When rejection feels overwhelming
If criticism cuts deeper than it should, if perceived rejection sends you into emotional freefall, if you spend hours replaying moments where you might have been judged - you're not alone, and it's not a character flaw.
What is Rejection Sensitive Dysphoria?
Rejection Sensitive Dysphoria (RSD) is an intense emotional response to perceived rejection, criticism, or failure. The word "dysphoria" comes from Greek, meaning "difficult to bear" - and that's exactly what it feels like.
RSD is most commonly experienced by people with ADHD, though it can occur alongside other conditions too. It's not about being "oversensitive" or "dramatic" - it's a neurological difference in how the brain processes social and emotional information.
The key word is perceived. RSD can be triggered by actual rejection, but just as often by situations that feel like rejection - a friend's delayed text reply, a neutral comment interpreted as criticism, or simply not receiving the positive feedback you hoped for.
What RSD feels like
A wave of intense emotion that hits instantly - like being punched in the chest. It can feel like panic, despair, or rage all at once.
Many people describe actual physical sensations - chest tightness, stomach dropping, feeling winded, or a crushing weight.
Thoughts either freeze completely or spiral into worst-case scenarios. It becomes hard to think clearly or respond.
Long after others have moved on, you're still replaying the moment, analysing what went wrong, feeling the sting.
"It's like everyone else got a tutorial on how to handle criticism that I somehow missed. When someone says something even slightly negative, my whole world collapses for hours. I know logically it's not that serious, but my emotions don't get the memo."
— A common experience shared by many with ADHD
Common triggers
Everyone's triggers are different, but these are some of the most common situations that can set off an RSD response:
The ADHD connection
Research suggests that people with ADHD have differences in how their brains regulate emotions and process social feedback. The same neurological differences that affect attention and impulse control also affect emotional regulation.
This means emotional responses can be more intense, arrive more quickly, and take longer to recover from. It's not a separate condition from ADHD - it's part of how ADHD affects the whole person, not just focus and organisation.
Some estimates suggest that up to 99% of people with ADHD experience RSD to some degree, making it one of the most common - yet least discussed - aspects of living with ADHD.
It's not a character flaw
If you've been told (or told yourself) things like these, here's the reality:
"You're just being too sensitive"
RSD is a neurological difference in how the brain processes social-emotional information. The pain is real, not imagined or exaggerated.
"Just don't take things personally"
The emotional response happens faster than conscious thought. It's not a choice - it's how your nervous system is wired.
"Everyone feels rejected sometimes"
While rejection hurts everyone, RSD involves a much more intense, rapid, and longer-lasting response that can be debilitating.
"You need thicker skin"
This isn't about resilience or willpower. The ADHD brain processes emotional pain differently at a fundamental level.
What can help
While RSD can't be "cured," there are many strategies that can help reduce its intensity and impact:
Recognising "this is RSD" in the moment can help create a small space between the trigger and your response.
When triggered, delay responding if possible. "Let me think about that" or "I'll get back to you" can prevent regrettable reactions.
Having someone who understands RSD and can offer perspective ("Was that really rejection or just a neutral comment?") is invaluable.
Understanding your specific triggers, warning signs, and recovery needs helps you prepare and respond more effectively.
Learning to treat yourself with the same kindness you'd offer a friend can help reduce the shame spiral that often follows RSD episodes.
Therapy (especially CBT or DBT), coaching, and sometimes medication can make a significant difference in managing RSD.
When to seek help
Consider talking to a professional if RSD is:
- Affecting your relationships - avoiding people, pushing them away, or constant conflict
- Impacting your work or education - avoiding opportunities, underperforming, or burnout
- Causing you to withdraw from activities you used to enjoy
- Leading to unhealthy coping mechanisms
- Contributing to depression, anxiety, or thoughts of self-harm
A clinician who understands ADHD and emotional dysregulation can help you develop strategies and explore whether medication might be helpful.
Measuring what you feel
One of the challenges with RSD has been the lack of proper measurement tools. How do you explain to a clinician something so internal and overwhelming? How do you track whether treatment is helping?
The RSD-RS (Rejection Sensitivity Dysphoria Rating Scale) was developed to fill this gap. It measures RSD across six dimensions:
- Trigger Sensitivity
- Dysphoric Pain & Shame
- Anticipatory Hypervigilance
- Acute Reactivity
- Recovery & Aftermath
- Functional Impact
This gives both you and your clinician a clearer picture of how RSD affects you specifically, and a way to track changes over time.
Frequently asked questions
You're not alone in this
Millions of people experience RSD. Understanding it is the first step toward managing it. If you're a clinician looking to assess RSD in your patients, or someone who wants to better understand your own experience, we're here to help.