An overview of what current research tell s us about Rejection Sensitive DYsphoria, including debates about its validity and ideas for reducing its negative impacts
Rejection hurts. To be excluded, criticized, or pushed away erodes our sense of value and belonging. But what if rejection—the experience of it, or even the mere threat of it—is a massively disruptive force in your life? What if it causes you such immense pain that you lose control of your emotions on a somewhat regular basis? What if that pain, over time, has damaged your very sense of self?
The experience I’ve sketched out has a name: rejection sensitive dysphoria (RSD). In recent years, it’s become an exceptionally hot topic in neurodivergent communities. Most often, it is associated with ADHD, although folks with autism also sometimes identify with this experience.
This post is a brief exploration of the history and meaning of the concept of rejection sensitive dysphoria. What is clinical research is telling us about RSD? Are there good ideas for how to improve this condition?
What is Rejection Sensitive Dysphoria?
If you google “rejection sensitive dysphoria”, you’re bound to read a wide variety of definitions, some of which expand beyond the experience of rejection. Wrapping your mind around what RSD actually is can be challenging.
William Dodson, a psychiatrist who specializes in ADHD medications and frequently contributes to websites like ADDitude, first coined the concept. One definition he has shared is this: “a strong fear of being rejected or receiving negative feedback from others”. Or, in peer reviewed research he co-published in 2024, he and his co-authors describe it as “episodes [that] begin with the experience of perceived rejection, demonstrating rejection sensitivity, that progresses into a nearly instantaneous dysphoric mood, which causes significant distress and impairment.”
Like many definitions, it raises questions.
For example, what is a “dysphoric mood”? Technically, this can only be defined by the person experiencing the mood. However, dysphoria is understood to be deeper and more difficult than sadness, fear, or anger. It’s a distressingly acute version of one or more of these emotions.
Well, then, what is “significant distress and impairment”? Once again, it’s ultimately up to the person experiencing this distress to define what constitutes “impairment”. However, a (very few forms of impairment that might come up in discussions of RSD are:
Serious interpersonal struggles (e.g., high levels of conflict)
Avoidant tendencies that cause you to miss out on positive opportunities
Coping with addictive substances
Losing significant amounts of time and energy to rumination/over-thinking
Do researchers recognize RSD as Valid?
As with other hot topics in neurodivergence, rejection sensitive dysphoria is not as of yet a well-researched concept. As such, there is no consensus among clinicians about how to define RSD. We are also unclear as to how often it might occur as part of the ADHD (or autistic) experience. Despite this, you will easily find “statistics” online that are seemingly impossible to trace back to peer reviewed research.
In fact, there is a debate among researchers as to whether or not RSD is even a valid psychological experience that deserves its own name. Certainly, individuals like Dr. William Dodson (2025) believe that RSD is so widespread among people with ADHD that it should be used as a criterion for diagnosis. But there are others who remain unconvinced that RSD is not just a new label for old constructs: anxiety, depression, and emotional regulation struggles in general.
Is RSD Just a new name for Existing DIsorders?
Stereckaa & Oręziak are good examples of RSD nay-sayers. In their 2025 study, they found that their ADHD-diagnosed subjects were only slightly more likely to experience RSD than neurotypical controls, as determined by their score on the Rejection Sensitivity Questionnaire. Moreover, they also assessed subjects for depressiveness, anxiety, and “difficulties in emotion regulation”. Ultimately, their analysis indicated that these traits caused a significant part of this experience of “rejection sensitivity”, weakening the slight correlation between ADHD and RSD that they found.
In other words, they concluded that the pain their subjects felt was driven by depression, anxiety, or emotional regulation challenges. Without suffering from these conditions, there essentially is no RSD.
IS RSD an emotional Regulation & Executive Function Challenge?
There are also, of course, researchers like Oroian et al (2024) who assume RSD is a useful and legitimate concept. In Ororian et al’s recent review of clinical literature on RSD to date, they also find a link between rejection sensitivity and emotional regulation challenges. But in their view, this link does not invalidate RSD.
They also found that executive function challenges appear to play a role in predisposing a person with ADHD to struggle with RSD. Briefly, “executive functions” are the mental activities we associate with our prefrontal cortex. In an (admittedly simplistic) breakdown of the brain’s parts and functions, the prefrontal cortex is responsible for tasks like:
organizing thoughts
organizing activities
prioritizing tasks,
time management,
decision making
The idea is that when the person with ADHD struggles these tasks, they might also find themselves less capable of dealing with, say, unwanted criticism. Here is one example of the many ways that particular scenario might play out:
The criticism hurts the person with ADHD badly, causing a surge of anger and sadness
The person with ADHD responds quickly, without prior reflection on how their outburst might be received
The surprised and offended criticism-giver responds in a way that hurts even more
The person with ADHD spends a long time mulling over disorganized and distressing thoughts that don’t help them take action that could make the situation better
Is RSD the legacy of a history of hurt?
Of course, there are researchers who say that these discussions about neurobiologically driven “challenges” and “sensitivities” can make us blind to the role of environment. Barbara Sandland (2025) is a good example. Her qualitative research (i.e., smaller-scale and focused on rich descriptions of subject experience) explores the way social experiences can set an individual up for “rejection sensitivity”.
In her research, she observes that RSD sufferers have learned to fear rejection. She proposes that people with ADHD typically do suffer from substantially more experiences of judgement than their neurotypical peers. Hence their pre-existing emotional challenges combine with difficult social experiences to create the perfect storm we call RSD.
Of course, the social difficulties people with ADHD experience are well-documented, supporting Sandland’s proposition. For example, we know that parents are more prone to criticize and react coldly towards children with ADHD traits (Psychogiou et al., 2007). Gardner et al (2020) shows that these early experiences of judgement and rejection lead children with ADHD to be on high alert for perceiving negativity from others. Tragically, this heightened sensitivity may even influence their behaviour in ways that make them more likely to be rejected (Meehan et al, 2018).
Is “Savouring” a solution for the Rejection Sensitive?
Muller et al (2024) definitely subscribe to the notion that nature and nurture both drive the experience we call RSD. Their analysis of college students with ADHD/RSD also points towards a potential solution.
In many ways, their research reflects that of the RSD nay-sayers, with a positive twist. They found that subjects who had ADHD but fewer symptoms of RSD also had higher levels of “well-being” and “self-regulation”. So, instead of emotional regulation challenges causing distress, like in Stereckaa & Oręziak’s work, emotional resilience skills prevented or reduced distress in Muller et al’s subjects.
But what if you have ADHD and you don’t happen to be one of the lucky ones with so-called better skills or higher resilience? Even in these instances, Muller et al discovered that a particular practice could improve the mental well-being and reduce rejection sensitivity of people with ADHD. This is called “savouring”.
In brief, savouring is the habit of actively seeking out, appreciating, and holding onto positive and pleasurable experiences. You work against avoidance and push towards whatever makes life meaningful for you. Over time, you internalize whatever brings you connection, contentment, and purpose. This sense of positivity can buffer the difficult feelings that rejection brings.
