to an event but still feel unable to control it.

Rejection sensitivity is commonly discussed in relation to ADHD, but it’s not a part of the official ADHD diagnostic criteria. Recent research has found that rejection sensitivity plays a significant role in the emotional experiences of some people with ADHD, even though traditional diagnostic measures don’t include it.⁵

Is rejection sensitive dysphoria a real diagnosis?

The concept of rejection sensitivity is acknowledged in scientific literature, but rejection sensitive dysphoria is not currently recognized as a diagnosable condition. The term “rejection sensitivity” appears only once in the DSM-5, as a potential specifier for certain presentations of bipolar and related disorders.⁶

Although rejection sensitivity has been studied in psychology for decades, the idea that RSD is related to ADHD is more recent. It’s gaining recognition among some clinicians who work with ADHD patients, but it’s still used as a clinical description rather than a diagnosis.

How rejection sensitivity and RSD present

There are no official “symptoms” of rejection sensitive dysphoria because it’s not a recognized diagnosis. However, in a recent case study series a group of researchers and clinicians explored a set of core experiences reported to them by hundreds of patients and clients with ADHD.⁷ These shared experiences included:

• Intense emotional or even physical pain in response to perceived rejection
• Profound feelings of shame and inadequacy
• Feeling ostracized or cast out
• Episodes that hit suddenly and without warning
• Strong emotional reactions triggered by rejection, criticism, or not meeting personal standards

Intense responses to rejection can present in different ways. Some people internalize the emotions in a way that might resemble a depressive episode. Others may respond with rage directed at the person or situation that triggered the feelings.

People with high rejection sensitivity are more likely to interpret unclear social cues as signs of rejection, and to be more distressed by that rejection, than people with low rejection sensitivity.⁸

It’s important to note that rejection sensitivity can affect anyone. It’s not determined or limited by age, gender, background, or whether you identify as neurodivergent. If you’re experiencing intense emotional reactions that are impacting your daily life, consider speaking with a therapist. They can help you identify patterns creating challenges in your life and develop healthy coping strategies.

What causes rejection sensitivity?

Understanding the causes of rejection sensitive dysphoria is a continuing area of research. Though the exact causes aren’t known, studies have identified several factors correlated with rejection sensitivity:⁹

• Developmental experiences: Studies have found associations between rejection sensitivity and childhood experiences with emotional abuse, parental harshness, and mistreatment. Although these experiences are linked to later rejection sensitivity, it’s important to note that it’s not certain they directly cause it.
• Genetic factors: Preliminary research suggests there may be genetic components to rejection sensitivity, with some studies finding associations between certain gene variants and vulnerability to feeling rejected.
• Brain chemistry: Early research indicates that differences in brain chemistry, particularly in regions involving pain processing, might play a role in rejection sensitivity.

Rejection sensitivity and ADHD

Research suggests that rejection sensitivity is commonly experienced by people with ADHD, though it’s not an official part of the criteria for diagnosis. One study found that young adults with ADHD saw rejection sensitivity as a significant part of their emotional experience of ADHD, despite not being an official symptom.¹⁰

Another study focused on children and adolescents with ADHD found they reported higher levels of rejection sensitivity and justice sensitivity compared to people without ADHD.¹¹

Rejection sensitivity and autism spectrum disorder

The connection between rejection sensitivity and autism spectrum disorder (ASD) is still being explored.

One study has shown traits associated with ASD are also associated with increased sensitivity to social rejection.¹² This heightened sensitivity could also increase symptoms of depression and anxiety.

Can I have intense rejection sensitivity without ADHD or autism?

Rejection sensitivity isn’t a diagnosable condition—it’s a pattern of emotional response. And it’s normal for a person to feel pain when they experience rejection. So you may identify as being sensitive to rejection even without an underlying mental health condition.

Rejection sensitivity has also been linked with conditions beyond ADHD and ASD.¹³ These conditions include depression, anxiety, borderline personality disorder (BPD), and body dysmorphic disorder (BDD).

The impact of rejection sensitivity on daily life

Rejection sensitivity can significantly affect how people navigate relationships and social situations:

• People with high rejection sensitivity tend to react more hostilely in a given situation than people with less RS.¹⁴
• Adults who are sensitive to rejection may behave in ways that unintentionally undermine their relationships, contributing to higher rates of relationship problems.¹⁵
• People with intense rejection sensitivity may develop coping mechanisms like perfectionism (to avoid criticism), people-pleasing (to avoid rejection), or giving up on challenging activities (to avoid failure).¹⁶ These patterns can significantly impact academic performance, work success, and personal happiness.

Treatment for rejection sensitivity and RSD

Rejection sensitive dysphoria treatment approaches are still developing. While there’s no standardized treatment specifically for intense rejection sensitivity, several approaches may help manage symptoms:

• Medication: One proposed treatment option includes certain ADHD medications and some antidepressants, which clinicians report may help manage symptoms.¹⁷ This may be especially helpful in people who experience dysphoria as a result of their RS.
• Mindfulness-based interventions: These approaches have shown effectiveness in treating conditions characterized by rejection sensitivity, such as social anxiety and BPD.¹⁸
• Cognitive behavioral therapy (CBT): CBT and mindfulness have shown promise in helping people manage rejection sensitivity, with participants reporting significant improvement in their emotional responses.¹⁹

If you or someone you care about are struggling with rejection sensitivity, consider speaking with a mental health professional. They can help determine whether the sensitivity is related to an underlying condition and develop appropriate strategies for managing intense emotions.

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