Neurological Disorders What to Know About Autism and Rejection Sensitive Dysphoria By Amy Marschall, PsyD Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health. Learn about our editorial process Updated on February 05, 2023 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Claire Eggleston, LMFT-Associate Medically reviewed by Claire Eggleston, LMFT-Associate Claire Eggleston, LMFT-Associate is a neurodivergent therapist and specializes in and centers on the lived experiences of autistic and ADHD young adults, many of whom are also in the queer and disability communities. She prioritizes social justice and intertwines community care into her everyday work with clients. Learn about our Medical Review Board Print Kittikorn Nimitpara / Getty Images Table of Contents View All Table of Contents The Connection Between Autism and RSD Complications Diagnosing Autism and RSD Support Coping For many autistic people, perceived rejection or failure can feel intensely emotionally painful, to the point that they struggle to cope with these feelings. This phenomenon is known as rejection sensitive dysphoria (RSD). Not all autistic people experience RSD, but those who do may struggle due to these feelings. Although RSD is not a clinical diagnosis, many autistic people struggle with these feelings. This article explores autistic people’s experiences of RSD, how autistic people cope with RSD, and ways to support an autistic person experiencing RSD. The Connection Between Autism and RSD Autism is a neurodevelopmental difference that manifests as atypical sensory perceptions, behaviors, and social styles. Currently, there is limited peer reviewed research about RSD and even less about its connection to autism. Kate, who is autistic, shares: “I think that being autistic in a world set up for neurotypicals leads to an almost constant sense of feeling like I’m doing everything wrong and second guessing so many of my interactions. This feeling coupled with some formative experiences of actual rejection have made me almost hyper-aware that people might not understand me and will reject me.” Essentially, autistic people are set up to experience rejection at a higher rate than non-autistic peers due to having to function in a world not designed for them. In addition, Kate says that being autistic impacts her experience of rejection and criticism: “I tend to assume people are mad at me, upset with me, or I did something wrong if they: have short answers to my questions, take a while to reply, are quieter than usual, etc. I feel an intense sadness & insecurity. Also a sense of urgency like I have to fix whatever is wrong with what I did or who I am to make the sense of rejection go away.” Behaving in ways that do not come naturally is known as masking, and autistic people experience pressure to mask at a higher rate than neurotypical peers. Additionally, research suggests that autistic masking is uniquely stressful and can lead to burnout. Increased rejection and punishment for not meeting neurotypical standards can cause autistic people to experience RSD. In addition, autistic people often have different sensory and perceptual experiences than non-autistic peers, which can include more intense emotional experiences. As H, an autistic person, shared: “Being a strong empath, in combination to having to mask our autistic traits, definitely complicates things.” Autistic people with strong emotional sensitivity experience social and interpersonal rejection stronger than non-autistic people, which can increase rejection sensitivity. What to Know About ADHD and Rejection Sensitive Dysphoria Complications of RSD for Autistic People Most people do not enjoy being rejected or criticized. However, RSD goes beyond simply disliking rejection. RSD is intensely emotional and can even be physically painful. A desire to avoid this pain and discomfort can lead to increased masking behaviors, putting the autistic person at higher risk for burnout. In addition, RSD can trigger mental health issues in autistic people, including anxiety, depression, and eating disorders. Kate shares that their experience of RSD as an autistic person causes them to be “very observant of patterns, and so when someone’s behavioral pattern is different, I notice it and often feel a sense of guilt about it, like I must have done something for them to feel upset and that’s why their behavior has changed.” This increased hypervigilance, over time, can be traumatic for the autistic person. Diagnosing Autism and RSD RSD is not part of the diagnostic criteria for autism in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This means that you do not have to experience RSD to be autistic (and many people who experience RSD are not autistic). If you are autistic and you struggle with rejection or criticism, you might be experiencing RSD. If you find that you cannot “move past” perceived rejection the way that others do, RSD might explain these feelings. A therapist might also notice patterns in your emotional responses that are consistent with RSD. If you are autistic and experiences of RSD resonate with you, you can learn more about this phenomenon and connect with others in the autistic community about how they cope with their rejection sensitivity. In particular, having a therapist who understands neurodivergence and how to be neurodiversity-affirming can help identify and cope with RSD. Awareness and Allyship: It's a New Day for Neurodiversity How to Support Autistic People Dealing With RSD When it comes to living with RSD for autistic people, education and shared experience is key. Kate shares: “Learning more about RSD, autism, and my other lived experiences have helped me feel more empowered in how I can work with my brain.” Support from loved ones has helped them “to more openly communicate my feelings, thoughts, and needs with others so they have the opportunity to actually be supportive of me.” Being able to live authentically is essential for autistic people as well. H shared that they benefit from finding space to be “very relaxed and try to unmask as much as possible.” Being accepted as one’s authentic self can reduce the need for masking and reduce sensitivity to rejection. As is true with all mental health issues, systemic issues such as racism, sexism, homophobia, and oppression contribute to individual experiences of RSD. Specifically, autistic BIPOC individuals and non-men experience RSD more commonly and intensely compared to non-minoritized groups. As such, RSD must be addressed both individually and on a societal level by addressing and dismantling these systems. How Autistic People Can Cope With RSD As described above, feelings of rejection can be particularly intense for autistic people. Autistic people can benefit from community support to connect with people with similar experiences and understand themselves better. Having safe, trustworthy social support can help with both education and coping with RSD. For Kate, having a patient partner is beneficial: “They communicate with me about things in their day that may have upset them or might explain why they’re quieter today.” In addition, their friends will let them know if they are busy and may take longer than usual to answer messages. Kate says, “It’s really helpful to know both that she’s not upset with me and that she’s safe. I think overall: communication, reassurance, and patience are the ways people can be supportive of me.” Therapy can also help with anxiety and emotional dysregulation that can come from rejection sensitivity and RSD. Finding a therapist who specializes in autistic experiences can help you learn skills to cope with your experiences and improve your overall well-being. Introducing: Neurodivergence at Work 5 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Hsu DT, Jarcho JM. “Next up for psychiatry: rejection sensitivity and the social brain.” Neuropsychopharmacol. 2021;46(1):239-240. Miller D, Rees J, Pearson A. “Masking is life”: experiences of masking in autistic and nonautistic adults. Autism in Adulthood. 2021;3(4):330-338. South M, Rodgers J. Sensory, emotional and cognitive contributions to anxiety in autism spectrum disorders. Front Hum Neurosci. 2017;11. Kelly C, Davies M. A review of anorexia nervosa, its relationship to autism and borderline personality disorder, and implications for patient related outcomes. J Psychiatry Psychiatric Disord. 2019;03(04). Zimmer-Gembeck MJ, Nesdale D, Webb HJ, Khatibi M, Downey G. A longitudinal rejection sensitivity model of depression and aggression: unique roles of anxiety, anger, blame, withdrawal and retribution. J Abnorm Child Psychol. 2016;44(7):1291-1307. By Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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