What Is Rejection Sensitivity Dysphoria?

Although not formally recognized as a disorder, rejection sensitivity dysphoria (RSD) can be defined as an overwhelming emotional reaction to real or perceived rejection or criticism that can interfere with daily life. The exact cause is unknown, but RSD tends to affect people with attention deficit hyperactivity disorder (ADHD) more often than others. RSD can cause problems at work and school and can put a strain on your relationships. It can also lead to low self-esteem.

Read on to find out more about RSD, including symptoms, common triggers, and treatment options.

Causes

More research is needed to determine the exact cause of RSD. It's associated with emotional dysregulation, which is when a person has difficulty experiencing and expressing their emotions. Emotional dysregulation is marked by rapid, exaggerated mood changes, excitability, and being quick to anger, and by some estimates, up to 70% of adults with ADHD show signs of it.

RSD is often triggered by specific situations such as:

• Rejection, either real or perceived
• Criticism, even if it's constructive criticism
• Teasing
• Personal failure, either real or perceived

Symptoms

Symptoms of RSD can include:

• Sudden outbursts of emotion after real or perceived criticism or rejection
• Lashing out in anger at others
• Withdrawal from social situations
• Thoughts of self-harm
• Negative self-talk that's consistent and repetitive

The mood changes can happen immediately and can be very disruptive. This can happen several times a day.

RSD is more than a feeling of being upset at rejection; it may even interfere with your ability to get through the day. Because of the need to avoid criticism and feelings of failure, you may become a people-pleaser or perfectionist.

Diagnosis

As RSD is not a formal diagnosis, there are not any clearly established diagnostic criteria. In many cases, it's categorized as a manifestation of the emotional dysregulation found in ADHD. RSD is not part of the criteria to diagnose ADHD in the United States, but emotional dysregulation is a diagnostic feature in the criteria for ADHD in the European Union.

Sometimes RSD is misdiagnosed as social anxiety disorder because people have a tendency to avoid social situations where they may be criticized. It can also be misdiagnosed as borderline personality disorder or rapid cycling bipolar disorder because of its transient and immediate nature, along with the strength of the emotional reaction.

Treatment

There are no medications approved by the Food and Drug Administration (FDA) specifically for RSD, but some people with RSD may benefit from Intuniv (guanfacine) and Kapvay (clonidine), two alpha agonist medications that have been approved for ADHD. More research is needed on how these drugs may help with RSD.

If you have ADHD in addition to RSD, getting an accurate diagnosis and then a treatment plan can help manage symptoms and reduce the intensity of RSD.

Coping

There are ways to cope with RSD that can help you handle the painful or uncomfortable emotions that come up. The eventual goal is to learn to react thoughtfully, instead of reflexively. Coping tactics can include:

• Take the time to process your emotions before acting out.
• Get an accurate diagnosis. Appropriate treatment can help with emotional dysregulation and provide you with coping tools.
• Practice stress management techniques. Doing so can help lower your overall stress levels and can also teach you to stay calm and centered during difficult moments.

Sometimes an ADHD support group, whether in person or online, can be helpful. People who know what it's like to be dealing with RSD can validate your feelings and experiences and share the coping techniques that have worked for them.

Summary

RSD is more than just being sensitive. The emotions are intense and sudden, and they can cause significant distress. If you believe you have RSD, talk to your healthcare provider about treatment options, including certain ADHD medications as well as stress management techniques.

A Word From Verywell

Rejection is painful for everyone, but for people living with RSD, it disrupts everyday life. The feelings that come up when you're criticized or rejected—or you're worried you will be—can be overwhelming and can cause problems with your relationships and at work or school. Be sure to talk with your healthcare provider about your symptoms and what you’re experiencing. There are tools to help you with your RSD, and for some people, medication can be helpful.