RSD when Rejection becomes Physical Pain
Ever found yourself obsessing over a text that didn’t get a reply? Or felt crushed by someone’s “ok” when you expected enthusiasm? For people with Rejection Sensitivity, or Rejection Sensitive Dysphoria (RSD), these moments can feel like an emotional grenade. The pain experienced isn’t just in our, we feel it in our body too. Rejection can feel like a tight chest, nausea, a deep ache in the stomach.
What Is Rejection Sensitivity Dysphoria (RSD)?
Rejection Sensitivity refers to a heightened emotional response to perceived or actual rejection. It can range from discomfort to full-blown dysphoria. RSD occurs when even minor criticism or ambiguous feedback (rolled eyes, or a shift in body language) can spark a physical reaction and internal chaos.
People with RSD might:
Replay conversations endlessly, looking for proof they’ve been rejected.
Interpret silence as disapproval.
Avoid people or situations entirely to pre-empt rejection.
React with intense anger, shame, or sadness over what seems like a small incident.
RSD is especially common among people who are neurodivergent (particularly those with Attention Deficit Hyperactivity Disorder and Autism).
Is It Social Anxiety?
No. While social anxiety and rejection sensitivity can look similar on the surface, they’re fundamentally different experiences.
Social anxiety is driven by a fear of embarrassment or negative judgement and tends to kick in before social situations. It can be a form of anticipatory anxiety, like before giving a speech or meeting new people and often leads to avoidance, overthinking, and worry.
Rejection Sensitivity Dysphoria (RSD) is fuelled by a deep fear of rejection, disapproval, or failure. It can be more powerful after the fact, in response to something that’s already happened (or is perceived to have happened).
While social anxiety whispers, “Don’t mess this up,” RSD screams, “You already messed it up, and now they hate you.”
The emotional fallout from RSD can involve intense shame, emotional outbursts, or even physical symptoms like stomach pain or tightness in the chest.
“It’s Not in Your Head — It’s in Your Body”
Studies show that the brain reacts to social rejection in the same way it processes physical pain. For someone with RSD, a mild comment like “that could’ve been better” can light up pain circuits in the brain just like a broken bone might.
It’s not dramatic. It’s neurological.
For many, it’s a physical reaction; tight stomach, flushed face, dizziness, or dissociation. Think of it like a trauma response, where the nervous system sees emotional disconnection as a threat.
Where Does This Come From?
Schema therapy can show us how many people with RSD carry deep-seated beliefs like “I’m unlovable,” “People always leave,” or “I’m too much.” These beliefs often stem from childhood environments that were neglectful, critical, or emotionally unpredictable.
Imagine a growing up constantly criticised for being “too sensitive” or “too much.” After hearing these comments repeated, they become internalised, and we learn to scan every interaction for signs of rejection, because we’ve been taught, both subtly, and blatantly that love or approval is conditional. These belief follows us into adulthood, showing up in workplaces, relationships, and later in how we read into our communication and text messages.
ADHD, Neurodivergence, and RSD
For people with ADHD, RSD can be even more intense. Why?
Dopamine Deficiency: ADHD brains are thought to lack dopamine (the “reward” neurotransmitter) so criticism stings harder, and praise doesn’t bring the same “reward”.
Emotional Dysregulation: ADHD can affect impulsivity, makes it hard to self-soothe or hit pause before reacting.
Lifelong Rejection: Many neurodivergent people grow up being corrected, misunderstood, or punished for how their brains work. Over time, this builds into a rejection sensitivity reflex that’s hard to unlearn.
Everyday Examples
A boss says, “We’ll talk later,” and your brain spirals into a catastrophic thought: “I’m getting fired.”
You say something in a group chat and no one responds, you instantly think: “They’re sick of me.”
You make a small mistake at work and it turns into: “I ruin everything.”
These reactions become survival strategies developed in environments where connection wasn’t safe or stable.
How Do You Manage RSD?
While there’s no “cure,” there are real ways to manage it, and to feel less at the mercy of every perceived rejection.
Self-Compassion and Awareness
Start by naming what’s happening: “This is rejection sensitivity.” Recognising it helps you separate past pain from present reality.
Schema Therapy
Helps you identify the core beliefs behind your reactions, and how to challenge them.
DBT (Dialectical Behaviour Therapy)
Builds skills to regulate emotions, tolerate distress, and shift the response when shame or fear takes over.
Safe, Affirming Relationships
Build a support system. Spend time with people who get you. The nervous system learns safety through connection.
Medication (for ADHD)
Some people with RSD find relief through ADHD medications, which help with impulsivity, and assist with regulating emotional responses by calming the nervous system.
RSD is not just “being sensitive.” It’s a complex reaction shaped by biology, lived experience, and nervous system reactivity. It’s also something you can understand, work with, and heal from if you’re given the right tools, support, and self-compassion.
