A woman sitting on a couch with a rejection letter in her hand and a coffee cup and laptop on the table in front of her.

Everyone experiences rejection in life, whether it’s from a loved one, at work or in school. There are proper ways to view rejection, but there are also unhealthy levels of worrying. Rejection sensitive dysphoria (RSD) is an extreme fear of any form of rejection and can debilitate a person’s ability to make decisions or hold healthy relationships, if not treated properly.

Feeling rejected, or, worrying about being rejected, can leave anybody feeling alone and unheard. That’s why it is important to understand how dysphoric beliefs around rejection form and why these feelings must be discussed with a mental health professional.

What is rejection sensitive dysphoria?

Rejection sensitive dysphoria refers to an elevated fear of rejection and/or criticism. In conclusion, not only does rejection cause worry, but simple conversations or interactions with people can also strike fear. Rejection sensitive dysphoria makes responding to potentially difficult talks or experiences difficult.


Remember, everyone may experience discomfort with rejection, even in small-scale circumstances. A dysphoric outlook toward rejection, however, is different and more extreme.

According to Psychology Today, there are some common signs to look out for if you think you may have rejection sensitive dysphoria. They include:

  • Increased fear or worry about rejection
  • Fear of failing
  • A feeling of guilt and/or shame frequently, especially after a conversation or interaction
  • Basing self esteem on what others think of you
  • Avoiding rejection by isolating yourself
  • Setting extremely high self standards


Specific causes of rejection sensitive dysphoria can be difficult to name, and therefore, psychologists do not fully understand all possible causes. However, there are some factors that can affect the likelihood someone will experience this. Most of these factors are environmental, and they include:

Do I have rejection sensitive dysphoria?

In some cases, people with rejection sensitive dysphoria may also live with a mental health condition. These can include:

  • An anxiety disorder, like Post-Traumatic Stress Disorder (PTSD) or Generalized Anxiety Disorder (GAD)
  • Major depression
  • A personality disorder, like Borderline Personality Disorder (BPD)

An elevated fear of rejection can exacerbate these conditions (and vice versa) if not treated.

People with ADHD symptoms may also be at a higher risk of experiencing RSD. This is likely due to a difference in cognitive makeup and perceptions and sensitivity to external interactions and experiences.

Treatment Options

A common treatment option for rejection sensitive dysphoria is therapy. Through therapy, people experiencing these tough symptoms can now have a space to openly discuss them with a trusted, safe clinician. Above all, therapy also teaches coping skills that can help people handle stressful situations outside of counseling.

Cognitive Behavioral Therapy (CBT) is one counseling technique clinicians may use to treat symptoms relating to rejection sensitivity. CBT involves naming unhealthy thought patterns and behaviors and reframing them into healthy ones. CBT teaches clients:

  • How to cope with grief, loss and uncomfortable feelings
  • Ways to express emotions and feelings in a healthy way
  • Skills to manage anger and worry
  • Strategies to process difficult experiences

Alternatively, some clinicians may recommend medication as part of your treatment plan. One reason may be if you have any other preexisting conditions, like depression or anxiety, that may affect your fear with rejection.

Getting the Diagnosis

In the beginning stages of treatment, your clinician will evaluate your symptoms and determine the root of them. Understanding the reason behind your fear of rejection can be a major healing force in your treatment. Most mental health clinicians will use the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) to reach a diagnosis.

For example, the diagnostic process may include topics such as:

  • Your family history with mental health disorders
  • Any experience with abusive or unhealthy parenting styles
  • Your history with mental health disorders
  • Feelings of anger toward social interactions and rejection

Receiving a diagnosis may be scary for some people. If you have any questions or concerns about your treatment or how it relates to a diagnosis, be sure to talk with your provider. They will be able to put your worries at ease and work through them with you in a healthy, safe space.

Final Thoughts

In short, rejection isn’t easy, especially for people with a heightened sensitivity to their environment and relationships.

Above all, seeking professional help is critical if you believe you are experiencing rejection sensitive dysphoria or another mental health condition. Talk with a trusted mental health professional if your worrying has lasted for weeks or feels unbearable to manage.

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