Rejection Sensitive Dysphoria (RSD): Why Rejection Hurts So Much and How to Manage It

A slow reply to a message. A blunt email from a colleague. Feedback that was meant kindly but somehow left you spiralling.

If you’ve ever felt crushed by something others brushed off easily, you’re not alone. For some of us, rejection doesn’t just sting, it sets off alarm bells in the body, hijacks our thoughts, and can leave us in an emotional hangover for hours or even days.

There’s a name for this: Rejection Sensitive Dysphoria, or RSD.

What is RSD?

Psychiatrist Dr William Dodson first used the term while working with people who have ADHD. He noticed how many described extreme emotional pain around rejection or criticism. Not just “ouch, that hurt”, but full-body distress, as if their whole sense of self had been threatened.

Dodson suggested that almost everyone with ADHD experiences RSD in some form. In my own work, though, I’ve seen how these patterns can also show up for autistic people, and even for some who don’t identify with either diagnosis. The intensity might look a little different, but the core experience can feel very similar.

Here’s a simple way I explain it in therapy:

When rejection (real or imagined) shows up, the amygdala (your brain’s smoke alarm) goes off. It floods your body with urgency: Danger! You’re not safe! They don’t like you!

Meanwhile, the logical, rational prefrontal cortex (the part that usually helps us pause, think, and respond) goes offline. I often refer to this as the “amygdala hijack.” This is why you might react before you’ve had a chance to think. Or why you can know logically that the rejection isn’t huge, but still feel it as if it is.

What RSD can look like

It shows up in lots of different ways:

• Avoiding opportunities because failure feels unbearable.

• People-pleasing, over-preparing, or perfectionism in the hope of avoiding criticism.

• Overthinking social interactions long after they’re done.

• “Emotional hangovers” of still feeling broken 24–48 hours after a trigger.

Living with RSD

Here’s the hopeful bit: RSD can be managed. Not by “toughening up” or pretending we don’t care, but by building ways to work with our sensitive nervous systems.

Below are some of the tools I return to again and again, both personally and with clients:

• The right environment: Constant criticism or invalidation keeps the nervous system on high alert. Protecting yourself from toxic jobs, draining friendships, or unsupportive spaces creates room to heal.

• Finding your people: Rejection stings less when we’re held by relationships that feel safe. Community, whether that’s friends, peers, or support groups provides a buffer. When you have people who get you, one piece of criticism doesn’t feel like a total collapse of belonging.

  
  

• Body-based tools: When the nervous system goes into full alarm mode, the thinking part of the brain (the prefrontal cortex) isn’t really accessible. This is why reasoning with yourself often doesn’t work in the heat of the moment. Instead, we can use body-based techniques to bring the system back into balance. Simple practices like cooling your face with water, doing a burst of intense exercise, progressive muscle relaxation, or steady breathwork send powerful signals to the body that it’s safe. Once the body begins to calm, the mind naturally follows.

  
  

  Once the mind begins to calm, we can perhaps then rely on more cognitive coping strategies such as...

• Naming it: Saying to yourself, “This is RSD” helps separate you from the intensity of the moment. It creates a little gap between the feeling and your identity.

  
  

• Challenging thinking traps: RSD often fuels catastrophic thoughts: “They hate me. I’ve ruined everything.” Asking, “What else could be true here?” gently interrupts that spiral. This doesn’t dismiss your feelings, it simply invites your rational, more compassaionate brain to sit at the table, too.

  
  

• Reaching out: Our nervous systems regulate best in connection with others. Talking to a trusted, compassionate friend can break the echo chamber in your head. They can validate your feelings, remind you of your strengths, while also offering perspective.

  
  

• Writing it out: Journaling helps move emotion from the swirl inside your body into a form you can see and reflect on. Sometimes the act of naming what happened and how it felt is enough to loosen its grip.

  
  

• Focusing on your strengths: RSD zooms in on the negative, erasing the bigger picture of who you are. Keeping a written list of your strengths and past wins can be grounding. When you’re spiralling, it’s a way of reminding yourself: “This rejection is a moment, not my whole story.”

  
  

• Therapy: Working with a neuroaffirming therapist can provide a supportive, non-judgmental space to explore your patterns, triggers, and emotional responses. It’s a place to approach RSD with curiosity rather than self-criticism. Therapy can also offer a form of self reparenting, helping you learn to give yourself the nuture, guidance, and protection you may not have received as a child, in turn helping you to better regulate your emotions.

  
  

A Gentle Reminder

Feeling rejection so deeply doesn’t mean you’re “too much” or broken. It’s just how your nervous system is wired, and that’s okay.

Living with RSD can be exhausting, but it doesn’t define you. There are ways to manage it, and with time and practice, those intense moments can feel a little easier to carry.