"It’s Not Just Overthinking": Understanding Rejection Sensitive Dysphoria (RSD)

With RSD, the smallest thing can feel overwhelming and devastating

Have you ever found yourself spiralling after a seemingly small social moment — a delayed text reply, a friend's tone, or gentle feedback? Do you over-apologise, avoid putting yourself out there unless you’re sure you’ll succeed, or feel physically shaken by even minor criticism?

If this resonates, you're not alone — and you're not "too sensitive." You might be experiencing something called Rejection Sensitive Dysphoria (RSD).

What Is RSD?

Rejection Sensitive Dysphoria is an intense emotional response to the perception (or anticipation) of rejection, criticism, or failure. It isn’t a formal psychiatric diagnosis, but it is a recognised emotional and neurological experience—especially common in people with ADHD, Autism, and complex trauma.

The term dysphoria means “difficult to bear.” And for those living with RSD, perceived rejection isn’t just upsetting — it can feel devastating. Even neutral feedback or everyday misunderstandings can trigger overwhelming shame, anxiety, panic, or sadness.

The Science Behind RSD

Although RSD is not yet listed in diagnostic manuals like the DSM-5, it is supported by emerging neuropsychological evidence. Researchers and clinicians believe it is linked to:

• Emotional dysregulation: Common in ADHD and Autism, where the brain has difficulty modulating emotional responses.

• Hypervigilance to social threat: Often rooted in past rejection, bullying, or trauma.

• Nervous system reactivity: The fight-flight-freeze-fawn response can be triggered by emotional cues, not just physical danger.

  
  

Dr. William Dodson, a psychiatrist specialising in ADHD, describes RSD as “an extreme emotional sensitivity and pain triggered by the perception that one is being rejected, teased, or criticised by important people in their life.”

What RSD Looks Like in Children & Teenagers

Children and teens with RSD often don't have the words to explain what’s happening — instead, they show it through behaviours, moods, or avoidance.

Here’s how it might show up:

In Younger Kids:

• Meltdowns after being told “no”

• Withdrawal or hiding after being corrected

• Refusing to try new things in case they "fail"

• Constant need for reassurance ("Did I do it right?")

• Saying things like, “Nobody likes me” or “I’m stupid”
  

In Teenagers:

• Avoiding social situations or school

• Fixating on friendships or messages ("Why haven't they replied?")

• Over-apologising or people-pleasing

• Explosive anger when criticised — or sudden shutdown

• Mood swings after a conflict or small embarrassment

• Obsessing over grades, looks, or social media validation
  

RSD often gets misinterpreted as being dramatic, manipulative, or immature. In reality, the young person is in pain, and their nervous system is treating perceived disapproval as emotional danger.

Why RSD Is So Common in ADHD and Autism

RSD is particularly common in neurodivergent individuals — especially those with:

ADHD:

• Many people with ADHD have a nervous system wired for intensity — thoughts, emotions, and reactions all hit hard and fast.

• ADHD also involves challenges with executive function and self-regulation, making it harder to manage emotional reactions.

• The social fallout from impulsivity, hyperactivity, or past "failures" can lead to a heightened sensitivity to future rejection.
  

Autism:

• Autistic individuals often grow up being misunderstood, criticised, or socially excluded, leading to internalised shame.

• They may struggle with reading social cues, making them more likely to misinterpret or overanalyze interactions.

• Sensory overload and emotional overwhelm can make even small interpersonal moments feel unbearable.
  

In both groups, masking (hiding traits to fit in) adds an extra layer of stress and vulnerability. If you've spent your life trying not to be "too much" or "get it wrong," then of course rejection — even the possibility of it — can feel unbearable.

How to Recognise RSD in Yourself or Others

You might be dealing with RSD if you:

• Rehash social interactions long after they’re over

• Feel deeply ashamed or crushed by small criticisms

• Assume people are upset with you if they’re quiet

• Need constant reassurance that you haven’t messed up

• Avoid conflict to the point of silencing your needs

• Experience full-body responses (shakiness, nausea, panic) after being corrected or misunderstood

• Struggle to try new things unless you're sure you’ll succeed

These aren’t signs of weakness or emotional immaturity — they’re signs of unhealed hurt and a nervous system that’s learned to equate rejection with danger.

Supporting Yourself or Someone You Care About

Whether you're supporting a child, teen, or yourself, here are ways to work with RSD, not against it:

1. Name It Without Shame

Understanding RSD can be profoundly validating. Once you know what’s happening, you can separate who you are from how your nervous system reacts.

“This isn’t me being dramatic. This is my nervous system reacting to a threat.”

2. Create Safety in Relationships

Be consistent, kind, and attuned. Let your child or teen know:

“It’s okay to make mistakes. I’m not going anywhere.”Predictable love creates emotional safety.

3. Practice Co-Regulation

Help kids and teens calm down using soothing voice tones, gentle touch, and grounding techniques like breathing or sensory items.

4. Use Scripts and Reframes

• “It’s okay to feel upset. That doesn’t mean you did something wrong.”

• “That person might be quiet for lots of reasons — it doesn’t mean they’re angry with you.”

• “We all mess up sometimes — it doesn’t make you bad or broken.”
  

5. Therapeutic Tools

Therapies like:

• CBT (to challenge distorted thinking)

• DBT (for emotion regulation)

• ACT (to sit with discomfort without letting it control your actions)

• Compassion-Focused Therapy (to address deep shame)

All can support people living with RSD to build resilience and self-worth.

6. Build a Rejection-Resilient Mindset

Instead of avoiding rejection altogether, practice tolerating it in small, manageable ways — with support. Over time, the shame-rejection link can loosen.

Final Thoughts

Rejection Sensitive Dysphoria doesn’t mean you're broken. It means you're deeply wired for connection — and that emotional wounds have made you cautious, even hyper-alert.

The good news? RSD can be understood, supported, and softened. With compassion, validation, and nervous system-informed care, you can move from fear of rejection to confidence in your worth.