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Rejection Sensitive Dysphoria: Were You Born This Way?

Updated: Nov 8, 2023


rejection sensitive dysphoria

What is Rejection Sensitive Dysphoria?


Although not a diagnosis in and of itself, Rejection Sensitive Dysphoria (RSD) is a common experience among many neurodivergent people. Essentially it refers to an unusually deep experience of pain following rejection, as well as the anticipation that rejection is coming without adequate evidence to support it. RSD is not currently a standalone diagnosis in the DSM-V or ICD -11, but it is a condition that many neurodivergent people identify with as a way of describing the pain they experience in the world and in relationships. As a therapist specializing in neurodivergent issues, many people come to therapy saying they “have” RSD, and I’m always curious about exactly what that means.


Making a Case Against Biological Determinism

Were you born with RSD, and why does it matter? An analogy can be made to the debate about biological determinism in the LGBTQIA+ community. The biological determinism argument has gone on for decades in the LGBTQIA+ community, where some people feel protected by the sense that if they’re “born this way” then being LGBTQIA+ is not a moral failing, as it’s been framed in the past.


It can be comforting to believe that some of the emotional pain associated with neurodivergence is just biology. It protects us from having to do the hard work of examining our histories and environments to find out where we learned that our worth was dependent on the approval of others, and where we learned to expect rejection. The answers are often uncomfortable to sit with. If it is an essential biological trait that you are born with, it means you are unlikely to be able to unlearn it, so why bother trying? We are socialized to discount the impact of the environment and over-emphasize biology as a kind of misdirection; a way of not having to critically examine the social world and the power structures within it.


What if the problem is in systems, not in individuals?


Kids with ADHD hear 20,000 more negative messages (think “no, stop, don’t do that”) before they are eight years old. Imagine the impact on a young person’s developing self-concept. As a therapist, I frequently hear stories from people who simply felt like they “didn’t fit,” either because of difficulty interpreting social cues, impulsive or sensory-seeking behaviour that marked them as different than their peers, or special interests that were not shared by others. Over time, these experiences build up to form an individual’s expectations about themselves and the social world.


Generally, these messages did not come from one specific unkind person, but from a whole culture that demands strict adherence to norms. As much as school is a place for academic learning, it is also a place for being socialized into these norms, and the school environment is one where many neurodivergent people report experiencing a lot of early pain and rejection. Frequently, it is the setting where an individual internalizes the message that they do not belong. What if the issue is not that individual neurodivergent people are “too sensitive” to rejection, but that we live within a system and culture that is too rigid about what you need to be like in order to be good and included. Over and over again, neurodivergent people are told they are “too sensitive”: to stimuli in the environment, to changes in routine, to negative depictions in media or careless language, and to rejection. I choose to reject RSD as a purely biological phenomenon because I believe it is a systemic issue as much as it is an individual one.


RSD is a Combination of Traits


Rejection Sensitive Dysphoria is often spoken about as if it’s one trait, that you either have or they don’t. I often hear people say things like “I have severe rejection sensitivity dysphoria.” However, RSD is actually made up of a combination of traits. Neurodivergent people, irrespective of diagnosis, may share some common traits including challenges with emotion regulation, difficulty interpreting social cues, impulsivity which makes it harder to conform to social norms (even if you can perceive them), and poorer quality relationships with their caregivers in early childhood.


Neurodivergent adults may continue to struggle in social roles like friendships, intimate relationships, and in the workplace. In combination, it’s possible that these traits come together to form something that looks like RSD. My own experience is that neurodivergent people are all very different. One person may have no problem regulating emotions but struggle with social cues, and another may experience the inverse. What I observe is that people actually experience RSD on a spectrum, from not at all to having it severely interfere with their lives. It may also fluctuate throughout the lifespan. A neurodivergent person who finds an affirming environment, an occupation they love, a supportive community, and self-acceptance may increase their sense of security enough that the sting of RSD is lessened. As a neurodivergent-affirming therapist, I will always take the position that problems are not caused by neurodivergence, but by the social conditions of the context the neurodivergent person exists within.


Sticky Brain


The debate over biological determinism, or whether we’re born with RSD, often gets over simplified in the media or in online debates into “nature vs. nurture,” but the truth is likely much more complex. Our unique collection of genes, or genotype, interact with our social and physical environment to produce our unique combination traits, including the ones that contribute to RSD. I am not claiming that early experiences of exclusion necessarily have a causal link to RSD, unmediated by other variables, but I do believe that our social world interacts with unique elements of our biology, such as temperament, in order to produce our emotional experience and influence how we make meaning about it.


One highly heritable (passed on genetically) trait that is common among neurodivergent people (including those with conditions such as OCD, eating disorders, and major depressive disorder) is referred to as “sticky brain.” Basically it means that once your brain is on one track, it’s harder to jump to a new track. People with sticky brain are more likely to perseverate on a particular thought or idea (eat the same food for lunch every day!). One of the ways that our genetics interact with the environment may be the tendency to “get stuck” on experiences of rejection and overvalue them, even when we have lots of other experiences where we weren’t rejected.


So what do we do with it?


Obviously, many people who identify with Rejection Sensitive Dysphoria find it incredibly distressing. It’s called dysphoria (a word that means a profound sense of unease) for a reason - it hurts. For adults looking for strategies to cope with RSD, I strongly recommend making changes to their environment so that they experience more acceptance and inclusion. This could look like making some new friends or joining a group where neurodiversity is valued, or it could mean making a change to a job where your neurodivergent traits are helpful to you. Neurodivergent-affirming counselling can help to find self-acceptance if you are living with RSD. If you are an adult with neurodivergent children in your life, remember that offering acceptance, inclusion, and affirmation may have a powerful sense on a child's developing self-concept.


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