Live Better. Love Better. Work Better.

What is Rejection Sensitive Dysphoria

Mary-Lauren O’Crowley, NCC, LPC 

What is Rejection Sensitive Dysphoria and How Does it Relate to ADHD?

Rejection and RSD

Rejection can make us feel unappreciated or unwelcome. These are natural responses to someone pushing us away or feeling as though we are not valued. While rejection is typically not pleasant for anyone, it can trigger a strong emotional response in people with rejection sensitive dysphoria. With rejection sensitive dysphoria, these feelings can result in severe physical and emotional distress, and, to date, researchers are not entirely sure why those with ADHD are more prone to such a reaction. 

Rejection Sensitive Dysphoria

Dysphoria is a condition that literally translates to “hard to bear” and it can lead us to feel hopeless, unhappy, or unwell. More specifically, rejection-sensitive dysphoria is the intense feeling of unhappiness and disappointment that results from both real and perceived criticism or rejection. It is a relatively severe condition that can lead to low self-esteem and diminished mood. If you have RSD, you may experience repeated emotional overreactions even in response to something like a slight disagreement. RSD can be difficult for both the individual and their loved ones, which can put a strain on personal relationships.


ADHD can cause deficits in emotion and mood regulation, which may account for the increased feelings of distress that accompany perceived or real rejection. In individuals with ADHD, certain medications can also stimulate the central nervous system in various ways, leading to feelings of increased agitation, nervousness, or even anger, thus altering the way the individual responds to rejection and other difficult circumstances. ADHD and other mental health issues can also lead to increased experiences with rejection, as those with mental illness continue to face stigmatization and increased social isolation. These experiences with criticism, judgment, and a general lack of understanding can make a person more fearful of and sensitive to future rejection. 

Symptoms of Rejection Sensitive Dysphoria

The RSD symptoms may vary from one person to another, but may include:

  • Taking small rejections as destructive
  • Perfectionist or people-pleasing tendencies
  • Feeling rejected when no rejection has occurred
  • A chronic fear of rejection
  • Thinking often or obsessively about negative experiences, especially experiences of rejection
  • Misconstruing requests for more information or neutral feedback as rejection

Diagnosis of RSD

RSD is not a medical condition and there is no official standalone diagnosis; however, based on the symptoms described by the patient, a therapist can make the determination that RSD may be present with ADHD. A therapist, doctor, or mental health professional will also likely want to rule out other diagnoses that mimic ADHD and RSD including bipolar and borderline personality disorders. 

Treatment of RSD

ADHD medications like Ritalin and Adderall have been proven to be highly effective. Antidepressants can also help with some symptoms of ADHD, particularly feelings of sadness or rumination. A variety of antidepressants are available and it is best to discuss options with a health care provider. Another treatment option for symptoms of ADHD and RSD is a therapy where the individual can work on developing coping skills for dealing with problems like rejection more effectively. While therapy can be a treatment option, talk therapy may not prove as effective given the emotional response. 

Final Thoughts

According to Dr. Dod,Rejection Sensitive Dysphoria can mean extreme emotional sensitivity and emotional pain — and it may imitate mood disorders with suicidal ideation and manifest as instantaneous rage at the person responsible for causing the pain.” Thus, seeking treatment to minimize symptoms and improve quality of life is incredibly important. 

If you or someone you know is struggling with symptoms of ADHD or has difficulty dealing with perceived or real rejection, please reach out to the intake specialists at Symmetry Counseling to get paired with a therapist in Chicago. Contact us today!


Symmetry Counseling Recent News Image 4
Recent Posts

I Feel Anxious. How Can I Cope? Part 3

Jul 10, 2024

In Parts 1 and 2, I introduced coping skills and cognitive restructuring techniques. Hopefully, you had a chance to try them out. Now, I will tie this blog series together through a discussion of core beliefs and acceptance. What are…

Read More

I Feel Anxious. How Can I Cope? Part 2

Jul 3, 2024

In Part 1, I introduced various coping skills for managing anxiety. I hope you had a chance to try out those techniques. Now, I will discuss strategies to understand, challenge and reframe maladaptive thoughts. This approach is rooted in the…

Read More

I Feel Anxious. How Can I Cope? Part 1

Jun 27, 2024

If you are reading this post, chances are you’re experiencing some level of anxiety. What if I told you that you hold more control over your anxiety than it does over you? Anxiety often feels overwhelming, but it is important…

Read More