Brain health · Sanctum

Rejection-sensitive dysphoria

It is not only criticism. A rejection, a knock-back, a moment of unfairness, any of them can land like a physical blow. A look, a tone, a message left on read, a rule applied to you and not to the person next to you, and you are winded, replaying it for days, certain you have been wronged or found wanting. You have probably been told you are too sensitive. You are not. Your brain registers criticism, rejection and injustice at a volume most people never have to manage.

Rejection-sensitive dysphoria is exactly that, an intense sensitivity to perceived criticism, rejection or injustice. It is the emotional edge of a brain wired around difference, and often around a lifetime of falling short of its own potential and being told to try harder. After enough of that, the alarm system gets loud. You people-please to head off the criticism, you avoid what you might fail at, and an unfairness, your own or someone else’s, can flatten an otherwise good day.

Because it looks like anxiety, low self-worth or a personality difficulty, it usually gets treated as those things, while the thing underneath is never named. It rarely travels alone. It sits on top of the focus, the masking, the exhaustion, and it is often what finally brings someone in.

We treat this as central, not a footnote, and we read it in the context of the whole picture. None of this is a diagnosis. It is what we explore with you. And if any of this feels heavy right now, you do not have to sit with it alone. Your GP can help, and the Samaritans are on 116 123.

Written by Dr Asad RaffiConsultant Psychiatrist · Founder & Medical Director