Rejection Sensitivity: Causes, Symptoms, Impact and Treatment

Rejection sensitivity (RS) is characterized by an anxious expectation of rejection, a heightened perception of social rejection cues, and an intense emotional response to perceived rejection. In a study involving 1,679 young adults aged 18-36 in Sweden, women and sexual minorities exhibited higher RS levels than their male and heterosexual counterparts, according to Maiolatesi AJ et al.’s 2022 study, “Rejection Sensitivity Across Sex, Sexual Orientation, and Age,” published in the Psychological Assessment Journal.

Individuals with high rejection sensitivity interpret ambiguous social interactions as unfavorable, leading to feelings of hurt or anger and maladaptive responses such as withdrawal or aggression. This cognitive-affective processing disposition is rooted in early experiences of rejection, which shapes how individuals react to social situations throughout their lives.

While rejection sensitivity refers to the general tendency to expect and react strongly to rejection, rejection sensitivity disorder describes explicitly the emotional pain and dysphoria that arise from perceived rejection, leading to severe emotional distress. 

RSD manifests as intense feelings of sadness or anger that are disproportionate to the actual event of rejection. In contrast, RS encompasses a broader range of anticipatory anxiety and defensive behaviors related to social interactions.

RS is examined in the context of other mental health issues. For example, studies show that approximately 12% of adults in the U.S. experience social anxiety disorder at some point in their lives, with RS being a factor contributing to this prevalence, according to the National Institute of Mental Health Research titled “Social Anxiety Disorder”.

The leading causes of RS include early childhood experiences characterized by inconsistent or harsh parenting, which foster a fear of rejection. Genetic predispositions and environmental factors, such as peer relationships, also contribute to the development of RS. 

Symptoms of RS typically involve emotional distress in social situations, including anxiety, anger, and withdrawal. People with high RS exhibit behaviors such as overreacting to perceived slights or misinterpreting others’ actions as rejection. 

The impact includes higher rates of depression, anxiety disorders, and relational issues. Treatment options include cognitive-behavioral therapy (CBT), which is effective in addressing maladaptive thought patterns associated with RS. Mindfulness practices and self-compassion training are also beneficial in helping individuals manage their emotional responses. 

CBT is considered the most effective for reducing symptoms and improving interpersonal functioning. Related conditions such as ADHD and autism spectrum disorders frequently co-occur with RS, further complicating treatment approaches. Friends and family members effectively support individuals with RS by fostering open communication, reassuring them, and promoting self-compassion.

What Causes Rejection Sensitivity?

The causes of rejection sensitivity include developmental factors, neurological and psychological factors, genetic contributions, and environmental influences. Approximately 70% of individuals with high rejection sensitivity report significant anxiety in social situations, indicating a direct impact on social interactions, according to Schaan VK et al.’s 2020 study, “Effects of Rejection Intensity and Rejection Sensitivity on Social Approach Behavior in Women,” published in the PLOS One journal. 

The causes of rejection sensitivity include:

Developmental Factors

Developmental factors refer to individuals’ experiences and relationships during childhood and adolescence. Childhood experiences play a crucial role in shaping rejection sensitivity. Children who experience inconsistent caregiving or neglect develop insecure attachment styles, leading them to expect rejection in social situations. 

Approximately 64.1% of children exhibit a secure attachment style, indicating a healthy emotional bond with their caregivers, according to Suphriya T et al.’s 2023 study titled, “Prevalence of Different Attachment Styles in 9 to 12 years old School Children: A Cross-sectional Study” published in the Journal of Clinical and Diagnostic Research. This expectation fosters a defensive stance, making them hyper-vigilant to perceived threats of rejection.

Experiences of past rejection or neglect have lasting effects into adulthood. Individuals carry forward a heightened sensitivity to social cues that suggest rejection. This manifests as overreacting to ambiguous social interactions, further undermining their relationships.

ejection sensitivity is a trauma response. Individuals with a history of trauma or emotional distress develop a heightened sensitivity to perceived social threats, which leads to maladaptive behaviors in relationships.

Neurological and Psychological Factors

Neurological factors are the brain’s response to rejection. Brain regions involved in emotional processing, such as the amygdala, show heightened activity in response to perceived rejection. This heightened reactivity is linked to neurochemical imbalances that affect mood regulation and emotional responses. 

For instance, in one study, participants showed a rejection rate decrease from 37.6% to 19.0% after benzodiazepine treatment, which also reduced amygdala responses to unfair proposals despite unchanged feelings of unfairness, according to Gospic K et al.’s 2011 study titled, “Limbic justice Amygdala Involvement in Immediate Rejection in the Ultimatum Game” published in the PLOS Biology Journal.

Individuals with poor emotional regulation skills struggle with processing rejection. The neural circuits responsible for managing emotional responses become dysregulated, leading to increased sensitivity and defensive reactions when faced with potential rejection.

Genetic Contribution

Genetic factors are referred to as the inherited traits from one’s parents. Genetic markers are associated with increased vulnerability to social anxiety and rejection sensitivity, suggesting a hereditary component in how individuals respond to social interactions.

A genome-wide association study (GWAS) reported a 12% SNP-based heritability for social anxiety in European American samples, with estimates varying across different ancestral groups: 21% in Latino Americans and 14% in males, according to Stein MB, Chen CY, et al.’s 2017 study, “Genetic Risk Variants for Social Anxiety,” published in the American Journal of Medical Genetics. This shows that genetics play a significant role in social anxiety and rejection sensitivity.       

Environmental Influences

Environmental factors such as family dynamics, peer relationships, and societal pressures shape rejection sensitivity. Neglectful family environments heighten an individual’s sensitivity to rejection, as early experiences of emotional unavailability or harsh criticism create a framework for interpreting social interactions through a lens of fear and anxiety. 

Approximately 50% of rejection-sensitive individuals misperceive ambiguous social cues as signs of rejection, impacting their social functioning and leading to increased anxiety in social situations, according to Chaudoir SR et al.’s study titled, “ Links Between Rejection Sensitivity and Biobehavioral Response to Laboratory Stress in Youth” published in the Personality and Individual Difference Journal. 

Similarly, peer relationships worsen this sensitivity. For instance, experiences of bullying or exclusion lead to an increased vigilance for signs of rejection, reinforcing the belief that one is unworthy of acceptance. Societal pressures, including cultural expectations and social norms, further compound these influences by promoting ideals of perfectionism and belonging, making individuals more susceptible to feeling rejected when they perceive themselves as falling short.    

What Are the Symptoms of Rejection Sensitivity?

The symptoms of rejection sensitivity are emotional symptoms like intense feelings of shame and worthlessness, behavioral symptoms such as people-pleasing tendencies, and physical symptoms like experiencing emotional pain akin to bodily injury.

The symptoms of rejection sensitivity are:

• Emotional symptoms: Emotional symptoms are referred to as the internal reactions and feelings that individuals experience as a result of rejection sensitivity. These include intense feelings of shame, worthlessness, and inadequacy. 

• Shame: Feelings of guilt are very intense for individuals with rejection sensitivity. They perceive any sign of rejection as a personal attack on their self-worth, leading to feelings of deep shame and inadequacy.
• Worthlessness: Similar to shame, individuals with rejection sensitivity feel a sense of worthlessness when they experience rejection. They view themselves as inherently flawed or unworthy of love and acceptance.
•  Inadequacy: Rejection sensitivity also leads to feelings of inadequacy, where individuals believe that they are not good enough or capable enough to meet the expectations of others.

A study involving 1,665 adolescents found that those with high levels of anxious rejection sensitivity reported higher depressive symptoms compared to their peers, according to Rebbeca B et al.’s study titled “Long-Term Associations of Justice Sensitivity, Rejection Sensitivity, and Depressive Symptoms in Children and Adolescents” published in the Frontiers Psychology Journal.

This shows that anxious rejection sensitivity is positively correlated with depressive symptoms.

• Behavioral symptoms: Behavioral symptoms are outward actions or behaviors that individuals engage in as a response to rejection sensitivity. They include people-pleasing tendencies, seeking constant approval and validation from others, and avoiding situations where they fear rejection.
  • People-pleasing tendencies: People with anxious rejection sensitivity engage in people-pleasing behaviors to avoid rejection. This manifests as constantly seeking approval and validation from others, putting others’ needs before their own, and avoiding conflict.
  • Seeking constant approval and validation from others: Individuals with anxious rejection sensitivity need constant reassurance and validation to feel accepted. This leads to seeking attention and praise, even if it means sacrificing one’s values or beliefs.
  • Avoiding situations where they fear rejection: Those with anxious rejection sensitivity actively avoid situations they perceive as potentially leading to rejection. This could include avoiding social events or interactions, not taking risks or trying new things, and staying in comfort zones.

Approximately 1 in 3 adults in the U.S. report feeling lonely, while about 1 in 4 lack social and emotional support, according to a  2024 Centers for Disease Control research titled “Health Effects of Social Isolation and Loneliness.” Fear of rejection causes people to shy away from social interactions or new experiences, leading to isolation.

• Physical symptoms: Physical symptoms refer to the physiological responses that an individual experiences when faced with rejection. Examples are increased heart rate, sweaty palms, muscle tension, and even physical pain, such as a physical injury.
  • Increased heart rate: When faced with rejection, the body’s fight-or-flight response is triggered, causing an increase in heart rate. This can be seen as a survival instinct to protect oneself from potential danger.
  • Sweaty palms: Similar to increased heart rate, sweaty palms are also a physical response to the fight-or-flight response. The body releases sweat to cool down and prepare for potential danger.
  • Muscle tension: Rejection causes muscle tension, particularly in the neck and shoulders. This is due to the body preparing for a potential physical confrontation.
  • Physical pain: Social rejection activates areas of the brain associated with physical pain. This explains why we often feel a sense of hurt and ache when facing rejection.

These symptoms manifest as a result of the fear and distress caused by rejection sensitivity.

While everyone experiences some level of sensitivity towards rejection at some point, those who struggle with chronic feelings of rejection have rejection sensitivity.

How Does Rejection Sensitivity Impact Daily Life?

Rejection sensitivity affects daily life by complicating interpersonal relationships, impacting workplace dynamics, and influencing mental health. In romantic and familial contexts, individuals with high rejection sensitivity perceive neutral or ambiguous interactions as unfavorable, leading to unnecessary conflicts and emotional turmoil. 

This heightened sensitivity results in overreactions to perceived slights or criticism, which strain relationships as partners or family members feel they must constantly navigate these emotional landmines. 

For instance, a simple disagreement might escalate into conflict due to the rejection-sensitive individual’s fear of abandonment or disapproval, leading to a cycle of distress and withdrawal.

In the workplace and social settings, rejection sensitivity manifests as social anxiety and difficulty managing professional interactions. Individuals avoid situations that could lead to criticism or rejection, limiting their opportunities for growth and connection. 

This avoidance hinders career advancement and contributes to feelings of inadequacy, further exacerbating low self-esteem and mental health issues such as anxiety and depression. 

The fear of rejection leads to a defensive posture in social interactions, where individuals either overly accommodate others or react with hostility when feeling threatened. This self-protective behavior undermines the very relationships they seek to cultivate, creating a self-perpetuating cycle of isolation and emotional distress.

What Are the Best Treatment Options for Rejection Sensitivity?

The best treatment options for rejection sensitivity are psychotherapy approaches and medication options. Research shows that approximately 60-70% of individuals benefit from CBT in managing emotional dysregulation and improving overall mental health outcomes, according to Matusiewicz AK et al.’s 2010 study titled “The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders,” published in the Psychiatry Clinical North American Journal. 

The  treatment options for rejection sensitivity, according to the Psychiatry Clinical North American Journal, include:

Psychotherapy Approaches

Psychotherapy approaches are “talking therapies” and involve working with a therapist or counselor to address underlying issues, develop coping strategies, and learn new ways of thinking and behaving. 

These techniques help individuals manage rejection sensitivity by reframing negative thoughts and improving emotional regulation. Some key approaches include Cognitive Behavioral Therapy, Dialectical Behavior Therapy, and Schema Therapy.

• Cognitive Behavioral Therapy (CBT): CBT focuses on identifying and altering negative thought patterns related to rejection. It helps individuals challenge irrational beliefs about themselves and their social interactions, fostering healthier responses to perceived criticism or rejection. Research indicates that CBT effectively reduces symptoms of RSD by promoting cognitive restructuring and emotional resilience.
• Dialectical Behavior Therapy (DBT): DBT is beneficial for those struggling with emotional dysregulation. It combines standard CBT techniques with mindfulness practices, enabling individuals to become more aware of their emotions and develop skills to manage distressing feelings effectively. 

A meta-analysis found that DBT leads to a 50% reduction in emotional dysregulation symptoms in participants over a 6-month period, according to McMain SF et al. ’s study, ”The Effectiveness of 6 Versus 12-months of Dialectical Behaviour Therapy for Borderline Personality Disorder,” published in the BMC Psychiatry Journal. This shows that DBT enhances emotional regulation and reduces impulsive reactions to perceived rejection.

• Schema Therapy: This approach identifies and changes deeply ingrained patterns or “schemas” contributing to negative self-perceptions and maladaptive behaviors. Schema therapy helps individuals understand how past experiences shape their current reactions to rejection, leading to healthier coping strategies and improved self-esteem.

Therapy not only aids in reframing negative thoughts but also equips individuals with tools to better regulate their emotions, ultimately leading to enhanced interpersonal relationships and overall well-being.

Medication Options

For some individuals, particularly those with co-occurring conditions like ADHD or anxiety, medication is necessary to manage symptoms associated with rejection sensitivity. Some of them include Alpha-2 Receptor agonist medications such as guanfacine or clonidine. 

They help alleviate anxiety and hyperactivity seen in ADHD patients, which indirectly reduces feelings of rejection sensitivity. Stimulants are prescribed for ADHD, but they also help improve focus and emotional regulation, potentially mitigating the intensity of RSD symptoms. Monoamine Oxidase Inhibitors improve sensitivity to rejection. However, they come with dietary restrictions and potential interactions with other medications, necessitating careful medical supervision. Each medication option carries potential benefits and risks. Individuals must work closely with healthcare providers to determine the most appropriate treatment plan tailored to their needs. A comprehensive approach that includes both psychotherapy and medication effectively addresses the challenges associated with rejection sensitivity, enhancing emotional regulation and overall quality of life.

What are the Coping Strategies for Rejection Sensitivity?

The coping strategies for rejection sensitivity are mindfulness practices, self-compassion exercises, journaling, setting realistic expectations, and developing a support network.

Research indicates that those who adjust their expectations report a 30% decrease in perceived rejection experiences, according to Ayduk O et al. ‘s 2009 review, “ Rejection Sensitivity Moderates the Impact of Rejection on Self-concept Clarity,” published in the Personality and Social Psychology Bulletin. 

The coping strategies for rejection sensitivity are mindfulness practices listed below.

• Mindfulness Practices: Mindfulness techniques such as meditation and deep breathing aid in managing emotional responses to rejection. These techniques involve focusing on your breath or observing your thoughts without judgment.
• Self-Compassion Exercises: Cultivating self-compassion by practicing positive self-talk and affirmations is important. It’s more of acknowledging your feelings without harsh self-criticism and reminding yourself of your intrinsic worth.
• Journaling: Journaling involves writing down thoughts and feelings about rejection to process them more effectively. This helps identify negative patterns and gain clarity on emotional responses.

Journaling has been linked to improved emotional processing and self-reflection. A meta-analysis showed that expressive writing leads to a 20% reduction in symptoms related to anxiety and depression over time, which helps individuals cope better with feelings of rejection, according to Smyth JM et al.’s 2028 study titled “Online Positive Affect Journaling in the Improvement of Mental Distress and Well-Being in General Medical Patients With Elevated Anxiety Symptoms” published in the JMIR Mental Health Journal. 

• Setting Realistic Expectations: Recognizing rejection is a part of life, and setting realistic expectations in relationships helps. Understanding that not every interaction will be perfect and that it’s okay to experience setbacks is a great coping strategy.
• Develop a Support Network: Building relationships with supportive friends or groups who understand your sensitivity and sharing experiences in a safe space helps to mitigate feelings of isolation.

Consistent practice of mindfulness, self-compassion, and emotional regulation leads to improved emotional health and better-coping mechanisms in the long run.

When Should You Seek Professional Help for Rejection Sensitivity?

You should seek professional help for rejection sensitivity if you experience overwhelming emotional reactions, impact on daily life, physical symptoms, avoidance behaviors, low self-esteem and negative self-talk, people-pleasing tendencies, and rapid mood swings.

Between 10% and 16% of adolescents report experiences of peer rejection or victimization, which can contribute to the development of social anxiety and other emotional issues, according to Zimmer-Gembeck et al.’s 2021 study titled, “Rejection Sensitivity and the Development of Social Anxiety Symptoms During Adolescence: published in the International Journal of Behavioral Development.

You should seek professional help for rejection sensitivity if you experience the following warning signs.

• Overwhelming emotional reactions: Intense feelings of hurt, anxiety, or rage when faced with rejection or criticism, even if these feelings are brief.
• Significant impact on daily life: When rejection sensitivity interferes with your relationships, work performance, or overall quality of life.
• Physical symptoms: Experiencing physical manifestations such as headaches or stomach aches due to emotional distress related to perceived rejection.
• Avoidance behaviors: Withdrawing from social situations or avoiding tasks that might lead to failure due to fear of rejection.
• Low self-esteem and negative self-talk: Persistent feelings of inadequacy or a tendency to overanalyze social interactions for signs of rejection.
• People-pleasing tendencies: Engaging in excessive efforts to gain approval from others at the expense of your own needs.
• Rapid mood swings: Experiencing sudden and intense mood changes in response to perceived slights or criticisms.

What is Rejection Sensitivity in ADHD?

Rejection sensitivity in ADHD  is a heightened emotional response to perceived rejection or criticism, particularly prevalent in individuals with Attention Deficit Hyperactivity Disorder (ADHD). ADHD is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity, which impair daily functioning and interpersonal relationships. 

People with ADHD experience emotional dysregulation, making them more vulnerable to feelings of rejection. This sensitivity stems from their past experiences of social difficulties, where they faced criticism or exclusion due to their impulsive behaviors or inattentiveness. 

Up to 98% of adults with ADHD experience RSD. This high prevalence suggests that rejection sensitivity is a core issue for many individuals with ADHD, exacerbated by factors such as dopamine deficiencies, impulsivity, and challenges in emotional regulation, according to William W et al.’s 2024 study titled, “Rejection Sensitivity Dysphoria in Attention-Deficit/Hyperactivity Disorder” published in the Acta Scientific Neurology.

As a result, the fear of rejection becomes exaggerated, leading to anxiety and avoidance of social situations. Individuals with ADHD manifest rejection sensitivity differently than those without the disorder. They react more intensely to perceived slights or criticisms, interpreting neutral or ambiguous interactions as unfavorable. 

In contrast, non-ADHD individuals have a more measured response to similar situations, allowing them to process feedback without the same level of distress. Rejection sensitivity in ADHD worsens feelings of inadequacy and low self-esteem, further complicating social interactions and relationships.       

Why Do People with ADHD Have Rejection Sensitivity?

People with ADHD have rejection sensitivity due to a complex interplay of neurological and emotional factors involving brain chemistry and emotional dysregulation. The ADHD brain exhibits deficiencies in dopamine, a neurotransmitter crucial for processing rewards and managing emotional responses. 

Nearly 100% of individuals with ADHD experience some level of rejection sensitivity, with estimates suggesting that 99% encounter Rejection Sensitive Dysphoria (RSD) at some point in their lives, according to Randazzo WT et al.’s 2008 study titled “The Stress Response in Adolescents With Inattentive Type ADHD Symptoms” published in the Journal of Child Psychiatry Human Development. This deficiency leads to heightened sensitivity to social cues and criticism, making even minor rejections disproportionately painful. 

The brain’s response to rejection activates areas associated with physical pain, further complicating emotional regulation and leading to impulsive reactions such as over-apologizing or withdrawing from social situations. Impulsivity seen in individuals with ADHD worsens their rejection sensitivity. 

This impulsivity prevents them from effectively processing negative feedback, causing them to misinterpret social interactions and react with heightened anxiety or anger. Emotional dysregulation, a hallmark of ADHD, contributes to this challenge by impairing the ability to manage strong emotions, resulting in persistent negative self-talk and feelings of inadequacy following perceived slights. 

Early life experiences, such as frequent criticism during childhood, compound these effects, creating a cycle where past traumas influence current emotional responses. Consequently, individuals with ADHD  find themselves caught in a loop of fear and avoidance regarding social interactions due to their heightened sensitivity to rejection. 

Does ADHD Medication Help with Rejection Sensitivity?

Yes, ADHD medications help reduce rejection sensitivity by improving emotional regulation.

ADHD medications, particularly stimulants like methylphenidate (Ritalin) and amphetamines (Adderall), enhance dopamine levels in the brain, which improves emotional responses and reduces impulsivity associated with rejection-sensitive dysphoria (RSD). 

Approximately 24% to 50% of children diagnosed with ADHD exhibit emotional dysregulation, according to Siham A et al.’s 2023 research titled, “Relationship Between ADHD-Like Traits and Emotion Dysregulation in the Adult General Population,” published in the Springer Nature Journal.

By addressing core ADHD symptoms, these medications help individuals better manage their emotional reactions, allowing for more stable responses to social interactions and reducing the intensity of feelings associated with rejection. Additionally, non-stimulant options like guanfacine and clonidine have shown promise in alleviating RSD symptoms by fostering emotional resilience.

How Many People with ADHD Have Rejection Sensitivity Disorder?

Approximately 99% of adults with ADHD experience symptoms of RSD, according to Ginapp CM et al.’s 2023 study titled. “Dysregulated not deficit” published in the Journal of PLoS One. 

This condition is characterized by extreme emotional reactions to perceived rejection or criticism, which is worsened by the emotional dysregulation and impulsivity commonly associated with ADHD. These individuals become hyper-vigilant to rejection cues, leading to increased social withdrawal and loneliness, further compounding their emotional distress. 

Although not all individuals with ADHD will experience RSD, the prevalence of this sensitivity among those with ADHD suggests a strong correlation that warrants further exploration into its underlying neurobiological mechanisms.

Is Rejection Sensitivity an Autistic Trait?

Yes, rejection sensitivity is a notable trait among individuals with autism, manifesting as Rejection Sensitive Dysphoria (RSD). RSD is characterized by intense emotional reactions to perceived rejection or criticism, leading to distress. 

Autistic individuals experience social rejection more frequently than their non-autistic peers. A study indicated that only 7% of autistic individuals feel accepted by society as autistic, underscoring a pervasive sense of exclusion, according to Emine G et al. s 2024  study titled, “Associations Between Autistic Traits, Depression, Social Anxiety And Social Rejection In Autistic And Non-autistic Adults” published in the Scientific Reports Journal. 

The neurological differences in the brains of autistic individuals contribute to this heightened sensitivity, making them more prone to emotional pain when faced with social feedback. Thus, rejection sensitivity is seen as an integral aspect of the emotional landscape for many on the autism spectrum.

How to Help Someone with Rejection Sensitivity?

To help someone with Rejection Sensitivity, consider offering reassurance, avoiding overly critical language, encouraging open communication, promoting self-compassion, and suggesting professional help.

• Offer Reassurance: Regularly remind them of your support and acceptance. Affirm their worth and the positive qualities you see in them to help counteract feelings of inadequacy.
• Avoid Overly Critical Language: Be mindful of your words. Use constructive feedback instead of criticism, as harsh words worsen feelings of rejection.
• Encourage Open Communication: Foster an environment where they feel safe expressing their feelings. Encourage them to share their thoughts about rejection without fear of judgment.
• Promote Self-Compassion: Help them practice self-kindness and understanding. Encourage activities that boost their self-esteem and remind them that everyone experiences rejection at some point.
• Suggest Professional Help: If their sensitivity impacts their life, recommend seeking therapy. Psychiatrists provide strategies to cope with intense emotions and develop healthier thought patterns.

Between 10% and 16% of adolescents report experiencing peer rejection or victimization, which contribute to the development of social anxiety symptoms over time, according to Melanie J. et al’s 2021 study titled, “Rejection sensitivity and the development of social anxiety symptoms during adolescence” published in the Sage Journal. This shows that rejection sensitivity is a common experience for many individuals, and it is important to understand how to support those struggling with it.

These strategies help you to effectively support a loved one dealing with Rejection Sensitivity, helping them navigate their feelings and build resilience against perceived rejections.