“We need to talk.” This simple phrase is generally harmless, and is really quite neutral.
But, for some people, hearing these words can cause deep and intense waves of anxiety and stress. This can result in excessive and unwarranted avoidance, fear, and a deep-seated need to somehow make things right (even though there may well be nothing wrong in the first place)!
People who experience rejection sensitivity dysphoria (RSD) are among those who experience even the slightest hint of a possibility of criticism as being a deep psychological wound. Many people with neurodiverse profiles, including those who have diagnosed attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) often report that they also experience RSD.
If you have been spending any time recently on the Internet (and really, who hasn't?) you have likely come across the phrase rejection sensitivity dysphoria (RSD). RSD is gaining traction in the world of online wellness influencers, and has caught particular traction in relation to those who have neurodiverse presentations. Specifically, according to many online podcasters and TikTok stars, RSD is an intangible and intense emotional reaction that is very common among neurodiverse individuals. It has been likened to an “emotional sunburn” by some. However, there is little clinical research to support this notion. That said, RSD certainly has a number of characteristics that appear to resonate with many people with ADHD and other neurodiverse presentations.
RSD is not a diagnosable condition and, as noted, has limited research to support its validity. From a clinical perspective, however, RSD appears to have a great deal of “lived experience” support amongst those who are neurodiverse. Specifically, RSD is a very intense negative reaction to even minor factors related to rejection. People with neurodiverse backgrounds, logically, can have a great deal of fear of rejection and negative experiences. Often, these people have been rejected over critical years of development by educators, parents and other family members, peers, employers, and so on. Over time, this sensitivity becomes hyperintense, and can result in extreme depression, avoidance, anxiety, and fear.
Most of us have experienced rejection at some level somewhere along the line. The job we interviewed for went to someone else. The person we asked for a date said no. Our request for something from a parent or other caregiver was not accepted. People with ADHD and similar neurodiverse presentations take such rejections highly personally, and, again, the degree of intensity with which they experience such rejection is very high, making them resistant to even trying anything that pertains to risk. For many with presentations of RSD, they have a very strong tendency to become people-pleasers. In their attempt to avoid rejection, they become very willing to accept unwanted or, in some cases, abusive behaviors from others in a desire to be liked and to avoid rejection.
The avoidance of risk for those who experience RSD inhibits the individual's ability to learn from mistakes and to truly live a fully experienced life. They live in a world in which they try to be safe, but in doing so, miss most of the pleasurable experiences of being a human who is not perfect. In fact, perfectionism can also be a factor related to RSD which makes risk-taking highly unlikely.
The other significant factor in relation to RSD is people-pleasing. We all know people who are people-pleasers, and perhaps you are one yourself. We struggle to learn that pleasing others is a futile effort and will never be an achievable goal, which makes us feel like failures and again, results in unpleasant emotional reactions.
RSD does appear to have a relationship with neurological functioning, although there does not appear to be a causal relationship between the two. We also know that people who have experienced significant trauma such as physical, sexual, or emotional abuse or witnessed such things happening in the early childhood years are more prone to experience RSD. For many, understanding these roots can be helpful in the same way that understanding that RSD, while not a clinical diagnosis, is a syndrome of thinking and behavior that is maladaptive.
There is some evidence that some anxiolytic medications may be helpful, as may some antidepressants. As with many psychological syndromes, psychotherapy combined with medication is often the optimal approach, and a focus on developing more healthy behaviors can also be helpful in reducing some of the intensity associated with RSD. The usual recommendations that are always good recommendations around a healthy diet, exercise, and good sleep habits are true for RSD, as they are for many other psychological challenges.
A specifically useful recommendation is to develop a modified way of thinking about a learning orientation when making mistakes. Making mistakes, reflecting upon our mistakes, and learning to alter our thinking and behavior to prevent us from repeatedly making the same mistakes is normal, healthy, and is perhaps the best form of learning we have! RSD keeps us from learning and causes pain, so it is really a zero-sum mindgame we play with ourselves. The goal often is to make risk-taking more likely and people-pleasing less important.
Brent Macdonald, PhD, is a psychologist with Crux Psychology and a long-time contributor to Calgary’s Child. He can be reached at
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