Are you overly sensitive to rejection? Do you take it particularly hard when you’re criticised, playing the moment over and over again in your head? Are you constantly on the lookout for mild disapproval from others? If so, you might have Rejection Sensitive Dysphoria. Or… you might just be human.
Rejection Sensitive Dysphoria, or “RSD”, is just one of the latest buzzwords that has become associated with autism and ADHD following the uptick in diagnoses for both conditions. Between 2019 and 2023, there was a fivefold increase in the number of open suspected autism referrals in the UK, while prescriptions for ADHD medication saw a 51 per cent increase over this same time period, according to the Nuffield Trust.
As awareness increases, the standard ADHD or autism diagnosis has become insufficient for some sufferers, who are seeking more niche subsections of the condition they can identify with. RSD, for example, is understood to be an extreme emotional sensitivity to rejection or criticism. It’s a fairly recent addition to the mental health lexicon, having been coined by psychiatrist William Dodson in the 2010s.
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An equally popular cluster of ADHD/autism symptoms is Pathological Demand Avoidance, aka PDA, which is when an individual experiences an extreme resistance to doing something that is requested or expected of them. This can include anything from big tasks to everyday demands, like the mere act of going to work, as per the UK-based PDA Society, which defines PDA as “a determined avoidance of so-called ‘common’ demands of life.” Despite PDA being coined by psychologist Elizabeth Newson in the 1980s, it’s important to note that neither of these terms is included in formal diagnostic systems.
That hasn’t stopped them from taking root on TikTok, where users are embracing the terms with open arms. “You sent me into fight or flight, you completely nailed my inner thoughts,” one comment under a video explaining RSD says. “I can almost hear the teachers voices from when I was a kid scolding me in front of class. Was that RSD or the formation of RSD?” another asks.
One of the most popular videos on the Rejection Sensitive Dysphoria tag is from a board-certified psychiatrist detailing her own personal RSD triggers, including “When someone doesn’t match my energy in a conversation” and “When I do something well and worry that someone could have done it better”.
@thepsychdoctormd @thepsychdoctormd and it gets worse if you’re overwhelmed 😩 #drsasha #adhd #adhdtiktok
♬ CUFF IT - Beyoncé
Meanwhile, people are using Pathological Demand Avoidance to explain why they’ve struggled to hold down jobs, feel unable to say no to others, and why they experience deep rage when asked to do a task they were already planning on doing. “[This] explains why societal and social demands also stress me out,” one TikTok commenter says under a popular video explaining PDA’s various symptoms. “I have a visceral response to demands and perceived demands. Like the opposing poles of a magnet. It is impossible for me to do the thing,” another adds.
To some extent, these terms can be helpful for individuals experiencing real suffering. In a case series published in 2024, researchers from the Department of Psychology at Curry College, Massachusetts, detailed a series of extreme cases of RSD. These included a man whose RSD had prevented him from ever applying to a job or asking a person on a date, leading him to drop out of college; a woman whose RSD appeared to lead to migraines and insomnia; and a woman who researchers believed was homeless due to factors including RSD. Treatment addressing their RSD significantly benefited all of the above individuals, as per the published case series.
Sometimes, even being able to label the issue as RSD or PDA can be beneficial. “When a client realises that a painful pattern they've experienced might be linked with something like RSD, it gives them a way to explain their experience to others without reducing themselves to being ‘too sensitive’ or ‘too emotional’”, says BACP registered therapist Roya Royle, who has experience working with individuals with autism and ADHD.
@katimorton What is pathological demand avoidance or PDA? Do you have it? #pathologicaldemandavoidance #autism #autismawareness
♬ original sound - Kati Morton, LMFT
These aren’t standard rejection responses — hence the use of the word “extreme” within RSD’s generally accepted definition. The same is true of PDA. “The distinction from everyday avoidance lies in the pattern being pervasive, anxiety-driven, and significantly impairing. It affects daily living, relationships, education, and work in a way that exceeds ordinary reluctance or procrastination,” explains Dr Ute Liersch, a Counselling Pyschologist at The Soke.
But PDA and RSD symptoms are also inherently relatable, meaning that many less extreme sufferers also identify with these terms. And just like a standard-issue ADHD and autism self-diagnosis, there can be a cost to slapping yourself with a label without getting properly clinically assessed for it.
“People seem to have a natural desire to find the exact condition that fits them as a way to feel understood and ‘normal’,” explains BACP registered therapist Clare Patterson. “Sometimes this can become an addiction or even a never-ending search, where labels seem to fit and apply, but then not satisfy in the long term, which leads them seek deeper and for more nuanced terminology.”
In turn, psychologists meet these demands by “creating” or coining new terms. “And so the loop continues,” Patterson says. “It becomes ‘real’ for the person. It’s something else to identify and feel understood by.”
But what if labelling yourself with RSD or PDA becomes a self-fulfilling prophecy? Suddenly that task can’t be completed for what can be perceived as a legitimate psychological reason. Or the response to rejection is legitimised, with even small everyday rejections becoming serious issues that require psychological intervention.
“If people believe they have an incurable condition, it can keep them stuck”, says Patterson. “Often there are very real things someone can do to get better which they do not accept because they have a ‘condition’ which means they cannot change.”
These terms pose a risk of becoming a “crutch”, Patterson notes, preventing an individual from growing, healing, or challenging their own thought patterns. “By identifying with terms and labels from the outside we do have a danger of missing the reality of our humanity — that we have the ability to heal from within.” Terminology can help, she says. “But it’s also important to know these are not inherently who we are.”
The popularity of RSD and PDA are part of a wider trend of overpathologising inherently human characteristics, something therapists across the world have noticed from their clients. “We are in a cultural moment where psychological language is widely used but not always used accurately,” says Dr Liersch. “The central risk is that people stop distinguishing between everyday emotional pain, which is part of being human, and neurodevelopmental or clinical conditions that genuinely require structured support.”
“I’ve noticed more clients coming in with the language already in their mind to explain what they’re going through, like understanding that their strong reaction to perceived rejection might be caused by RSD,” Royle adds. “But there is a risk when these terms become so widespread that they start to overshadow the basic truth that many of these feelings are part of being human. Human beings fear rejection for all sorts of reasons. People avoid tasks for all sorts of reasons. This a major risk of overpathologising because people might begin to think that every uncomfortable feeling needs a label, when often what we all need most is understanding and compassion.”
So, yes, maybe you are overly sensitive to rejection. Maybe you do take it particularly hard when you’re criticised, playing the moment over and over again in your head. Maybe you are constantly on the lookout for mild disapproval from others. But maybe you don’t have Rejection Sensitive Dysphoria. Maybe you’re a human, and you’re capable of change.
