Rejection Sensitive Dysphoria

Rejection Sensitive Dysphoria (RSD) is an intense emotional and sometimes physical reaction to real or perceived rejection, criticism or disapproval. This reaction is often immediate and may come with feelings of pain, shame, anxiety or self-criticism. RSD is an experience shared by many autistic people and can significantly influence relationships, self-perception and the way someone navigates the world. RSD is not recognised as a formal diagnosis but is widely used within neurodivergent communities to describe experiences of extreme rejection sensitivity.

Rejection Sensitive Dysphoria may look or feel like:

• Overwhelming physical pain at perceived rejection
• Emotional overwhelm or shutdown
• Fear of disappointing others
• Perfectionism or people pleasing
• Strong feelings of shame
• Reassurance seeking
• Replaying and feeling deeply distressed by perceived mistakes

Rejection Sensitive Dysphoria was initially discussed within ADHD communities. However, a growing body of evidence and self-reports suggests that autistic people, particularly women and girls are also likely to experience heightened rejection sensitivity. Several explanations may underlie this shared experience, including invalidation and misunderstanding from others, masking, pattern recognition and differences in emotional processing

When provided with an environment which is empathetic to your needs, someone is likely to grow up believing their own emotional reactions are acceptable and make sense. However, if those around them cannot or do not react in ways which feel empathetic or safe, they are likely to start viewing their internal experience as something which is wrong. They may in turn start to feel that they themselves are wrong. They may fear their own feelings or struggle to trust their own judgements.

Many autistic people speak of experiences at school or amongst peers where their needs and feelings are overlooked, treated as invisible or else dismissed as oversensitivity (Mullally et al., 2026). They may also have experienced therapeutic interventions which are focused on reducing visible autistic traits, which then leave them feeling they are ‘a problem which needs to be fixed’ (Anderson, 2023).

Emotional invalidation can look like bullying, discrimination and abuse. However, it may also look like well-meaning others, who do not accurately understand what it is like to experience the world as an autistic person. This double empathy problem can occur between autistic and non-autistic people due to differences in processing and communication style (Milton, 2017).

Repeated emotional invalidation can trigger high alertness to perceived rejection, and beliefs that approval is fragile, and reliance on internal experience is unsafe or unacceptable.

It is increasingly acknowledged that some autistic people, particularly girls and women may engage in masking behaviours. This is any behaviour, conscious or unconscious, which is used to hide autistic traits and appear less autistic to others. Whilst masking can be a protective strategy, minimizing immediate risk of social rejection, it can come at a mental and physical cost. This can contribute to unmet support needs, mental health difficulties, exhaustion and feelings of disconnection from self and others (Pearson & Rose, 2023).

Masking can be thought of as both a result of, and an exacerbating factor for rejection sensitivity. Many autistic people have experienced bullying, rejection and discrimination, which increases their fear of further victimisation, thus leading to masking. However, masking can also exacerbate
a feeling of being on high alert and always performing. There may be difficulty in knowing where the mask ends and internal experience begins (Belcher, 2022). This impact on self-perception can be significant, with the development of beliefs such as I am only likable if I perform in a certain way, and I would be unlikeable if you knew the real me.

Many autistic people have a strong orientation to detail and may notice things which others may miss (Jones, 2024). This can be beneficial for systems- based thinking and identifying patterns. However, it can also lead to heightened awareness when something changes within a familiar or
predictable situation. For example, someone may notice a subtle change in tone of voice, or that somebody has not offered them a cup of tea despite usually doing so every day. When the reason for this change is unclear, or not made explicit, individuals with rejection sensitivity may interpret this as a sign they have done something wrong, or that the other person is upset with them in some way. This may be particularly likely if past experiences have included criticism or rejection from others.

Autistic people often experience emotions intensely, and there may be a sense that emotions stay for a long time. They may additionally experience high levels of sensory sensitivity, and confusion or overwhelm in unpredictable social situations. These experiences can be felt physically as well as emotionally, leading to fight-or-flight responses and nervous system activation (Neff, 2024).

Additionally, some autistic people may experience differences in interoception, meaning it is difficult to name or recognise their own internal emotional states. This may be linked with alexithymia meaning it is harder to name or communicate their emotional experience to others (Poquerusse et al., 2018). Pressure to respond quickly in social situations, paired with uncertainty around one’s own thoughts and feelings, can contribute to significant stress and anxiety.

In a state of high stress, someone is likely to be more hypervigilant, alert and perceptive to threats, including the threat of harm, hurt or rejection from others. Emotional regulation can be impacted as a result and even small signs of disapproval can become overwhelming.

Rejection sensitive dysphoria can have many impacts on daily functioning, including withdrawal from close relationships, fear of taking risks and feelings of stuckness.

For example:

An autistic girl may spend many hours replaying a conversation, as she detected a change in tone of voice and is convinced she must have upset the other person.

An autistic person may feel deeply threatened when their partner requests they do something differently, as it triggers a fear of being fundamentally wrong or unlovable.

Consequently, many autistic people can benefit from support, or self- care strategies which help them manage their reactions to RSD. These may include neuroaffirming therapeutic support, strengthening safe and supportive relationships, reducing masking and developing levels of self-compassion

Neuroaffirmative therapy means that a therapist is able to recognise autism as a neurological difference, without subscribing to a medical model which says autism is a deficit. A neuroaffirmative therapist should work alongside you to accept and understand how being autistic shapes your experiences and emotions. They should be able to adapt their communication and ensure you have the processing time you need, as well as considering factors such as your sensory processing and how these influence your experience of therapy.

Neuroaffirmative therapy can provide a space where you can explore how past experiences have influenced your thoughts, feelings and beliefs in the present.

Reducing masking may initially involve noticing where, when and with whom you are most likely to mask. As masking is often a survival strategy, it may not be possible or even desirable to unmask in all situations. However, it may be useful to gradually identify people or situations where it may be safe to express yourself more authentically. This could mean no longer suppressing certain stim movements, feeling able to communicate in a more direct manner, asking directly if something feels unclear, or acknowledging sensory needs as they arise.

For some autistic people, relationships with others have often become a source of stress or fear. It may therefore be hard to recognise safe relationships, or know how to best nurture these when they do occur. It may be worth asking the questions of whether this is a person or situation where differences, boundaries and emotions can be expressed without humiliation, punishment or dismissal. This may involve testing this in small ways, for example expressing an opinion you know the other person may disagree with, or naming a need or desire.

Other signs of a safe relationship may include people who communicate clearly and directly, or who are willing to clarify things when you feel unsure. They may be someone who reacts with empathy and curiosity rather than judgement, and someone who accepts and encourages authenticity. Strengthening supportive relationships may also involve strengthening boundaries in existing relationships, if these have not previously been well established.

Many autistic people who experience RSD may have a harsh inner critic. This critic may have developed in an attempt to keep themselves safe and avoid emotional hurt and harm from others. However, over time self-criticism can contribute to feelings of defectiveness, shame and the belief that one has to be perfect to be liked.

Self-compassion, on the other hand involves speaking to yourself like you may speak to a friend or someone you care about. It can include recognising your emotional experiences make sense within the context of your lived experience and accepting them as part of who you are. It may mean reducing self-blame and taking care of yourself, for example allowing recovery time after busy social events. Additionally self-compassion can mean reacting to mistakes with curiosity rather than self-blame. This process is often gradual and may feel challenging if you are used to being very self-critical.

Rejection Sensitive Dysphoria can be a painful experience that significantly impacts an autistic person’s emotions, behaviours and sense of self. Understanding these experiences through a neuroaffirmative lens allows us to see how such reactions can develop in contexts where autistic people consistently do not feel seen, heard, safe or understood.

Not all autistic people will experience rejection sensitivity in the same way. However, it is important to consider RSD both in terms of internal emotional experience and the environmental and social factors that may contribute to the development and maintenance of it.

Rejection sensitivity can be supported through increased self- compassion, self-understanding and self-advocacy. It also requires a broader recognition of societal and relational factors which contribute to masking, emotional invalidation and feelings of being unsafe, all of which heighten sensitivity to perceived rejection.

Anderson, L. K. (2023). Autistic experiences of applied behavior analysis. Autism: The International Journal of Research and Practice, 27(3), 737– 750.

Belcher, H. L. (2022). Taking off the Mask: Practical Exercises to Help Understand and Minimise the Effects of Autistic Camouflaging. Jessica Kingsley Publishers.

Jones, S. (2024). The Autistic Survival Guide to Therapy (1st ed). Jessica Kingsley
Publishers.

Milton, D. (2017). A mismatch of salience: Explorations from the nature of autism from theory to practice. Pavilion.

Mullally, S. L., Wood, A. E., Edwards, C. C., Connolly, S. E., Constable, H., Watson, S., Rodgers, J., Rose, K., & King, N. (2026). Growing-up autistic: Sharing autistic children’s experiences and insights. Autism, 30(5).

Neff, M. A. (2024). Self-Care for Autistic People: 100+ Ways to Recharge, de-Stress, and Unmask! (1st ed). Adams Media Corporation.

Pearson, A., & Rose, K. (2023). Autistic masking: Understanding identity management and the role of stigma. Pavilion Publishing.

Poquerusse, J., Pastore, L., Dellantonio, S., & Esposito, G. (2018). Alexithymia and Autism Spectrum Disorder: A Complex Relationship. Frontiers in Psychology, 17(9).

Heather Connolly-Smith is a writer, therapist and specialist university mentor for neurodivergent students. She is particularly interested in neuroaffirmative practice and the importance of systemic change to support the wellbeing of autistic people.