Picture this: Your friend says they can’t meet for coffee tomorrow, or your boss chooses one of your co-workers to deliver that presentation you were hoping to tackle. Plenty of people might be able to brush these things off, pinpointing reasons for the behaviors that have nothing to do with them; perhaps the friend had a work conflict pop up, or your boss is just spreading the love when it comes to assignments. Ultimately, these things, while annoying or disappointing, might just not be the biggest deal. But if, to you, these types of occurrences feel like a complete punch in the gut, entirely derailing your day, you may have rejection sensitive dysphoria (RSD).

What, exactly, is rejection sensitive dysphoria, and how does it manifest?

Though RSD isn’t recognized as a mental-health condition in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it’s gained credence lately among mental-health practitioners and the public alike for its distinct characteristics. Though plenty of people fear rejection—and it’s a totally normal, human thing to dislike rejection—those with rejection sensitive dysphoria have a particularly “intense and severe” emotional response to rejection or any degree of perceived rejection, says psychotherapist Georgina Sturmer, MBACP.

While, again, anyone might feel angry, sad, frustrated, embarrassed, or perhaps all of these feelings at once in the face of being (or feeling) rejected, “it seems that with RSD, these experiences are overwhelming,” says Sturmer, “and the intensity—and how it can send you spiraling—is what makes RSD different from other emotional responses.”

“The intensity [of the sensitivity around rejection]—and how it can send you spiraling—is what makes RSD different from other emotional responses.” —Georgina Sturmer, MBACP, psychotherapist

The resulting response tends to show up in one of two ways: high anxiety or high anger. The former reflects a desire to withdraw from others and ruminate on the minutiae of everyday interactions where you might’ve perceived rejection; whereas, the latter involves lashing out at or seeking revenge on whomever has rejected you. The common denominator? A hypersensitivity to any kind of rejection that can feel hard to shake or move forward from.

Who is at the greatest risk of developing rejection sensitive dysphoria?

The term “rejection sensitive dysphoria” has risen in popularity largely for its connection to attention deficit hyperactivity disorder (ADHD), which has also been more openly discussed in recent years. People with ADHD are thought to be particularly at risk for RSD—which may even be a symptom of ADHD—because both involve a level of emotional dysregulation, where external events can trigger an outsized or disproportionate emotional response.

For similar reasons, RSD has also been linked with autism. It’s possible that the unique brain functionality common in folks with autism and ADHD may prevent feelings of real or perceived rejection from being processed effectively, putting the nervous system on the fritz.

Because RSD can lead to such an emotionally painful experience in response to anything that could be seen as rejection (even neutral responses like, “I might be free,” or “I’ll check my calendar”), it’s also common for people with RSD to have anxiety and depression—both of which are comorbid conditions that could worsen RSD, too.

What are common signs of rejection sensitive dysphoria?

“Because RSD is not well-defined, presentations may vary widely,” says psychiatrist Andres Fonseca, MBBS, co-founder and CEO of Thrive Mental Wellbeing. Below, he and Sturmer share a few common signs that you might have the condition:

• You feel the desire to withdraw, hide away, or avoid new experiences (to mitigate your potential for rejection)
• You have a tendency for perfectionism or hold yourself to extremely high standards
• You attempt to ignore or reject your feelings, leaving you numb, disconnected, or lonely
• You’re prone to rageful or otherwise emotional outbursts in response to others’ actions
• You people-please at all costs to ensure that you are liked or accepted
• You feel as if you have to work hard to fit in or be understood
• You tend to ruminate on the words or actions of others and what they reflect about you
• You feel intense humiliation, shame, or despair when you sense that you’ve been rejected, critiqued, or criticized by others

Because, again, RSD is not a formally recognized mental-health diagnosis, there’s no particular combination of the above traits that means you have the condition. But if any of the above rings true for you, or generally speaking, you feel like you take rejection harder or more personally than those around you, you may have RSD.

What are common triggers of RSD?

Because any scenario that can be perceived as rejection, critique, or criticism can set off RSD, the triggers vary from person to person, and certain situations or people can trigger more intense RSD than others for some people, says Sturmer.

You might find that work is a trigger for your RSD, for example, whether it’s because you’re overlooked by your boss for something, you get a job rejection, or you don’t achieve a particular work task in the way that you’d hoped, and you suspect that others can tell.

Or, it might be friends or relatives that trigger your RSD, or your romantic relationship. Do you feel particularly low when your friend cancels on you or when your partner takes a rain check on date night, for example? To that end, social situations that prompt comparisons with others and relationship conflicts are also both common triggers, says Dr. Fonseca.

How can you cope with the symptoms of RSD?

The first step to coping is identifying when and how your RSD is manifesting. “Notice if there are specific people or interactions that trigger your severe emotional responses,” says Sturmer, who also suggests considering whether lifestyle factors—like diet, drink intake, and exercise—might come into play. These factors can influence your state of mind and thus play a role in how you might perceive and respond to someone’s words or actions.

By the same token, it might help to identify whether your RSD flare-ups tend to come with certain physical symptoms, which may feel more controllable to you than your emotions in the moment. “Notice your body and breath when you’re feeling an intense emotional response to rejection,” says Sturmer. “If you can tune in to the physical sensations that accompany these emotions, you can devise physiological ways to soothe yourself—for example, massaging a clenched jaw, stretching a tight neck, or opening your chest by taking deep breaths.”

Sturmer also recommends practicing mindfulness, as “staying present can help all of us to regain perspective, calm negative thoughts, and feel more in control.” Different things work for different people, but you might decide to focus specifically on your breathing, do a grounding exercise, or listen to an audio meditation. Or, get a pen and paper, and write down your feelings. Putting feelings to paper can help you create some psychological distance from them, and in turn, gain some control over them, too.

It’s also a good idea to tell your loved ones about your experience of RSD, so that they can better understand your responses in certain scenarios and show you the compassion that you need, adds Sturmer.

Often, people with RSD worry that by telling their friends and family members how they’re feeling, they’re manipulating or guilt-tripping them—for example, suggesting that they cancel their plans with others or walk on eggshells around them. But, there’s a world of difference between manipulating someone or trying to direct their behavior, and just expressing how you feel so that they can take those feelings into account.

If you feel like your response to rejection is effectively holding you back from living and enjoying your life, or the above tactics aren’t helpful, it’s also wise to consult with a mental-health professional, who can “help you understand any potential underlying conditions and your specific triggers, and help you develop strategies to cope with them,” says Dr. Fonseca.

How to support a loved one who has RSD

If a loved one shares that they have RSD or experience hypersensitivity to rejection, just letting them know that you’re there for them can mean a lot and help ease the pressure they feel. And while you might not want to walk on eggshells around them—and they’re unlikely to expect you to do so—even just being tactful and considering how you word comments that could be perceived as criticism can be immensely helpful.

“If you are supporting a loved one with RSD,” adds Dr. Fonseca, “educating yourself, being compassionate and patient, communicating openly, avoiding unnecessary criticism, encouraging professional help, and setting boundaries are all vital.”

Rejection, to some degree, is a part of life. And even for people without RSD, it can really sting sometimes. RSD, however, can be debilitating, and as it’s not often discussed—or well-defined in a clinical sense—it can be difficult for those affected to get help. Thankfully, things are changing, albeit gradually, and there are ways to manage the condition.

If you are struggling with rejection more than most, it’s worth being proactive to consider whether rejection sensitive dysphoria could be at play and if you might benefit from the above coping techniques or consulting a mental-health practitioner.