Introduction

“I want to talk to you about some feedback we’ve received.” For many, this might be a routine conversation. However, if you experience rejection sensitive dysphoria (RSD), a condition commonly found in ADHDers and also present in some autistics, such ambiguous statements can evoke intense fear and negative anticipation. The hypersensitivity to behaviors that fall within the acronym “REJECTion” (Ridicule, Exclusion, Judgment, Errors [mistakes, failure], Criticisms, and Teasing) is a hallmark of RSD.

What is Rejection Sensitive Dysphoria?

RSD is characterized by acute sensitivity to others’ REJECTion. Individuals with RSD often interpret ambiguous situations or actions, like a delayed text response, as REJECTion. The mere prospect of receiving a message can even trigger RSD if a negative outcome is anticipated. This hypersensitivity often stems from a history of interpersonal oppression, which can lead individuals to constantly self-evaluate in an effort to avoid judgment. This constant state of vigilance can leave individuals feeling perpetually on edge, bracing for potential REJECTion.

The Impact of RSD

Once RSD is triggered, individuals may become trapped in perseverative thinking – repetitive, obsessive thoughts that consume significant mental energy and lead to a downward emotional spiral. This can be particularly challenging for neurodivergents (NDs). The emotional toll can be immense, impacting self-esteem, relationships, and overall mental health.

Here are some typical symptoms associated with RSD:

• Hypervigilance: Constantly expecting REJECTion during social interactions or specific activities, even when there’s no apparent reason.
• Social Anxiety: Experiencing anxiety before, during, and after social interactions, often accompanied by perseverative thinking around REJECTion.
• Avoidance: Evading social situations and specific activities that could lead to REJECTion, including aborting interactions or quitting activities, and adopting a defeatist attitude.
• Conflict Aversion: Steering clear of conflict for fear of REJECTion, and hesitancy in setting boundaries or self-advocacy to reduce the risk of triggering REJECTion.
• Praise Aversion: Disliking praise and compliments due to the evaluative nature of statements, fearing insincerity or the potential for REJECTion.
• Suspiciousness: General mistrust of others’ intentions, often misinterpreting neutral actions as REJECTion.
• Fight-Flight Response: REJECTion, or the perception of it, triggers a fight-flight response, resulting in immediate defensive, offensive, or avoidant reactions.
• Intense Pain: Experiencing perceived REJECTion as physical pain and/or an existential crisis.
• Shame: Believing one is inherently inferior, inadequate, bad, unlikeable, unlovable, etc.
• Rumination: Dwelling on past, present, or potential future REJECTion, intensified by perseverative thinking about specific subjects or concerns.
• Self-Criticism: Engaging in relentless self-criticism.
• Over-Responsibility: Feeling responsible for others’ emotions and engaging in people-pleasing to avoid potential REJECTion.
• Self-Harm: When triggered, can become preoccupied with thoughts of self-harm and/or suicide, and may act on those thoughts.

Avoidant Personality Disorder: An Overview

Research indicates that 19% of ADHDers and 25% of autistics meet the criteria for avoidant personality disorder (AVPD). AVPD is a mental health condition similarly characterized by chronic feelings of inadequacy, extreme sensitivity to negative evaluation, and a pervasive fear of social REJECTion. Individuals with AVPD tend to avoid social interactions and new experiences because of their intense fear of being REJECTed. This avoidance can lead to significant social isolation and hinder personal and professional development.

Those with AVPD often struggle with mentalization – the ability to understand the mental states of oneself and others. This difficulty is also observed in autistics, suggesting a possible co-occurrence of autism and AVPD. 

Coping Strategies for RSD and AVPD

1. Mindfulness and Self-Awareness: Practicing mindfulness can help individuals become more aware of their emotional triggers and reactions. This awareness can reduce the intensity of emotional responses and help manage RSD and AVPD symptoms.
2. Therapeutic Interventions: Cognitive behavioral therapy (CBT) and other therapeutic approaches can provide tools to challenge negative thought patterns and develop healthier coping strategies. Therapy can also address underlying attachment issues contributing to AVPD.
3. Building Support Networks: Having a supportive network of friends, family, or support groups can provide a safe space to discuss experiences and feelings. This support can reduce feelings of isolation and provide validation and encouragement.
4. Self-Compassion: Practicing self-compassion involves treating oneself with kindness and understanding, especially during difficult times. This can help mitigate the harsh self-criticism often associated with RSD and AVPD.
5. Gradual Exposure: Gradually exposing oneself to social situations and new experiences can help reduce the fear of REJECTion. This process should be done at a comfortable pace, allowing individuals to build confidence over time.

The Importance of Understanding

Understanding RSD and AVPD is crucial for developing effective coping strategies. Recognizing the impact of these conditions on mental health and relationships can lead to better support and treatment options. For those affected, knowing they are not alone and that there are ways to manage their symptoms can be empowering.

Concluding Thoughts

RSD and AVPD are both marked by intense emotional responses to perceived REJECTion, often leading to significant distress and avoidance. Recognizing the symptoms and underlying causes of these conditions among autistics and ADHDers is crucial for developing effective coping strategies. By understanding and addressing these conditions, we can improve mental health outcomes and support the well-being of individuals affected by RSD and AVPD.