Toolkit Description
Why might Autistic people be especially sensitive to rejection and judgment? This toolkit explores Rejection Sensitive Dysphoria (RSD), a co-occurring experience where perceived rejection or criticism triggers intense emotional pain. It explains the emotional, behavioral, and cognitive symptoms of RSD, the factors that cause it, and how it uniquely affects Autistic individuals.
Readers will also learn about the real-life impact of RSD on relationships, work, and mental health. While there is no quick fix, this toolkit outlines practical approaches and self-help strategies that can make a difference. Whether you experience RSD yourself or want to support someone who does, this resource provides validation, insight, and tools to navigate the challenges of living with RSD.
Rejection Sensitive Dysphoria (RSD) Toolkit Series:
- Part 1 - An Introduction
- Part 2 - Understanding RSD Triggers
- Part 3 - Autism, RSD and Mental Health
- Part 4 - Impact on Daily Life
- Part 5 - Managing RSD
Table of Contents
- Introduction to Rejection Sensitive Dysphoria (RSD)
- What is Rejection Sensitivity (RS)?
- Rejection Sensitive Dysphoria (RSD)
- About That Lack of a Formal Diagnosis…
- Is The Word ‘Dysphoria’ Pathologizing?
- Is RSD a Serious Condition?
- How Common Is RSD in the Autistic Population?
- Recognizing Signs of RSD
- Twelve RSD Characteristics
- Rejection Sensitive Dysphoria (RSD) Self-Assessment
- Summary and Some Final Comments
- References
Introduction to Rejection Sensitive Dysphoria (RSD)
Though it is a human experience that everyone may encounter, no one likes to be rejected. We all prefer to feel welcomed, liked, and appreciated. Unfortunately, Autistic people – regardless of their level of intelligence – encounter exclusion, rejection and related experiences like judgment, criticism and correction all too often.
Why is this so? As Autistic people, we are vulnerable to social rejection because our natural ways of communicating, interacting and expressing ourselves are often misunderstood or devalued by a society that expects sameness and is uncomfortable with difference (behaviour that differs from theirs). This can be the result: Autistic people hold the shame of rejection and constant correction that begins at an early age and comes from a variety of important people in their lives. Also, as Autistic people if we don’t understand a human response toward us, we may fill it in with emotions related to perceived rejection, even if there wasn’t any.
This ongoing experience of receiving negative feedback for Autistic differences, combined with differences in the way we process emotions and pain in our brain can exact a heavy toll: they leave Autistic people vulnerable to Rejection Sensitivity (RS), showing up in the most debilitating of ways — as Rejection Sensitive Dysphoria (RSD). Let’s take a look at these two descriptions of emotional response to rejection.
What is Rejection Sensitivity (RS)?
Anyone who experiences rejection sensitivity can have a heightened awareness of perceived or actual rejection. For example, people with a history of trauma and who are Highly Sensitive People may experience it, as can those with diagnoses including ADHD, Autism, Social Anxiety Disorder, Generalized Anxiety Disorder (GAD), Borderline Personality Disorder (BPD), Complex PTSD (C-PTSD), and Depression.
People who anticipate that others will reject them are said to be rejection sensitive. These may be the people who often say things like, “I’ll never get the job,” “She’ll never want to go out with me,“ or “I’ll never get picked for that team.” Now, while it can range in severity, rejection-sensitive people can expect to feel uncomfortable, unpleasant emotions when they encounter rejection/criticism/corrections, but they can push through and shake them off. They also recover and move on past the social injury with relative ease. In the moment, they may be able to suppress and manage their emotional response to rejection and find ways to cope with the very unpleasant emotions that arise.
Now imagine measuring degrees of rejection sensitivity on a linear spectrum from mild symptoms to more severe, and let’s consider the most extreme end.
Rejection Sensitive Dysphoria (RSD)
Intolerable social pain. Intense internal distress. Crushing self-criticism. RSD takes rejection sensitivity to a whole other level. While not an official diagnosis, RSD is a term commonly used in our neurodivergent communities and among professionals to describe intense emotional pain triggered by rejection. It can be triggered when someone feels invalidated by criticism, exclusion, or negative feedback.
For some people, the feelings of rejection—actual or perceived—can trigger a complete loss of emotional control, resulting in dramatic emotional and/or behavioural responses. They may be inconsolable and cry at length, unable to contain their devastation. They may also lash out verbally as they lose control. The emotional pain may be so intense it can be described as piercing, overwhelming, or shattering.
Interestingly, those who experience RSD may also describe physical pain with rejection, including sharp chest pains, the feeling of having the wind knocked out of them, or a sudden jolt of shock through their body. Science tells us this pain is real. A Columbia University study found that rejection and physical pain use the same parts of the brain. That means the pain from rejection is real. It can show up in the body even when there’s no physical injury.1 This means that the physical pain people report from social rejection has a biological basis and is real.
About That Lack of a Formal Diagnosis…
The characteristics of RSD (the common kinds of responses and behaviours that are seen and will be learned about more deeply in this toolkit) are so compelling that it is hard to understand why it is not a formal diagnosis with the benefits of ‘best practice’ treatments to support people. Learning that the cluster of characteristics people experience has a name can be extremely validating for Autistic people. It can give us words to help recognize, understand, and seek support for emotional challenges that might otherwise go unseen.
RSD is often experienced as a sudden, immediate emotional crash in response to being rejected, judged or criticized. The person will shift from regulated to distressed in a flash. Their emotional collapse in response to real or perceived judgment can feel like a gut punch and can bring them to their knees emotionally and sometimes physically. Many with RSD report physical symptoms that also include stomach aches or nausea.
A person’s experience of rejection-sensitive dysphoria can go one of two ways: they will internalize their emotional distress—embarrassment and self-loathing will bubble up instantly. They may blame themselves for causing the rejection, self-isolate and may be unable to communicate as they descend into shame —or they will externalize their reaction. In the latter instance, they may shift immediately to extreme anger or rage, focusing blame on the one who hurt them. They yell, cry, become defensive, slam doors, or make impulsive and consequential choices, like leaving the school building or stomping off the job. The intensity of their response, for both the person who keeps all the emotion hidden from others and the one who lets it all out, is the same: it is far out of proportion with the real or perceived incident.
The person with RSD has limited or no ability to tamp down their response or hold it until they can have some space. It can take hours or days to return to an even keel. However, the social injury—the incident that caused the feelings of rejection and judgment—can take longer to put behind them.
Social ‘injuries’ caused by social rejection can take a long time to resolve. There is no hard and fast rule for just how long, but it can be hours, days, weeks or longer. Incidents that were especially devasting—being the only one not invited to a party, a spouse or partner leaving, being fired without warning from a much-loved job—can take a person right back to the pain when they are reminded of something that happened years ago. The impact is not forgotten.
Is The Word ‘Dysphoria’ Pathologizing?
Many in the Autistic community do not endorse pathologizing words related to our identity, and it is not the intention of this toolkit to do so, either. It is worth noting the origin of the word ‘dysphoria’ in considering the name of RSD. Dysphoria is a combination of two Greek words—dys for ‘difficult’ or ‘bad’, and phero, which means ‘to bear’. RSD then, is appropriately named: it is when the rejection (a ‘bad’ thing to experience) is just too much ‘to bear’. It is not a weakness of character for an Autistic person to seek help when RSD is triggered. Rather, it is a sign of self-awareness and knowledge of the impact it has on one’s life.
In reality, RSD can be painful emotionally and physically, and when this is the case, the person could benefit from professional help to manage the experience. As well, it can be argued that being Autistic in an ableist, non-Autistic society can lead to challenges that become disabling and painful. This does not mean that the Autistic person is ‘less than’, ‘broken’, or inferior to others in any way. It means that RSD seems to be an example of how simply being Autistic—that is, being ‘othered’, can leave a person open to the experience of rejection.
Is RSD a Serious Condition?
Once again, RSD is not an official diagnosis, but a co-occurring state of emotional dysregulation that can manifest in Autistic people with the right set of circumstances. Is it serious? Ask anyone who experiences it, and they will tell you that it impacts their life and relationships to a large degree. That said, it is not a disease, so it poses no risk from that standpoint. However, it is reasonable to assume that the mental health issues that can be compounded or caused by RSD can pose a risk. The Autistic community has very high suicide rates that are five times higher for Autistics without intellectual disability (Autistics with intellectual disability do not have a higher risk of death by suicide) than the general population.2 It seems a reasonable hypothesis that neurodiversity-affirming interventions for RSD may have a positive impact on these dire statistics.
How Common Is RSD in the Autistic Population?
To this point, the vast majority of RSD research has been conducted in consideration of those with ADHD. There is no research-based response to how many from that population have RSD, and similarly, there is no definitive research for the Autistic community.
What we do know is this: Dr. William Dodson, a psychiatrist, is an expert in adult ADHD and a pioneer in the area of RSD. He says that almost all (98 - 99%) of his ADHD adult clients experienced rejection sensitivity.3 We also know that though statistics vary, it is commonly understood that 50-70% of Autistic people have a co-occurring diagnosis of ADHD. So—let’s put that together:
- Critically, the vast majority of people with ADHD have RSD.
- Approximately one-half to two-thirds of Autistics have ADHD.
- What about the remaining one-third? No one is certain, but consider that Autistic people may not seek a second diagnosis for ADHD, assuming that their struggles are related to executive function and emotional regulation traits commonly seen in Autistic people.
Though science has yet to catch up, the points above make it reasonable to conclude that Autistic people would have very high rates of RSD.
Given the distressing nature of experiencing the emotional crashes that define RSD and the number of people in our community who may be suffering with it in silence, AIDE Canada felt that it was time to provide a resource to learn about this challenging emotional experience.
For many of Dr. Dodson’s patients, RSD was the most challenging part of their ADHD. “One-third of my adult patients report that RSD was the most impairing aspect of their personal experience of ADHD, in part because they never found any effective ways to manage or cope with the pain” The pain that accompanies RSD is real. 4
Let’s take a look closer look at what it can mean to experience RSD. In the next section, we share some emotional, behavioural, and cognitive signs of RSD, and offer a non-diagnostic self-evaluation tool developed by Dr. Dodson and adapted for this toolkit.
Below is a chart that further describes what it can mean to experience the emotional crashes triggered by RSD. You’ll find examples of emotional, behavioural, and thinking/cognitive signs of RSD, followed by a deeper dive into some of the more common characteristics. For those interested, you’ll also find a non-diagnostic self-evaluation tool developed by Dr. Dodson and adapted for this toolkit.
Recognizing Signs of RSD
Rejection Sensitive Dysphoria (RSD) is a common co-occurring experience for Autistic people that describes the intense emotional pain felt when they perceive they have been rejected or criticized.
Examples of emotional, cognitive and behavioural signs of RSD are outlined below. You can also view this as a PDF infographic here.
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Emotional Signs
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Cognitive Signs
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Behavioural Signs
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Twelve RSD Characteristics
Dr. William Dodson, a psychiatrist for nearly 50 years, has focused on diagnosing and supporting adults with ADHD for over 25 years. He was one of the first clinicians to take adult ADHD seriously, at a time when most professionals believed it was something children would get over.
Over many years and working with many patients, Dr. Dodson noticed his patients with ADHD experienced emotional pain in response to rejection or criticism – sudden and intense emotional pain. Around the mid-2010s, he gave this experience a name: rejection sensitive dysphoria (RSD). For many of his patients, RSD wasn’t just part of ADHD — rather, it was the part that caused the most suffering.
Below are some common emotional experiences of RSD gleaned from a ‘deep dive’ on the internet, as well as reading many of Dr. Dodson’s articles and videos, and hearing recorded interviews. Each characteristic has been expanded upon to explain and clarify. This is not a checklist, just information provided to better explain RSD.
- Very Intense Emotional Pain
People with RSD experience overwhelming, emotional pain when receiving real or perceived rejection, criticism, correction, negative feedback or failure—for instance, not getting on the team, not getting the job, someone gave you a ‘look’, telling you they don’t like you. Any or all of these can be devastating.
- Instant Emotional Responses
These emotional responses happen instantly and are so intense and overwhelming that emotional control seems impossible. They can overtake you so quickly you cannot protect yourself from them. It doesn’t give you a chance.
- Rejection Turned Inward
Feelings of rejection are turned inward towards oneself and become feelings of shame, self-criticism, or self-blame. Your inner voice might insist that you are the problem, you’ll never find love, a job, a friend, if only you would stop talking so much, talk at all, and stop being such a burden. It’s brutal!
- Rejection Turned Outward
A feeling of rejection can cause sudden rage or anger directed towards the source of the social injury. The rage spews out of you before you can stop it. People lose their jobs for verbal aggression toward others. Partners are unnerved by it. Friends leave.
- Risk Avoidance
To guard against rejection, failure or criticism, you may pass on social invitations or employment opportunities, or trying new things. Interesting courses are avoided in high school because you might not do well or might fail.
- Physical Symptoms
Rejection may cause crying, pain or tightness in the chest or stomach, or nausea when triggered. People may say you’re being overly dramatic when you say it hurts. You avoid emotional pain that will accompany failure or rejection.
- People-Pleasing Behaviour
A tendency to go above and beyond to win approval from others, may result in ignoring your own needs and wishes. Children may give their treats away, their money away, or do homework for other people. They just want to be accepted. Adults will take on extra projects, agree to help even if they are out of energy and not keeping up with their own work.
- Extremely Self-Critical Thoughts Not Based in Reality
Inner dialogue is filled with negative, very critical comments directed at oneself. You tell yourself things like, ‘I are a burden’, ‘no one will ever love me’, or ‘I am a waste of space’. You say terrible and untrue things to yourself. Sometimes, you think of what happened weeks later and you start saying terrible things to yourself all over again.
- Trust is Hard
You find it hard to accept that anyone would want to be with you. You constantly feel that people will stop being your friend or partner. You believe that all social connections are temporary because everyone eventually will want to stop hanging out with you.
- Self-Isolation
Loneliness can result from self-isolating to avoid rejection. Your brain warns you that the potential for rejection lurks everywhere, so you stay safe by staying home. People think you do that because you are Autistic. That’s not why. You want to have people in your life, but it’s too risky.
- Negative Feedback is Devastating
Even when feedback is overwhelmingly positive, even minor suggestions for improvements can trigger emotional chaos. A teen may experience an RSD crash when they see a small edit on their essay. They drop their creative writing class and vow to never write again. A first grader gets a few red X’s on a math sheet they did well on, but cannot stop crying.
- Relationships are Strained
Sudden, dramatic emotional responses can put stress on relationships with partners, friends, and work colleagues. Romantic partners can be frightened and leave you; bosses can fire you; friends may not want to be around to see that behaviour again. As hard as you try, you cannot prevent these sudden emotional outbursts from happening.
Rejection Sensitive Dysphoria (RSD) Self-Assessment
Dr. William Dodson developed a list of traits and characteristics of RSD.4 If you’re interested in whether or not your experiences align with RSD, an adapted questionnaire can be found on the Sachs Center: https://sachscenter.com/rsd/
Summary and Some Final Comments
In this first toolkit of a series focusing on RSD, we explored what RSD is and how to determine if it is present. In the next toolkit (Part 2), we will identify triggers of RSD, followed by additional toolkits examining how to help with RSD. There is help for this often-debilitating emotional struggle, and sharing your story with others and trusted health care providers knowledgeable in RSD and autism, is an important step forward.
Click here for additional resources on RSD.
Next: Rejection Sensitive Dysphoria (RSD): Part 2 - Understanding RSD Triggers
References
- Kross, E., Berman, M. G., Mischel, W., Smith, E. E., & Wager, T. D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of Sciences - PNAS, 108(15), 6270–6275. https://doi.org/10.1073/pnas.1102693108
- Santomauro, D. F., Hedley, D., Sahin, E., Brugha, T. S., Naghavi, M., Vos, T., Whiteford, H. A., Ferrari, A. J., & Stokes, M. A. (2024). The global burden of suicide mortality among people on the autism spectrum: A systematic review, meta-analysis, and extension of estimates from the Global Burden of Disease Study 2021. Psychiatry Research, 341, 1-7. https://doi.org/10.1016/j.psychres.2024.116150
- ADDitude Magazine. (2021, October 6). Defining features of ADHD that everyone overlooks: RSD, hyperarousal, more (w/ Dr. William Dodson) [Video]. YouTube. https://www.youtube.com/watch?v=vycWIzURgZM
- Dodson, W. Adapted from content hosted on the Sachs Center website: https://sachscenter.com/rsd/, accessed 8 June 2025.
