Rejection sensitive dysphoria symptoms and management tips

Most people struggle with rejection, especially when it relates to something personal, like a breakup or being excluded by your friends. But for people experiencing rejection sensitive dysphoria (RSD), any type of rejection or criticism can lead to extreme pain and distress. 

Here, we review common causes and symptoms of RSD so that you can learn how to access the right mental healthcare for your needs. 

What is rejection sensitive dysphoria?

RSD is a term that describes an extreme emotional sensitivity to rejection, criticism, and failure. People with RSD often experience feelings that are disproportionate to a situation and struggle to control their emotional reactions. Rejection can cause intense feelings of pain, sadness, betrayal, and confusion in people with RSD. Some people have even likened RSD to experiencing “stabbing knives, white-hot rage, and debilitating fear.”

For someone with RSD, something as innocent as being asked to explain their work process to their boss can lead to extreme distress. While most people would view this as a simple request, someone with RSD might interpret it as a painful personal attack that implies that they aren’t doing a good enough job and need to prove themselves. They may respond by lashing out or becoming upset enough to want to quit their job. 

Common symptoms of rejection sensitive dysphoria

RSD is characterized by sudden emotional outbursts that are extreme and difficult to manage. People with RSD also tend to show some of the following symptoms and behaviors.

Emotional symptoms:

• Fear of criticism or rejection
• Low self-esteem 
• Self-consciousness and being easily embarrassed 
• Negative self-talk
• Perfectionism 

Behavioral symptoms:

• People-pleasing behaviors
• Withdrawal from social situations
• Relationship issues, such as defensive behaviors 
• Avoidance of projects, tasks, or goals that risk failure

The emotional distress caused by RSD can also lead to physical complications, such as headaches, stomachaches, and muscle tension.

Causes of rejection sensitive dysphoria

Anyone can experience RSD, but it’s closely linked to mental health conditions like attention deficit hyperactivity disorder (ADHD) and autism. Research suggests that people with ADHD tend to feel emotions more intensely than those without the condition, making them more prone to anger, irritability, and dysregulated emotions. 

It’s worth noting that ADHD has a genetic component, meaning you’re more likely to develop RSD if someone in your family has ADHD and associated emotional regulation issues. Environmental factors may also contribute to RSD. For example, if you frequently experienced criticism, rejection, or bullying as a child, you may be more sensitive to rejection.

Four tips to manage rejection sensitive dysphoria

When left unmanaged, RSD can affect your self-esteem, interpersonal relationships, and performance at work and school. Luckily, there are several best practices for coping with difficult experiences and emotions. 

If you’re experiencing symptoms of rejection sensitivity, consider looking into:

1. Talk therapy: Therapeutic approaches like cognitive behavioral therapy (CBT) are designed to teach people how to identify and challenge unhealthy thought patterns, behaviors, and emotions. By working with a therapist, you can learn to more effectively cope with rejection, improve your communication skills, and strengthen your relationships.
2. Medication management: While there are no FDA-approved medications for RSD, some people benefit from medications typically used to treat ADHD. If you’re considering medication for RSD, it’s best to meet with a psychiatrist or other health provider.
3. Lifestyle changes: Similar to other mental health symptoms, RSD can sometimes be managed with healthy lifestyle choices. For example, regular exercise and adequate sleep can improve your mood and reduce stress. And pursuing your passions can boost self-esteem and help you find more joy. 
4. Awareness and self-compassion: RSD is a painful cycle that can be tough to break, but it starts with understanding your emotional triggers. By identifying what sets you off, you create space to bring more self-compassion and empathy into your life. To start, consider some positive affirmations to remind yourself of your worth. For example, “I am enough” or “I am worthy.” When you boost your self-worth in this way, perceived rejection from others carries less weight.

How to help someone with rejection sensitive dysphoria

If someone in your life is dealing with the symptoms of RSD, there are several ways to offer emotional support.

• Learn about RSD. To start, make an effort to learn more about RSD and how it affects people.
• Practice active listening. Validate your loved one’s feelings through active listening. Maintain eye contact, express empathy, and try verbal acknowledgments like “I understand that you’re in pain.”
• Be consistent. To avoid making someone’s RSD symptoms worse, try to offer consistent emotional support and understanding. 
• Encourage professional help. If you notice that RSD is starting to negatively affect someone’s daily life, encourage them to seek professional mental health support.

Find care with Rula

If you think that you or someone you care about has RSD, you may consider seeking support from a mental health professional. Rejection is a normal part of life, but extreme sensitivity and over-the-top reactions may indicate an underlying concern. 

Rula makes it easier for people to access mental health support from the comfort of their homes. In just a few minutes, you can use our therapist-matching program to find the right therapist for your mental health needs, who also accepts your insurance. From there, our teletherapy platform makes it easy to schedule your first appointment and begin receiving care as soon as tomorrow. 

Find a therapist with Rula