What is rejection sensitive dysphoria?

Mental Health

What can you do when rejection feels utterly unbearable? Here we explore rejection sensitive dysphoria and its ties to ADHD

No one likes to be rejected, do they? As humans, we’ve evolved to fear social rejection – back when we lived in caves, we needed the support of our tribe to stay alive. If we were rejected, we were quite literally left out in the cold. These days, many of us are able to push past this fear, learning that, while rejection isn’t pleasant, it won’t hurt us and we’ll get through the day.

For those with rejection sensitive dysphoria (RSD), however, this learning doesn’t quite stick.

What is rejection sensitive dysphoria?

RSD is intense emotional sensitivity and pain triggered by the perception that you’ve been rejected, criticised by someone, or feeling like you don’t belong. “Dysphoria literally means ‘unbearable suffering’ in Greek, and that matches my experience of it for sure,” online educator and RSD sufferer Sara Tasker explains. “It’s overwhelmingly painful and frightening – even if I know that what’s being said about me isn’t fair or true.”

For Sara, getting rejected (or even just suspecting that she might be rejected) can take her from feeling fine to desperate and suicidal, with a low mood that can last for days or weeks. The speed at which this mood can change has led to some people being misdiagnosed with rapid cycling mood disorder.

Counsellor Nic Higham also experiences RSD and notes that, while these events may seem insignificant for others, for those with RSD, it feels like “an injury that can’t be soothed”.

“In response, they might instantly act defensively, seek acceptance compulsively, attempt to numb the pain, or become withdrawn,” Nic explains. “They may also pursue a euphoria-inducing activity or substance as a way of coping, which could be said to be the opposite extreme of dysphoria.”

When she was younger, Sara’s coping mechanism was to withdraw and become a chronic people-pleaser. “Every single criticism of me was valid and true, as far as my brain was concerned and, by my late 20s, I had cripplingly low self-esteem, and felt like I needed to perpetually apologise just for my existence.

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“As I’ve gotten older, and had a lot of therapy, I’ve been better able to show up without that fear in my everyday life.

“But because my work is quite visible – I’m an online educator, with a big podcast and Instagram following – there are still lots of occasions where rejection hits me really hard. Something as simple as a book review or tweet from a troll account can send me spiralling, and cripple my ability to work, parent, or even function for days.”

When asked how she came to learn about RSD, Sara explains that she discovered it after receiving a diagnosis of ADHD.

If you have ADHD or are neurodivergent in other ways, chances are you may well recognise the RSD symptoms described.

“Up to 99% of adults with ADHD are more troubled by the perception of rejection than those who are neurotypical,” Nic says. “The ADHD mind and nervous system don’t like to leave things unfinished; specifically, things that activate a state of hyperfocus. A seemingly rejecting interaction will activate this state, and so it feels impossible to let it go.”

ADHD is characterised by internal hyperactivity, hypersensitivity and hyperarousal, memory difficulties, and often perfectionism. “All of which provide a fertile ground for rejection sensitivity,” Nic says. “Frequent bouts of ambiguity and overwhelm nourish the seeds of rejection, and the impulsivity and scattered attention make the experience hard to bear.”

When Sara read about RSD, and was able to give her experience a name, she says she cried with relief. Similarly, Nic says knowing he wasn’t alone, and that there was a name for this “unique form of pain”, meant everything. For many, learning what RSD is and recognising that it’s far more than being ‘thin-skinned’ helps immensely.

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What can help?

The condition is notoriously difficult to treat, with some experts saying medication is the only thing that can help, while others say therapy can be useful. Sara agrees that she’s not found anything that can stop the pain of the immediate experience, but she has learnt lots of strategies to help her stop believing it’s true.

“Whereas previously, I would have adopted the criticism as an essential fact about myself, now I’m able to question the feedback, set up boundaries, and hold firm in the things that I know to be true about myself,” Sara says. “I’ve done a lot of work on choosing whose opinions really matter to me, and allowing myself to stay strong in my knowledge of the good things about myself.”

Nic agrees there are strategies to help, and believes counselling can be supportive for those with RSD.

“A person who experiences RSD may discover equanimity, belonging, and clarity in counselling, and ideally will be supported in cultivating these qualities and holding the pain.

“What’s key is to learn that although rejection is hard to bear, it isn’t unbearable, and will eventually pass”

“While episodes of profound rejection will continue, counselling may bring to light ways to soften the blow, for example, with distress, tolerance, and resilience skills. They may also gain greater awareness of how generalising, deleting, and distorting thinking has shaped the event.”

Softening the blow and limiting the damage caused by rejection does appear to be possible. It may not be easy, and it may take a multi-pronged approach, but the key thing is it is possible.

If you recognise the symptoms described, Nic recommends considering an ADHD assessment. “I was 36 when I was diagnosed, and I found the self-understanding the diagnosis brought life-changing.”

Speaking to others who ‘get it’ can also be a help. Sara notes that there are helpful online spaces, like Reddit, where you can read about how others cope. “Most of all, though, I’d say to remember that you are not what other people think of you. That’s not what defines who you are in this world. Really recognising this, and starting to slowly internalise it, has been the biggest change for me with this issue.”

Similarly, what helps Nic is reminding himself that, despite his feelings of not belonging, he’s very much present and alive.

“What’s key is to learn that although rejection is hard to bear, it isn’t unbearable, and it will eventually pass.”


To connect with a counsellor who can help you to develop tools to manage rejection, visit counselling-directory.org.uk

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