Rejection Sensitive Dysphoria (RSD): Part 5 - Managing RSD

Introduction

This is the fourth and final section in our toolkit in a series addressing Rejection Sensitive Dysphoria (RSD). In Toolkits #1 - 4, we explored why Autistic people might be especially sensitive to rejection and judgment, triggers that may result in RSD, and how RSD can have deep impacts on relationships, work, and mental health. In this fifth part, we examine how to manage RSD. While there is no quick fix, this toolkit outlines treatment options and practical self-help strategies that can make a difference. Whether you experience RSD yourself or want to support someone who does, this resource provides 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

• Background
• Therapy Approaches and Medications
• Therapy Options for Autism and RSD
• Medications Sometimes Used for RSD
• Strategies to Help
• How Loved Ones and Others Can Help
• How Teachers Can Help
• Self-Help ideas for Autistic People with RSD
• Conclusion – Moving Forward with Understanding and Strength
• Additional Resources
• References

Background

RSD is a deeply painful experience, so intense that many go to great lengths to avoid the people, places, and situations that might trigger it. Some may never tell any health care provider about their intense emotional responses due to fear of being judged and feeling shame. People may suffer in silence as they retreat into safe, sheltered routines to avoid the ‘danger’ of emotional eruptions and the judgments that may follow. It doesn’t have to be that way. There are ways you can learn to avoid your triggers and better manage your emotions. Of course, the best strategy could be to work toward societal transformation so we experience goodwill and can hope that all non-Autistics learn who we are and to respect our Autistic culture.

Right. But in the absence of that and in the here and now, there are some resources that you might find helpful in coping with overwhelming emotions.

This section introduces ways to manage RSD and offers a place to begin looking for support. It outlines five types of therapy and how each may, or may not, help Autistic people with RSD. A short overview of medication follows, along with self-help strategies and tips for emotional regulation and recovery after an RSD crash. Finally, we include support ideas for those who want to help, including loved ones, supportive others, and teachers who care but may not know what to do.

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Therapy Approaches and Medications

If you or a loved one might experience RSD, consider finding a professional to give guidance through the process. Many adults may choose not to tell anyone about RSD symptoms because they are ashamed of their inability to manage their emotions and of the damage that can result in their relationships. People who engage in therapy may find it liberating to speak about their experiences and know there are others just like them.

Since the emotionally-based symptoms of RSD are related to emotional regulation and not a formal diagnosis, a medically endorsed approach to help has not been established. Instead, it is treated much like ADHD, with medications that can improve RSD symptoms, combined with individual or group therapy. If you decide to seek help, researching to identify a professional who has extensive experience working with Autistic people and RSD can be beneficial.

One more important consideration as you choose your provider is potentially seeking a mental health practitioner or counsellor who identifies as neurodiversity-affirming. Here’s why:

A neurodiversity-affirming therapist is not defined by a program or method. Instead, they are defined by their approach. Their goal is not to “fix” the Autistic person or force them to appear non-Autistic. Instead, they create a therapeutic space that respects and accommodates each person’s sensory, communication, and learning needs as they support Autistic identity.

Many of these therapists are neurodivergent themselves, and that can contribute to feeling heard and understood. The emotional pain is believed, and incidents of rejection are supported with the gravity they deserve. When Autistic people are facing rejection sensitivity and other mental health struggles, this kind of help can make a positive difference. Of note: these therapists can be hard to find and may have long waitlists.

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Therapy Options for Autism and RSD

**This is not a comprehensive list of therapy options available. It describes five types of therapies that have emerged for Autistic people seeking help for RSD.**

Autism and RSD: Therapy Options

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Medications Sometimes Used for RSD

The following chart lists types of medications that might help with rejection sensitivity. Some are approved by Health Canada¹ for ADHD or depression, but none are officially approved for RSD. In Canada, doctors can prescribe medication for purposes other than their primarily-intended use, at their discretion. Note that we cannot and are not offering medical advice. Rather, it is important to consult your medical doctor in considering potential medication use and treatments.

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Strategies to Help

1. How Loved Ones and Others Can Help

**This section speaks directly to parents and supportive others**

RSD can make everyday situations feel emotionally catastrophic. For Autistic people, the fear of being judged, left out, or misunderstood can quickly turn into internalized self-critical messaging or externalized rage. The person cannot control their emotional response, which often leads to deep remorse and self-blame. When loved ones or supportive others offer the right kind of support, it can make a huge difference. Small gestures can reduce the individual’s fear of being rejected and help lessen feelings of shame and regret. Here are ways that family, friends, and other supportive people can help:

1. Be Their Non-judgmental Safe Person

   Let the individual know they don’t have to mask with you. Let them know you ‘get it’ by listening and giving supportive feedback. Don’t offer advice unless they ask for it—and any advice must avoid criticism of their role in the incident.

2. Avoid Jokes at Their Expense and Watch Your Tone

   You may think it is harmless humour, but they may perceive sarcasm or teasing as rejection. Texting one-word replies are ripe to be identified as anger toward them. If that’s all you have time for, add a love or sunshine emoji at the end. That can signal ‘no worries’ – you’re busy.

3. Trust What They Say

   The pain of RSD provides a major emotional punch, even if the triggering event seems minor to you. Don’t make the Autistic person justify their reality. It is gaslighting and is triggering. For reference, gaslighting is, “psychological manipulation of a person usually over an extended period of time that causes the victim to question the validity of their own thoughts, perception of reality, or memories and typically leads to confusion, loss of confidence and self-esteem, uncertainty of one's emotional or mental stability, and a dependency on the perpetrator” (Merriam-Webster: Gaslighting).

4. Keep It Together When They Cannot

   Your quiet and non-judgmental support can help them recover. Don’t try to fix the problem or deny its gravity. If they just want to sit in silence with you, do it. Follow their lead.

5. Predictability is Powerful Support

   If you’re running late, let them know so their mind doesn't begin to spiral. If you had a bad day and arrive home stressed, tell them it’s not their fault.

6. Agree on Communication Expectations

Remind them that work or school responsibilities, and life in general—even dead batteries that can prevent communication—can mean calls or texts are delayed or don’t happen. Avoid reading a text but failing to reply, and let them know if you plan to turn your phone off. Quick, one-word replies are ripe for being evidence of anger toward them. If a single touch of the phone screen is all you have time for, send a sunshine emoji, a heart, or something else. It can be a prearranged symbol that you care, but you cannot chat right now.

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2. How Teachers Can Help

Many Autistic children hold a great deal of anxiety around attending school. A Swedish review of 42 studies from high income countries verifies this: in a 20-day period, 42.6% of the Autistic student participants had school refusal behaviour compared to only 7.1% of non-Autistic students.² It makes sense: the fast pace and volume of the social, sensory, and academic demands were created for typically-developing children, and can overwhelm those who are Autistic.

For those who also have co-occurring RSD, school can have them on high-alert all of the time, scanning for danger in the environment. The sources are teasing, the bullies, the social rejection, and tasks where they could suffer the emotional pain of being called out for making an error. There is a unique kind of pain that settles deep in a parent’s heart when every school day their child, who is clearly distressed, begs to stay home. The child gets on the school bus with fear, and returns home after school overwhelmed. This is incredibly difficult for the child.

There’s good news, though... Teachers: you have the power to make a positive difference for your Autistic students. As you learn what it can mean to be an Autistic student with co-occurring RSD, you’ll have some skills and strategies that can reduce the real or perceived rejection, and can do things in a way that works better for Autistic students with RSD.

Keep in mind that while reactions from RSD can be dramatic to experience and to observe, they are triggered by the negative feedback that convinces the individual that people don’t like them, and that they are a failure. The crash they experience as a result is characterized by intense feelings of shame, despair, or anger and rage. While it looks like what is commonly called a meltdown, meltdowns are associated with sensory overload, anxiety, and demands that are poorly matched to the ability to cope. Thus, while a crash and meltdown may look the same, the causes are different.

That said, common behaviour strategies such as rewards or discipline that focus on controlling behaviours instead of addressing the underlying cause will not be effective. Once an RSD response begins, it will continue until it has run its course. You can’t stop it. What you can do is consider and implement any of the following tips that make sense for your life. These tips are shared with you in hopes they add some effective ways to prevent the crash from happening in the first place.

1. Make Your Classroom Bully-Free

   Teachers can establish rules about how students treat each other. Their attitude and response to bullying can help create a safe environment for all. Canadian scholars differ in their bullying policies across provinces and territories, and schools may have varying bullying programs implemented. Also, schools differ in their willingness to apply the policies in ways that make the bullied children feel safe and their families feel heard. It is noted that these programs may not be a solution for all situations, and more intensive supports may be required.³ About 26% of Canadian youth aged 10 to 17 reported being bullied at least once in the past month.⁴ In British Columbia, a more detailed survey found that 53% of students aged 12 to 19 experienced at least one form of bullying in the past year.⁵ Keep in mind that students who are bullied repeatedly over time can develop a trauma response called Complex PTSD. It makes them very vulnerable to RSD.

2. Validate Their Experiences: Believe Them

   If the student has a crash—whether it is in the form of protracted crying, withdrawing into themselves, or lashing out physically or verbally—believe them when they tell you what happened. Sure, they may have misinterpreted someone’s intention as rejection or judgment, but they received whatever the other person was saying or doing in that way. The emotional pain they are feeling is real. Telling them the other person didn’t mean that or it didn’t happen, promises to prolong the often-excruciating discomfort that comes after being triggered.

3. Use Gentle, Clear Language

   Contrary to popular myth, Autistic students often have a great sense of humour, but sarcasm and teasing can feel like rejection or criticism because they may take things literally. This can lead to an instant emotional crash, especially in middle school when “trash talk” is common. Metaphors can also be confusing. Instead of avoiding them, it helps to explain what you mean as you go—like saying, “It’s raining cats and dogs. That just means it’s raining really hard.” A simple explanation like that can prevent misunderstandings, reduce embarrassment, and even help avoid an RSD spiral. It is also helps the individual understand the meaning of the metaphor if it is used again in this or another context.

4. Give Private Feedback

   Autistic children are often very sensitive to correction, especially if they’ve developed RSD. This may be from years of adults constantly pointing out what they’re doing “wrong.” Even small edits or feedback can feel overwhelming. The goal isn’t to avoid correction but to change how it’s done. Use mistakes as class-wide teaching moments without naming the student. Say to the class, “Maybe I didn’t explain this very well. I am going to try again.” By modelling for the student that even teachers can improve, you help to demonstrate that everyone makes mistakes, and everyone may need to try again or ask for help. Always provide personal feedback in private, not in front of peers. Use errorless teaching when possible—for example, mark only correct answers on spelling tests. These small changes help protect the child’s dignity and reduce emotional crashes.

5. Provide Accommodations

   If a child has been identified as needing accommodations to learn, then those supports must be in place consistently. These tools aren’t optional; they’re necessary for the child to do well with the curriculum. If you don’t have what you need to support the student, please be a strong advocate and push for what’s required, even when it means challenging the system. A student can’t succeed without the tools they need. For example, memory aids are vital for students who have documented memory challenges, or whose memory fails them when they are highly anxious.

   You see, the emotional brain takes over for the thinking brain when this happens. Accommodations. Not optional. Whether it’s one-to-one support, a laptop, regular check-ins, or alternative assessments, consistent accommodations help the child to feel and be capable. Ultimately, accommodations have the potential to reduce the triggers for RSD, and consistent support can improve academic results.

6. Won’t is Can’t

   Often, when an Autistic child won’t do something, it’s because they can’t. Maybe they never fully learned the skill they’ve been asked to undertake, forgot how to do it, didn’t understand the task, or couldn’t ask for help when it was being taught. Sometimes, they refuse because they’re terrified of doing something wrong, feeling shame, and losing emotional control. Autistic students may avoid anything unfamiliar to avoid the risk of failure. So, the next time a student puts their head down during a test, remember—not all students who won’t do something are being defiant. Sometimes, they’re protecting themselves from something that feels dangerous. They’re trying to shield themselves from the RSD.

7. Apply What You Know to Group Work

   Your Autistic student with RSD might really struggle with group projects. Difficulties speaking up and advocating for what they want can be a challenge, so when other people in the group loudly proclaim what they will contribute to the project, the Autistic student might be left with the role no one wanted. They cannot complain because they want to be accepted. They may seem willing to do the bulk of the work, but that’s part of the people-pleasing aspect of RSD. Some peers may have asked them to do their work and the student agreed. The Autistic student can’t say no for fear of someone judging or rejecting them. For group work, consider selecting the groups and assigning the individual roles. Check in with the child before expecting them to give project presentations. Making a misstep in front of the class could be an instant crash. With a little consideration, Autistic students can be successful in groupwork. For students who cannot cope with groupwork, however, consider providing an alternative way to demonstrate their learning.

8. Collaborate With the Family

Whoever is raising the student knows them best. Meet regularly with them to get insight into their child. What are their experiences of the crashes? Can they identify for you any triggers you might be unaware of? How do they support the child? It might be helpful to meet with the family. You may find that they’ve never heard of RSD, and they thought that what you recognize as RSD behaviours are actually meltdowns. Given that RSD is not yet a formal diagnosis, you may be the one helping parents or guardians to better understand their child.

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3. Self-Help ideas for Autistic People with RSD

RSD can have a significant impact on many aspects of your life. You already know that, though, don’t you? When you're constantly bracing for rejection—when you expect it even from those who care about you—it can shape how you move through the world. It can make you avoid or drop friends, fear feedback from your manager, or turn down opportunities in favour of your emotional safety and predictability.

With awareness that the very strong and painful emotional responses you routinely experience are RSD, there is potential for things to get better. Given that RSD responses seem impossible to stop, your first step is to find a professional to guide you through the process. Clinicians seem to agree that therapy can help you to get insight into your triggers, and help you to develop strategies to cope. It seems most therapists consider prevention of an RSD crash to be the preferred goal. That’s because it can take years of therapy to learn how to more accurately interpret social cues, and to challenge the catastrophic conclusions you draw from how people interact with you. You may even gain skills in asking people to clarify what they meant, or asking if they are upset with you. The next section of the toolkit lists some of the popular therapies that seem to work well with RSD.

While therapies and even medication can be an integral part of easing the grip RSD has on you, it is not necessary to look outward for all the things that will benefit you on this journey. As you gain strength and awareness, you can be an enormous help to yourself in the process by choices you make. A best next step is to increase your knowledge of both RSD and autism.

1. Do a Deep Dive

   One of the first steps is to learn everything you can. Read about RSD. Learn about Autism. Watch YouTube videos, read blogs, or scroll through comment sections where others describe what you may have felt. You’ll likely see your own experience reflected back to you—and that kind of validation can be powerful.

2. Boundaries Make a Difference

   RSD also means setting boundaries. If someone regularly makes you feel unsafe, judged, or constantly on edge, or takes far more than they give in your friendship, that relationship needs limits. It’s okay to take a step back to protect your well-being and mental health.

3. Share the News

   If you're in a relationship, open and honest conversations about RSD can actually strengthen your connection. The people who love you can’t support you if they don’t understand what you're going through. Putting a name to the unpredictable emotional roller coaster they’ve witnessed you experience, may be reassuring to them.

4. Eat, Sleep, Move

   Real self-care matters. Sleep, nutrition, and exercise are so essential to physical and mental health, yet we tend to diminish their benefits because it just sounds too simple, However, prioritizing all three can make a huge difference in your health. Adequate sleep helps with emotional regulation. Exercise can release stress, and good nutrition builds a physically healthy body. When this trio is out of whack, all sorts of consequences follow. The prefrontal cortex, that helps us to stay calm and to think rationally, is not at its best when you’re sleep deprived. It becomes foggy and less efficient. When you're hungry, you might miss a cue or misread a situation, because hunger impairs focus and attention. It can also affect your mood, with people commonly losing patience and becoming easily angered. When you’re irritable from eating poorly or not enough and missing out on sleep, these can be triggers for your RSD. Taking care to prioritize these foundational aspects of health matters.

5. Write it Down

   Writing things down can also help. Journaling gives you space to sort through what happened, what you felt, and what might have triggered the reaction. It helps you ask questions like, “Was that person really upset with me, or were they just having a hard day?” Over time, this kind of reflection builds insight, and this insight can help you do the hard work in therapy.

6. Create New Habits

Try creating new habits to reduce the chances of being triggered. For example, wait to read a performance review until you're at home. You'll be in a safer space, with time to process, instead of reacting emotionally in front of a boss or co-worker. Strategies like this won’t erase RSD, but they can help you manage it. At the very least, reading your review at home is better than breaking down at work.

Let’s say, for example… At home, you burst into tears after noticing two sections out of twelve, where your boss rated you as “meets expectations” instead of “exceeds expectations.” You collapsed to the floor, wailing and rocking. The emotional impact drained you so completely, you had to call in sick the next day.

Why was this still a good strategy? On your sick day, with a calmer mind, you finally read the whole review. It was actually great. The two comments that hurt so much were about new skills you’d just learned, and even those were solid. With glowing feedback on your core responsibilities, you felt proud and relieved.

Had you read it at work, the emotional fallout would have been public. The shame from losing control in front of your team could have driven you to quit a job you loved. Reading it at home didn’t stop the RSD, but it protected your dignity, your energy, and maybe even your future.

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Conclusion – Moving Forward with Understanding and Strength

Our goal in offering this resource is to educate our community about and raise awareness of RSD. This painful and overwhelming emotional experience packs a powerful strike when it shows up, unannounced, at the slightest hint of rejection. When that happens, RSD takes over, and emotions can spiral out of control. If you are an Autistic person with RSD, it is our deepest hope that this toolkit can help you start to reclaim that control.

At the heart of this toolkit is a simple truth: RSD doesn’t occur in isolation or without cause. In our Autistic community, it seems to emerge from a perfect storm—Autistic traits that make us more sensitive to social pain, a society that often rejects us for those traits, and a lifetime of experiences where our needs were invalidated, our differences punished, or our identities misunderstood. Many of us are also carrying the weight of co-occurring anxiety, depression, or trauma—not because we are Autistic, but because of how we’ve been treated for being Autistic.

Though RSD is not an official diagnosis, the term has become an important way for the neurodivergent community to describe a very real and unbearable form of emotional dysregulation. It’s fast, intense, and deeply physical and emotional. However, learning that there is a name for what you’re feeling—and knowing there are others who experience it too—can bring relief. Language to explain our RSD experiences gives us power. Understanding it brings us clarity, and clarity can open the door to self-compassion and support.

If you recognize yourself in this toolkit, know that you’re not alone. And know that support is available. Asking for help can feel impossible, especially when fear of rejection is at the core of what hurts. If all you can do is ask someone to help you ask—that’s a meaningful first step. Start there. Reach out to someone you trust and who won’t judge you.

RSD may feel overwhelming, but knowledge is power. Getting answers for your emotional responses gives you the tools to understand them, and from there, find your way forward. With awareness, support, and compassion—for yourself and from others—things can get better.

We’re not waiting around for acceptance—we’re building it. One resource, one conversation, one act of truth-telling at a time. If this toolkit helped you understand RSD, share it with someone else. Awareness grows when we pass it on.

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Additional Resources

Resources from AIDE Canada

Toolkits and Infographics:

• Recognizing Signs of Rejection Sensitive Dysphoria (RSD)
• Emotional Regulation and Dysregulation in Autism: Considerations in Adulthood
• Treating Mental Health Conditions in Autistic Individuals: A Toolkit for Understanding Approaches to Mental Health Care
• An Introductory Overview of Some Mental Health Challenges and their ‘Co-Occurrence’ with Autism
• Alexithymia & Autism: When you don’t know what emotion(s) you are feeling

Videos:

• Co-occurring Mental Health Conditions and ASD
• Promoting Better Mental Health: Animated Video

Course:

• Discovering Your Autistic Identity: A self-directed course for late-diagnosed autistic adults

Overviews:

• Becoming More Trauma Informed Collection
• Adult Diagnosis Collection
• Healthy Relationships and Sexuality Collection
• Burnout Collection

Resources from the AIDE Canada Library

How to ADHD : an insider's guide to working with your brain (not against it)

By Jessica McCabe

• Book
• eBook
• Audiobook

Neurodiversity-affirming schools: Transforming practices so all students feel accepted and supported.

By Emily Kircher-Morris

• eBook

The neurodivergence skills workbook for autism and ADHD: Cultivate self-compassion, live authentically, and be your own advocate

By Jennifer Kemp

• Book
• eBook

The ADHD workbook for teen girls

By Catherine J. Mutti-Driscoll, PHD; Foreword by Edward M. Hallowell, MD.

• Book

The teen's guide to PDA

By Laura Kerbey

• Book
• eBook

The (Slightly Distracted) Woman's Guide to Living with an Adult ADHD Diagnosis

By Laura Kerbey

• eBook

The (Slightly Distracted) Woman's Guide to Living with an Adult ADHD Diagnosis

By Laura Kerbey

• eBook

Some Additional Reading and Resources

• Prosper Health – “Understanding Rejection Sensitive Dysphoria in Autism: A Guide for Autistic Adults”
• Verywell Mind – “What to Know About Autism and Rejection Sensitive Dysphoria”
• Reframing Autism – “The Unbearable Heartache of Rejection Sensitive Dysphoria”
• Autism Parenting Magazine - “Rejection Sensitive Dysphoria and Autism: Is There a Link?”
  • Explores RSD in Autistic children and how emotional pain from perceived rejection affects behaviour
• The Autistic Coach - “Rejection Sensitive Dysphoria: A Guide for Autistic Humans”
  • Offers an affirming, identity-respecting overview of RSD in autistic folks, including coping strategies
• ASD Today – “Autism: Connection to Rejection Sensitive Dysphoria (RSD)”
• Embrace Autism – “Rejection Sensitive Dysphoria in ADHD & Autism”

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References

1. Health Canada. (2025, October 31). https://www.canada.ca/en/health-canada.html
2. Beran, T., Mishna, F., McInroy, L. B., & Shariff, S. (2015). Children’s experiences of cyberbullying: A Canadian national study. Children & Schools, 37(4), 207–214. https://doi.org/10.1093/cs/cdv024
3. Cappadocia, M. C., Weiss, J. A., & Pepler, D. (2012). Bullying experiences among children and youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(2), 266–277. https://doi.org/10.1007/s10803-011-1241-x
4. Forsyth, K., Mahdal, D., Thawer, Z., Peled, M., Jones, G., Poon, C., Smith, A., & McCreary Centre Society. (2020). Balance and connection in Fraser North: The health and well-being of our youth. https://www.mcs.bc.ca/pdf/balance_and_connection_frasernorth.pdf
5. Nordin, V., Palmgren, M., Lindbladh, A., Bölte, S., & Jonsson, U. (2024). School absenteeism in autistic children and adolescents: A scoping review. Autism: The International Journal of Research and Practice, 28(7), 1622–1637. https://doi.org/10.1177/13623613231217409

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