There are few emotions more painful than the burning sensation of shame. Many people would agree with this.

However, what do you do when the experience of shame is so intense that it makes you want to leave your body? 

Even more embarrassing is when that shame response flares up at moments that, for most people, would not even register as uncomfortable, let alone deeply damaging.

For example, you know you need to cancel an invitation you accepted, so you send a text to communicate this. You worry that your cancellation will affect the relationship. You word the text in a way that you justify and over-explain.

As you press ‘send’, the first flushes of shame are already being felt within the body...
- The heart begins to race
- Heat seems to spread from your stomach, up your front, to the top of your head
- Even your hands shake.

All of this mass of physiological information is taking place in response to a trigger.

But what was the trigger? Nothing more than the contemplation of rejection.

Up to this point, nothing has happened. Unfortunately, our anticipation of rejection can bring about the very thing we have tried so hard to avoid. It has dictated that the text we sent appeared furtive as if we were hiding something.

After ten minutes, there is still no reply. In response, the ramping up of symptoms of distress. After an hour it is almost unbearable, and many people report that they feel compelled to send another message to get confirmation that they have not been rejected. This can further jeopardise relationships and create a self-fulfilling prophecy.

I hope this example begins to illustrate the difference between a healthy and rational response to rejection, and one which is out of control and ruling your life.

Rejection sensitive dysphoria (RSD)

William Dodson MD has written extensively about this phenomenon which is termed ‘rejection sensitive dysphoria’, or RSD. The term ‘dysphoria’ comes from the Greek which translates as ‘unbearable pain’. Dodson states that this is a condition unique to those with ADHD. However, in my clinical experience, and according to other sources, it is also found amongst other groups, including, but not limited to, those on the Autistic Spectrum.

If you have been under significant stress for a long time, if you are recovering from limbic dysregulation (the part of the brain that processes threat), if you are recovering from the effects of trauma, even long Covid, the chances are you will also be struggling with an oversensitive limbic response to rejection or criticism. 

You will be the one best placed to know if you are experiencing RSD because you will notice two things: firstly, you will experience intense and almost unbearable pain in response to criticism or rejection (even your thoughts). Secondly, you will notice that you control your life to a rather dramatic degree to avoid that pain. 

Rejection as physical pain

Neuroscience confirms that rejection activates the same brain regions as physical pain (the dorsal anterior cingulate cortex and the anterior insula). This is why rejection can feel overwhelming, triggering anxiety, shame and a physical stress response. 

So why do we need yet another name for this condition? Isn’t this just medicalising a natural human reaction? If people just toughened up a little, surely this would stop being an issue?

 In my opinion, this attitude is deeply damaging to individuals experiencing an exaggerated limbic response to shame. It also means that the condition is driven underground and is misunderstood and mistreated.

If you’ve struggled with an unbearable reaction to relatively small triggers, the chances are that you already feel ashamed of your ‘over-reactions’. No doubt, like many of my clients, you have tried your very best to find ways of overcoming it; mainly because it is so debilitating. Knowing that it has a name and that it’s a condition that does not respond to psychological techniques alone, can help to lessen the shame for many. It also helps to destigmatise what is in effect a neurological response. Most importantly, it gives the powerful message that we are not alone.

But why does rejection hurt so much, and why do traditional coping methods often fall short?

Causes of RSD

Rejection-sensitive dysphoria occurs in response to triggers. Many conventional approaches focus only on the thinking brain (cognitive strategies), missing the deeper, limbic-based response that caused the trigger in the first place.

Many approaches that claim to tackle RSD are hugely helpful at reframing unhelpful thoughts, but when an intense physiological response occurs, they fail to address the overwhelming emotional and physical pain triggers.

Anything that requires a sustained mental effort when the body is in a heightened stress state, such as cognitive behavioural therapy (CBT), will have limited success in certain situations. 

Unfortunately, in the absence of a more robust therapy, this leads to avoidance and people-pleasing behaviours to lessen the impact. Whilst such tactics may be effective in the short term, in the long term, this leads to higher stress levels and lower self-esteem and further derails the limbic system stress response.

This leads to (you guessed it) worsening RSD symptoms.

Effective methods address

• The body’s reaction

• The limbic system

• The deep emotional patterns that are driving rejection pain

How can hypnotherapy help?

Luckily, most well-trained hypnotherapists can use a range of highly effective tools to target the pain of Rejection Sensitive Dysphoria; as long as they know what it is (and what it isn’t).

If we try to treat the response solely as a psychological event, not only will it not be fully effective, but it will also lead to further feelings of inadequacy and shame. Perhaps leading people to give up on treatment completely.

So how do we work with rejection pain more effectively?

• The key here is to address the symptoms from the ground up. 

• I’d like you to imagine that the symptoms of RSD (outbursts, sulking, people-pleasing, obsessively asking for reassurance) are like a withered flower blooming on a plant.

• The blossom is the most eye-catching and last thing to grow. However, before any flower can appear, there must be a seed, earth and roots. 

The seed in this analogy is our core self, and the earth is the environment around us now, and in which we were raised. If there is a problem with the flower, we could try to treat the petals or, for better results, consider the soil in which the plant is growing. Can we fertilise? What can we add to promote strong healthy growth? 

A Strong Sense of Safety

The very first thing that anyone who experiences RSD needs to feel is a strong, sustainable sense of safety and inner trust; this is the soil from which we grow. We often feel that is only possible to feel this after we have solved our problems. 

However, hypnotherapy can help to instil a deep sense of internal security, reducing the nervous system’s fight-or-flight response. And it can be an enjoyable process! Techniques such as visualisation, neutralising limiting beliefs and installing empowering memories can all have a highly beneficial effect. Self-trust is strengthened, so external validation becomes less of a driving force.

The next step is to address the trigger

This is the structure of the issue (or the stem and leaves). In my experience, it is difficult to spot triggers unless we feel safe and resourceful. Interrupting the habitual neural messages works so well because instead of just thinking differently, we train the brain to feel differently, reducing emotional reactivity at a deep level. This means change can feel effortless at times and many things can change spontaneously.

Neuroscientist Dr. Norman Doidge explains that the brain is not fixed—it is constantly rewiring itself based on experience. This means that our response to rejection need not be permanent but can be reshaped through targeted interventions like Core Transformation, hypnotherapy, and limbic re-education. Many people find this incredibly hopeful and it also allows people to separate the behaviour from personality further reducing shame.

I hope this exploration of rejection sensitive dysphoria gives you a feeling of optimism. Rejection isn’t just something to tolerate—it can be transformed into a powerful opportunity for deep self-acceptance and growth. When we work with the body, the nervous system, and the unconscious mind, rejection loses its grip on us. With the right tools, rejection can become a key to freedom rather than a source of suffering.

References

Andreas, C. and Andreas, T., 1993. Core Transformation: Reaching the Wellspring Within. Moab, Utah: Real People Press.

Dodson, W.W., Modestino, E.J., Titiz Ceritoğlu, H. and Zayed, B., 2024. Rejection Sensitivity Dysphoria in Attention-Deficit/Hyperactivity Disorder. Acta Scientific Neurology, 7(8), pp.1-8

Doidge, N., 2007. The brain that changes itself: Stories of personal triumph from the frontiers of brain science. New York: Viking.