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On Rejection Sensitive Dysphoria

Yeah, there's a term for that and actually a ton of people experience it!
Rejection Sensitivity, sometimes referred to as Rejection Sensitive Dysphoria or RSD, is a condition that seems to crop up a lot in neurodivergent people. Basically, we experience really intense feelings of deeply personal rejection when we feel like other people are in any way disappointed in us. Seriously, it’s beyond disappointment or fear, it cuts to the core of you and makes you feel like you shouldn’t even exist. It’s that strong, and it’s something that a lot of people are shocked to read about because they’ve always assumed they were the only ones dealing with it.
Nope. But it hasn’t been well-studied so you won’t hear about it from by-the-book medical-model therapists or psychiatrists yet; you mostly hear about it from neurodivergent people online who are comparing their own experiences. This essay is my contribution to that chorus.
So: we don’t really know what’s going on with Rejection Sensitivity, but there are two primary schools of thought. One says that this is a trauma response; one says that this is an innate sensitivity that simply comes with a variety of neurodivergent conditions. Personally I’ve wobbled back and forth between these two models and currently suspect they both contribute — so let me step you through the two models.
Model 1: Rejection Sensitivity as a Learned Behavior
Studies have shown that kids with ADHD are corrected up to 13x more frequently than their neurotypical peers. Nobody has studied autistic kids but you’ve gotta figure it’s at least that high. This means that a much higher percentage of our interactions with caregivers and peers consists of them telling us to do things differently.
Really think about that: a significant percentage of all social interactions that ND kids experience consist of them being corrected, told they’re doing something wrong, asked to behave or think or speak differently, etc. This theory argues that these cumulative corrections become traumatic, and that eventually to people raised this way the very idea of being corrected brings up feelings of childhood powerlessness and causes an emotional flashback.
(Note that the “rejection” in Rejection Sensitivity is specifically a perceived rejection. RSD can be triggered by any number of totally innocent interactions that were in no way actual rejections but which were interpreted as such by someone primed for rejection. That makes this really hard: a lot of times my RSD is triggered because I’ve projected way too much meaning onto something someone else has said, for instance.)
A lifetime of this adds up. You become deeply sensitive to the idea that someone around you may be unhappy with something you’re doing. You probably become a people pleaser - you start trying to anticipate the corrections and acting on them before you have to hear them. You get good at it, actually - people comment on how thoughtful you are, how intuitively you understand them and anticipate their needs. And you feel good because you’ve “earned’ another day of existence, but deep inside you have learned to center your worth on how other people feel about you.
So then because your self-worth gets situated in the approval of others you are in a position where you can lose your self-worth when you lose that approval. This is a really toxic and dangerous place to be — it leaves you vulnerable to peer pressure, abuse and all kinds of exploitation because you’ll do anything to “earn” back your self-worth from the people in your life who may be withholding their approval for any number of reasons.
Rejection Sensitivity, under this model, is what we call it when you lose someone’s approval and as a result lose your sense of self-worth. This makes a ton of sense!
Except that under this model there’s a testable hypothesis: we would expect rejection sensitivity to show up in adulthood because that’s when traumatic childhood experiences manifest in behavior. We would not expect to see children — especially very young children — exhibiting signs of rejection sensitivity because they have not yet had the time to build up the trauma and decenter their sense of self.
But as anyone who has ever played with neurodivergent toddlers can tell you they absolutely seem to experience rejection sensitivity at least as strongly as adults. So that leads to model number two...
Model 2: Rejection Sensitivity as Neurodivergence
So maybe Rejection Sensitivity is part of the neurodivergent profile. Under this model we would perhaps argue that just as ND people can be sensitive to light or sound or touch we can also be sensitive to emotions. That emotions are in fact a type of sense, one which informs you of internal state changes instead of external ones. (See for more about this), and that a lot of ND people are particularly sensitive to feelings of rejection in the same way that a lot of us are sensitive to loud noises.
This theory makes a lot of sense to me as well — as an ND individual I seem to experience most emotions more strongly than the people around me, and rejection is definitely in that camp. It’s possible that this is simply one more highly variable neurodivergent trait, where some ND people are highly sensitive to it and others are less sensitive to it than the baseline.
If this is the case we should see plenty of ND people who don’t experience RSD (and we do, it’s not everyone) and we should probably see some ND people who are particularly immune to social pressure and don’t experience RSD at all (and we definitely see this too: “immune to social pressure” is practically a folk diagnostic criteria for autism, for instance.)
So why do some ND people experience rejection sensitivity so strongly and others don’t seem to be bothered at all?
My Current Thinking
RSD is probably something that’s based in hyper-sensitivity to strong feelings, and trauma probably makes those particular strong feelings more likely to appear. The “cure” for RSD is to show up and be enough for yourself — to realize that even if everyone in your life abandons you and rejects you you can still be enough for you, and in fact have to be.
So like, I think it’s an emergent condition informed by both of these models intersecting. I think when you learn not to center your identity and self-worth on other peoples’ approval you are far less likely to experience intense, ND-enhanced, overwhelming feelings of rejection. That’s easier said than done, but it is the way forward.
A Note on Recovery
Recovery is possible, but the work is uncomfortable. It looks like practicing saying “no” and not explaining yourself to people you love. (Did your heart catch in your chest at the thought of that?) It looks like disappointing someone who then gets angry at you and practicing remembering that that anger is not for you to hold, it’s for them to deal with appropriately. It looks like learning to notice and then intercept the thought “I’m worthless” when someone is upset with you, and challenging and replacing that thought with “I have intrinsic value”.
These are things that can be done, but it’s slow. Be gentle. Get a friend or loved one to help you practice, or better yet a trauma-informed therapist (just be prepared to pay through the nose for an out-of-network specialist). Observe the patterns that you’re following, observe the beliefs that arise, and then without applying any kind of emotional judgment simply evaluate these beliefs to see if they’re true. Likely they’re blown way out of proportion.
Good luck, you’ve got this! :)

Comments about On Rejection Sensitivity
Who are you?
Learning about this has been very helpful to me. I have spent whole days dealing with intense pain over disappointing someone who isn’t even that close a friend. The last time it happened, I was able to view it as my brain telling me something that isn’t true. It didn’t make the pain go away immediately, but it helped, and I think the simple act of naming it has helped me cope better in general.
I discovered RSD only in the last year or so and it has made so much sense of our family dynamics. I have wondered about the roots of it as well, and your perspective is in line with my own suspicions. I can see the origin of my own RSD in significant rejection by a parent in early childhood. On the other hand, my daughter, who has grown up in an accepting, loving family, has shown extreme sensitivity to things like perceived negative tone of voice from a young age, even without as many obvious rejections in her life. We're an entire family of NDs trying to learn to manage these big emotional reactions.
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