Rejection sensitive dysphoria and its connection to Autism

By the time I reached my late teens, I couldn’t walk through the local shopping centre without feeling like everyone was laughing at me.

That I had never met these people didn’t matter. That they were occupied with others in their own circle of friends, never crossed my mind. That they only looked at me because I looked at them first – not an unusual human response – wasn’t a factor. They were laughing and I was walking by so ipso facto they were judging and mocking and laughing, at me, and they wouldn’t stop.

It slayed me inside. I would hurry past with my head down, heat radiating through every corpuscle, wishing for the moment to be over.

I had only gone out to buy a CD, or some new tennis balls, maybe drink a vanilla milkshake.

But now everything was ruined. I couldn’t stop and look at anything, buy anything, enjoy flavoured milk!

This is an example of rejection sensitive dysphoria (RSD) as I know it, and how it has affected my life. RSD is a term I have only learned recently, but it’s something I now realise has coloured many of my interactions and experiences.

And it affects a lot of Autistic people.

What is rejection sensitive dysphoria?

The term ‘rejection sensitive’ relates to intense emotional responses or emotional dysregulation typically caused by real or perceived rejection, criticism, or teasing, while the general definition of ‘dysphoria’ is a state of feeling very unhappy, uneasy, or dissatisfied with life.

The original Greek dusphoros translates as ‘hard to bear’, or ‘unbearable’, which I believe better does its impact justice.

Formal definitions aside, to me RSD is a very normal response to living in a world that doesn’t accept anything beyond an incredibly narrow set of acceptable behaviours and standards.

If you’re Autistic, and/or have ADHD, or any other neurological or physical difference, and you spend your entire life on the receiving end of ableism, and, as a result, suffer from internalised ableism yourself, how can you not experience RSD?

Add to that, being born into this world a sensitive person, with an abundance of empathy (in stark contrast to what some would have you believe about us Autistic types), and you’re really asking for it.

It’s as if all the conditions throughout my life had conspired to guarantee I experienced RSD.

At the time of writing this article (late 2023), no official diagnosis exists for RSD. (Which does make me wonder what all the psychiatrists are doing – something else I’ll be writing about in the coming weeks.)

Instead, according to Dr. William Dodson, a prominent ADHD clinician, and the first person to use the term RSD, it is: “…one of the most common and disruptive manifestations of emotional dysregulation.”

You don’t have to be Autistic to experience RSD, and not every Autistic person does experience it. Further, some people who do experience RSD are not Autistic or neurodivergent in any other way at all.

If you do experience RSD in your lifetime, you will typically display or experience some or all of the following features (it’s a long list! 😟):

• Perceiving criticism or feedback as rejection
• Feeling embarrassment or deep-seated shame
• Perceiving light-hearted teasing or playfulness as rejection (even though you may do the same)
• Misreading / misinterpreting others’ emotions or comments
• Difficulty reading tone
• Social anxiety
• Emotional lability
• Persistent, general irritability
• Acute memory of past rejection
• Fostering hyper-awareness of potential triggers, often leading to pathological demand avoidance
• Responding to feedback with anger or emotional outbursts
• Possessing low self-esteem or self-worth
• Being told that you are “too sensitive”
• Being a “people pleaser” and second guessing yourself
• Replaying social situations in your head to figure out what you did “wrong”
• Avoiding getting too close to people
• Fearing disappointing others or making mistakes (perfectionism)
• Constantly asking for reassurance from others
• Sadness and hopelessness
• Intense sensory and emotional reactions
• Fearing being judged by others even when doing everyday activities

Alexithymia, a condition where people have problems recognising their own emotions, may further exacerbate the experience of RSD in Autistic people. [Note that I’ll be covering the broader topic of ‘Interoception’ very soon.]

Research indicates 40-65 percent of Autistic people have alexithymia, compared to only 4-13 percent in the general population.

RSD is not the same as PTSD, social anxiety, or depression. But it may lead to one or all of these associated conditions.

Importantly, if you do experience RSD, it doesn’t mean that you’re to blame for everything that’s wrong in your life and within your relationships, despite what some people might tell you.

As I have mentioned above, and in stories throughout this website in my efforts to raise awareness about the unique challenges and struggles faced by Autistic and neurodivergent people in general, ableism, rife as it is in our societies, sets many of the conditions for RSD to flourish.

There will always be people ready to step forward and tell you that the way you are feeling and thinking is “wrong”, rather than looking more deeply, acknowledging your reality, and encouraging you to look for constructive and possibly life-altering answers.

Unrealistic expectations, ignorance, and ‘gaslighting’ (a form of coercive control) can mean that the people around you who don’t experience RSD, who you believe are on your side and should be supporting you, will instead be contributing to a potentially broader issue.

When you’re in the thick of it, it can be difficult to rationalise where the truth begins and fiction ends, which is why when it’s safe to do so, you should always leave unhealthy relationships, and seek professional medical intervention.

What does rejection sensitive dysphoria look like?

For as long as I can remember, I have always felt like I was either “in trouble”, or about to get “in trouble”. Whether this is the reality or not, even to this day I can’t tell you.

As a child, I did get scolded a lot by my parents. Usually for teasing my sister, or for being too boisterous during the 6 o’clock news. I remember, on numerous occasions, being sent to my room and slamming the door and tearing at my bed covers and (yes mum and dad) removing the fly screen and running into the back yard (to do what, I’m not sure). But after less than a minute, I would always jump back through the window, replace the fly screen, and straighten the bed covers for fear of getting into even more trouble.

I remember always living in fear of doing the “wrong thing”, at home and at school, and I know that made me a very shy, skittish kid.

If somebody didn’t want to do something with me, I immediately jumped to the conclusion that they mustn’t like me (and maybe they didn’t!) because of some inherent, inescapable flaw.

I’m talking here about my actual friends, people that on my better days I knew did like me. But their telling me they were busy with their own families on the weekend and so couldn’t play, turned into the ultimate rejection – it was, for me at the time, the proverbial ‘end of the world’.

Once, when I was around 10 and a friend of mine had slept over, I was inconsolable when he said he couldn’t stay for a second night. I remember crying and yelling and the contorted look on his face as he watched me implode in front of him.

I was also petrified of ever asking a girl out. For the high school formal, I waited until the latest conceivable moment before asking someone (I won’t name her here, but I do remember her name) to go with me for fear her, or anyone else that I asked, would say no, and that the rejection would end me.

This was gut-twisting, head-screwing fear. Paralysing fear. The type of fear someone probably and very reasonably has before they go off to war.

As the years passed and I entered my 20s, these feelings didn’t improve. In my early romantic relationships, it caused many issues, to the point that I decided I would rather be single, be alone, than have to deal with my thoughts and my feelings in relation to someone, anyone, else. Solitude became my sanctuary.

Even today, this very day, if someone takes longer than I expect to reply to an email or a text, or they give short answers to my questions, or they’re quiet, or show any sign of a shift in mood at all, I can feel intensely insecure and immediately believe that something’s wrong, and that I am most likely the root cause of any issue.

Often these feelings appear like a burn or a nick with a knife – a physical wound that needs immediate dressing. I might therefore feel the need to question or confront someone over what has, or hasn’t, happened, to stop the bleeding, and this generally only causes more problems.

Coping with rejection sensitive dysphoria as an Autistic person

If you’re Autistic and you do experience RSD, you will also most likely find it incredibly difficult to ‘rebound’ from particular situations.

More than once it has taken me days or even weeks to recover from a misunderstanding with a colleague in the workplace (when I was working, of course), when I know that for them the matter is usually long forgotten.

However, with hard work and a measure of self-awareness, things can get better.

At some point in my life’s journey, and long before my Autism diagnosis, I did come to realise that I am not actually responsible for the way another person may be feeling, and that has helped bring me some amount of solace.

Likewise, these days, with my efforts to unmask and to listen to my intuition, I can and often do better rationalise that quietness in my wife, for example, is just that – and not the result of some earlier (long forgotten) altercation. (Although in this specific example it might be that my wife is quiet because of something I’ve said or done – I am sometimes an oafish male, and we have been together for a long time now. 😉)

Having said that (glibly), my wife is actually one of the main people helping me work through and reduce my instances of RSD, as is my clinical psychologist.

Open communication is the key. With my wife that might look like her telling me how she’s feeling, including letting me know about anything during the day that might have upset her or caused her to go quiet. It also includes debriefing with myself about the day’s events, my observations, my feelings, and my reactions, and, qualifying anything that I need to.

This level of communication, with anyone and in any relationship, goes a long way towards helping provide the RSD sufferer perspective, and to resolving any issues.

Like most things in life for an Autistic person, moving from a position of feeling like you lack acceptance and validation, to one where you feel supported and valued for who you genuinely are, is vital to achieving better outcomes and better overall health and well-being moving forward.

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