Obsessive compulsive disorder - OCD treatment and therapy from NOCD

How can therapy help me deal with rejection?

By Elle Warren

Jan 18, 20247 minute read

Reviewed byApril Kilduff, MA, LCPC

Nobody likes rejection. It stings, especially if it has to do with something—or someone—you really care about. You might be able to move on from it relatively quickly, or need strategies to better cope with your feelings. 

Either way, therapy can help you work through the thoughts you have surrounding rejection. Therapy won’t try to convince you to like this uncomfortable, sometimes hurtful experience, but it can help build your tolerance for the discomfort, says April Kilduff, LPCC, LCPC, LMHC, a therapist and clinical trainer at NOCD who specializes in OCD, anxiety disorders, and autism. 

The key, though, is identifying the right sort of therapy for your specific mental health struggle—and that may be easier said than done.

Why is rejection so difficult?

“Back in humanity’s cave days, your best chance of staying alive was to be in a group,” says Kilduff. “These primitive instincts have wired us to want connection. So when someone doesn’t offer that, it feels like a blow that can actually trigger some of the pathways in the body that make us experience physical pain.”

Being rejected can hurt your self-esteem, particularly if you base the way you see yourself on how you’re perceived by others. You may interpret rejection as meaning you’re unworthy or incapable of love, belonging, or success.  

If you have perfectionist tendencies, you might have an especially hard time with rejection. It might feel catastrophic to not be liked. You might wonder what you could have done better or differently, or why you weren’t able to live up to others’ expectations.

Could difficulty dealing with rejection be a sign of a mental health condition?

Yes, it’s true that certain mental illnesses may make you particularly sensitive to rejection. They include: 

Social anxiety disorder can make you constantly afraid of rejection. You may fear being judged, criticized, and humiliated. Like all anxiety disorders, it’s characterized by intense, excessive worry that could also make you engage in safety-seeking behaviors, namely avoiding new or uncomfortable social interactions. When rejected, you might feel like your worst fears are true—that there’s something wrong with you, and/or that you don’t know how to properly connect with others.

Obsessive-compulsive disorder (OCD) has three distinct components. First, there’s the presence of repetitive, unwanted intrusive thoughts, fears, urges, sensations and/or feelings (obsessions) that don’t align with your beliefs and values. And as a result, you feel extreme distress over these thoughts—that’s the second piece. While everyone has intrusive thoughts or worries from time to time, if you have OCD you take them extremely seriously and are unable to dismiss them. And finally, the whole cycle starts over, where you engage in mental or physical actions (called compulsions) in an attempt to rid yourself of the intrusive thoughts and ensuing distress. 

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In some cases of OCD, rejection can trigger intrusive thoughts. For example, there is a common theme of the disorder known as scrupulosity OCD, in which you worry about violating your moral, ethic, or religious code. So if you’re rejected, you might wonder, is it because I’m a bad person? Did I get rejected because I didn’t uphold my values well enough? What if I’m never good enough? What if my god rejects me because of bad things I’ve done?

Another example is relationship OCD, which involves obsessive worries or doubts attached to personal relationships, most commonly romantic or intimate ones. If you struggle with this theme, any number of things could feel like rejection—you might worry that your partner’s bad mood is a sign that they’re no longer in love, or ruminate for hours on a friendly interaction they had with a stranger.

Depression. Depression is much more than sadness. It can involve a loss of interest in activities you once enjoyed, feelings of numbness, a lack of appetite, sleeping too much or not sleeping enough, lethargy, and isolation. One often feels literally weighed down. Because of pulling back from hobbies, social circles, and a tendency to interpret this experience as “lazy” (thanks to mental health stigma), those with depression commonly have low self-esteem. When you’re already feeling down about yourself, rejection adds an extra sting. You might feel like rejection “proves right” your negative perspective of yourself.

Personality disorders, particularly histrionic and borderline. Those with personality disorders feel emotions very intensely, often swinging rapidly between moods and dispositions. Specifically, those with borderline personality disorder possess a fear of being abandoned and being alone. Thus, being rejected can trigger that fear. 

Those with histrionic personality disorder crave constant attention. They’ll often go to extreme measures to obtain it. Being rejected can feel like the end of the world. 

Neurodivergences, particularly ADHD and autism. There’s a personality disposition called “rejection sensitivity”, and while we don’t know exactly why, it’s especially common among those with ADHD. People with high rejection sensitivity report feeling actual physical pain when they’re rejected (or when they perceive rejection). 

Autistic people may also spend a lot of time trying to figure out the social “rules” and dynamics at play in any given situation. They worry that they’re not interpreting something correctly and won’t act in the “right” way. When rejected, people with autism might worry that they “missed something” about a situation and didn’t speak or behave properly, or that they’re socially “defective.”

Plus, neurodivergent folks often grow up facing above average amounts of rejection and criticism from both peers and adults. They may have been met with questions like, Why are you behaving that way? or Why can’t you be normal? Therefore, even in adulthood, rejection may poke at a lifelong, possibly traumatic wound.

How can therapy help me deal with rejection?

“There’s a lot of distorted beliefs and catastrophizing when people get rejected,” says Kilduff, “so therapy can help people learn to think about the rejection differently so it isn’t so crushing or catastrophic.”

Depending on why you have a hard time with rejection, there are several types of therapy that could be a good fit. Your interpretation of your experience is entirely valid, but the best way to understand all its nuances and be guided in an appropriate course of treatment is to consult a licensed psychologist or psychiatrist for diagnosis. 

For those experiencing either OCD or social anxiety disorder, the gold-standard, evidence-based treatment is exposure and response prevention (ERP) therapy. ERP consists of gradually introducing one to the places, people, situations, sensations, feelings, and other stimuli that trigger their intrusive thoughts and/or anxious worry. Importantly, one learns how to resist engaging in compulsive or safety-seeking behaviors before, during, and after the exercise. Over time, the ERP client comes to understand that they can tolerate discomfort and uncertainty, living according to their own values rather than being guided by fear and anxiety.

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The modality of therapy best suited for depression is cognitive-behavioral therapy (CBT). This technique helps one understand the relationship between their thoughts, feelings, and actions. With a better awareness of that relationship, one learns how they can restructure their patterns of thinking and, ultimately, alter the unwanted behavior. 

A go-to method of therapy for personality disorders is dialectical behavioral therapy (DBT). It’s designed for those who experience emotions intensely and struggle to regulate those emotions. It helps individuals to develop stronger awareness around what triggers them to behave in destructive and impulsive ways, teaching them new coping skills that don’t result in those behaviors. It also helps clients to accept seemingly contradictory truths, such as both the need to accept their reality and change aspects of it.

DBT may also be useful in addressing some cases of ADHD and for some autistic people, if extra support is needed in emotional regulation. CBT is commonly used as well to help neurodivergent folks understand how to better cope and live with the symptoms of the way their brain works. For more resources on autism in adults, check out this list. And for more resources on ADHD in adults, check out this one

Because of the stigma around neurodivergence, it’s important to note that ADHD and autism are not mental illnesses that one can, or needs to, recover from. Rather, they are developmental differences that many learn to thrive with—especially with sources of support and accommodations.

Kilduff says we can all “learn that rejection is part of life. It feels really awful but it isn’t actually dangerous.” We can “normalize rejection,” she says, and while “it’s never going to feel good,” we can experience it and “not have it rock our entire world to the point of impairment.”

Remember: you don’t need to be suffering from a specific condition in order to seek help. It can be hard to be a human in general, and that is plenty of grounds for getting therapy. Regardless of your experience, there are trained professionals who can help you live a more full life.

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