What Is Rejection Sensitivity?

Take our Rejection Sensitivity Test

Find a therapist near me

RSD is not a mood disorder unto itself, but reactivity to perceived criticism, especially in those with ADHD.

It manifests as immediate rage or depression, often with avoidance of activities that could lead to criticism.

RSD is not a "behavioral" issue, but might be perceived as such, leading to ineffective interventions.

Chances are you’re familiar with children diagnosed with attention deficit hyperactivity disorder (ADHD) who are prone to rage or bursting into tears. Consequently, these kids might also be diagnosed with disruptive mood dysregulation disorder (DMDD). However, there’s also a good chance those reactive moods are better accounted for by rejection-sensitive dysphoria (RSD).

The term RSD was first used in the 1960s to describe how some depressed people had a heightened sense of rejection that contributed to their bad mood. In the 1990s, ADHD expert Dr. William Dodson, M.D., adopted RSD to describe reactive moods he saw in many people with ADHD and has written extensively about it.

Despite this, RSD has remained unaddressed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a component of ADHD.

What does RSD look like?

Dodson et al. (2024) described RSD as when someone perceives or imagines rejection that sets off an almost instant, impairing mood shift. This could be rage at the perceived rejector/critic, or if the frustration is internalized, it could look like immediate onset of a major depressive episode.

Researchers have noted that the hallmark emotional reactions of RSD are associated with specific triggers, frequently related to perceiving criticism, and relatively short-lived. This is unlike depressive or bipolar disorders, where mood changes are more insidious and enduring, or in DMDD where anything might lead to the dysregulation.

Some people with RSD might also become people pleasers to avoid the potential for disapproval (Dodson 2025), or constantly strive for perfection as a prevention for criticism or rejection (Cleveland Clinic, 2022). Thy also tend to avoid activities that could lead to criticism.

Dodson (2024) and Rowney-Smith et al. (2026) provide numerous case studies to illustrate what RSD can look like and how it affects the person.

Alonzo (2025) noted RSD is a neurological failure to maintain emotional integrity in the face of relational trauma. Essentially, the dysregulation in RSD is the product of more complex, internalized processes. Chances are, the person has a poor self-image, a common feature of ADHD sufferers (e.g., Masoodi et al., 2024; Turner & Harty, 2025).

Poor self-images are ripe for feeling shame or embarrassment if criticized, even if constructive criticism. Researchers (e.g., Scharf et al., 2014) have also found evidence that people with ADHD who have dismissive and preoccupied attachment styles (i.e., those avoidant of emotional intimacy and those with constant need for approval/fear of rejection, respectively) are more prone to anger and anxiety. Add to the above that there seems to be biological contributions such as an underregulated amygdala (Retter, 2026), the part of the brain that processes aggression and anxiety, in people with RSD, and a perfect storm has brewed.

What Is Rejection Sensitivity?

Take our Rejection Sensitivity Test

Find a therapist near me

Imagine what it must be like for someone prone to this being frequently told how poorly they are behaving, especially when they may not fully understand why until it is explored with someone familiar with RSD. Let’s illustrate a basic profile with a teen we’ll call Alex.

Alex was court-involved due to property destruction at the school. They had history of ADHD treatment dating back to kindergarten and special education accommodations. With age, Alex isolated more in class, and when asked to participate or when the teacher’s aide would try to assist Alex, they would storm out of class rage at the teachers. Sometimes they even damaged school property. Alex’s psychiatrist suggested an additional diagnosis of oppositional defiant disorder (ODD). Alex’s parents had them meet with Dr. H., who specialized in teens with complex cases of ADHD, such as those involving inordinate dysregulation. Dr. H. asked Alex what happens internally leading to outbursts at school. As they examined Alex’s experience, it became clear they felt they were being set up for criticism when called on, and that the teacher’s aide’s help was criticism of their academic performance. They also perceived the teacher’s encouraging comments as patronizing and as slights. Alex described feeling so sensitive to criticism, or the potential for it, that they’d get overwhelmed with anger towards the source, and storm out. Alex acknowledged their angry reactions, which they felt little control over, led to actual criticism, and a lower self-image. Hence, Alex felt if they were just left alone in class, they would be less likely to react as such. Familiar with RSD, Dr. H met with Alex’s parents and the school to help them better understand Alex’s experience and devise a more productive way to work with them. It had nothing to do with ODD, which is rooted in a wish for omnipotent control. Clearly, exploring Alex’s emotional landscape and thought process was important for a more accurate diagnosis and productive intervention.

Alex was court-involved due to property destruction at the school. They had history of ADHD treatment dating back to kindergarten and special education accommodations. With age, Alex isolated more in class, and when asked to participate or when the teacher’s aide would try to assist Alex, they would storm out of class rage at the teachers. Sometimes they even damaged school property. Alex’s psychiatrist suggested an additional diagnosis of oppositional defiant disorder (ODD).

Alex’s parents had them meet with Dr. H., who specialized in teens with complex cases of ADHD, such as those involving inordinate dysregulation. Dr. H. asked Alex what happens internally leading to outbursts at school. As they examined Alex’s experience, it became clear they felt they were being set up for criticism when called on, and that the teacher’s aide’s help was criticism of their academic performance. They also perceived the teacher’s encouraging comments as patronizing and as slights. Alex described feeling so sensitive to criticism, or the potential for it, that they’d get overwhelmed with anger towards the source, and storm out. Alex acknowledged their angry reactions, which they felt little control over, led to actual criticism, and a lower self-image. Hence, Alex felt if they were just left alone in class, they would be less likely to react as such.

Familiar with RSD, Dr. H met with Alex’s parents and the school to help them better understand Alex’s experience and devise a more productive way to work with them. It had nothing to do with ODD, which is rooted in a wish for omnipotent control. Clearly, exploring Alex’s emotional landscape and thought process was important for a more accurate diagnosis and productive intervention.

The first step is understanding the person’s internal experience and triggers and working to minimize them, especially collaborating with staff if it is in a school setting. While Dr. Dodson has opined that psychotherapy has little effect on reducing RSD because of its strong biological underpinnings, that does not mean it cannot help.

If a poor self-image can be foundational to rejection sensitivity, working toward altering the person’s self-image may be useful. Dialectical behavioral therapy (DBT) may also be helpful as it focuses on distress tolerance and learning to be responsive and not reactive, and is effective in treating borderline personality disorder, which has its own brand of reactive rage and self-destruction.

As for medication, the ADHD medication guanfacine and the antihypertensive medication clonidine have proven effective in reducing the reactions. Dodson (2025) noted that 60% of teens and adults on one of these medications have a reduction in the reactivity.

Clearly, for some with ADHD, what may seem like vexing over-reactivity could be a matter of rejection sensitivity that has gone unaddressed. If you encounter someone like Alex who has ADHD and intense, reactive moods and treatment has not reduced the reactivity, a more thorough clinical exploration of the person’s internal experience of the outbursts could shed light on RSD, leading to more effective interventions.

Disclaimer: The material provided in this post is for informational purposes only and is not intended to diagnose, treat, or prevent any illness in readers or people they know. The information should not replace personalized care or intervention from an individual’s provider or formal supervision if you’re a practitioner or student.

To find a therapist, please visit the Psychology Today Therapy Directory.

Alfonzo, T. (2025). Emotional Governance Theory: The Missing Link in ADHD and Rejection Sensitivity Dysphoria (RSD). https://zenodo.org/records/15224784

Cleveland Clinic (2022, August 30). Rejection sensitive dysphoria (RSD). https://my.clevelandclinic.org/health/diseases/24099-rejection-sensitiv…

Dodson, W., Modestino, E., Ceritoğlu, H., & Zayed, B., (2024). Rejection sensitivity dysphoria in attention-deficit/hyperactivity disorder: A case series. Acta Scientific Neurology, 7(8), 23-30. 10.31080/ASNE.2024.07.0762

Dodson, W. (2025, November 3). How ADHD ignites RSD: Meaning & medication solutions. ADDitude Magazine. https://www.additudemag.com/rejection-sensitive-dysphoria-and-adhd/?srs…

Massoodi, A., Moudi, S., Malekiamiri, M., & Gholinia Ahangar, H. (2024). Comparison of self-esteem and quality of life in 8-12-year-old children with ADHD with and without learning disorders. BMC Psychology, 12(218). https://doi.org/10.1186/s40359-024-01732-7

Retter, E. (2026, February 25). The rise of rejection sensitive dysphoria: ‘My chest feels like it’s collapsing.’ The Guardian. https://www.theguardian.com/society/2026/feb/25/rise-of-rejection-sensi…

Rowney-Smith, A., Sutton, B., Quadt, L., & Eccles, J.A. (2026). The lived experience of rejection sensitivity in ADHD - A qualitative exploration. PLoS One 21(1): e0314669. https://doi.org/10.1371/journal.pone.0314669

Scharf, M., Oshri, A., Eshkol, V., & Pilowsky, T. (2014). Adolescents' ADHD symptoms and adjustment: The role of attachment and rejection sensitivity. American Journal of Orthopsychiatry, 84(2), 209-217. doi: 10.1037/h0099391.

Turner, E.H. & Harty, S.C. (2025). Daily activities and self-esteem among university students with and without ADHD. Frontiers in Psychiatry, 16:1622354. doi: 10.3389/fpsyt.2025.1622354

There was a problem adding your email address. Please try again.

By submitting your information you agree to the Psychology Today Terms & Conditions and Privacy Policy

© Psychology Today