25/10/2025
Rejection Sensitivity Dysphoria (RSD) – Simple Explanation
Rejection Sensitivity Dysphoria (RSD) means feeling very hurt or upset when you think someone has given you feedback sometimes constructive but you brain interprets it as being criticised, or disapproved of you and unconsciously you may feel rejected, even in small or imagined ways. The emotional response is much stronger than what most people experience — it can feel like an emotional wound or “crash.”
🧠 Why It Happens
RSD is not a separate diagnosis but a common experience for people with ADHD and/or Autism. The brain’s emotional regulation system is more sensitive usually hypersensitive, meaning rejection or perceived failure feels overwhelming. It’s linked to:
Difficulties in managing intense emotions.
A lifetime of real or perceived criticism or misunderstanding. The consequence of being Neurodivergent.
Low self-esteem from repeated experiences of perceived rejection.
💥 What It Feels Like
People describe RSD as:
Sudden waves of intense hurt, shame, sadness, or anger.
Feeling instantly worthless or humiliated, disrespected.
Wanting to withdraw, avoid, or “people-please”- linked to anxiety to stop it from happening again.
Sometimes, reacting with defensiveness or anger to protect themselves.
🧩 Common Triggers
* Not getting a reply to a message.
* Constructive feedback or correction.
* Being left out or not invited.
* Someone seeming annoyed, distant, quiet, silent.
* Failing to meet one’s own high standards.
🌱 Helpful Strategies
STOP-think!
Apply a filter strategy.
Is this information "true for me"? Yes/No
Is this more information more about the other person than me?
Is there something going on for them that could better explain their words or actions? Its not always about YOU!
Is there something constructive here, I can take and work on to improve myself?
Then move on.....
Recognising, understanding and naming it. “This is RSD” helps create distance from the emotion.
Pause and check the facts: Ask yourself, “Is there evidence they rejected me?” constructive versus destructive feedback.
Is this person helping or harming me.
Self-compassion: Speak to yourself as you would to a friend.
Educate yourself!
Seek therapeutic support if you need it: CBT, DBT, or Emotion Regulation Therapy can help.
Medication: For people with ADHD, stimulant or non-stimulant medication may help reduce emotional intensity prescribed by a Psychiatrist only.
For intense pain like a break up Tylenol (Paracetamol / Acetaminophen) can help.
Research (e.g. Dewall et al., Psychological Science, 2010) has shown that acetaminophen reduces activity in the brain regions that process both physical and emotional pain particularly the anterior cingulate cortex and insula.
These are the same areas activated when someone feels rejected, embarrassed, or humiliated.
So, in theory, Tylenol can dull the emotional sting of rejection a little bit, the same way it dulls a headache for acute times.Think of it as a comfort aid, not a cure.
Some people with ADHD or RSD report that it takes the edge off during intense emotional pain episodes.
⚠️ Important Caveats
It’s not a long-term or primary treatment for RSD.
It doesn’t address emotional dysregulation, sensitivity, or self-esteem wounds.
It should only be used at safe doses (max 4,000 mg per 24 hours for adults, usually 500–1,000 mg every 4–6 hours).
Overuse can damage the liver.
It’s most useful as a short-term aid, perhaps alongside therapy or other self-regulation strategies.
🌱 What Works Best Overall
Approach What It Helps With Examples
Medication for ADHD or mood Regulates emotional reactivity
Stimulants, SSRIs, guanfacine (Intuniv)
Therapy Understanding and reframing rejection triggers CBT, DBT, schema therapy
Body-based calming reduces physical arousal linked to emotional pain
Deep breathing, grounding, cold water
Tylenol (short-term)
Mildly reduces emotional pain activation in the brain 500–1000 mg occasionally when safe
🩺 Evidence-Based Summary
“Acetaminophen reduces neural responses to social rejection in brain regions associated with distress.”
— Dewall et al., Psychological Science (2010); Durso et al., Social Cognitive and Affective Neuroscience (2015).
