What you need to know about rejection sensitive dysphoria, an extreme fear of rejection that can damage your relationships, according to a psychologist

• Rejection sensitive dysphoria (RSD) is an extreme fear of rejection that can harm relationships.
• It's not officially recognized condition, but many people online strongly identify with it.

Most people strive to be accepted by others; beyond the benefits of social connection, rejection is linked to emotional and even physical pain.

But there's a point where worrying about rejection can go too far — where anxiety around possible future ostracization can make you closed off or accusatory, ironically damaging your relationships.

While it's not officially recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition — the main diagnostic guide for mental health professionals in America — rejection sensitive dysphoria (RSD) is a cluster of symptoms that has resonated with many people online. The hashtags #rsd and #rejectionsensitivedysphoria have over 265 million combined views on TikTok, with users sharing what it's like to misinterpret a neutral tone of voice as negative or assume that invites to hang out aren't genuine.

And therapists and medical professionals are increasingly addressing it as a real condition.

Psychologist Dr. Andrea Bonior said she first heard of the term, popularized by Dr. William Dodson, about a decade ago but has seen it talked about a lot more in the last five years. "We're sort of trying to figure out exactly how to define it, how to have parameters about it," she told Insider.

Bonior defines RSD as "an extreme version of that fear of rejection" and "something that interferes with your functioning."

"None of us like rejection, we're sort of evolutionarily wired to not be comfortable with it," she said, "but with rejection sensitive dysphoria, it's to a degree that is so intense that we're basically really in distress about it and it causes all kinds of ripple effects."

This may be especially true for people who have ADHD or autism, both of which can cause emotional dysregulation that is tied into perceived rejection. However Bonior sees it as a "chicken and egg scenario," because living with autism or ADHD can result in receiving more actual judgment and rejection.

Combined with the potential neurological differences in anticipating rejection, she said this can create a "self-perpetuating cycle" of feeling abandoned.

Bonior spoke to Insider about the signs you may have RSD — and how to address it.

You can't relax around people because you worry if they like you

A big part of having RSD is feeling incredibly anxious in social interactions — specifically around whether people really like you or if you're secretly annoying everyone. For example, you might not get a response to a text because a friend is busy, but assume they just don't want to hang out with you.

In romantic partnerships, Bonior said RSD can translate to becoming suspicious and overly anxious about the other person leaving or cheating on you.

She said this gets in the way of maintaining relationships and "basically sabotages you" because you can be "really afraid to connect with people in the first place."

You've blown up at someone because you anticipated abandonment

Symptoms like reactivity and impulsivity can also tie into how you respond to RSD, Bonior said.

"We might take slights so personally that we erupt in anger at friends because we're so reactive to the potential of the friends rejecting us," she said. It could be blowing up at a friend if they're late to meet you up or hung out with a mutual friend without you because you immediately interpret their behavior as them not caring about you.

She said this can create a "ripple effect" because the blow-up can cause breakups and tensions between friends, leading to actual rejection.

Specific forms of therapy and ADHD treatment can help

Bonior said that cognitive behavioral therapy (CBT) that "involves becoming aware of your triggers" can be incredibly beneficial for learning to "observe some of the thoughts that you're having and choose a better outcome."

She also recommended acceptance and commitment therapy (ACT) as another mindfulness-based therapy practice that teaches you to sit with hard feelings without judging them.

If you know you have ADHD, she said finding ways to manage it can relieve symptoms of RSD too, including developing executive-functioning strategies or taking medication.

"The more stress that you're under, the more both RSD and ADHD are going to be exacerbated," she said. Things like getting enough sleep, fresh air, and exercise can clear your mind — and make you more likely to stop yourself the next time you start to spiral over an unanswered text.