What services do you offer?

Snow Globe Counseling offers telehealth therapy for teens and adults in Washington and Arizona. I specialize in ADHD, OCD, and anxiety therapy, with a particular focus on the deeper work of understanding yourself, healing old patterns, and building a life that actually fits your brain.

Do you offer online therapy in Washington and Arizona?

Yes! All sessions at Snow Globe Counseling are conducted via secure telehealth, which means you can access therapy from the comfort of your own home. I am licensed in both Washington and Arizona, so I can work with clients throughout both states including Seattle, Bellevue, Tacoma, Spokane, Phoenix, Tucson, Flagstaff, and surrounding areas.

How can I get started?

Getting started is simple! Reach out through the contact page to schedule a free 15-minute phone consultation. This is a no-pressure call where we can make sure we are a good fit before committing to anything. If we decide to move forward, we'll schedule your first session and go from there.

What makes you different?

A few things set Snow Globe Counseling apart. I hold a specialized certification in ADHD (ADHD-CCSP) in addition to my license as a clinical social worker, which means I bring both clinical training and deep expertise to ADHD treatment. I have completed specialized OCD and ERP training through the IOCDF and NOCD, and am trained in Inference-Based CBT (I-CBT), an approach that works especially well for clients who struggle with traditional ERP. Every session ends with something concrete to take into your week, and over time the work goes deeper than symptom management. And as someone who is neurodivergent myself, I bring personal understanding to the work I do with my clients.

What is your pricing model?

Individual therapy sessions are $225 per session. I am not in network with any insurance plans, but I can provide a superbill after each session that you can submit to your insurance company for potential out-of-network reimbursement. Many clients receive partial reimbursement this way. I recommend checking with your insurance plan ahead of time to understand your out-of-network mental health benefits.

What is it like to work with you?

Therapy with me is about doing the real work and then using what we find to move your life forward in a way that actually feels sustainable. We'll explore the deeper stuff: where your patterns come from, how your history has shaped the way you see yourself, and the parts of you that have been working overtime just to keep up. And then we take all of that and turn it into something useful. Boundaries that actually hold, systems that fit your brain, ways of relating to yourself that don't leave you exhausted. You'll feel genuinely heard and understood, and you'll also leave sessions with something real to show for it. Clients often describe feeling lighter and like they finally have a path forward.

Is rejection sensitive dysphoria a real diagnosis?

No, rejection sensitive dysphoria is not a clinical diagnosis or an official symptom of any diagnosis. However, it is widely recognized by clinicians as a common and painful experience among people with ADHD, and naming it can be the first step toward understanding yourself better.

Can you have RSD without ADHD?

Yes! Though RSD is most commonly associated with ADHD, some individuals experience an intense emotional reaction to rejection without an ADHD diagnosis. If this resonates with you, it still may be worth exploring with a therapist.

What does rejection sensitive dysphoria feel like?

Rejection sensitive dysphoria can feel like extreme anxiety spirals, rapid mood swings, low self-esteem, and an intense need to retreat or shut down. For many people, it feels completely out of proportion to the situation, which adds an extra layer of confusion and shame.

RSD is treated by understanding where the intense reaction comes from, often tracing back to early messages received in childhood about being too much or not enough. Therapy approaches like IFS and ACT can help you offer compassion to the parts of yourself that are carrying this pain and build a life guided by your values rather than your fears.

What Is Rejection Sensitive Dysphoria?

Sep 30

Written By Brielle Armstrong

You were rejected. Again. Maybe your friends hung out without you, you got ghosted by your Hinge crush, you did worse on a test than you thought, or you were passed up for the promotion. And now you feel like you can’t breathe. Your thoughts are spinning. You’re ready to block everyone and run away, wondering if you’ll ever NOT think that people are going to leave you. You retreat and it takes hours to feel like yourself again. You’ve Googled or typed this experience in ChatGPT and stumbled across Rejection Sensitive Dysphoria (RSD). But what is it? Doesn’t everyone handle rejection poorly?

So What Is RSD?

Back in the 1990s, psychiatrist Dr. William W. Dodson noticed a pattern among his ADHD patients. They all seemed to experience a deep, crushing pain in response to a perceived rejection or failure. He termed it “rejection sensitive dysphoria,” with ‘dysphoria’ referring to the overwhelming, debilitating feeling of defeat.

Since that time, rejection sensitive dysphoria has become more strongly associated with ADHD. It is not a clinical diagnosis, nor even an officially recognized symptom for an ADHD diagnosis, but is now widely recognized as a pattern among individuals with ADHD. We now understand that the ADHD brain processes emotions differently than neurotypical brains. Sure, everyone faces rejection and gets upset, but rejection hits harder, faster, and longer for folks with RSD. So what does this actually look like in real life?

What RSD Actually Looks Like

RSD shows up across multiple domains of life: at work, in relationships, and internally. At work, any feedback, even a gentle critique, can feel absolutely gutting. Spirals of worry about job security can follow. In dating and communication with a partner, a “no” to spend time together or a delayed response can lead to hours of replaying past conversations and overanalyzing behavior. With friends, a side-eye can trigger a flood of self-doubt and a desperate need to prove themselves. Even small rejections and failures can stack up, leading to internalized shame and low self-esteem. Over time, the weight of it becomes exhausting. It starts to feel impossible to just enjoy being around people. And yet talking about it is often the hardest part.

Why RSD Is So Hard to Talk About

When people with RSD speak up about their feelings, others around them often say they are overreacting. Anyone who has experienced RSD often knows that their emotional response seems bigger than it should be, and even feels illogical to themselves. But knowing that doesn’t make the reaction any easier to control. Sometimes they reject their own response and hide or mask it in fear of being called “too sensitive.” Again. They’ve learned that showing their reaction can invite more rejection, so they keep it to themselves. They are often misunderstood, and sometimes misdiagnosed with anxiety, bipolar disorder, or borderline personality disorder. Over time, these misunderstandings shape how people with RSD navigate their relationships.

How RSD Affects Relationships

Folks with RSD develop all kinds of strategies to avoid rejection. People pleasing is one of the most common. It’s easier to go along with what others want than to risk drawing attention to their own needs. Keeping everyone happy becomes default mode. Sometimes the opposite happens too. Instead of pleasing, they withdraw from friendships before the rejection has a chance to come. It feels safer to disappear than to risk being left.

But internally, resentment builds. It starts to feel like they are being taken advantage of. And when they finally try to set a boundary, the pushback can feel massive, confirming exactly what they feared all along. So they go back to people pleasing. And the cycle continues.

For many people, these patterns started long before adulthood. Learning to keep the peace, shrink themselves, and earn love through performance often begins in childhood.

What Actually Helps

You're not alone in experiencing these cycles. RSD is not a character flaw. Understanding that it has a neurological basis can be the first step toward having more compassion for yourself and building more fulfilling relationships.

Therapy can help you explore where these tendencies came from and start to shift them. This means understanding the parts of yourself that learned to please and hide in childhood, and offering them the compassion they never received. It also means reconnecting with what actually matters to you, and building a life guided by your values rather than your fears. Real change is possible. You don't have to keep shrinking yourself to keep the peace.

If this sounds like you, you're not overreacting and you're not too sensitive. You're misunderstood. Your brain just works differently. If you're curious whether ADHD and RSD might be part of your story, I'd love to connect. You can learn more about how I work with ADHD here, or schedule a free 15-minute consult here.

FAQ:

Is rejection sensitive dysphoria a real diagnosis?
- No, rejection sensitive dysphoria is not a clinical diagnosis or an official symptom of any diagnosis. However, it is widely recognized by clinicians as a common and painful experience among people with ADHD, and naming it can be the first step toward understanding yourself better.
Can you have RSD without ADHD?
- Yes! Though RSD is most commonly associated with ADHD, some individuals experience an intense emotional reaction to rejection without an ADHD diagnosis. If this resonates with you, it still may be worth exploring with a therapist.
What does rejection sensitive dysphoria feel like?
- Rejection sensitive dysphoria can feel like extreme anxiety spirals, rapid mood swings, low self-esteem, and an intense need to retreat or shut down. For many people, it feels completely out of proportion to the situation, which adds an extra layer of confusion and shame.
How is RSD treated?
- RSD is treated by understanding where the intense reaction comes from, often tracing back to early messages received in childhood about being too much or not enough. Therapy approaches like IFS and ACT can help you offer compassion to the parts of yourself that are carrying this pain and build a life guided by your values rather than your fears.

rejection sensitive dysphoriaRSDemotional regulationADHD therapyADHDrejection sensitivityADHD emotionsADHD relationshipsADHD adultspeople pleasinganxiety and ADHDtelehealth therapy Washingtontelehealth therapy ArizonaADHD teensfamily of origin

Brielle Armstrong