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  • Writer's picturePatty Laushman

What is Rejection Sensitive Dysphoria with ADHD or Autism?

Updated: Jul 5

By Patty Laushman


For people who are especially sensitive to criticism or rejection, it can feel like their emotions are not within their control. Though not a recognized diagnosis in the DSM-5, the concept known as rejection sensitive dysphoria (RSD) is meaningful to many neurodivergent people. In fact, it is commonly associated with autism and ADHD for a medley of reasons.


RSD is characterized by extreme sensitivity and emotional pain that is triggered by the perception that you have been rejected or criticized by people who are important to you. It tends to be more common in autistic individuals or those with other types of neurodivergence like ADHD because these people tend to have difficulty socializing, communicating, and understanding the actions of neurotypical people who usually comprise the majority of people they interact with.


In this blog post, we'll look at what RSD is, why understanding it is so important, and how to cope with it in you or your loved one with ADHD or Autism.

A man leaning against a wall looking upset

What is Rejection Sensitive Dysphoria?

Rejection sensitive dysphoria (RSD) is characterized by extreme emotional sensitivity and intense feelings of shame and rejection in response to perceived or real criticism or rejection from important people in one’s life.


People with RSD often experience overwhelming feelings of sadness and anxiety that can last for days or weeks after any perceived slight. Symptoms can include avoiding social situations, difficulty concentrating, irritability, self-loathing, mood swings, and even, unfortunately, suicidal thoughts.


It’s important to understand RSD because those affected by it may not even realize they are suffering from it — many people just assume they are simply “oversensitive” when dealing with certain situations.


By recognizing the signs of RSD and seeking help from a neurodiversity-informed mental health therapist, individuals can begin taking steps toward developing healthier coping strategies for managing their reactions when faced with difficult circumstances, which ultimately reduces their suffering and improves quality of life.


And ideally, educating others about the condition helps create an environment where those affected by RSD can get the understanding and support they need instead of facing ridicule or judgment for their sensitivities.


Why is RSD More Common in ADHD and Autism?

autistic man feeling anxious while people are talking behind him

Rejection-sensitive dysphoria (RSD) is more common in neurodivergent people, such as those with autism or ADHD. It’s not always the case, but there can be a connection between the two conditions that make it likely for some individuals. So why is that?


People diagnosed with autism often struggle with understanding social cues and forming relationships due to their communication differences compared to neurotypical people. Similarly, those with ADHD may have trouble paying attention and resisting impulses in ways that negatively impact their relationships.


Due to extreme sensitivity and challenges with regulating emotions, when they are overwhelmed, many people with autism can succumb to emotional outbursts and can be very hard on themselves if they don’t meet certain standards or expectations. All of these factors can lead to feelings and symptoms of RSD when faced with situations involving perceived rejection or criticism from others.


The exact cause of RSD is still being studied, but experts suspect it is related to differences in brain structure that create challenges in regulating emotions. Trauma, genetic predispositions, and neurological predispositions have all been proposed as possible causes as well.


One theory is that their already heightened sensitivity makes neurodivergent people more susceptible since they are already prone to experiencing strong emotions and reacting more strongly to certain stimuli. Some researchers believe that because autistic individuals often have difficulty understanding the emotions of others around them, it can lead to more frequent relationship misunderstandings and conflict that could compound their emotional dysregulation even further.


It’s also thought that because autistic and otherwise neurodivergent individuals often struggle with communication skills and expressing themselves so they can be understood by those around them, their difficulties communicating create more scenarios in which they are criticized or rejected. This can cause them to suffer an intense emotional reaction, which makes them less able to communicate, creating a feedback loop.


There can also be some societal factors at play. According to studies, by the time a child with ADHD turns 12, they hear 20,000 more negative, corrective, or critical messages than the average neurotypical child. As you might expect, this can lead to a major anticipation (and fear) of rejection later on.


How Does Rejection Sensitive Dysphoria Present?

Rejection sensitive dysphoria presents as a feeling of intense emotional pain and discomfort that comes in response to criticism or perceived rejection. People with RSD often feel angry, embarrassed, and vengeful after being criticized or rejected, even when it’s done in a polite way.

autistic woman crying and in intense emotional pain due to rejection sensitive dysphoria

This can lead to them avoiding social situations, as well as developing low self-esteem and post-traumatic stress disorder. People with RSD are also often diagnosed with anxiety, depression, bipolar disorder, and more.

They may engage in approval-seeking behavior, people-pleasing behaviors. They often have high expectations for their own performance while experiencing fear of failure simultaneously.


All these symptoms make it difficult for those living with RSD to live their life without worrying what others think of them and fear that they will reject them at any moment.


How to Support People With Rejection Sensitive Dysphoria

Rejection sensitive dysphoria is a difficult thing to live with, but it doesn't have to be all-consuming. There are ways to manage RSD and still lead a happy, fulfilling life. Here are some tips.


Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people think about situations differently and find ways to cope with them more effectively.


CBT can help people learn healthier habits for managing stress, figuring out solutions to problems, and improving relationships with other people. It can also help those living with RSD become more aware of their triggers and learn alternative ways to respond in situations where they may be rejected or criticized.


Incorporate Exercise and Opportunities for Relaxation

two autistic people exercising together managing stress and anxiety

Physical exercise can help those living with RSD reduce their overall levels of stress and anxiety. Encouraging your loved one to incorporate regular exercise into their routine can also increase their sense of self-esteem which can make them less likely to overreact in situations where they may be rejected or criticized.


Not only that, but providing opportunities for relaxation such as yoga classes, meditation sessions, or participating in something like a hiking or walking club can give them tools for managing their stress in more healthy ways.


And if the exercise is done in a group situation, they have an opportunity for making social connections based on a common interest in that activity.


Educate Yourself About RSD

The best way you can support your loved one is by understanding what they are going through. Educating yourself about RSD in addition to their neurodivergence (autism, ADHD) will help you gain insight into what they are experiencing so you can better understand why your loved one reacts the way they do in certain situations. Talking openly with your loved one about their experience will also help strengthen your bond and make them feel supported by you during difficult times.


Practice Mindfulness

autistic woman sitting on a mat in a beautiful park doing meditation

Mindfulness is a practice that involves paying attention to the present moment without judgment or reaction. Practicing mindfulness regularly encourages us to observe our thoughts without getting caught up in our emotions, which can be helpful when dealing with intense reactions related to RSD.


For example, if your loved one starts feeling overwhelmed by negative thoughts or feelings, if this is something that works for them, remind them to take a few moments to focus on their breath and acknowledge the emotions without letting them take over completely.

Ask Questions and Take Time to Explain Feelings and Intentions

Asking questions about how your loved one feels instead of assuming you know what’s going on inside their head is an important step in supporting someone living with RSD because it shows them that you care about what they’re going through and that you want to understand it better so that you can support them more effectively.


Taking time out every now and then to explain why certain things have been said or done allows both parties involved in any situation the opportunity to reflect on their own behavior while also viewing each other's actions from different perspectives. This is not easy to do, but is invaluable when trying to effectively manage issues related to RSD between two people.


Find a Good Therapist Who Really Understands RSD

autistic woman talking with a neurodiversity-informed therapist

Finally, finding a good therapist who really understands RSD specifically and neurodiversity in general is essential if RSD is taking over your loved one's life. It's important to know that not all therapists are knowledgeable when it comes to this particular subject matter, so ask up front.


A good therapist will help guide your loved one through this process by providing useful strategies for managing stressful situations more effectively while still respecting their individual needs as a person who lives with RSD every single day.


Final Thoughts

Rejection sensitive dysphoria can be a debilitating problem for autistic and ADHD adults. It is characterized by an intense fear of rejection and can lead to depression, anxiety, self-harm, and even suicide.


If you are struggling with RSD, know that you are not alone, it's not your fault, and there is help available. A neurodiversity-informed therapist can support you in managing your RSD and reduce the intense suffering that results. You deserve to live a happy and healthy life, free from the fear of rejection, and you can absolutely get there with the right help.

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