Understanding rejection sensitive dysphoria (RSD)

If you’ve ever spiralled emotionally after a small comment, or found yourself replaying vague interactions for hours, you might be familiar with the experience of rejection sensitive dysphoria or RSD.

For many people, particularly those living with ADHD, these experiences can be deeply painful and confusing.

RSD isn’t currently a formal diagnosis, but it’s gaining recognition among mental health professionals. For adults who were diagnosed with ADHD later in life or not at all, RSD can be one of the most distressing parts of their emotional experience.

What is rejection sensitive dysphoria?

Rejection sensitive dysphoria is used to describe intense emotional responses triggered by perceived rejection, criticism, or failure. The emotional pain can feel disproportionate to the situation and often comes on suddenly.

These reactions might be internal, like shame, sadness, or withdrawal, or external, such as outbursts of anger or frustration.

The word dysphoria comes from Greek, meaning a state of unease or dissatisfaction. In the case of RSD, that unease is often sharp, overwhelming, and difficult to manage.

Rejection sensitivity vs RSD: What’s the difference?

Rejection sensitivity is a broader term describing a heightened fear of rejection. Most people dislike being judged or criticised, but those with rejection sensitivity often anticipate rejection even in neutral situations.

RSD takes this further. The emotional reaction is more than discomfort. It can feel like grief, humiliation, or panic. These reactions may lead to long-term patterns of avoidance, perfectionism, or strained relationships.

What causes RSD?

While there’s no single known cause, several factors may contribute to RSD:

• Differences in brain activity: People with ADHD often have differences in the brain regions responsible for emotional regulation, such as the prefrontal cortex and amygdala. This can lead to stronger emotional responses, particularly to social feedback.

• Learned emotional patterns: Many people with ADHD grow up receiving frequent criticism or feeling misunderstood. Over time, this can condition the brain to expect rejection, even in safe or neutral situations.

• Emotional sensitivity: People who naturally feel things more deeply may also be more prone to RSD, particularly when emotional needs haven't been met or validated in earlier life.

Who’s likely to experience it?

RSD is more likely to affect people who are already sensitive to social feedback or have difficulty managing strong emotions. Certain traits and neurodevelopmental conditions can increase the likelihood of experiencing it:

• People with ADHD, diagnosed or undiagnosed

• Adults who were not recognised as neurodivergent in childhood

• Individuals with a history of perfectionism, anxiety, or people-pleasing behaviours

• Those who find social settings emotionally draining or who often assume the worst in ambiguous interactions

Signs and behaviours that may point to RSD

People experiencing RSD often describe a mix of emotional and behavioural patterns. Here are some of them:

Emotional patterns

• Sudden, intense emotional pain after real or perceived rejection

• Overthinking interactions and worrying about how they came across

• Feeling crushed by even gentle or constructive feedback

• Avoiding situations where failure or criticism is possible

• Struggling with low self-esteem, even in areas where they’re competent

• A deep fear of letting others down

Outward behaviours

• Outbursts of anger, often following small misunderstandings

• Withdrawing socially after a perceived rejection

• Ending relationships or quitting jobs suddenly, after a moment of disapproval

• Compensating through perfectionism or overachievement

How is RSD different from mood disorders?

While RSD can resemble anxiety or depression, it’s distinct in that the emotional shifts are typically linked to specific triggers like rejection, failure, or criticism. The intensity and speed of the emotional reaction, combined with a clear trigger, often help differentiate RSD from a mood disorder that’s more persistent and generalised.

RSD and conditions like anxiety and depression can overlap. Repeated emotional pain from perceived rejection may contribute to longer-term feelings of hopelessness or social withdrawal, especially when support is lacking.

How to manage RSD?

1. Getting the right support

If you think you might be experiencing RSD, consider speaking to a GP, psychologist, or psychiatrist who understands ADHD in adults. You can ask your GP for a Mental Health Treatment Plan, which may provide access to rebated psychology sessions through Medicare.

When you speak to a professional, explain how emotional reactions affect your life. Share examples where your response felt disproportionate to the situation, especially if it impacts your work or relationships.

2. Learning your emotional patterns

• Use mood tracking tools to note what triggered your response and how you reacted

• Ask yourself questions like "Is there another way to look at this?" or "Is there solid evidence I was rejected?"

• Name the experience instead of judging it. Saying something like "This feels like rejection sensitivity" can help you slow down and reflect

3. Building practical strategies

• Cognitive Behavioural Therapy (CBT) can help you recognise unhelpful thought patterns and replace them with more balanced ones

• Mindfulness allows space between reaction and response

• Boundary setting helps protect you from situations that consistently cause emotional overload

• Self-compassion practices help reduce shame and support emotional recovery

• Gradual exposure helps retrain avoidance habits by facing feared situations step by step

4. Talking to a doctor about medication

Although RSD is not a formal diagnosis, some medications used for ADHD or emotional regulation may help reduce the intensity of emotional responses.

Keep in mind that any decision about medication should be made with your treating clinician.

Supporting someone with RSD

If someone close to you seems to respond strongly to feedback or criticism, there are several ways to support them. Strategies that might help are:

• Listening without judgement

• Validating their experience, even if you don’t fully understand it

• Gently helping them separate perception from reality

• Encouraging professional support if they seem overwhelmed or stuck

• Avoiding language that dismisses their feelings, like "You're too sensitive" or "Just let it go"

When to seek urgent help

Seek immediate help if you or someone you care about is feeling unable to cope with emotional pain or is having thoughts of self-harm or suicide. 

In Australia, you may contact:

• Lifeline: 13 11 14

• Suicide Call Back Service: 1300 659 467

• Your GP or nearest emergency department

Final thoughts

RSD can feel like emotional whiplash. You may go from feeling calm to crushed in moments. And while that experience can be hard to explain to others, it’s real, and it matters. Learning about RSD is a step toward understanding your emotional world and finding ways to respond with care instead of self-judgement.

You can’t always prevent emotional pain, but you can learn how to manage it, reduce its hold on your life, and respond to challenges with more confidence.

Speaking with a therapist or mental health professional who understands ADHD and emotional sensitivity can be an important part of that process.