What is the treatment for Rejection Sensitivity Dysphoria (RSD)?

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Last updated: March 12, 2025View editorial policy

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From the Guidelines

Treating Rejection Sensitivity Dysphoria (RSD) primarily involves cognitive behavioral therapy (CBT) as the first-line treatment, incorporating exposure with response prevention (ERP), family or carer involvement, and adaptation to the individual's developmental level. This approach is based on the most recent and highest quality study available, which emphasizes the importance of CBT in addressing the underlying thought patterns and emotional regulation issues associated with RSD 1.

Key Components of Treatment

  • CBT: focusing on challenging negative thought patterns and improving emotional regulation skills
  • Family or carer involvement: to provide support and help the individual develop healthier relationships
  • Adaptation to developmental level: ensuring the treatment is tailored to the individual's age and developmental needs

Medication Considerations

While CBT is the primary treatment, medication may be considered in certain cases, such as when RSD co-occurs with other conditions like ADHD or depression. However, the provided evidence does not specifically address the use of medication for RSD, and therefore, CBT remains the recommended first-line treatment 1.

Importance of Recent and High-Quality Evidence

The recommendation is based on the most recent study available, which provides the highest quality evidence for treating RSD. This study, published in 2024, emphasizes the importance of CBT in addressing the underlying issues associated with RSD 1. Other studies, such as the one published in 2022, may provide valuable insights into treatment-resistant depression, but they do not directly address the treatment of RSD 1.

Prioritizing Morbidity, Mortality, and Quality of Life

In treating RSD, it is essential to prioritize the individual's morbidity, mortality, and quality of life. CBT has been shown to be effective in improving these outcomes, and therefore, it remains the recommended first-line treatment 1. By addressing the underlying thought patterns and emotional regulation issues associated with RSD, CBT can help individuals develop healthier responses to perceived rejection or criticism, ultimately improving their overall well-being.

From the Research

Treatment for Rejection Sensitivity Dysphoria (RSD)

  • The treatment for RSD is not directly mentioned in the provided studies, but some studies suggest that psychotherapy can be beneficial for patients with treatment-resistant depression (TRD) who may also experience RSD 2.
  • Cognitive-behavioral therapy (CBT) has been shown to be effective in reducing depressive symptoms and improving response and remission rates in patients with TRD 2.
  • Other forms of psychotherapy, such as intensive short-term dynamic psychotherapy (ISTDP), interpersonal therapy (IPT), and group dialectical behavioral therapy (DBT), may also be beneficial for patients with TRD 2.
  • Rejection sensitivity (RS) has been identified as a key factor in the development of TRD, and addressing RS may be an important aspect of treatment 3.
  • Biological markers for RS, such as the involvement of the μ-opioid receptor function and hypersensitivity of the dopamine D4 receptor (DRD4), may be targeted in the development of new treatments for TRD 3.

Psychotherapy for RSD

  • Psychotherapy has been shown to be effective in reducing depressive symptoms and improving response and remission rates in patients with TRD 2.
  • CBT has been shown to be effective in reducing depressive symptoms and improving response and remission rates in patients with TRD 2.
  • Other forms of psychotherapy, such as ISTDP, IPT, and DBT, may also be beneficial for patients with TRD 2.

Biological Markers for RSD

  • The involvement of the μ-opioid receptor function and hypersensitivity of the dopamine D4 receptor (DRD4) have been identified as biological markers for RS 3.
  • Manipulation of these biological markers may be a potential target for the development of new treatments for TRD 3.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Psychological therapies for treatment-resistant depression in adults.

The Cochrane database of systematic reviews, 2018

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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