No one likes feeling rejected. That deep pit in your stomach, weight in your chest, lump in your throat, face flushed red with shame.
For most people, this intense reaction is thankfully rare, reserved only for the biggest rejections. But for some, these pangs strike on a regular basis.
It doesn’t have to be a scenario that others might find distressing, either. This claw-your-skin-off feeling might arise because a friend forgot to reply to your text, a performance review at work wasn’t wholly positive, or someone made a slightly tactless remark.
Feel familiar? You might have RSD.
What is RSD?
Even if you know the feeling all too well, you’re unlikely to have heard the acronym before. RSD stands for Rejection Sensitivity Dysphoria, and in simple terms, it’s defined as an intense reactivity to perceived rejection.
“Most of us can relate to feeling some level of distress if we’re being criticised or disapproved of,” says Dr Victoria Barclay-Timmis, a clinical psychologist at the University of Southern Queensland. “But RSD refers to an intensity that is beyond what the average person would experience.”
The term RSD has become popular among those who identify with it, she explains, but is not yet a clinically recognised disorder. However, the term is increasingly gaining weight among psychologists.
For instance, in 2024, psychologist Dr William Dodson wrote a paper introducing the world to RSD, stating he had seen approximately 300 patients with the condition, and his colleagues had too.
RSD, Dodson wrote, always followed the same pattern: first, a trigger. This might be rejection, teasing, criticism, or the internal belief of failure.
Then comes a complete and instantaneous change of mood; the onset of unbearable emotional pain, sometimes expressed as sadness or rage.
Dodson’s patients describe this as “feeling like my guts were on the floor” or “like somebody had just punched me in the chest”.
But RSD doesn’t just affect people in these moments. The fear of rejection – and the consequent fallout – can become so strong that individuals develop strategies, aiming to prevent it from happening again.
“But their coping behaviours might heighten that experience,” says Dr Antonia Dittner, a psychologist at King’s College London. “So, they might withdraw from people, avoid standing up for something they believe in, or avoid going into situations where they fear conflict.”
For example, Dodson describes how a patient of his, called Josh (not his real name), coped with his RSD by socially isolating himself, because in his words, “having people know me just wasn’t worth the pain.”
At 29 years old, Josh had never asked anyone on a date or applied for a job, for fear of being turned down.
There are other possible coping strategies too. Dittner says: “They might get angry with those around them, and lash out impulsively, which is unhelpful. They might inadvertently get into conflicts because they respond in this intense way.”
This was the case for another of Dodson’s clients. Amy (also not her real name) said her marriage was under severe strain.
She believed her husband was constantly “tormenting me by making fun of my struggle with taking care of the house and our two children,” which would cause her to lash out in retaliation, or leave the house in floods of tears.
Barclay-Timmis adds that many of her clients with RSD develop anxiety issues centred on their relationships.
Alternatively, she says: “It might manifest as perfectionism, leading to burnout, exhaustion or even chronic fatigue, from that constant effort to be a step ahead of potential disapproval.”
For example, Hannah (another alias) was a 17-year-old who sought Dodson’s help because her frequent stress-induced migraines were stopping her from attending school.
Despite her absences, Hannah said she was determined to be “the perfect over-achiever who never made a mistake and was always the top of the class.”
It’s this extreme, potentially debilitating reaction that sets RSD apart from simple sensitivity.
Dittner explains: “Most people are probably sensitive to perceived rejection, but this is something people are describing as a really marked experience of crying, intense shame, intense sadness, and not being able to go about their day. It’s a really marked and distressing part of their life.”
If that sounds like you, then you might have RSD – but we’re still missing one major part of this picture.
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How it’s linked to ADHD
The other component that separates RSD from just sensitivity is its connection to neurodivergence, particularly ADHD.
Several studies have found a direct correlation between other ADHD symptoms – such as difficulty concentrating, forgetfulness, fidgeting and talking over others – and the signs of RSD.
For instance, a US study of 10- to 15-year-olds, and a Hungarian study of 300 university students, both found correlations between ADHD symptoms and self-reported RSD.
“The stronger the symptomology of ADHD, the stronger the response was to rejection,” says Barclay-Timmis, about the Hungarian study. “But also, there was a weakened response to positive feedback and acceptance. So, there’s a bit of a double whammy, if you like, for individuals with ADHD.”
This link, she says, might have roots in how it feels to grow up with ADHD.
“Some research suggests that, by age 10, kids with ADHD will have heard 20,000 more negative comments than their neurotypical peers,” Barclay-Timmis says. “Because of how ADHD manifests in young people, it elicits a lot of criticism from peers, from parents, from teachers. Like, ‘be quiet, put your hand down, sit down’.
“You can imagine, if you’ve already had that disproportionate amount of negative feedback in your life, that might lead to a desire to avoid that criticism.”
But it’s not just that. Certain symptoms of ADHD can directly lead to inflated emotional reactions, as Dittner explains.
“Emotional sensitivity and reactivity are part of ADHD,” she says, “and therefore people are likely to have a heightened emotional response.
“They may be more vulnerable to particular patterns of repetitive thinking as well, which might mean they’re more likely to ruminate on what’s happened, which will prolong the emotional experience.”
We can see this from brain-imaging studies of people with ADHD, which found differences in parts of the brain responsible for emotion processing, and more acute reactions to negative facial expressions.
“The neurobiology is just a little bit different,” says Barclay-Timmis. “It all combines to create this heightened sensitivity.”
Treatment for RSD
If this is all sounding uncannily relatable, there is hope: RSD is treatable. You don’t have to struggle through this alone.
Dittner and Barclay-Timmis say that all the classic mental-health strategies, like therapy, mindfulness, and certain grounding techniques, can play a role.
“Therapy can help us reframe those negative thoughts with some more compassion,” says Barclay-Timmis.
And, she adds, ADHD medication can help too. “Whilst I’m not saying you need to take a magic pill, I would suggest that you consult with a healthcare provider and consider utilising medication.
“Balancing out that neurobiology can really help with the regulation of emotional responses, not just attention and concentration.”
These interventions certainly helped Dodson’s example patients. For instance, two years after Josh was diagnosed with ADHD, he had graduated from university, was working as an aerospace engineer, and had a girlfriend.
He still had RSD episodes once in a while but could now “talk myself down with the CBT I learned.”
Amy began taking ADHD medication and she said it had a “life-changing” effect, adding: “I didn’t realise how afraid I was of being hurt by people in general and my husband in particular.”
And, for Hannah? She was also on medication and her migraines had gone from several each week to once per month, and she was back at school.
All of these individuals found medication helpful – but that doesn’t mean everyone with RSD needs drugs.
Barclay-Timmis says that simply having a label can be transformative for some people with the condition, and help the loved ones of people with RSD to gently support them through their dysphoric moments.
“Once we give things a name and we realise we’re not alone, it gives us a way of developing compassion for ourselves,” she says. “When others can validate that for us, as a psychologist, I think that’s really powerful.”
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