What is rejection sensitivity, and why does it co-occur with so many different diagnoses? Does that pattern tell us about the causes of RSD? And how can we experience less distress in response to rejection?

What is rejection sensitivity?

Rejection sensitivity, also known as rejection sensitive dysphoria (RSD), describes intense distress in response to even minor or perceived rejection. We all dislike rejection and can become upset by it, but to those struggling with rejection sensitivity, the emotional response to perceived rejection is extreme and debilitating. Any sort of exclusion, criticism, rejection, or judgment from others can lead people with RSD down a rumination spiral. People with rejection sensitivity also tend to overestimate how much people dislike or judge them.

What causes rejection sensitivity?

Most people take a multidisciplinary approach when investigating causes of rejection sensitivity. Some doctors believe that a predisposition to rejection sensitivity passes down genetically through families, and that early life circumstances can bring out and exacerbate symptoms.

Early life experiences that can predispose people to rejection sensitivity range from rejection by peers to neglect and abandonment by parents. In addition, rejection sensitivity co-occurs with a number of different struggles and diagnoses: ADD/ADHD, autism, CPTSD, and BPD, to name a few.

ADD/ADHD

Rejection sensitivity is one of the most common symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in adults. Dr. Stephen Hinshaw, a psychology professor at UC Berkeley, has conducted quite a few studies surrounding ADHD and peer rejection.

In the 2013 paper, “Peer Rejection and Friendships in Children with Attention-Deficit/Hyperactivity Disorder: Contributions to Long-Term Outcomes”, Hinshaw and his co-authors found that children with ADHD are significantly more likely to be rejected by their peers. Other studies have reported similar findings. It then follows that as adults, people with ADHD would be much more sensitive to rejection, real or perceived, since they grew up experiencing it.

In addition, since those with ADHD often experience heightened emotions and stimuli in general, they may also have a more intense neurological response to rejection.

Autism

People with autism spectrum disorder (ASD) also experience a higher amount of rejection sensitivity. This is assumed to be because often, people with ASD have a difficult time communicating. They may also struggle reading the actions and intentions of those around them. Another facet of ASD is the experience of heightened emotional states and more intense reactions to emotional stimuli, in general. Therefore, the perception of rejection can cause major distress.

BPD

Borderline Personality Disorder (BPD) is characterized by an ‘anxious preoccupation with real or imagined abandonment’ (DSM-5), which rings similar to the general idea of rejection sensitivity. Rejection sensitivity seems to almost be a symptom of BPD. Often, BPD is a result of maltreatment in childhood: abuse, neglect, abandonment, etc. The fear of those things carrying through into adult relationships can haunt those with BPD. This fear also maintains and exacerbates their experience of rejection sensitivity.

CPTSD

Post-Traumatic Stress Disorder (PTSD) has also been linked to higher levels of rejection sensitivity, though more research needs to be done compared to ADHD and autism. A characteristic symptom of PTSD is heightened emotional states and responses. One 2012 study done by Dr. Grace Kiriakos found that rejection sensitivity was positively correlated to PTSD symptom severity, but equally common amongst people with BPD and people with PTSD.

Why does RSD overlap with so many conditions?

All of these mental health labels have a common symptom: heightened emotional states and responses. This shared symptom likely relates to varying levels of chemical difference, genetic difference, early life experience, and neurodivergence.

How to cope with rejection sensitivity

Part of dealing with rejection sensitivity is dealing with the perception of rejection. From time to time, we all perceive rejection that isn’t happening; people who experience RSD go through this misperception just a little more often. So learning not to anticipate rejection (or to anticipate it less) proves crucial for coping.

In addition, since we cannot do much about actual rejections, it helps to cultivate milder reactions to those experiences. Below, find some resources and methods used to help alleviate feelings of desperate abandonment.

Therapy

The three types of therapy that can help with rejection sensitivity the most are Cognitive Behavior Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT). All of these work on targeting people’s harmful thought processes and shifting them in order to alter desired behaviors. In addition, learning coping mechanisms and healing past trauma will help reduce sensitivity to criticism, as well as the anticipation of abandonment.

By working through and changing rejection-sensitive thought patterns, a therapist can help a client perceive less false rejection and be less distressed by true rejection.

Medication

Ultimately, your doctor is the only one who can make decisions regarding medication that might help you feel more functional. However, a variety of medications have shown promise for reducing rejection sensitivity.

Antidepressant medications have shown symptom improvement. In addition, some medications that target physical reactions, such as blood pressure medication, have also been shown to reduce distress as a result of rejection. These medications mostly target the symptoms, not so much the root of the problem.

Peer support

You might imagine a safe place where rejection is totally off the table–but that place isn’t just a fantasy. Safe spaces exist, like in anonymous peer support chats. Under those conditions, the possibility of rejection feels less threatening (nobody knows who you are). And regardless, chats are kept positive and productive by moderators–no rejecting, unhelpful behavior allowed.

As you can see, there are ways to cope better with rejection sensitivity. None are simple fixes, but wouldn’t it be nice to live with less social pain? Less fear of others’ judgement? The effort will pay off.

You’re not alone, and you aren’t helpless. Now that you know you may be struggling with rejection sensitivity, you’ve completed the first and hardest step: awareness of the problem. It doesn’t have to dominate your everyday life.