What Is Rejection Sensitive Dysphoria?

Rejection sensitivity is when a person is anxious about and expects rejection, often thinks they are being rejected, and has intense emotional reactions to that perceived rejection. 

Rejection sensitivity can be severe enough that it affects daily life. When the sensitivity reaches that level, it is sometimes referred to as rejection sensitive dysphoria (RSD), clinical psychologist and best-selling author Andrea Bonior, PhD, told Health. 

However, RSD is not in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the resource healthcare professionals use for mental health diagnoses. This means RSD is not yet its own specific formal diagnosis. 

Even though RSD is not its own official diagnosis, the term might still be used in different places online. But often, the cited studies have to do with rejection sensitivity. And rejection sensitivity is something that’s been studied and that the DSM-5 recognizes, Karam Radwan, MD, associate professor of Psychiatry and Behavioral Neuroscience at The University of Chicago, told Health. 

So to understand what some unofficially refer to as RSD, it is actually important to understand rejection sensitivity. 

Signs and Symptoms

Rejection in a social or relationship setting is a feeling nobody likes but that everyone is bound to experience at some point in their life. When you are rejected, some people may use that experience to either repair the relationship or seek a new one.

Some people are more sensitive to rejection, though, and may not be able to use rejection as a catalyst for change. They might have rejection sensitivity.

The main signs of rejection sensitivity are overly worrying about social rejection and having a heightened reaction to perceived rejection. People with rejection sensitivity will also often misinterpret negative cues, such as someone not answering a phone call, as a form of rejection.

Other signs of rejection sensitivity include:

• Problems with relationships
• Difficulty regulating emotions
• A tendency to experience negative emotions
• An increase in intense, aggressive behavior
• Heightened physiological responses to social experiences
• Social avoidance
• Hypervigilance for signs of rejection

Rejection sensitivity might affect you to the degree that it becomes what some may consider RSD.

“You can think of rejection sensitivity itself as a concept [or] characteristic that exists on a spectrum. Everyone might be on the spectrum somewhere, with some degree of it,” said Bonior. “But when [rejection sensitivity] gets to the point of ‘dysphoria,’ that means that it is extreme enough to cause distress that makes a negative impact in someone's daily life or impairs them in some way.”

What Causes Rejection Sensitivity?

Rejection sensitivity is believed to be linked to having experienced rejection earlier in life from either a caregiver or in social situations. A childhood that has rejection, abuse, or neglect could lead to the development of rejection sensitivity. Rejection from a parent or peers is shown to cause greater rejection sensitivity. 

Those early experiences of rejection can lead you to expect rejection later on in life. Past experience with rejection can also make you try to avoid rejection.

So in a way, rejection sensitivity is a defense mechanism. Because your past rejection has taught you to expect it, being sensitive to rejection allows you to detect it and respond to it. 

But the defense mechanism can start to affect your everyday life if your reaction to the perceived rejection is unwarranted or prevents you from achieving goals.

Linked Conditions

Rejection sensitivity, or the unofficial RSD, is not usually thought to be a diagnosis on its own. Instead, it is more commonly believed that rejection sensitivity is a symptom of a mental health disorder. 

“The DSM-5 and most psychiatrists do not recognize [RSD] as one illness or cluster of symptoms that can be treated with medications but rather a symptom that can be related and linked to other psychiatric disorders," said Dr. Radwan.

Rejection sensitivity has been found to be associated with many mental health conditions. Rejection sensitivity is a diagnostic criterion or feature in:

• Social anxiety
• Depression
• Borderline personality disorder
• Avoidant personality disorder
• Premenstrual dysphoric disorder, a severe form of premenstrual syndrome
• Bulimia
• Body dysmorphia
• Suicidal ideation
• Substance or alcohol use disorders

Rejection sensitivity has also been linked to autism and attention deficit/hyperactivity disorder (ADHD).

“Within the field of ADHD research especially, the concept of [RSD] has been cited. But again, it is not diagnosable as per the DSM, so that accounts for a lot of the ambiguity,” said Bonior. 

How Is Rejection Sensitivity Treated?

Treatment of rejection sensitivity can depend on the degree to which you experience the condition. Any other condition you have alongside the sensitivity may also impact treatment. 

One approach that may work is a mindfulness-based intervention. Such an intervention would mean purposefully bringing awareness to the rejection sensitivity at the moment you are experiencing it. This may look like talking out what it is you are feeling. The exercise should be done in a judgment-free space. 

Practicing mindfulness during an episode of rejection sensitivity could lessen the sensitivity you have around the perceived rejection. Such help was seen in disorders characterized by rejection sensitivity, including social anxiety and borderline personality disorder.

When to See a Healthcare Provider

Everyone experiences rejection from time to time. But if you find that you seem to be anticipating rejection more than others or that you seem to be reacting to rejection stronger than others, those might be signs of rejection sensitivity. 

A healthcare provider can help determine whether you have rejection sensitivity and, if so, to what degree. Because RSD is not a diagnosable condition, you will not be diagnosed with that particular level of rejection sensitivity. But if the sensitivity interferes with your everyday life, relationships, mental health, and well-being, the provider can recommend treatments based on your symptoms and any other mental health conditions you may have. 

A Quick Review

Rejection-sensitive dysphoria is a term not officially recognized in the medical community. When the term is used on an unofficial basis, it is often in regard to a severe degree of rejection sensitivity. Rejection sensitivity is a trait that makes it so that you anxiously expect rejection and then intensely react to any perceived rejection. 

Rejection sensitivity is often caused by previous rejection, typically earlier in life, and is associated with several mental health conditions, such as anxiety, ADHD, and borderline personality disorder. 

Treatment for rejection sensitivity may include mindfulness techniques at the moment you are experiencing the sensitivity. You should consider seeing a healthcare provider if your intense fear of rejection and heightened response to it is disrupting your life in any way.