Rejection Sensitivity Dysphoria: The Actual Research |
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Rejection sensitivity dysphoria (RSD) is defined as extreme sensitivity to perceived or actual criticism.
This construct has been talked about in relation to ADHD.
Personal and patient accounts suggest RSD may be a real problem for those who are neurodivergent.
At the same time, RSD research has a lot of room for growth.
One thing I’ve learned over the years as a clinical psychologist is that psychological research would be nothing without clinical input. Scientific research should be driven by theory, and theory does not exist in a vacuum—it develops from personal, real-life experiences.
This is where the concept of Rejection Sensitive Dysphoria (RSD) started—through personal stories online and in clinical practice. RSD is a concept that was popularized by psychiatrist William Dodson, starting in the 1990s. Through his lectures, podcast interviews, and blog posts, Dodson defines RSD as extreme sensitivity to perceived or actual criticism by others, and he ties RSD to ADHD. In one of his lectures, he described RSD as one of the most disruptive and common manifestations of emotional dysregulation based on his experience as a psychiatrist specializing in ADHD.
The online world seemed to agree, as the concept of RSD caught on like wildfire in the early 2000s. Since then, the phenomenon of RSD has increasingly grown in interest, driving people to wonder the following:
What is RSD, exactly?
How is it different from a mood disorder or from social anxiety disorder?
Is it a standalone diagnosis or a distinct, underrecognized aspect of ADHD?
Is it specific to ADHD or is it also present in autism?
What are the specific symptoms of RSD that make it unique from rejection sensitivity more generally?
The problem is that, without sufficient research, people can only speculate. And when there is such a demand and thirst for knowledge on a subject area, the public can start to guess and spread misinformation.
However, we do not need to guess. There is some empirical research on RSD that already exists. Does it answer all of our questions? No—far from it. But it's a good start.
As someone who has published a book on this subject, I want to review the available scientific research on RSD. Researchers, clinicians, and the general public can use this information as their baseline knowledge of what has been shown through science so far. These studies can (and should) serve as a springboard for further research on RSD.
The research on ADHD has already shown that 25-45% of ADHD youth and 30-70% of ADHD adults significantly struggle with regulating their emotions. Because Dodson conceptualizes RSD as one manifestation of emotional dysregulation in ADHDers, it is probable that RSD is common among neurodivergent individuals.
But right now, there are only five research studies that sufficiently address some of the questions about RSD listed above. All of these studies have small samples (ranging from 4 to 43 participants) and all of them are qualitative, meaning they include interview-style, open-ended questions about RSD. Again, qualitative isn’t bad. It’s exactly where research should start when we are exploring an underexplored construct. But we are still in the beginning stages of truly understanding RSD on an empirical level—and it is important to recognize that.
In their 2024 paper, Dodson and colleagues provided detailed case descriptions of 4 ADHD adults who struggled with RSD: a 29-year-old male, and 17-, 19-, and 42-year-old females. They described RSD as “episodic attacks of physical and emotional pain, intense shame, and feeling ostracized” in the face of perceived or actual rejection.” All participants had a history of feeling misunderstood and of being misdiagnosed by mental health professionals.
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Sandland (2025) conducted a qualitative study of RSD in 7 neurodivergent adults (1 ADHD; 3 autistic; 2 ADHD and autistic; 1 with autism, ADHD, and dyspraxia). Two participants were male, 4 were female, and 1 was nonbinary. Sandland describes RSD as a phenomenon that is impacted by biological and environmental factors. Overall, participants described their experiences with RSD as complex and involving emotional and physical distress that led to self-silencing or avoidance. Participants reported that RSD affected all areas of their lives, but they received little support for these difficulties. There was variability in the way participants defined RSD, suggesting confusion between individuals and even within individuals. That is, some participants defined RSD differently throughout the study. Awareness of RSD came out of their neurodivergent communities, from which they said they had experienced support and acceptance.
Rowney-Smith et al. (2026) defined RSD as an aspect of emotional dysregulation in ADHD that is underexplored. This study included 5 undergraduates with ADHD who participated in focus-group interviews. The researchers identified three key themes from their exploration of RSD: (1) withdrawal, (2) masking, and (3) bodily sensations. Participants stated that RSD was associated with intense physical discomfort and that this led them to respond with masking (shaping their behaviors to be accepted by others). The masking then led to withdrawal, loneliness, exacerbated mental health difficulties (e.g., anxiety), and disrupted social functioning (e.g., at work).
Morley and Tyrrell (2023) published a study in the Journal of Attention Disorders. Their research included 8 female college students with ADHD who were all diagnosed in adulthood, and most of these women reported struggling with RSD.
In the largest study on RSD, Ginapp et al. (2023) asked 43 adults aged 18-35 (84% female) about their experiences of ADHD in adulthood, and “most participants reported that the diagnostic criteria did not accurately capture their experiences with ADHD.” For example, 33 participants (about 77%) reported struggling with RSD even though RSD (and emotional dysregulation, more generally) is not included as a core symptom of ADHD in the DSM-5-TR.
Given the expanding interest in RSD and the role it plays for those who are neurodivergent, it’s important to understand the current state of research and what is left to explore. As you can see, we have a long way to go in RSD research. Beyond qualitative research, the first important step will be to develop a valid and reliable measure of RSD. This would clarify what RSD actually is, whether it is different from other constructs, and whether RSD can be measured and defined consistently across research studies.
Dodson, W. W., Modestino, E. J., Ceritoğlu, H. T., & Zayed, B. (2024). Rejection sensitivity dysphoria in attention-deficit/hyperactivity disorder: A case series. Acta Scientific Neurology, 7(8), 23–30.
Ginapp, C. M., Greenberg, N. R., MacDonald-Gagnon, G., Angarita, G. A., Bold, K. W., & Potenza, M. N. (2023). “Dysregulated not deficit”: A qualitative study on symptomatology of ADHD in young adults. PLOS ONE, 18(10).
Morley, E. & Tyrrell, A. (2023). Exploring female students’ experiences of ADHD and its impact on social, academic, and psychological functioning. Journal of Attention Disorders, 27(10), 1129–1155.
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).
Sandland, B. (2025). Neurodivergent experiences of rejection sensitive dysphoria expose the environmental factors too often overlooked. Neurodiversity, 3.
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotional dysregulation in attention-deficit/hyperactivity disorder. American Journal of Psychiatry, 171(3), 276–293.
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