A first principle derivation is given of the neutrino damping rate in real-time thermal field theory. Starting from the discontinuity of the neutrino self energy at the two loop level, the damping rate can be expressed as integrals over space phase of amplitudes squared, weighted with statistical factors that account for the possibility of particle absorption or emission from the medium. Specific results for a background composed of neutrinos, leptons, protons and neutrons are given. Additionally, for the real part of the dispersion relation we discuss the relation between the results obtained from the thermal field theory, and those obtained by the thermal average of the forward scattering amplitude.