At some point or another, most have had the experience of wanting nothing more than to belong—it’s a desire hardwired into our being. Belonging and connection are foundational human needs, so being concerned with others’ perceptions of us and whether or not we are liked is a universal experience. It also means that the feeling of rejection stings for pretty much everyone.
Whether it’s trying to make new friends, wanting to join a sports team, asking someone to go on a date, or applying for a new job— it hurts being told “no” when we’ve put ourselves out there and have asked for something we want. Rejection is never a fun experience, and it is normal, even expected, for someone to feel disappointed, sad, and even discouraged in response. However, some experience hypersensitivity to rejection that extends beyond the discomfort expected in a healthy response. In this case, rejection sensitivity or, more intensely, rejection-sensitive dysphoria (RSD) may be at play.
Emotional Dysregulation
Before delving into rejection sensitivity and RSD, it is important to touch on the role of emotional dysregulation briefly. In simple terms, emotional dysregulation refers to difficulty managing and controlling emotions effectively and appropriately. It involves experiencing intense emotional reactions disproportionate to the situation and having difficulty returning to a baseline emotional state after being triggered.
Various regions of the brain are responsible for processing and modulating emotions. Emotional dysregulation occurs when there is an imbalance in the brain’s response to emotional stimuli. For example, the amygdala, which is involved in the initial emotional response, may become overactive or hypersensitive, leading to heightened emotional reactions. At the same time, the prefrontal cortex, accountable for executive functions like emotional regulation and impulse control, may struggle to modulate and regulate these intense emotions effectively.
This imbalance can result in difficulties in self-regulation, causing emotional responses to become overwhelming, prolonged, or challenging to manage. It’s important to note that emotional dysregulation can manifest differently in individuals, and various factors, including past experiences, genetics, and environmental influences, can contribute to its development.
Rejection Sensitivity v. Rejection Sensitive Dysphoria
Individuals with rejection sensitivity are on high alert for potential rejection, constantly looking for signs that may indicate they are about to be rejected. They often feel rejected more frequently than their peers and experience a more intense emotional reaction to rejection—real or perceived. Rejection sensitivity is understood as existing on a spectrum where individuals may exhibit varying degrees of intensity. Some may experience a slight increase in sensitivity to rejection, while others may demonstrate extreme sensitivity to it. Common characteristics of rejection sensitivity include:
- Anticipation of rejection before it’s happened causes severe anxiety, sadness, anger, and other negative emotions.
- Misinterpretation of innocuous or slightly negative social cues as an explicit rejection
- Extreme adverse reactions to negative social cues—real or perceived
- Avoidance or withdrawal from interpersonal relationships and/or intense anxiety in interpersonal relationships that are maintained
- Preoccupation with evaluating all interactions for possible signs of rejection
- Disregard of alternative explanations or justifications for the perceived rejection, including reassurances from the perceived rejector
- More emphasis is placed on previous instances of rejection rather than those of acceptance
Rejection Sensitive Dysphoria
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the official resource used by mental health professionals to help diagnose and classify different mental health conditions, omits RSD, meaning RSD does not have an official set of criteria, nor is it a formal diagnosis.
However, the term is colloquially used when referencing rejection sensitivity in its most severe state, a ten on a scale ranging from 1 to 10. The most discernible trait of RSD is the experience of an overwhelmingly intense feeling of emotional pain in response to rejection. People with RSD are more prone to aggressive behavior, isolating themselves socially, and engaging in self-harm to cope with this discomfort.
People with RSD find themselves consumed by the need to be liked by others but have a tough time forming close, meaningful relationships in which they feel comfortable. It can quickly result in a lack of social relationships, especially romantic connections, leading to loneliness, hopelessness, and low self-esteem.
The exact causes of RSD are still unknown. Still, based on the findings about rejection sensitivity—which there is a larger body of research on—it is likely that many factors are at play, including childhood experiences, genetics, and biological factors. Accordingly, RSD is seen more frequently in individuals with specific other mental health diagnoses, including body dysmorphic disorder, attention-deficit/hyperactivity disorder, borderline personality disorder, depression, and more.
Treatment
Mental health treatment is highly individualized and varies from person to person. When determining the most appropriate treatment plan, mental health providers consider the severity of symptoms, any coexisting mental health diagnoses, and, importantly, what resonates with the individual.
Similarly, treatment for RSD varies depending on the individual’s needs. Individuals may confidently manage their symptoms through independent learning of coping skills emphasizing relaxation techniques and emotional regulation. However, many people find additional support to be helpful. Therapeutic interventions with a licensed mental health professional are often beneficial, allowing for a safe space to explore and address RSD-related challenges. In some cases, medication may also be included as part of the treatment plan, offering additional support in managing RSD symptoms. This diverse range of treatment options available for RSD ensures that individuals can find a personalized approach that best suits their needs and provides the necessary support for effectively managing their symptoms.
