An employment tribunal has awarded a worker £12,000 after ruling her employer acted unlawfully regarding a condition called rejection sensitive dysphoria, a case that highlights the growing recognition of a deeply distressing but often misunderstood psychological experience.
The tribunal heard the employee, diagnosed with dyslexia and RSD, was told by her boss “no thinking outside the box” when she requested a breakout space at a work party to manage feelings of overwhelm. The remark was found to be discriminatory, with the employee saying it felt like a demand to “mask, act neurotypical and don’t rock the boat.” This legal precedent is bringing a condition long discussed in clinical circles and on social media into sharper public and professional focus.
A Life Shaped by “Unbearable” Sensitivity
For Jenna Turnbull, a 36-year-old civil servant from Cardiff, the reality of RSD is a lifetime of intense, physically painful reactions to perceived rejection or criticism. She recalls an innocuous childhood comment about hairy arms made 25 years ago that still causes her chest to tighten. A light-hearted quip from a friend about her tidiness six years ago triggered such shame it led to obsessive cleaning, a symptom that contributed to her later diagnosis of obsessive compulsive disorder.
“The shame of carrying that I was going to be a separated, single mum was honestly the most horrendous feeling I’ve ever had in my life,” she says of a crisis point during divorce proceedings in 2022. Calling a mental health helpline that night was a turning point. The nurse suggested she might have attention deficit hyperactivity disorder and rejection sensitive dysphoria, a term Turnbull had never heard. She has since received an ADHD diagnosis.
RSD is characterized by intense emotional pain in response to perceived or actual rejection, criticism, or disapproval. While not a formal diagnosis in psychiatry’s main diagnostic manual, it is widely acknowledged by clinicians. The core symptom is severe, often disproportionate distress that can manifest as profound sadness, anger, or shame. For Turnbull, it has meant physical symptoms so severe she once visited her GP convinced she was having an asthma attack after a colleague corrected an error in a work email; it was a panic attack brought on by shame.
The Neurological and Psychological Landscape
Leading expert Dr William Dodson, a psychiatrist based in Denver, Colorado, began noting the pattern in the mid-90s. He describes RSD as “several orders of magnitude stronger” than everyday sensitivity to rejection. The “dysphoria” – from Greek meaning ‘unbearable’ – is what differentiates it. He estimates about 95% of his patients with ADHD identify with RSD symptoms, with a quarter calling it the most disabling part of their lives.
The condition is strongly linked to ADHD, with some estimates suggesting a very high degree of overlap, stemming from shared challenges with emotional regulation. Consultant psychiatrist Dr Shyamal Mashru, an adult ADHD specialist in north London, says little is definitively known about causes but points to theories involving an underregulated amygdala and prefrontal cortex, leading to powerful emotional responses. He also emphasises the role of nurture, noting the “mini traumas” of childhood criticism that erode self-esteem in those with ADHD.
Lauren O’Carroll, 41, from Cambridge, diagnosed with ADHD at 21, was labelled “oversensitive” and a “drama queen” as a child. For her, any request felt like a criticism, triggering shame and explosive rage. “It would feel like a punch in the guts,” she says. Even in adulthood, the fear of shame leads her to conceal mistakes, once lying to her parents for decades about causing a car crash.
The behavioural consequences can be profound. Dr Dodson notes people may adopt life-altering strategies to avoid emotional pain: becoming people-pleasers, perfectionists, or, in severe cases, withdrawing completely. “Very bright, educated people who still live in their parents’ basement, unemployed… They’re just crippled by it,” he says.
Dhiren Doshi-Smith, 42, from Loughton, Essex, describes years of self-isolation to avoid the intensity of potential rejection. For him, even digital communication is fraught; a delayed text reply can feel catastrophic, causing a “churning in the stomach.”
Management, Treatment, and a Path Forward
Treatment approaches vary. Dr Dodson has found a class of blood pressure drugs called Alpha-2 Agonists can be effective for RSD, though these are not typically prescribed for this purpose by the NHS. Dr Mashru tends towards non-medical approaches, such as coaching to relearn emotional responses. Psychotherapy, like Cognitive Behavioural Therapy, is also used to develop coping mechanisms and reframe negative thoughts.
For Jenna Turnbull, an antidepressant combined with therapy for low self-esteem has helped “massively.” After 18 months of therapy, she can better identify the onset of her physical symptoms and ground herself. The change has been significant. Previously too terrified of rejection to seek promotion, she recently applied for and secured a more senior role. “Understanding it has helped me accept me,” she says.
The condition’s rise in awareness, fuelled by social media support groups and countless TikTok posts, is colliding with a lingering scepticism. Comments on news stories range from dismissal—’touchy’—to assertions that disliking criticism is simply human nature. Turnbull encounters similar attitudes, with some dismissing RSD as a “modern-day excuse.” Yet for those who experience its acute reality, the validation of putting a name to their pain, as a nurse did for Turnbull that night, can be transformative. “Just putting a name to it was the big thing,” she says.
