Why You Feel Everything So Deeply (and how to survive it) - Dr Sasha Hamdani
In a Nutshell
Rejection sensitive dysphoria (RSD) stems from an overactive amygdala and underactive prefrontal cortex that causes intense, prolonged emotional responses to perceived rejection or criticism, often accompanied by physical symptoms like chest pain and breathing difficulties. The core problem isn't being emotionally sensitive—it's being in environments that don't utilize this trait, which can be reframed as a strength for emotional intelligence, deep relationships, and certain careers like psychiatry. Effective management involves movement, delayed reactions, and mindfulness to interrupt amygdala-driven spirals before they consume hours of mental energy.
These notes were generated by AI and may contain inaccuracies.
Dr. Sasha Hamdani became interested in researching emotionally sensitive people because she is emotionally sensitive herself and observed patterns in her clinical work with patients.
Emotionally sensitive people feel things quickly, deeply, and for a long time. They spend significant mental energy overanalyzing every interaction, reading social cues for signs of disapproval, and interpreting whether they or others are acting strangely. They constantly evaluate whether someone is upset with them.
These individuals also engage in substantial anticipatory work - predicting potential issues before they occur, changing their behavior, masking their natural responses, and overcompensating for perceived problems.
Rejection sensitive dysphoria is a neurological phenomenon involving a robust emotional and sometimes physical response to rejection or criticism. It goes beyond normal hurt feelings to feeling like "the air has been pushed out of my lungs" and questioning whether recovery is possible. This response can consume the person and may resemble a major depressive episode.
The fear of disappointing others is central to RSD, stemming from the underlying fear of rejection, criticism, or negative judgment.
The term "highly sensitive person" is not clinical and refers to sensitivity across multiple domains - not just emotions, but also sounds, lights, and sensory input. RSD specifically addresses the emotional angle of sensitivity.
Dr. Hamdani places RSD on a spectrum of emotional sensitivity. Some people experience minimal impact from emotional data, others have healthy emotional fluctuations, and some experience emotional data that can "sink them" with reactions disproportionate to the stimulus.
The term "rejection sensitive dysphoria" was coined by Dr. William Dodson based on longitudinal patient data showing profound emotional responses to rejection and criticism.
Dr. Hamdani advocates expanding the conversation around emotional sensitivity in general, noting that emotional dysregulation has been under-discussed in relation to ADHD and anxiety for many years.
Social rejection triggers significant neurobiological responses. The brain struggles to emotionally regulate, leading to suspension in low mood and high anxiety where individuals "spin and chew" on the rejection for hours.
Two key brain areas are involved: a highly attuned amygdala (threat receptor) that picks up seemingly negative emotional data, and an underactive frontal lobe responsible for judgment and processing that fails to assess situations appropriately.
This creates a situation where emotional responses occur before logical thinking can intervene.
Dopamine dysregulation plays a central role - it's not simply high or low baseline dopamine, but rather insufficient dopamine at the right place at the right time. Proper dopamine function helps individuals weather emotional ups and downs and regulate better.
Dr. Hamdani references the COMT variant (having two copies), which affects the ability to clear adrenaline and catecholamines. This genetic variation means chaotic environments make focus difficult, while predictable environments make it hard to stop focusing. Environment design becomes particularly important for such individuals.
Norepinephrine creates the physical response to rejection sensitivity. Beyond emotional pain, individuals may experience physical symptoms including difficulty breathing, rib pain, chest pain, elevated heart rate, sweating, and trembling - symptoms that can mimic anxiety or heart attacks.
The body genuinely responds as if there's a real problem, creating a feedback loop where physical symptoms convince the person something is seriously wrong.
Beyond hyperactive amygdala and underactive prefrontal cortex, the linkage between these areas is also "frayed," impairing the prefrontal cortex's ability to control amygdala responses.
The limbic system handles emotional circuitry. When processing significant emotional data (whether justified or based on perceived rejection), the limbic system activates intensely, creating communication patterns that generate major emotional responses requiring real-time navigation.
Emotional sensitivity involves three components: perceiving emotions, experiencing them in the moment, and the duration spent processing them afterward. Sensitive individuals scan environments for emotional cues including body position, tone, and voice volume, sometimes perceiving problems where none exist.
Hormones significantly impact emotional sensitivity. Estrogen drops correlate with dopamine drops, reducing emotional regulation capacity. Women may experience heightened rejection sensitivity during times of lower estrogen levels throughout their menstrual cycle.
Testosterone can be protective, helping with alertness, emotional regulation, and balance. As testosterone drops in men during their 50s and 60s, emotional sensitivity may increase significantly.
Men receive less education about emotional sensitivity and are socialized to suppress emotions except anger, which becomes the primary socially acceptable emotional outlet. This can lead to misdirected anger that may actually represent unrecognized emotional sensitivity.
From early childhood, boys receive different emotional socialization than girls - when boys fall down, they're told to move on, while girls are comforted. This limits boys' ability to explore and navigate emotional sensitivity from a young age.
From an adaptive standpoint, social rejection historically meant being kicked out of a small tribe where survival alone was unlikely. Despite the pain of rejection sensitivity, Dr. Hamdani values her emotional sensitivity, noting it makes her a better physician, parent, and partner, and represents a sign of emotional intelligence.
Anger is often more socially acceptable than sadness, particularly for men. Over 90% of men in the UK who take their own lives have already accessed some form of mental health counseling, indicating that the issue extends beyond simply talking about feelings. The challenge lies in creating genuine space for men to feel their emotions without judgment. Many men claim they want their friends to open up, but this support often fails to materialize in real-time situations, especially when the emotional expression falls outside the acceptable range of "things are hard, but I'm getting back in the gym."
Society operates with an implicit system where men accumulate surplus masculinity through muscularity, strength, success, money, or notoriety. This accumulated "masculinity bank account" allows men to withdraw from it when expressing emotions. Chris Bumstead, a six-time Olympia world champion, receives sympathy when crying because his masculine achievements provide cover for emotional expression. The men who most need support—those without these trappings of success—receive the least sympathy and face the highest risk.
A week-long retreat focused exclusively on emotions for 12 hours daily in Northern California, followed by a seven-day Janna meditation retreat involving 6-8 hours of daily silent sitting, demonstrates commitment to processing emotional sensitivity. Growing up as a sensitive child in a working-class blue-collar environment without adequate support created both remarkable achievements and coping mechanisms that sometimes deny parts of one's authentic self.
From age eight, hiding under tables or in closets when overwhelmed by embarrassment and sadness led to a conscious decision that emotional expression was incompatible with adult functioning. This resulted in patterns of claiming to be "fine" when experiencing difficult emotions, and avoiding conversations that might trigger crying as proof of sensitivity. The insight that suppression is not the same as strength reveals that performing composure differs fundamentally from actually having composure.
The real challenge lies not in feeling deeply, but in living in a world that doesn't always know how to support that sensitivity.
Operating in an intense, chaotic, fast-moving world requires creating coping mechanisms and walls that allow daily functioning. However, this guarding denies parts of one's experience and prevents accessing associated strengths. The question becomes how to maintain functionality without becoming emotionally disconnected.
Emotional sensitivity directly connects to emotional intelligence. Key strengths include:
- Deep understanding of other people's emotional experiences
- Ability to pick up on body language and subtle cues that others miss
- Enhanced capacity for psychiatry, friendship, partnership, and parenting
- Superior emotional data reading that enables better interpersonal navigation
Emotional sensitivity can negatively impact self-esteem when emotional data is consistently read negatively, leading to feelings of unwelcomeness that may not reflect reality. However, in psychiatry, this same sensitivity becomes celebrated as patients feel truly understood for the first time. Self-esteem represents inherent self-worth, while confidence fluctuates based on perceived capabilities and skills.
People with rejection sensitive dysphoria often require constant reassurance because they read neutral or positive input as negative, creating amygdala loops of fear and cascading stress hormones. Understanding that these feelings stem from neurobiological brain patterns rather than personal failings can significantly bolster self-esteem. Compliments may be difficult to accept, particularly from certain relationships or when already feeling self-conscious.
Relationships create vulnerability minefields where emotional sensitivity becomes particularly challenging. Many highly sensitive people with rejection sensitive dysphoria stop dating entirely, finding the emotional demands unbearable. A delayed text response triggers immediate narrative-filling: "If they were interested, they would respond right away" or "They're with somebody else," leading to anger before any actual information arrives.
Anxious individuals may sabotage relationships preemptively to avoid rejection. In the speaker's twenties, any increasing closeness triggered fears that authentic emotional sensitivity would cause abandonment, leading to ending relationships before partners could discover and reject these traits. This pattern meant never experiencing being broken up with, as the speaker always left first.
After opening up and sharing vulnerably, a period of spinning thoughts emerges: "Now they know this, they probably think I'm a huge weenie who can't handle anything." This creates a direct trajectory from vulnerability to embarrassment to pulling away from the relationship.
Emotional sensitivity exists on a spectrum ranging from under-sensitivity through healthy regulation to high sensitivity, with pathological sensitivity manifesting as rejection sensitive dysphoria. The most sensitive individuals require environments that utilize rather than pathologize their traits.
The critical factor is finding environments and relationships that match one's disposition rather than requiring constant suppression. An emotionally sensitive psychiatrist would struggle as UFC CEO, while someone like Dana White would likely make a poor psychiatrist. The same traits that create challenges in mismatched environments become superpowers in compatible ones.
Obsessive attention to detail, developed through childhood reading habits, enabled noticing a half-point offset on product packaging that millions of others missed. While this level of attention might create problems in some professions like bridge engineering or surgery assistance, it becomes invaluable in brand building, copywriting, and podcast creation where precision matters.
The issue is not you being sensitive, the issue is you being in a world that doesn't utilize your sensitivity properly. Finding an environment that can hold all of that emotional sensitivity is really important, and the same thing goes for friendships and relationships.
Dr. Sasha Hamdani went into medical school with the hopes of doing pediatrics like her mother, who is a pediatrician. She got through pediatrics and found it boring, realizing she couldn't be in clinic all day and couldn't be sick every winter. She pivoted to PE's ICU, believing it was her calling because it was the superhero job of saving children. During her letter of recommendation process, a woman stopped her at the door and said "I hope you're not coming in here for a letter. You cry all the time. You cannot do this. You will burn out in 5 seconds." Dr. Hamdani knew in that moment the woman was correct. She would go to work in the pedu scared and upset, crying while reporting to her attending at the bedside. She left the office and sat in her car, asking what area of medicine she could cry in, which led her to psychiatry.
Uncertainty is harder to deal with than bad news because it's not definite. With bad news, at some point you can say "okay that's really bad but here are the steps I need to do to make it better" and make a game plan. With uncertainty, people will convince themselves that a way worse outcome is happening in real time. They've already convinced themselves that the worst possible outcome is happening rather than if they actually get the knowledge that something bad is happening, they often find it's not as bad as what they thought it would be.
The brain abhors having uncertainty so much that it would rather fantasize a nightmare than deal with ambiguity. People create situations in imagination that defy the laws of physics, like a dead great grandmother coming back from the grave to laugh at them about something that can't even happen.
Ghosting is damaging because there's no closure. For an emotionally sensitive person, ghosting is not just the dissolution of the relationship. The brain automatically goes into "there's something about me that forced this person away" and the uncertainty gets turned on the person, leading them to conclude "I'm insufficient." This makes ghosting particularly cruel to do to somebody else.
The line between emotional sensitivity and emotional fragility is not for another person to make that decision. It's for the person experiencing that moment. Emotionally sensitive people have been told they're too sensitive, too fragile, too weak, and need to strengthen themselves, but no one has told them how to do that.
The world is currently a hard place to be a human in, especially if you want to feel feelings. If you don't want to feel feelings, it's actually quite a fun place to be in because there's so much novelty and infinite stimulus to enjoy. But if you actually want to feel feelings, it's kind of horrendous.
What it boils down to is receiving emotional data and catching it in that moment to impact the intensity and duration, getting past it and making it a usable moment. There are skills and tools that come with that. Dr. Hamdani developed the "calm your mind toolkit" which contains 12 tools. All of them are things people have probably heard before like challenge negative thoughts, move your body, and delay your reaction. However, for an emotionally sensitive person going through big emotions in real time, things can get so overwhelming that nothing is happening cognitively and they can't think or process.
One favorite tool is utilizing movement. When incredibly emotionally overloaded, there's tremendous value in physical movement for pattern disruption. Moving gets oxygenated glucose to the brain and shunts it to the frontal lobe so resources are available to think, process, and override the amygdala in real time. This doesn't require heavy weightlifting or specific cardio. During a meeting where Dr. Hamdani was talking about leaving a practice after 9 years and starting her own practice, she felt overcome with guilt and fear. She started tensing her calves and moving her legs under the table. Fidgeting can be seen as a form of emotional regulation and self-stimulation, surging dopamine and norepinephrine.
Delay your reaction is another favorite tool. The initial impulse when pressed up against the wall or having big emotional stuff is to respond with urgency. If there's a delay in a text message, the tendency is to text multiple times asking where someone is and what's happening. Delaying the response allows the amygdala to stop spinning as much and allows the frontal lobe to come online. The narrative being told becomes significantly less negative, and usually by that time the person has responded. This is a purposeful and mindful thing being done for the brain, not just stepping away hoping they'll respond. It's about giving the brain time to stop overheating.
Being a mom with emotional sensitivity can be chaotic, but all parenting is kind of chaotic. Dr. Hamdani feels lucky because her husband is very measured, calm, and patient, serving as a good emotional barometer. In that context of safety where everyone is given free reign to explore feelings and navigate through life, being emotionally sensitive as a parent has been really helpful. It helps understand that kids can be very annoying and that noise and stuff they do is part of being a kid whose frontal lobes aren't developed. Being emotionally sensitive allows recognizing what a big emotional moment feels like and what can help come out of it, giving safety and freedom to explore and figure out solutions rather than snapping, yelling, or trying to pull them out by force.
Mindfulness is the third favorite tool. The key is not thinking about nothing during meditation. The difference is giving space to non-judgmentally just observe what's happening in the brain. A study from Yale showed that mindfulness and the power of just observation instead of judgmentally rushing to solve a feeling reduces activation in the brain. The approach is about emotional conductivity, seeing what you're feeling completely non-judgmentally. Whether letting a thought go or bringing it in, the key is lack of judgment. This prevents the shame spiral.
Social media is a difficult place. Dr. Hamdani gets triggered by social media all the time, constantly comparing herself to others. For a long time, her day-to-day relationship with self-worth was driven by numbers like how many likes a post got and how much engagement was happening. Even as a physician who went to med school and studied the brain, this still happens. For kids whose frontal lobes aren't fully developed, they are at higher risk. The train is moving and kids can't be completely sheltered from everything, so they need to be taught how to navigate these constantly evolving waters.
There is a huge genetic component to emotional sensitivity. There is also a huge component if someone grows up in an incredibly chaotic and tumultuous home, they become hypervigilant, searching for cues, which can make them more emotionally sensitive. If those two things get combined, the effect is amplified.
Rejection sensitivity can be seen in 2-year-olds and 3-year-olds.
Some parenting behaviors that parents do in hopes of getting a more resilient child include teaching them they don't need to cry about something, they need to move on, or that something isn't a big deal. When raising her own kids, Dr. Hamdani thinks about this constantly. Her child had a tantrum about not getting the heel of a loaf of bread, which is objectively the worst part. The child hasn't dealt with disappointment yet and this was probably one of the worst things that had happened to date. The approach is to teach navigating disappointment instead of saying this isn't a big deal, because it probably is a big deal to the child who really wants that heel of bread. The heel of bread serves as a meme for the difference between validating feelings and encouraging victimhood, which applies in adulthood as well.
There are situations where what someone is after is a heel of bread, and everybody around them, including their better self, has every right to say no. The challenge lies in finding the line between validating feelings and not encouraging further weakening of emotional resilience.
In one example, a child wanted the heel of bread and was stuck on this idea. Instead of dismissing it as silly, the parent took out the heel of bread and another piece of bread and asked the child to describe what they liked about one versus the other. This allowed the child to reach the conclusion themselves that they didn't actually want the heel of bread.
Rejection Sensitive Dysphoria (RSD) shows up differently in professional settings. Before someone can even reach overcompensation, they may not put themselves out there at all. Some patients report getting spooked during job interviews and walking out because they didn't feel liked.
In work environments, high achieving people, especially high achieving women, face pressure to do everything and not complain. When additional responsibilities come their way, they override signs of burnout and keep adding more to their plate because they don't want to appear less capable than peers or look incapable.
An essay titled "The Ambitious Mother Paradox: Good Mother or Wasted Potential" highlights a key tension: women have fought for equal access to the workforce and don't want to ask for accommodations that imply they're different. Yet many women's emotional sensitivity makes the workplace feel spiky, unforgiving, and sterile, particularly in capitalist, meritocratic, fast-paced environments.
Women in high-powered careers feel caught between wanting to be there, not wanting it taken away, and feeling bad about asking for accommodations that highlight differences from male colleagues who may suppress emotions more effectively.
Highly sensitive women may feel they need to show up like the men running companies while wanting to be women running companies, yet they're denying their nurturing, empathetic people skills that represent competitive advantages. They don't want to be seen as less than, want to protect opportunities for others, but also don't want to deny themselves.
From a logistical perspective, child rearing creates additional complexity. At the peak of career, having a child requires stepping away, then reintegrating, often finding that opportunities have been kept out of reach because priorities are assumed to be completely different.
Mothers experience approximately 2.5% gray matter loss after having a child, affecting executive function for everything except child-related tasks. What was once military-level organization can feel like "fluff in the brain."
Instead of viewing brain changes as weakness, mothers should consider transitioning careers to utilize new skill sets. The pruning of executive function creates space for heightened empathy that could make becoming a therapist a valuable opportunity.
Work environments should accommodate these changes by pivoting roles to utilize new skills rather than keeping mothers in the same roles. However, imposing such changes can make women feel they're being told they're less capable.
The framing matters significantly: positioning new skills as gains rather than losses, and ensuring the decision remains the woman's choice rather than externally imposed.
The market doesn't care about personal circumstances. Businesses need to be profitable and growing. Finding the line between validation and when to push or pivot is crucial, and this applies equally to men whose testosterone drops and mental quickness decreases at age 65 compared to age 28.
Emotional sensitivity functions as the input while emotional intelligence serves as the output. Emotional sensitivity can be both difficult and wonderful, providing certain advantages and challenges.
Emotional stuff differs from ADHD executive function challenges because you can't hack, delegate, or outsource emotions. They exist internally and require processing. When completely consumed by emotions or struggling with regulation, thinking becomes impossible and moving forward from moments becomes extremely difficult.
People who feel the world is too spiky for their emotions simply don't have the tools yet. Life is hard, and being emotionally sensitive is often a beautiful thing, but having tools to grab hold of and use appropriately during emotional intensity is life-changing.
Dr. Sasha Hamdani's book "Too Sensitive" is available August 25th.
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