Rejection sensitive dysphoria, or RSD, is a community and clinical term often used to describe intense distress in response to real, perceived, anticipated, or ambiguous rejection. For autistic and AuDHD people, this may include feeling criticised, misunderstood, excluded, unwanted, or socially unsafe. RSD is not currently a formal diagnosis, and autism-specific research has not yet established it as a distinct clinical construct. Research has mainly examined related concepts, including rejection sensitivity, social pain, ostracism, negative social evaluation, threatened belonging, and emotion dysregulation.¹
Current evidence suggests that rejection-related distress can be intense, embodied, exhausting, and closely linked with previous experiences of exclusion, criticism, invalidation, or misunderstanding.² At this stage, RSD is best understood as an emerging term for a recognisable pattern of rejection-related distress that research is still working to define more clearly in autistic and AuDHD populations.
What can rejection-related distress feel like?
Rejection-related distress can involve emotional, cognitive, and behavioural responses. In autism-specific qualitative research, autistic adults described rejection and criticism as overwhelming, exhausting, and difficult to move on from. Distress could include sadness, fear, anger, guilt, shame, panic, self-blame, and a strong urge to repair the relationship or understand what went wrong. ²
The response may arrive quickly and feel all consuming. Minor, ambiguous, or unexpected social events can be interpreted as evidence of broader rejection, such as being disliked, unwanted, judged, or only tolerated. Feedback may be experienced as a threat to the whole self, rather than as information about a specific task or situation. This can lead to rumination, replaying the interaction, and struggling to disengage, even when part of the person recognises that the feared rejection may not be accurate.²,³
Exclusion studies suggest that rejection-related distress may be physiologically present even when it is not clearly reported in mood ratings.⁴ People may respond by crying, seeking reassurance, apologising, becoming defensive, expressing anger, withdrawing, shutting down, masking, leaving, avoiding future contact, or becoming intensely self-critical.²
Why might it develop?
Rejection-related distress appears unlikely to develop through a single pathway. Current evidence suggests it may arise through the interaction of a number of factors including feelings of distress, intense physiological responses (for e.g. blushing, heart rate increase) repeated perceived criticism or rejection, uncertainty about the relationship, and negative self-evaluation. Many autistic and AuDHD people have experienced bullying, exclusion, criticism, misunderstanding, invalidation, or pressure to mask. Over time, these experiences may increase vigilance for signs that rejection, criticism, or disapproval is about to happen again.²,³,⁵
Autistic people may also find it difficult to know whether a change in tone, facial expression, routine, response timing, or usual social pattern means that someone is upset with them. When the reason is unclear, previous rejection may make threat-based interpretations more likely. Perceived rejection can therefore be difficult to separate from realistic memories of exclusion, relational mismatch, or being misunderstood.
Masking can reduce the immediate risk of rejection, but it may also increase exhaustion, self-monitoring, unmet support needs, and beliefs such as “I am only acceptable if I perform in a certain way.” Repeated invalidation can further contribute to low self-worth, self-criticism, and expectations of being disliked, burdensome, or wrong. Over time, these experiences may also contribute to depressive symptoms.
Some people also report repeated experiences in environments that are not socially safe, including experiences of ableism, heterosexism, racism, transphobia, or other forms of discrimination.⁶ Dating and disclosure contexts can involve ambiguity, ghosting, ridicule, or rejection after autism disclosure.⁷ Thus, these experiences suggest that rejection-related distress may be understood as a response to repeated social threat, uncertainty about where someone stands with others, and negative self-evaluation. I
What can trigger it?
RSD responses may be triggered by clear rejection, but also by uncertainty about whether rejection is happening. Commonly reported triggers include:
- criticism, constructive feedback, or being asked to do something differently
- exclusion, being ignored, disapproval, teasing, or conflict
- perceived failure, mistakes, evaluation, or social comparison
- delayed replies, cancelled plans, changed tone, unclear facial expressions, brief responses, or changes in someone’s usual behaviour
- feeling that someone is angry, disappointed, pulling away, or only tolerating the person
In qualitative research, autistic adults described distress in response to explicit rejection or criticism, ambiguous rejection or criticism, anticipated rejection, vicarious rejection, self-rejection, and invalidation.² Social exclusion tasks have been linked with threatened belonging, reduced self-esteem, and physiological arousal, while peer rejection has been associated with stronger hurt feelings in people with higher autistic traits.⁴,⁸ Dating and disclosure contexts may add triggers such as ghosting, being unmatched, ridicule, ambiguous rejection, or negative responses after autism disclosure.⁷
Feedback may be easier to process when it is constructive, respectful, and supported by enough cues to understand what the other person means.²
What do we still need to know?
RSD is increasingly recognised in community and clinical discussions, but autism-specific research is still developing. Many studies examine related experiences, such as social pain, ostracism, peer rejection, threatened belonging, or negative social evaluation, rather than RSD directly.¹
Research is still clarifying how RSD fits within broader work on rejection-related distress, anxiety, trauma responses, masking, and emotion regulation. It also needs to include autistic people with intellectual disability, complex communication needs, or high and complex support needs. Clearer language would help people describe their experiences and help clinicians, families, and supporters understand why rejection-related distress can feel so intense.
Where to from here?
Understanding RSD can help explain why rejection, criticism, exclusion, or relational uncertainty may feel so intense for some autistic and AuDHD people. Our upcoming webcast, Rejection Sensitivity Dysphoria (RSD)and Neurodivergence, on 21st August 2026, extends this further by exploring assessment considerations, relevant constructs, and practical strategies for supporting autistic and AuDHD people who experience intense rejection-related distress.
References:
Asselt, A. v., Reekers, D., & Roke, Y. (2026). Rejection Sensitivity Dysphoria in Autistic Adults: A Scoping Review. Neurodiversity, 4. https://doi.org/10.1177/27546330261441753
Asselt, A. v., Roke, Y., Begeer, S. M., & Scheeren, A. M. (2025). ‘Feeling constantly kicked down’: A qualitative phenomenological study exploring rejection sensitivity in autistic adults. Autism : The International Journal of Research and Practice, 29(11), 2703–2714. https://doi.org/10.1177/13623613251376893
Levi, M. K., Schreuer, N., Granovsky, Y., Bar-Shalita, T., Weissman-Fogel, I., Hoffman, T., & Gal, E. (2023). “Feeling unwanted, when nobody wants you around”: Perceptions of social pain among people with autism. The American Journal of Occupational Therapy, 77(2). https://doi.org/10.5014/ajot.2023.050061
Trimmer, E., McDonald, S., Kelly, M., & Rushby, J. A. (2017). The Physiological and Psychological Effects of Ostracism in Adults with ASD. Journal of Autism and Developmental Disorders, 47(8), 2326–2335. https://doi.org/10.1007/s10803-017-3146-9
Beck, K. B., MacKenzie, K. T., Kumar, T., Breitenfeldt, K. E., Chang, J. C., Conner, C. M., Mandell, D. L., White, S. W., & Mazefsky, C. A. (2026). “The World’s Really Not Set Up for the Neurodivergent Person”: Understanding Emotion Dysregulation from the Perspective of Autistic Adults. Autism in Adulthood, 8(1), 68–78. https://doi.org/10.1089/aut.2023.0214
Maroney, M. R., Chickerella, R., Coombs, E., Levitt, H. M., & Horne, S. G. (2025). “These Experiences also Relate to my Neurodiverse Identity”: An Intersectional Understanding of Heterosexist Events Among Autistic-LGBTQ+ Individuals. Autism in Adulthood. https://doi.org/10.1089/aut.2024.0326
Safran, S., Indiana University, Bloomington School of Education (2018- ), & Indiana University, Bloomington. (2025). Searching for connection : motivations, barriers, and support needs in online dating for autistic young adults [Dissertation, Indiana University ; ProQuest Dissertations Publishing]. https://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqm&rft_dat=xri:pqdiss:31769656
Lin, X., Zhuo, S., Liu, Z., Fan, J., & Peng, W. (2022). Autistic traits heighten sensitivity to rejection-induced social pain. Annals of the New York Academy of Sciences, 1517(1), 286–299. https://doi.org/10.1111/nyas.14880
