Think back to a physical injury. Maybe you broke your arm or cut yourself with a knife while preparing dinner. Remember childbirth? We can revisit those memories without feeling any physical or emotional pain.

Now think about your first breakup or the time when someone said something hurtful. That still stings. That’s because our brains experience rejection as a form of physical pain, and studies show that adolescents who are rejected by their peers are at greater risk for anxiety and depression.

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Carrie Mastens, PhD, of UCLA, found that children and teenagers display unique neural patterns when they feel distress during peer rejection. Her research was published in the journal Development and Psychopathology and Social Cognitive and Affective Neuroscience.

Additional studies found that social rejection influences emotion, cognition and even physical health. Mark Leary, PhD, a professor of psychology and neuroscience at Duke University, analyzed 15 cases of school shooters and discovered all but two suffered from social rejection. His research published in the journal Aggressive Behavior says, “Ostracized people sometimes become aggressive and can turn to violence.”

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While rejection can provoke violent acts toward others, it is more often turned inward. “It can destroy our self esteem,” said Karen Liberato of The Calais School in Whippany, New Jersey, and Therapeutic Options in Fairfield, New Jersey. “Adolescents tend to blame themselves.”

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“I see it anecdotally. When someone is rejected — especially a child — they often say, ‘I’m a terrible person.’ Teenagers who experience a romantic breakup will question their worth. I hear, ‘If I was a better person or a better girlfriend, then the rejection would not have happened.’ We sit there and blame ourselves.”

Liberato says reasoning with the person who was rejected doesn’t always work. “You can say, ‘You didn’t even like the guy that much.’ It still hurts.”

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“I also see it when a child is called ‘stupid’ by his peers,” she says. “We know they are smart. I will ask them to look at their report card or a recent test where they got a high grade.”

Some children blame themselves for their parents’ divorce. “We know this has nothing to do with them,” says Liberato, “but it’s real to them, and we need to listen.”

“Watch for signs,” she adds. “A teenager who develops a crush on someone who doesn’t reciprocate, is in a negative relationship, or is experiencing a breakup, can develop depression, which can show up in the form of a change of mood, eating and sleep patterns, and low self worth. What’s bothering them may not seem like a big deal to you, but it is to them.”

Liberato suggests the following to battle rejection:

  1. Listen to your child.
  2. Look for any changes of mood, diet, or sleep patterns.
  3. Remind your kids that they should treat others with kindness.
  4. Explain the importance of having one or two good friends if your child is excluded from a popular clique.
  5. Find something your child likes and excels at. It can be a sport, a coding workshop, or art, music, or dance class. You know what your child enjoys; try to match his likes with an after-school program.
  6. Talk to your child about his skill sets, his talents and abilities.
  7. Don’t let him ruminate on negative feelings. This can become a negative habit.
  8. Spend time with your child and do something he likes.
  9. Let your child spend time with friends who care about him.
  10. Celebrate your child’s accomplishments.

When a child’s (or our own) self esteem is low, it takes a while to recover. Don’t expect him to “snap out of it.” Understand that healing from rejection takes time.

According to Guy Winch, psychologist and author, “We need to take our emotional health as seriously as we take our physical health. By practicing personal hygiene, our quality of life could rise dramatically.”

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