What is RSD?

Here’s another analysis and theorization of a new-ish term, one that gives language to a felt experience that has typically eluded popular consciousness: Rejection Sensitive Dysphoria (RSD). As with most social science terminology, the language pathologizes a seemingly personal and private experience. But as is the case with PDA, OCD, Autism and really just about every diagnosis, RSD is more than what it is called. I’m highlighting it here because it describes another form of life that deserves a social materialist treatment so as to lay bare its complexity en route to treating it and alleviating distress.  


To describe RSD, let’s look at the descriptions of how it feels to people who experience it. I will draw from two published research articles, both of which you can access online. The first, from Rowney-Smith et al. (2026), cites some beautifully/horrifyingly evocative descriptions. One member of the study described it as the feeling you get when a chair is pulled out from under you. Another member in the same study likened the feeling of RSD to the hand-warmers you can buy from drug stores: “you know the hand warmers, when you click, it becomes solid and warm… getting warmer inside me…. everything inside me starts to burn.” The second study, from Sandland (2025), includes similarly visceral descriptions, but these come from people who openly identify as neurodiverse, a fact that matters because RSD is frequently cited as a subset of neurodiverse conditions such as Autism, ADHD, and Dyslexia. Sandland writes, “When reflecting on whether RSD was part of being neurodivergent, Hannah replied ‘it feels like it's one of the core, it shouldn’t be, but it feels like it's one of the core experiences of being a neurodivergent human in this world.’” Rather than define RSD, then, it may be more valuable to reflect on these descriptions of lived experience and try to imagine our way into these feelings.


More schematically, researchers identify three key aspects of RSD that arise in most studies on the phenomenon. The first is bodily sensations, such as those I’ve just cited. RSD registers in the body as a feeling, often a painful one. The second aspect is masking, meaning that people who fit the paradigm of RSD often act as though they are tougher than they are, more impervious to criticism. Masking in this way, however, only leads to a felt incongruence between the actual self and the performed self, which reinforces the feelings of inferiority and sets up a vicious cycle of self-loathing and social performance. Third, researchers cite withdrawal as a common behavior amongst those with RSD. Whether physically, psychologically, or emotionally fatigued, people with RSD will often retreat from social interactions to recoup strength. Too often, these periods of isolation extend and lead to feelings of alienation from social circles. Finally, I’d add a fourth facet to this list: addiction. In my practice, I come across many people whose experiences rhyme with descriptions of RSD from research studies and who self-medicate with alcohol or other drugs to compensate for the psychic burden. Similar to the problem with social withdrawal, addiction quickly becomes unmanageable, and many people find themselves dealing with two distinct problems, substance abuse and RSD, rather than experiencing a reduction in RSD symptoms.

 

My primary call for action in this post involves moving away from the pathologizing label toward a more descriptive narrative of the problems people are facing. As Sandland writes, “Many of the terminologies associated with RSD present neurodivergence and emotionality through a deficit-based cognitive lens (McMahon et al., 2022), using language such as ‘dysregulation’, ‘dysfunction’, or ‘sensitivity.’” How else might we think of RSD, what to call it, and how to treat it?



RSD — ADHD

I start rethinking RSD by scrutinizing the apparent affinity between ADHD and RSD. Theresa Alfonzo (2025) sees RSD as the emotional counterpart to the full cognitive crash that people with ADHD often experience during moments of overwhelm. She invents the term Emotional Governance (EG) to explain this, writing “Emotional Governance is the brain’s ability to regulate, contextualize, and redirect emotional data without losing cognitive control.” EG is something like an emotional coup d’etat. It wipes the subjective face of the entire mental apparatus in an effort to reboot the system. If that’s the effect, then the cause of the coup is a “pattern recognition of threat, a neurobiological betrayal of trust, and a loop of internalized self-destruction.” In terms of neurobiology, Alfonzo points to hormone fluctuations as the chemical signature of the hard EG reset, specifically identifying the link between ADHD and women with Premenstrual Dysphoric Disorder (PMDD) as a precursor to her own findings. In any event, where there is RSD there often seems to be ADHD, so, as Alfonzo shows, it’s helpful to think through the former by thinking through the latter. 

 

For me, ADHD is not primarily a matter of (in)attentiveness or hyper-activity. It is, instead, a matter of motivation. A person diagnosed with the inattentive type of ADHD may appear inattentive in certain circumstances but then hyperattentive in other situations. Extreme focus, like the kind we see in the “restricted” or “special” interests of other neurodiverse folks, develops out of internal motivation. A person is impelled by their motivation to focus on certain things and not others. When asked to produce motivation for something deemed uninteresting or arbitrary, the person with ADHD cannot simply flip a switch and become motivated. The switch is “sticky,” it only works maybe 1 out of 100 times. Perhaps, then, the rejection portion of RSD has something to do with motivation?


What motivates us? Let’s rethink “negative” and “positive” motivation such that we turn away from goals (i.e., what we seek to achieve) and look more closely at causes. “Positive” carries a philosophical meaning, something like “attributable to constraints produced by people instead of natural sources.” In this sense, the cause of positive motivation is a constraint or field of constraints that generate creative responses in the form of behaviors and actions. By contrast, a “negative” cause would be a starting point within lack or a condition of wanting. Something is absent. I seek to obtain it, either to produce a pleasing feeling (impulsive action) or forestall an imagined catastrophe (compulsive action). This absent thing could be tangible, imaginary, mythical, or produced by delusion. What matters is its quality as missing and that quality’s capacity to produce a not-quite-right feeling in the present moment of experience. Positive and negative causes motivate us throughout each day, though we rarely (outside of therapy) stop to think about which is which.


From that conclusion, I would argue that we experience rejection not only when we hear no or don’t get what we want. Rejection is, more broadly, an experience of being thrown back or out. It is similar to excretion, the act of separating out. And “similar to excretion” means similar to excrement, shit. When I am (socially, interpersonally, intrapersonally) rejected, I am separated out (from others and/or myself) like waste. Where RSD is present, this rejection is not only felt; this rejection becomes an identity: I am shit, I am re-ject. Once I am shit, the entire premise of motivation falls away. Shit don’t do shit. Now, it’s not that there is a sticky switch such as we see in ADHD, but, rather, there is simply no switch at all, nothing to which I might switch my motivation since, after all, I am shit. Nobody takes this identity well because we are told to be subjects, not rejects. We are rejected in this way a lot, but perhaps only certain people experience it as visceral pain. 


Sub-ject / Re-ject

When I think of “subjects” in a social sense, I turn to Michel Foucault’s (1982) understanding of the term. 

There are two meanings of the word "subject": subject to someone else by control and dependence; and tied to his own identity by a conscience or self-knowledge. Both meanings suggest a form of power which subjugates and makes subject to. (781) 

People with RSD cannot sustain a sense of self congruent with the second version. If I am subject to someone else, then I am always positioned externally, outside of someone else’s personage and authority. To be outside in this way is also to be ob-ject, where “ob-” means “in front of.” This position also makes one ab-ject, cast out, expelled. The painful part of the “Rejection” aspect of RSD may be that it acknowledges an identity alwasy sutured to a position removed from sub-jectivity. Try as I may, if I exist outside of “subject” as reject, object, abject, or excrement, then why would I or how could I motivate myself to do anything? I would find myself shaped almost entirely by the Other, prone to their whim.


Though I take on the identity of the "re-ject" and claim an inability to act, I am cajoled nonetheless into the premise of motivation through external ploys. On the one hand, society presents a field of generative constraints that compels participation through advertised rewards. On the other hand, I experience a visceral lack—which is to say, I desire. Here, the dialectic sharpens. The mere fact that I desire reveals that I am not, in fact, pure waste. "Shit don't desire shit." If I can allow desire to conduct me, I can begin to dispel the illusion of my abjectness.  


But for the re-ject, this transition is fraught. In Lacanian terms, desire persists precisely because its ultimate object (objet petit a) remains unattainable. The re-ject senses this impossibility unconsciously, but instead of navigating the lack, the re-ject interprets the unreachability of desire as personal confirmation of their own unworthiness. Desire does not propel them forward; rather, it turns the re-ject into a re-tract. Desire acts as an elastic cord anchoring the subject to the Other: it pulls the individual toward the social field only to violently snap them back the moment the threat of rejection looms. Caught in this perpetual recoil, the subject experiences motivation not as agency, but as an exhausting, involuntary twitch. "I" do not act for myself. I act entirely in reaction to anOther—and I am exhausted by the performance. In this precise mechanism, one becomes always already rejected. 


Summing up: That which we currently call RSD delimits the play of identity through which an individual feels the retraction of desire and the control or power of that to which one is subject. This identity feels these forces so viscerally that the only logical situation is to calculate the path of least resistance, the line of flight through the social that will produce the fewest bruises. Sometimes masking (performing as if) is the best tactic for this. At other times, not performing at all (isolation and withdrawal) is the best choice. Sometimes intoxication helps to blunt the visceral feeling of retraction/rejection. How, though, do we treat this issue globally in terms of whole-person health?


Treating “RSD”: The Emperor’s New Clothes


My current theory is that treating “RSD” requires laying bare the “identity” one has donned as an outfit. In this way, I think of The Emperor’s New Clothes. In case you forget the story, here’s a brief synopsis. A king surrounds himself with sycophants, and, in turn, the sycophants produce a reality for the king based on the king’s own imaginings, presuppositions, fantasies, delusions, etc. This particular king has a strong liking to fine clothing and is known far and wide to spend unfathomable sums on new clothes. One day, two conmen appear with the intention of making money while also exposing the fragility of the king’s image. The conmen, posing as master tailors, unfurl the finest fabric on Earth. They describe its exquisiteness with superlatives and ornate imagery. The fabric is, however, unreal. The “tailors” only mime its presence and conjure its reality through deceit and flattery. Not wanting to be perceived as stupid or ignorant of such beautiful fabrics, in the event that such a fine thing might exist, the sycophants act along with the tailors’ performance. The king grows excited. The sycophants metastasize his joy. The king, awash in the cascade of echoes, purchases the fine material for a hefty sum and declares that he will debut the new attire at a public parade.


With the kingdom’s subjects gathered, the king debuts his new clothes amid much fanfare. Silence befalls the crowd of onlookers. We can relate to this silence. It is the silence that breeds collusion. That is, it dawns on the multitude that it would be best to act as if the new clothes and, most importantly, the king who is wearing them is indeed majestic and resplendent. Before the group can act in unison, however, a young boy cuts through the performance, points at the king, and yells out: “He’s naked! The king is naked!!” Once the spell appears to be broken, the rest of the crowd joins in. “He’s naked!!” The king, however, is unwilling (or unable?) to accept the reality of the multitude and thus he continues down the street, parading his birthday suit.


How does the story graft back onto the issue of RSD and identity development within a complex social environment? First, let’s look at the boy who deflates the farce. Is he not the avatar of the neurodiverse person who, unattached to the social customs that shape neurotypical discourse and interpersonal relationships, simply says what he sees? The boy’s action, less an act of bravery and more an effect of disenchanted sight, empowers the crowd to drop all pretense. We might think that the multitude’s version of reality would then disturb the king’s sense of self, but that doesn’t happen. Of course it doesn’t happen. The king, standing in for what Lacan calls the “quilting point” of the status quo that holds the signifying chains of neurotypicality together, goes about his business, immune to alterity. The rogue tailors in the story are like the mischievous Yes Men who use culture jamming to expose the vulnerable points of the symbolic order. The most interesting character in the story is us, the readers. If we had to imagine what happens on the “next page” of the story, what would we say? How would we react to the splitting of the scene, the bifurcating paths taken by the king and those who see through the imaginary clothes? Do we shrug our shoulders and say, “oh well, back to work”? Do we feel gas-lit despite the popular outcry of nudity: “Am I the only one who sees that the king is naked?” These questions are all interesting, but the point I want to make is that anyone who experiences RSD always already feels the pain of the absurdity of this situation. What if the feeling of RSD is the feeling of knowing each daily task to be an act of pretending the emperor isn’t naked?


Neurologically, RSD crosses paths with PDA, OCD, and traumatic responses. The brain supplies the chemicals needed to fortify acts of resistance against what appear to be life-or-death situations. But this is not the only thing to treat. Zoloft may blunt the chemical effects in the brain, but it doesn’t change the fact that the emperor is naked and parading around while everyone else is pretending like that’s not happening. If we want to call RSD a traumatic response and recognize the fight-or-flight mechanism at work in the painful, visceral experiences of perceived rejection, then we need also to specify what precisely is so threatening. The problem isn’t this or that particular rejection by a lover, a teacher, or whoever. The problem is the felt identity of being a reject, always outside of some seemingly impenetrable social configuration. What’s worse, the goal is not to belong to that configuration. That would simply be colluding with people who don’t acknowledge the king’s nudity. The goal leads, rather, to that famous Groucho Marx saying, “I wouldn’t want to be a part of any club that would have me for a member.” The true split is the split around which “I” am built.  


SOURCES

Foucault, Michel. (1982). “The Subject and Power.” Critical Inquiry, 8(4): 777–795. http://www.jstor.org/stable/1343197


Rowney-Smith A, Sutton B, Quadt L, Eccles JA. (2026).“The lived experience of rejection sensitivity in ADHD - A qualitative exploration.” PLoS One. (January)21(1):e0314669. doi: https://doi.org/10.1371/journal.pone.0314669. Erratum in: PLoS One. (March) 21(3):e0345112. doi: https://doi.org/10.1371/journal.pone.0345112. PMID: 41564005; PMCID: PMC12822938.


Sandland, B. (2025). “Neurodivergent Experiences of Rejection Sensitive Dysphoria Expose the Environmental Factors too Often Overlooked.” Neurodiversity, 3. https://doi.org/10.1177/27546330251394516