Rejection Sensitivity Disorder In Adults – The Shortest Guide

Do you constantly worry about what others think of you and try to avoid situations where you may be rejected? If so, you may have a rejection sensitivity disorder.

None of us like being disliked or dismissed. In fact, the need to be accepted, included, and liked by others is a fundamental human motivation (Baumeister and Leary, 1995).

At the same time, peer rejection is a common social phenomenon and we all keep getting rejected.

However, rejection sensitive people are vulnerable to even mild criticism and feel unease at even the thoughts of being turned down.

Dive into this short and complete guide to rejection sensitivity.

What is rejection sensitivity disorder in adults?

Rejection sensitivity (RS) is an individual tendency to highly anticipate and react strongly to the possibility of social rejection. It causes the sensitive person to anxiously expect, readily perceive, and intensely react to experiences or perceptions of rejection.

People with rejection sensitivity:

  • Have a high desire to be liked and accepted by others, and
  • Remain overly sensitive to perceptions of being rejected by those they care about.
  • Have unusually high vigilance for any perceived slight, alert to catch the signals of being ignored, dismissed, or treated as if they don’t matter.

The sensitive person can feel embarrassed and overwhelmed even if they perceive or expect rejection. They may go quiet, become upset or angry, start to cry, or even say things that eventually lead to the rejection.

Rejection sensitivity (RS) is not a clinical diagnosis, and it is not the same as Rejection Sensitivity Disorder (RSD). There is a relationship between ADHD and RSD: What is rejection sensitivity dysphoria in adults?

How experts define rejection sensitivity?

Downey & Feldman (1996) define rejection sensitivity (RS) as “the predisposition to defensively expect, readily perceive, and react strongly to interpersonal rejection.”

McDonald and colleagues (2010) define rejection sensitivity as the tendency to anxiously or angrily expect rejection.

“Rejection sensitivity (RS) is a personality trait characterized by a heightened sensitivity to rejection and a fear of being abandoned.”

What causes rejection sensitivity?

Rejection sensitivity (RS) is a well-researched topic. However, the exact cause of rejection sensitivity is not fully understood, but it is believed to be influenced by a combination of factors.

1. Genetic predisposition

Some individuals may be genetically predisposed to rejection sensitivity.

Research suggests that a specific gene (the OPRM1 gene) may be associated with acute emotional pain in response to social rejection. If a parent or close relative has RSD, there may be an increased likelihood of developing it.

“G-carriers seem to have less capacity to supress responses to pain (and) compensate for negative emotion.”

Kar Zubieta, psychiatric researcher at the University of Utah

2. Links to other conditions

Rejection sensitivity is often linked with clinically diagnosed conditions like attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), generalized anxiety disorder (GAD), and certain depressive disorders.

This study suggests that youth with ADHD show more sensitivity to peer rejection, and less response to peer acceptance (Babinski et al., 2019).

Lord & Liverant (2022) suggest that RS “may be a transdiagnostic trait associated with a range of psychiatric symptoms and psychosocial dysfunction.”

3. Early life experiences

Stressful childhood experiences, such as having critical or neglectful parents, being bullied or teased by peers, or experiencing rejection or abandonment in relationships, can contribute to the development of rejection sensitivity.

These experiences can shape how individuals view themselves and impact their self-esteem and fear of rejection.

4. Learned emotional response

Rejection sensitivity can also be a learned emotional response.

Individuals who have experienced repeated rejection or criticism may develop heightened sensitivity to future instances of rejection. Over time, this sensitivity can become ingrained and automatic.

5. Rejection Sensitivity Model

The Rejection Sensitivity Model (Levy et al., 2001) suggests that individuals exposed to many rejections in the past may develop a heightened sensitivity to rejections in adulthood.

Cause and Cycle of Rejection Sensitivity
The Cycle of Rejection Sensitivity

Levy’s model shows how rejection sensitivity can be a self-fulfilling cycle:

  • Rejection Experiences: Starting point of the cycle. After many repeated rejections, one’s need to belong, be accepted, included, and liked by others remains unrealized.
  • Rejection Sensitivity: This causes them to become more likely to expect rejection from others.
  • Perceptions of Rejection: Such expectations get activated in situations where rejection is a possibility, even if there is no real evidence of rejection.
  • Cognitive-Affective Reactions: This perception of rejection can lead to anxiety, hurt, and anger.
  • Behavioral Reactions: People with RS may then behave in defensive and self-defeating ways, such as hostility, aggression, or social withdrawal.
  • Self-Fulfilling Prophecy: Ironically, these overreactions can actually provoke rejection from others, producing a self-fulfilling prophecy, completing the cycle (Downey & Freitas, 1998).

What are the symptoms & signs of rejection sensitivity?

Rejection sensitivity is a triggered response.

At the root of RS is a fear of being turned down by the people they care about. They are anxious that people they value may reject them, and remain ready to anger about it.

  • Avoidance of social situations. People with rejection sensitivity may altogether avoid social situations, or they may only participate if they feel very confident that they will not be rejected.
  • Overly defensive or hostile behavior. When they feel that they are being rejected, they may become overly defensive or even hostile. They may lash out at the person who they perceive as rejecting them, or they may withdraw from the situation altogether.
  • Interpretation of benign or mildly negative social cues as catastrophic. They may interpret benign or mildly negative social cues as catastrophic. For example, if someone doesn’t respond to their text message right away, they may assume that the person is angry with them or doesn’t like them.
  • Jumping to the worst-case scenario. They are often quick to jump to the worst-case scenario. If they think that they might be rejected, they may start to catastrophize about the situation. They may imagine all of the terrible things that could happen, and start to feel very anxious or depressed.
  • Inability to function in daily life. In some cases, rejection sensitivity can be so extreme that it interferes with a person’s ability to function in daily life. They may have symptoms similar to severe social anxiety disorder, and have difficulty making friends or maintaining relationships. They may also experience anxiety or depression, which can further impair their ability to function.
  • Ignoring other, more logical explanations. When people with rejection sensitivity feel rejected, they may ignore other, more logical explanations for the situation. For example, if someone doesn’t respond to their text message right away, they may assume that the person is angry with them, or planning to leave them.
Rejection Sensitivity Disorder in Adults

What are the effects of rejection sensitivity?

Studies have shown that adolescents and adults have similar negative mental health outcomes to rejection, just as children have (Bierman, 2004; Williams, 2001).

Researchers have long known how peer rejection in children can lead to a range of mental health issues like anxiety, unhappiness, anger, depression, and low self-esteem (Sandstrom & Zakriski, 2004).

Further, rejected children tend to do worse at paying attention to and interpreting peer cues (Dodge & Feldman, 1990), solving social problem tasks (Nesdale & Lambert, 2008), knowing how to act properly (Jones & Abbey, 1998), making new friends, and succeeding in prosocial play (Nesdale & Lambert, 2007).

Research shows that by adolescence, chronic rejection is associated with self-destructive and antisocial behaviors, including academic difficulties, truancy, dropping out of high school, violence and aggression, adolescent delinquency, and substance abuse (Kupersmidt, 1990; McDougall, 2001).

Further, findings reveal that rejection and exclusion in adults are associated with cognitive disorientation, emotional distress, and depression (Baumeister & Twenge, 2002; Williams & Cheung, 2000); as well as self-defeating behaviors, such as risk-taking, unhealthy behaviors, and procrastination (Twenge, Catanese, & Baumeister, 2002).

How can we measure rejection sensitivity?

The Adult Rejection Sensitivity Questionnaire (A-RSQ) is a self-report measure of rejection sensitivity.

The A-RSQ was developed by Kathy R. Berenson, Orhan Ayduk, and others in 2006. It is a 12-item measure that assesses two dimensions of rejection sensitivity: rejection expectancy and rejection concern.

  • Rejection expectancy refers to the belief that one is likely to be rejected by others.
  • Rejection concern refers to the emotional distress that one experiences when they believe they are being rejected.

This study found that rejection expectancy was linked with reduced positive affect, while rejection concern was more strongly associated with indicators of negative affect. Both rejection concern and rejection expectancy were associated with indicators of interpersonal dysfunction.

The A-RSQ can be used to identify people at risk for developing a range of different psychiatric symptoms and psychosocial problems as a result of their high levels of rejection sensitivity.

It can also be used to track changes in rejection sensitivity over time, which can be helpful in evaluating the effectiveness of interventions designed to reduce rejection sensitivity.

Can rejection sensitivity be treated or managed?

Rejection sensitivity can be managed and treated. While there is no cure for rejection sensitivity, there are several ways to manage and reduce its symptoms. Here are some treatment options:

  1. Medications: Some people with rejection sensitivity may benefit from ADHD medications, especially those who have the severe form, Rejection Sensitivity Dysphoria (RSD), with medication.
  2. Cognitive-behavioral therapy (CBT): CBT can help those with rejection sensitivity identify and challenge negative thought patterns and develop coping strategies to manage their emotions. CBT can also help individuals develop more positive self-talk and self-esteem.
  3. Mindfulness: Mindfulness techniques, such as mindfulness meditation and mindful writing, can help individuals with rejection sensitivity to become more aware of their thoughts and emotions and to develop greater trigger thresholds.
  4. Positive reinforcement: Reinforcing strengths and focusing on positive aspects of oneself can help sensitive individuals build self-esteem and reduce sensitivity to rejection.
  5. Support groups: Joining a support group can give a sense of community and understanding. Support groups can also provide a safe space for individuals to share their experiences and learn from others.

Seek help from a mental healthcare provider to identify the most effective treatment options, especially if there seems to be an overlap with other disorders.


  1. Is “RSD” the same as “RS” (Rejection Sensitivity)?

    Rejection Sensitivity (RS) is not the same as Rejection Sensitive Dysphoria (RSD). Rejection Sensitivity disorder can be shortened to RS or RS disorder, but not as RSD.

    The term Rejection Sensitivity Dysphoria (RSD) was coined by Dr. William Dodson, who suggested that the condition is exclusive to people with ADHD.

    RSD can be thought of as a severe form of rejection sensitivity common among those with ADHD and autism, though not exclusive to them.

  2. How is rejection sensitive dysphoria different from rejection sensitivity?

    Rejection sensitivity (RS) and rejection sensitive dysphoria (RSD) are not the same thing, but rejection sensitivity can lead to RSD.

    Rejection sensitivity is a general term used to describe a heightened sensitivity to rejection or criticism, while RSD is a syndrome of severe emotional pain triggered by the perception of interpersonal rejection or criticism.

    RSD is not a formal diagnosis, and it can be associated with various mental health conditions, including ADHD, but it is not exclusive to ADHD. People with RSD have an intense fear of rejection and often experience intense emotional pain when they feel rejected.

  3. What are some coping mechanisms for rejection sensitivity?

    To cope with rejection sensitivity, consider the following steps:
    1. Notice your emotions: Notice what and how you are feeling. Is your face getting hot? Are you trying not to cry? Is your stomach or fist tight? When emotions are high, it’s not the right time to act or bring up sensitive topics.
    2. Act with an appropriate plan: Choose a calming activity depending on your emotional state. If calm, use grounding activities (that help you focus on the present moment) like walking barefoot, counting backwards from 100, or listening to calm music. If a little tense, try calming down with massaging your vagus nerve, or doing an adult coloring book. If very upset, turn to strategies like going for jogging, or voice-guided meditation.
    3. Analyze your thoughts: Check your initial interpretation of a situation. We often misinterpret situations when emotional or biased. Ask yourself: “What story am I telling myself?” “Is there evidence this story is true?” “Could there be another explanation?”
    4. See the situation through a new lens: Avoid falling into a negative thinking loop. Consider other reasons for the response you received. Perhaps they were busy or had other plans. Often, what we think is rejection is just a mismatch of needs.

  4. How does rejection sensitivity affect relationships and social interactions?

    Here’s how rejection sensitivity can create challenges in social interactions and relationships:
    1. It makes it hard for people to form and keep close relationships. Their fear of rejection might lead them to avoid social situations or pull back from relationships.
    2. It can cause dissatisfaction in relationships. The heightened sensitivity to rejection can create tension and conflict.
    3. It can give rise to social anxiety. People with rejection sensitivity may skip situations where they fear rejection, such as social events.
    4. It can trigger negative self-talk, affecting their self-esteem and confidence. This could turn into a self-fulfilling prophecy where the fear of rejection becomes real.
    5. It can affect social behavior, making people with rejection sensitivity hesitant to approach others or participate in social interactions.
    6. It can lower the quality of social interactions. For example, a 2021 study found that people high in rejection sensitivity had less quality interactions with their close ties.

  5. What does an RSD episode look like?

    Some common signs of Rejection Sensitive Dysphoria (RSD) include sudden emotional outbursts, low self-esteem, fear of failure, avoidance of social settings, high expectations for oneself, and persistent fear of being rejected or criticized.

    During an episode of RSD, the sensitive individual may feel overwhelmed with negative thoughts and emotions, experience physical pain, and have difficulty thinking rationally.

    Symptoms of RSD can sometimes resemble mental health conditions like depression, social phobia, bipolar disorder, borderline personality disorder, and post-traumatic stress disorder (PTSD).

    RSD is often associated with Attention Deficit Hyperactivity Disorder (ADHD), and it is more common in people with ADHD. However, RSD is not a formal diagnosis.

  6. What triggers rejection sensitive dysphoria?

    Rejection sensitive dysphoria (RSD) can be triggered by perceived or actual rejection, criticism, or failure,a sense of falling short, failing to meet one’s own high standards or others’ expectations.

    People with RSD have a heightened sensitivity to rejection or criticism, and even minor or nonexistent rejection or criticism can cause intense emotional pain and distress.

    While the exact reason for RSD isn’t fully understood, it can be a learned emotional response or a result of genetics. RSD has been linked to Attention Deficit Hyperactivity Disorder (ADHD), and it is more common in people with ADHD.

  7. Is RSD exclusive to ADHD?

    No, rejection sensitive dysphoria (RSD) is not exclusive to ADHD. While people with ADHD may be more susceptible to RSD, anyone can experience RSD, and it is not exclusively associated with any particular condition.

  8. What is emotional dysregulation?

    Emotional dysregulation is the inability to manage emotional responses to stimuli and keep them within the usual range of reactions.

    Symptoms of ADHD and emotion dysregulation are separate but related dimensions, each supported by partly overlapping separate brain-based deficits.

    This study suggests that emotion dysregulation is a core, defining feature of ADHD.

  9. Are general anxiety and rejection sensitivity linked?

    Anxiety symptoms may often coexist with symptoms of rejection sensitivity.

    People with generalized anxiety disorder (GAD) worry excessively and uncontrollably about everyday things. They may feel more embarrassed or self-conscious in social situations, whether real or imagined, if they also have rejection sensitivity.

    These people may also have self-confidence issues, be overly self-critical, and have pessimistic inner dialogue.

Final Words

  • Rejection sensitivity is not a sign of weakness, and people who experfsocialience it do live normal lives.
  • Rejection is a normal part of life, and though painful, it does not define your value as a person.

You can learn to control your rejection sensitivity and live a fulfilling life.

Consult a mental health clinician if you feel hurt at the mere thought of being ignored, overlooked, avoided by others, excluded from a group, or not being responded to when they’re talking.

Psychotherapy can help you manage your triggers around your feelings and thoughts of rejection.

“No one can make you feel inferior without your consent.”

– Eleanor Roosevelt

Researched and reviewed by Dr. Sandip Roy — medical doctor, psychology writer, and happiness researcher.

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