By Janet Coulter, MSN, MS, RN, CCM, FCM
Have you ever felt like a minor critique hit harder than it should? Does feedback or suggestions make you question yourself? Have you ever replayed an awkward interaction for days, convinced it ruined everything? If this resonates with you, it might be more than just taking things personally. You could be experiencing something called Rejection Sensitive Dysphoria (RSD). This condition is gaining recognition for its intense emotional impact, especially in high-responsibility, people-centered roles.
Rejection Sensitive Dysphoria is a term most often associated with individuals who have ADHD. However, its reach can extend to anyone who experiences an extreme emotional reaction to rejection, criticism, or perceived disapproval. “Dysphoria” means “hard to bear.” That’s exactly what RSD feels like - emotional pain that seems disproportionate to the trigger. It can be particularly difficult for case managers where feedback is frequent and outcomes do not always align with effort.
So, what does this look like for a professional case manager? Maybe you are presenting at a meeting and one person scrolls through their phone, and suddenly you are thinking: Was I boring? Did I miss the mark? Should I even be doing this? Or a client doesn’t respond to your outreach, and instead of brushing it off, you’re plagued by thoughts that you failed them , and maybe you could have done more. The response is not rational - it’s emotional, deeply personal, and often invisible to others. But the internal toll can be exhausting.
Sometimes, it is as subtle as receiving a neutral email from a supervisor and reading it five times to make sure it is not hiding disapproval. Or being left off an invite list and spending the rest of the day wondering what you did wrong. You might overanalyze your tone in case notes, worry you offended a provider or client, or replay a tense phone call with a family member long after your shift ends. Even positive events, like receiving an award can trigger RSD: What if I do not live up to it? What if they realize I am not as good as they think?
This hypersensitivity to rejection can shape behavior such as avoidance of leadership roles, procrastination out of fear of criticism, hesitance to speak up in meetings, or overcompensation to earn approval. You may say “yes” too often, push past burnout to avoid disappointing anyone, or apologize excessively for things out of your control. Sound familiar?
Understanding RSD is not about self-diagnosing. It is about increasing self-awareness. Recognizing these patterns allows us to step back and reflect rather than react. For case managers who are constantly navigating complex systems and advocating for clients, managing our own emotional responses is just as important as managing others’ care plans.
What helps? Naming the feeling is a start. When rejection feels like the end of the world, pause and ask: “Is this a fact or a feeling?” Grounding techniques, mindfulness, and emotional regulation strategies can help retrain your brain to respond rather than react. Therapy, especially cognitive behavioral therapy, can also be powerful in addressing the roots of rejection sensitivity. If ADHD is a factor, medication and coaching may play a role in managing RSD symptoms.
Perhaps most importantly, know that you’re not alone. Many case managers thrive because they care deeply. That same deep sensitivity can come with hidden vulnerabilities. Talking about RSD openly can reduce stigma and create space for compassion for ourselves and our colleagues. After all, what if that “end of the world” moment is just a bump in the road you are more than capable of navigating?
So, the next time a small rejection feels overwhelming, pause and remind yourself: this is not a reflection of your worth or competence. It is an emotional response asking to be acknowledged. You are still the same skilled, compassionate professional you were moments before. One unanswered email, a missed response, or an offhand comment does not define you.
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Bio: Janet Coulter, MSN, MS, RN, CCM, FCM is President of CMSA. She is a transplant case manager with a wide variety of experiences including educator, administrator, team leader, and Director of Case Management. Janet holds a Master of Science in Nursing from West Virginia University and a Master of Science in Adult Education from Marshall University. She has published many articles in CMSA Today and the Professional Case Management Journal and served as a reviewer for the Core Curriculum for Case Management Third Edition. She has served as President-Elect of CMSA, Chair of the CMSA Today Editorial Board, Chair of the Nominations Committee, and Vice-President of the CMSA Foundation board. Janet was the recipient of the CMSA National Award of Service Excellence and Southern Ohio Valley CMSA Case Management Leadership award and was recently inducted as a Case Management Fellow from CMSA.