What is rejection sensitivity dysphoria?
Rejection sensitivity dysphoria (RSD) is not an officially recognised medical diagnosis but refers to a heightened emotional response to perceived or actual rejection. It is often discussed in the context of certain mental health conditions, most notably Attention-deficit/hyperactivity disorder (ADHD), although it can occur in other contexts as well. People with RSD experience intense emotional pain, even in response to minor criticism or rejection, which can significantly impact their daily lives.
How does RSD present?
There are a number of ways that rejection sensitivity dysphoria may present, including:
- Extreme emotional reactions: Individuals may feel overwhelming sadness, anger, humiliation, or shame when they perceive rejection or criticism, even if it was unintended. Emotional outbursts or meltdowns after feeling rejected are common.
- Perceived rejection: The reaction may occur even when there is no actual rejection, but the person interprets a situation as rejection.
- Avoidance behaviours: To avoid the pain of rejection, individuals may avoid social interactions, take fewer risks, or become overly self-critical.
- Interpersonal impact: RSD can make relationships, both personal and professional, challenging because the individual may overreact to feedback or perceived slights. Sudden feelings of worthlessness or low self-esteem are often present.
- Short duration but high intensity: The emotional response is often intense but typically short-lived. This can often include intense anger or resentment toward others who are perceived as rejecting or criticising.
Are there any typical causes or associations of RSD?
RSD is frequently linked to ADHD, as people with ADHD may have heightened emotional sensitivity and difficulty regulating their emotions. A history of trauma, rejection or criticism, especially in childhood, may make someone more prone to developing RSD-like reactions. Some experts believe that RSD may arise from neurological factors such as differences in brain function related to emotional regulation.
How can RSD be managed?
Since RSD is not an official diagnosis, treatment typically focuses on managing the underlying condition (like ADHD) and addressing emotional regulation. This can include the following treatment recommendations which would need to be tailored by a professional according to the individuals specific symptoms and needs.
- Therapy: Cognitive behavioural therapy (CBT) can help individuals challenge distorted thoughts about rejection and develop healthier coping strategies or dialectical behaviour therapy (DBT) may help improve emotional regulation. We also explore how acceptance and commitment therapy (ACT) can support later in this article.
- Medication: Some ADHD medications (e.g., stimulants or non-stimulants) may help reduce emotional reactivity. In some cases, mood stabilisers or antidepressants may be recommended.
- Self-care strategies: Developing mindfulness skills to stay grounded during emotional distress. Building strong support networks to reduce feelings of isolation.
- Education: Learning to identify and challenge thought patterns that lead to perceived rejection.
Can ACT therapy help individuals with RSD?
Acceptance and commitment therapy (ACT) can be an effective approach for individuals experiencing rejection sensitivity dysphoria by helping them develop healthier ways of responding to emotional pain, perceived rejection, and self-critical thoughts.
Here are some examples of how ACT therapy can help individuals with RSD:
- Acceptance of emotions: Instead of trying to suppress or avoid painful feelings, ACT encourages individuals to accept their emotions as a natural part of being human. This reduces the “struggle” with emotions and helps people respond with less distress.
- Self-compassion: ACT gently encourages self-compassion, helping individuals accept their imperfections and treat themselves kindly. This reduces the cycle of self-blame and shame that exacerbates rejection sensitivity.
- Defusion from unhelpful thoughts: ACT teaches cognitive defusion, a skill that helps individuals distance themselves from their thoughts rather than being controlled by them. Instead of seeing thoughts as absolute truths, they learn to view them as passing mental events.
- Mindfulness: Mindfulness practices in ACT help individuals stay grounded in the present moment, reducing the power of past or future-focused anxiety. By focusing on the here-and-now, individuals can respond more calmly to situations.
- Values-driven living: ACT emphasises identifying core values, i.e. what truly matters to the individual, and committing to actions aligned with those values, even in the presence of emotional discomfort. This helps people focus on living a fulfilling life rather than working on how to avoid rejection.
- Psychological flexibility: Builds resilience by enabling individuals to respond to rejection in adaptable, constructive ways rather than avoiding or overreacting. This flexibility allows individuals to handle rejection without it defining their self-worth or derailing their goals.
For individuals
If you or someone you know is experiencing symptoms of RSD, consulting a mental health professional can help better understand and manage the condition. If you are considering ACT therapy for RSD, our clinical team are trained in ACT and can provide you with targeted support and guidance.
For professionals
We offer a range of workshops and resources covering ACT therapy and other topics such as neurodiversity and ADHD to support extended learning around this topic.
