For many Thais, rejection—whether from friends, family, or colleagues—can feel like a sting, but for some, even the smallest slight feels devastating. This overwhelming emotional reaction, described as “rejection sensitive dysphoria” (RSD), is gaining attention thanks to social media, research, and a wave of first-person accounts. The latest article from The New York Times draws on real-life stories, clinical insight, and emerging science to examine a phenomenon seldom found in medical textbooks but increasingly recognized in the mental health community, including among younger generations in Thailand and worldwide (source: The New York Times).
RSD refers to an extreme emotional response to perceived or actual rejection, criticism, or teasing. While everyone experiences some pain from being dismissed, those who identify with RSD feel as if a single negative comment is the “end of the world.” The concept, while popular in online discussions, is rarely used in official clinical practice, and RSD is not yet included in diagnostic manuals such as the DSM-5. Nevertheless, the term has resonated deeply, especially among people diagnosed with attention deficit hyperactivity disorder (ADHD), who often struggle with emotional regulation and may be particularly vulnerable to the intense pain of perceived rejection (source: NYT, ADDitude Magazine).
The prominence of RSD in public discourse can be traced to Dr. Bill Dodson, a psychiatrist who has worked extensively with ADHD patients. Dr. Dodson borrowed the term from literature on atypical depression, applying it to capture the recurrent distress observed among his patients when faced with rejection or criticism. He first presented the concept at a 2010 ADHD conference and has since articulated criteria for recognizing RSD, fueling online conversation and peer support networks (source: NYT).
Clinically, RSD is not synonymous with “rejection sensitivity,” a broader phenomenon historically linked to mood and personality disorders, as outlined by Dr. Erick Messias of Saint Louis University. What distinguishes RSD, according to Dr. Dodson, is the instantaneous mood change—often a switch to depression or rage—that occurs after a perceived slight. This intense internal suffering is paired with harsh self-criticism and a persistent sense of not measuring up, compounding feelings of dysphoria—a painful, dissatisfied emotional state (source: NYT, Psychology Today).
Skepticism remains among mental health professionals regarding the scientific validity of RSD as a unique syndrome. Dr. Max Wiznitzer, a pediatric neurologist, cautions that outsized emotional reactions may reflect coexisting mood disorders rather than a discrete condition. Others, like psychologist Lindsay Blass, acknowledge that while the scientific basis for RSD remains debated, the terminology serves a practical function by giving voice to those who experience genuine anguish in the face of rejection. “You’re not just disappointed,” Dr. Blass explained. “You’re devastated. And other people don’t necessarily understand why it’s that intense” (source: NYT).
The lived experience of RSD can be all-consuming. For Erin Ryder, a young teacher with ADHD, learning about RSD was a revelation. She described her emotions after a minor change in plans with her boyfriend as catastrophic, obsessing over what she might have done wrong and feeling emotionally overwhelmed—only to realize later that her response was out of proportion. Stories like this echo those shared by many in Thailand’s growing mental health awareness communities, where young people turn to online forums or TikTok for validation and advice.
While no medications are specifically approved for RSD, clinicians sometimes prescribe treatments for anxiety, though their effectiveness is mixed. Therapy—particularly approaches such as cognitive-behavioral therapy (CBT) and exposure therapy—can help individuals manage reactions and gain perspective. Dr. David W. Goodman of Johns Hopkins advises those prone to rejection sensitivity to gradually practice tolerating uncomfortable situations, helping build resilience over time (source: NYT, Johns Hopkins Medicine). Other practical coping skills include acknowledging one’s own sensitivity, reality-checking interpretations of events, and communicating directly about feelings rather than making assumptions.
Recent scientific research offers further insight into the connection between rejection sensitivity, cognitive bias, and risk for depression. A 2017 study published in Clinical Psychological Science demonstrated that people who anxiously anticipate rejection are more likely to develop negative interpretations of ambiguous events, thereby increasing their risk of depressive symptoms. Interventions that challenge these negative interpretations may hold promise for reducing depression among those who anticipate rejection—echoing Thai cultural values around self-awareness (สติ) and gradual self-improvement (source: PubMed).
Research also highlights the association between ADHD and emotional dysregulation, of which RSD is one potential manifestation. A 2023 qualitative study noted that young adults with ADHD often describe their condition in terms of emotional intensity and instability, not just inattention or hyperactivity. This reflects a more holistic understanding of ADHD—one increasingly acknowledged by Thai doctors and mental health professionals as they encounter diverse presentations among young patients (source: PubMed).
Data on RSD in the Thai population remain scarce, but anecdotal evidence suggests many Thais—especially younger generations navigating intense academic and social pressures—identify with the experience. “Face” (เกียรติยศ) is a central concept in Thai society, reflecting honor, reputation, and social acceptance. Fears of losing face due to perceived failure or criticism may amplify the impact of rejection, particularly in highly interconnected communities such as schools, universities, and family networks. In clinical settings, Thai psychiatrists report a rise in cases involving social anxiety, perfectionism, and self-esteem issues linked to heightened sensitivity to criticism.
Thailand’s education system, with its emphasis on high-stakes exams and group conformity, can exacerbate rejection fears. Students facing academic or peer criticism may internalize these experiences, leading to avoidance, emotional shutdowns, or even mental health crises. At the same time, Thai culture’s strong family ties may provide important buffers—including intergenerational advice and Buddhist mindfulness practices that encourage emotional acceptance.
Looking globally, discussions around RSD intersect with ongoing debates about the medicalization of everyday experience. Where is the line between ordinary pain and pathological sensitivity? In the age of social media, the amplification of emotional distress—sometimes shared as humorous “relatability content”—may blur these boundaries. For some, having a label like RSD helps explain feelings that previously had no name; for others, it risks pathologizing normal ups and downs.
The future of RSD research lies in disentangling its relationship to ADHD, mood disorders, trauma, and broader concepts of emotional regulation. Some researchers argue that RSD represents a cluster of symptoms rather than a stand-alone diagnosis (source: ResearchGate, medRxiv). Large-scale studies are needed to establish prevalence, causes, and effective interventions, especially among non-Western populations like Thais, where cultural expectations may shape the experience and expression of emotional pain.
What can Thais do if they—or someone they care for—seems vulnerable to rejection sensitivity? Experts recommend several practical steps. First, recognize and validate your own feelings without judgment, เข้าใจตัวเองก่อน (understand yourself first). Second, seek support from friends, family, or a licensed therapist, rather than bottling up pain. Third, practice mindfulness—ซึมซับปัจจุบันขณะ (being present)—which can help put emotions in context. Finally, remember that everyone, regardless of culture or background, experiences rejection at times: it’s part of what makes us human.
For educators, mental health professionals, and policymakers, the growing conversation around RSD is a call to cultivate more emotionally supportive schools and workplaces. Offering safe spaces for expressing vulnerability, embracing compassionate discipline, and reducing stigma around counseling all contribute to collective resilience.
In summary, while rejection sensitive dysphoria is not yet an official diagnosis, it represents a real, lived experience for many Thais—especially those with ADHD, histories of trauma, or young people navigating a competitive society. As research deepens and public awareness grows, Thailand is well positioned to blend modern science with cultural wisdom, creating new paths to healing for those who feel every “no” as if it’s the end of the world.
For those seeking more information or support, consider reading about RSD at The New York Times, ADDitude Magazine, or connecting with Thai ADHD and mental health communities via social media or local hospitals.
Sources:
- The New York Times: When a Small Rejection Feels Like ‘the End of the World’
- PubMed: Dysregulated not deficit: A qualitative study on symptomatology of ADHD in young adults
- ADDitude Magazine: New Insights Into Rejection Sensitive Dysphoria
- Science Daily: Fear of rejection influences how children conform to peers
- Psychology Today: Rejection Sensitivity
- ResearchGate: Rejection Sensitivity Dysphoria in Attention-Deficit/Hyperactivity Disorder
- medRxiv: The lived experience of rejection sensitivity in ADHD