Understanding Rejection Sensitive Dysphoria in Autism: A Guide for Autistic Adults

Do you ever feel intense emotional pain when faced with the slightest bit of criticism? Or, does rejection send you into a spiral of shame and avoidance? For some people, these are signs of rejection sensitive dysphoria (RSD).

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Rejection sensitive dysphoria is an intense emotional response to perceived rejection, criticism, or failing to meet expectations. In both autistic and allistic (non-autistic) people, it manifests as an acute sensitivity to rejection, often leading to feelings of deep emotional pain, anxiety or depression when an individual believes they’ve been dismissed or judged negatively. 

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For autistic individuals, RSD may manifest differently than typical rejection sensitivity. Emotion regulation challenges may mean that their emotional response to perceived rejection can be more intense and long-lasting, often leading to avoidance of social situations or heightened anxiety about relationships and social interactions. This can create a cycle where fear of rejection limits opportunities for connection and support. Differences in social communication, such as struggling to interpret nonverbal and other social cues, could also exacerbate RSD for autistic adults. 

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Read on to learn more about RSD, its psychological impacts and how to cope. 

It’s important to understand that RSD isn’t an official diagnosis, so there is no official list of symptoms or set criteria someone has to meet. RSD was originally conceptualized by ADHD specialists, who had observed its presence in the vast majority of ADHDers. Although there is not yet enough research to indicate that RSD occurs more commonly among autistic individuals specifically, research does suggest that autistic individuals commonly struggle with emotion regulation, and it is clear that autism and ADHD co-occur at high rates. This suggests that autistic individuals and those with attention deficit hyperactivity disorder (ADHD) on top of autism (AuDHD) may experience RSD at higher rates. However, RSD can also affect people who are not autistic or ADHDers, such as those with social anxiety and personality disorders

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Some common traits of people with RSD are:

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• Struggling with emotional regulation, especially when related to feedback, criticism or rejection
• Low self-esteem
• Easily feeling self-conscious or embarrassed
• People pleasing or otherwise seeking approval of others
• Trying hard to be perfect
• Avoiding failure where possible, including not trying new things

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These traits often influence how individuals experience and respond to specific situations, particularly those involving social interactions and perceived judgment.

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Although triggers for RSD vary from person to person, some common examples of RSD triggers are:

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• Teasing, bullying and harassment
• Feeling embarrassed (even for ‘positive’ reasons)
• Rejection or disapproval
• Exclusion
• Plans that change at the last minute
• Failure
• Being misunderstood
• Confrontation or conflict
• Receiving feedback or criticism

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Understanding the common triggers of rejection sensitive dysphoria is the first step toward managing its impact, but recognizing these triggers alone is not enough. Learning how to regulate the intense emotions that arise in response to these situations is crucial. Developing effective emotional regulation strategies can help reduce the severity of RSD episodes and improve overall mental well-being.

RSD affects multiple aspects of autistic adults’ mental health and life in general, including the following.

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Trouble with emotional regulation

Autistic adults with RSD often experience very intense emotional reactions to situations involving real or perceived rejection or criticism. Reactions to these situations can include overwhelming feelings of sadness, anger or shame. 

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Because these are all emotions that can cause dysregulation, they can be difficult to handle or work through. As a result, even minor incidents can trigger disproportionate emotional distress, making it challenging for individuals to navigate daily interactions without feeling overwhelmed.

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On top of this, alexithymia, which is also common in autistic people, can make it hard to identify not only what emotions they are feeling but also where these emotions are coming from––making it even harder to regulate emotions.

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Low self-esteem

RSD can profoundly impact self-esteem, shaping your self-worth. The intense emotional reactions triggered by perceived rejection or criticism often lead to internalized negative self-talk. 

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For example, adults with RSD may frequently question their abilities and worthiness, interpreting even minor setbacks as personal failures. If you have RSD, you might ruminate or focus heavily on moments of failure, and get stuck in a cycle of shaming and blaming yourself. 

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This constant self-scrutiny can erode confidence, creating a cycle where low self-esteem makes you more vulnerable to rejection.

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Perfectionism and fear of failure

RSD can also contribute to perfectionism and a heightened fear of failure. This fear often causes individuals to avoid opportunities for growth or connection, as they fear rejection or not being ‘perfect enough’ in their own eyes. The persistent negative self-talk that accompanies RSD can become a mental habit, making it difficult to challenge and replace with more affirming thoughts.

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The inverse of this can also be true. Many people dealing with RSD may feel their value comes from helping or interacting with others. This can result in people-pleasing behavior, where someone may struggle to say no or overextend themselves. All of these behaviors can exist in one person, too.

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Struggles with feedback & criticism

Receiving feedback—especially perceived criticism—can be an emotionally challenging experience. Even constructive feedback intended to help or improve performance can feel overwhelming or intensely personal. The heightened emotional response can lead to feelings of shame, anxiety or inadequacy, making it difficult to process the feedback objectively.

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When you’re highly sensitive to criticism, you often fear rejection. This may lead you to interpret neutral and sometimes even positive feedback negatively. You may also overanalyze comments, believing you’re being harshly judged or not meeting expectations. 

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As a result, many autistic adults with RSD avoid situations where feedback is inevitable in an attempt to protect themselves from potential emotional pain.

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Social anxiety

Many autistic adults with RSD develop heightened social anxiety due to a fear of rejection, which can lead to avoidance of social situations altogether. This avoidance can exacerbate feelings of isolation and loneliness, reinforcing a negative feedback loop. Over time, the constant fear of rejection and the subsequent withdrawal from social situations can harm existing relationships and hinder the development of new ones, leading to a diminished social support network.

Without appropriate intervention, rejection sensitive dysphoria can have lasting detrimental effects on your mental health and well-being. Persistent emotional dysregulation, fueled by chronic feelings of rejection, can lead to heightened stress levels, increased anxiety and a greater risk of depression. 

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These emotional challenges often contribute to additional conditions—like depression and anxiety—and autistic burnout, a state of physical and emotional exhaustion that can result from prolonged stress and moving through a neurotypical world.

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To mitigate these long-term effects, it is crucial to recognize RSD and get help managing it as early as possible.

Rejection sensitive dysphoria is a significant challenge for autistic adults. However, many strategies can help manage these feelings and build resilience. Here are some coping strategies that can help you manage RSD.

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Understanding and naming emotions

One of the first steps in managing RSD is developing a better understanding of emotional triggers. You may benefit from learning to recognize and label your emotions accurately, which can help de-escalate intense feelings of rejection. Tools like emotion-tracking apps or journaling can help you better identify these emotions.

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Developing emotional regulation techniques

Tailoring emotional regulation strategies to your own needs is crucial. Techniques such as deep breathing, mindfulness and sensory grounding can be particularly effective for autistic adults. For instance, you can incorporate sensory-friendly elements like weighted blankets or noise-canceling headphones during moments of distress. Practicing these techniques regularly can build a foundation for more effective coping when rejection triggers occur.

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A therapist familiar with RSD and autism—such as those here at Prosper Health—can help find the right techniques for you.

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Reframing negative thoughts

Reframing negative thoughts (a common strategy in cognitive behavioral therapy) can help shift the perception of rejection. CBT encourages you to challenge automatic negative thoughts and replace them with more balanced perspectives to reduce the intensity of their emotional reactions. 

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For example, instead of viewing a declined invitation as a personal failure, CBT can help to reframe it as a scheduling conflict or a mutual misunderstanding to lessen the emotional impact.

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Developing coping strategies

Practicing self-soothing techniques, such as engaging with special interests or stimming, can help manage the intense emotions that RSD can trigger. 

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It’s also important to engage in activities that boost self-esteem and provide a sense of accomplishment. For example, someone might learn a new skill or work on creative projects. This can help reduce the emotional impact of perceived rejection, as well as stress and the chances of burnout.

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Regular self-care routines, such as exercising, good sleep hygiene, and engaging in hobbies or other relaxing activities, can bolster emotional resilience and provide a healthy outlet for stress. Setting boundaries may help reduce stress and limit RSD traits. 

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Practicing self-compassion

Practicing self-compassion is essential for everyone, but it’s especially helpful for those with RSD, which heavily impacts self-esteem. It’s important to remind yourself that rejection is a common experience that virtually everyone has. It does not reflect personal worth.

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Connecting with other people with RSD

RSD can feel isolating. Connecting with others in your shoes can make a big difference. Online communities and forums provide valuable information on coping strategies and shared experiences. You can check out organizations such as the Autism Self Advocacy Network (ASAN) and the Autistic Women & Nonbinary Network (AWN).

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Support groups are another great option. They offer a safe space to share experiences and learn from others who understand the unique challenges of RSD. Many of these groups are available online—such as those run by the Association for Autism and Neurodiversity—providing accessible options for those who prefer virtual interaction or don’t live in an area with as much in-person support. 

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For autistic adults, managing rejection sensitive dysphoria while navigating interpersonal relationships can be particularly challenging. RSD can cause you to have an intense emotional reaction to perceived or actual rejection, making social interactions and dating daunting. Here are a few tips for navigating relationships with RSD.

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Understanding RSD

Self-awareness is the first step in managing RSD in relationships. Recognizing patterns of emotional responses and identifying triggers can help you prepare for and mitigate the impact of rejection sensitivity. Reflecting on past experiences to understand how RSD influences reactions can foster greater self-compassion and patience.

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Effective communication

Clearly expressing feelings and needs can prevent misunderstandings and reduce anxiety around potential rejection. Sharing your experiences with RSD with trusted friends or partners can help them understand your perspective and support you more effectively.

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Setting boundaries

Establishing clear boundaries is essential for maintaining emotional well-being. You may benefit from setting limits on how much social interaction you can handle or how often you extend your help to others if you’re a people-pleaser. This creates a sense of safety and predictability in relationships, which can reduce the fear of rejection.

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Seeking professional support

Professional support––such as therapy with a provider experienced in working with autistic individuals––can offer tailored strategies for managing RSD. Therapy can provide a space to explore feelings of rejection, develop resilience and improve interpersonal skills.  Though there are no medications that are officially approved to target RSD, some psychiatric providers may prescribe medications off-label, such as guanfacine or clonidine, to help reduce symptoms of RSD.

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By understanding your own sensitivity and implementing these strategies, you can build and maintain healthier, more supportive relationships. With time and effort, you can navigate social connections more confidently, even in the face of RSD.

If you struggle with RSD, seeking professional help can be life-changing. A therapist can help you learn effective coping skills and navigate the challenges of RSD.

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Therapy for RSD

Therapeutic approaches such as cognitive behavioral therapy (CBT), modified to suit the neurodivergent brain, can help autistic adults manage the emotional intensity of RSD. 

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Aspects of both acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) may also be beneficial, offering strategies to cope with rejection and build emotional resilience. 

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Specialized training in autism

It’s best to seek therapy from someone who specializes in autism neurodivergence. These therapists understand the unique ways autism affects emotional processing and interpersonal relationships. Opt for providers who practice neurodiversity-affirming therapy.

If you struggle with RSD, Prosper Health is here to help. Prosper Health’s virtual therapists provide mental health support for autistic and neurodivergent adults, covered by insurance. 

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Our expert clinicians incorporate evidence-based therapies into our sessions, tailoring all care to the unique needs of autistic adults. Clients see a material improvement in their quality of life in as few as four sessions with our therapists.
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With Prosper’s support, coping with RSD is possible. Fill out the form below or give us a call to start today!