What Is Rejection Sensitive Dysphoria (RSD)?

Written by Stephanie Watson, Nicole Hollimon
Medically Reviewed by Jabeen Begum, MD on July 29, 2025
6 min read

Most people don’t like rejection. Be it in a romantic relationship, a friendship, or at work, it’s common to have negative, unpleasant feelings creep up. It can often range from confusion and sadness to rage. But usually, you’re able to manage your emotions rather quickly.

But suppose the same rejection causes you to have extremely intense negative feelings and severe emotional pain that’s difficult to control. In that case, you might have what experts call rejection sensitive dysphoria (RSD). Studies show you’re more likely to have it if you have attention deficit hyperactivity disorder (ADHD).

RSD doesn’t have an official set of symptoms and isn’t a formal medical diagnosis. But doctors and therapists often use the term when they notice exaggerated reactions connected to an official behavioral condition like ADHD.

The word “dysphoria” comes from an ancient Greek word that translates to intense feelings of pain or discomfort. People who experience RSD don’t handle rejection well. In fact, they find it hard to describe what they feel and often use words like “unbearable” or “devastating.” It could also cause you to develop a serious fear of rejection.

Emotional dysregulation and rejection sensitivity vs. RSD

Emotional dysregulation is when you have a hard time managing your emotions. This can lead to feeling overwhelmed or uncomfortable. It might even feel a bit painful.

With rejection sensitivity, you may:

  • Feel severe anxiety or other negative emotions before potential rejection
  • Have trouble viewing neutral or vague reactions as anything but rejection
  • Overreact to feelings of rejection with anger, rage, extreme sadness, or severe anxiety

A feeling of intense -- sometimes overwhelming --pain is what separates RSD from basic rejection sensitivity and emotional dysregulation.

Research on who develops RSD and how it’s linked to ADHD is still unclear. That’s because it’s hard to measure rejection. But Eugene Arnold, MD, a psychiatrist and behavioral health specialist at Ohio State University, believes people with ADHD are more likely to show symptoms of RSD due to differences in brain structure.

For people with ADHD, the frontal lobe of the brain — which controls your ability to pay attention, language, social skills, impulse control, judgment, and problem-solving — works slightly differently. This may cause you to miss or overlook certain social cues or details. You may also struggle to collaborate well within a team.

You might “lack insight” into how your behavior affects those around you. You may also interpret unclear conversations as a form of rejection, teasing, or criticism.

This could trigger overwhelming feelings of confusion, failure, betrayal, pain, and sadness. And you might find it difficult to regulate your emotions and control them as quickly as others without ADHD might.

Mental health conditions and mood disorders could also be linked to RSD. But experts need to conduct more studies on RSD to better understand it.

While RSD is not an official diagnosis, people with RSD are likely to:

  • Be strong people-pleasers
  • Feel more embarrassed or self-conscious
  • Have self-doubt and low self-esteem
  • Display sudden outbursts of physical emotions such as anger, tears, and sadness
  • Engage in negative self-talk
  • Have trouble managing their reactions
  • Find it draining to manage relationships
  • Suddenly become quiet, moody, or show signs of depression or anxious feelings

In some cases, the fear of disapproval or rejection from others could cause you to avoid certain tasks and responsibilities or withdraw from social interaction.

On the other hand, you might try to achieve perfection to avoid any chances of failure in the first place. This could take a toll on your overall quality of life.

Experts don’t fully understand the cause yet. But some believe the structure of your brain might play a role.

The parts of the brain that process and manage acts of rejection, failure, emotional awareness, and negative messages are called the amygdala and the prefrontal cortex.

They’re located at the front of the brain and cause children, teens, and young adults to lose their temper and become frustrated or upset. Usually, these parts of the brain get better at processing signals as you get older. You’re able to manage your feelings and keep them organized and under control so that you can interact with your surroundings and meet your goals.

But for some people with psychological or behavioral conditions, your brain might not regulate these signals properly. Instead, it might make negative emotions too painful to bear and overwhelming to manage or keep in check. This leads to what experts call “emotional dysregulation.”

Besides the brain’s physical structure, some experts think genetics might play a role. Especially because ADHD, which is closely linked to RSD, runs in families. But experts need to further study RSD and its links to mental health conditions.

RSD isn’t an official medical condition, and there’s limited research to support it. So, your doctor, counselor, or licensed therapist might not know much about it or mistake it for another condition.

But if you’ve already been diagnosed with ADHD or another mental health disorder, they might recognize the pattern of behavior around rejection sensitivity and associate it with other issues you have.

There’s no specific cure or treatment for RSD. But certain medications and therapies used to treat ADHD and other mental health conditions could help you manage your intense emotional responses.

Medications that might help include:

Alpha-2 receptor agonists. Prescription ADHD drugs such as clonidine (Kapvay) and guanfacine (Intuniv) are designed to activate brain receptors that improve your brain’s ability to receive and process emotional signals.

Stimulant medications. Prescription drugs such as amphetamine (Adderall) and methylphenidate (Ritalin) stimulate certain chemical messengers (neurotransmitters) that shoot signals between different brain cells. This helps your brain process incoming messages and improves communication skills. 

Monoamine oxidase inhibitors (MAOIs). This class of drugs is often used to treat depression. MAOIs are also known to improve your sensitivity to rejection. But you can’t take this drug along with other commonly used ADHD medications and certain foods like aged cheese or meat. It can cause your blood pressure to shoot up to dangerous levels.

Check with your doctor before you use the drug off-label for RSD.

Besides drugs, Arnold notes that psychotherapy, such as cognitive behavioral therapy and talk therapy, can help with rejection sensitivity, too. This form of therapy could help you gain insight and awareness into your emotional responses.

It can help you build good habits, such as listening to the other person, asking for clarifications, or waiting or taking time to think of a response rather than having an intense emotional outburst. It might also improve your impulse control. 

Over time, psychotherapy can help you build tools or strategies to deal with your emotions and keep them in check in various social situations.

If you or someone you know has a mental health crisis and are thinking about harming yourself or others, call 988 for the National Suicide Prevention Lifeline for emergency help. You can also call 911 or head to the nearest hospital for medical attention. 

Rejection sensitivity dysphoria is when rejection causes extremely intense negative feelings and severe emotional pain that’s difficult to control. You’re more likely to have it if you have attention deficit hyperactivity disorder (ADHD). A feeling of intense -- sometimes overwhelming -- pain is what separates RSD from basic rejection sensitivity and emotional dysregulation. Experts don’t fully understand the cause, but some believe the structure of your brain might play a role. Certain medications and therapies used to treat ADHD and other mental health conditions could help you manage the condition.

Can I have RSD without ADHD?

Yes. While RSD is most often linked to people with ADHD or anxiety, you can have it even if you haven’t been diagnosed with ADHD or anxiety.