The Neurodivergent's Guide to Rejection Sensitive Dysphoria

RSD isn't simply being "too sensitive" (despite what well-meaning but misinformed people might tell you).

So, you're in a meeting when your manager says, "Can I give you some feedback?" Your stomach drops. Your chest tightens. Your mind races to catastrophic conclusions before they've even spoken another word.

Or perhaps you send a slightly vulnerable text to a friend, and when they don't respond within the hour, you're convinced you've somehow ruined the entire relationship.

If these scenarios feel painfully familiar, you might be experiencing Rejection Sensitive Dysphoria (RSD) – a neurobiological response that's particularly common in neurodivergent brains.

What Is RSD, Really?

RSD isn't simply being "too sensitive" (despite what well-meaning but misinformed people might tell you). It's a genuine neurobiological phenomenon where perceived or actual rejection triggers an intensely painful emotional response.

Think of it as wearing your nervous system on the outside of your body rather than safely tucked away beneath skin and muscle. Everything feels raw, exposed, and intensely vulnerable.

For neurodivergent folks – particularly those with ADHD and autism – RSD can be a daily companion. Research suggests this heightened sensitivity to rejection may stem from differences in how our brains process social information and emotional stimuli. Areas of the brain that register emotional pain actually overlap with those that register physical pain, which explains why criticism can quite literally hurt.

My RSD Story: From Baffling Pain to Understanding

I remember sitting in my car after a team meeting, tears streaming down my face, completely unable to drive home. My manager had made a small suggestion about a report I'd written – nothing harsh, nothing personal – yet I felt utterly devastated. Worthless. Exposed.

"What is wrong with me?" I wondered for the thousandth time. "Why can't I just take feedback like everyone else?"

For 47 years, I lived with these overwhelming responses to perceived rejection without understanding why. As a mental health nurse, I could support others through emotional challenges with compassion and clarity, yet my own reactions to criticism felt bewilderingly intense.

Then came my ADHD diagnosis, and with it, an introduction to Rejection Sensitive Dysphoria. I still remember reading about RSD for the first time – the physical symptoms, the cognitive spirals, the intense shame – and feeling a profound sense of recognition. This wasn't a character flaw; it was a neurobiological response that made perfect sense given how my brain was wired.

I recall one particularly illuminating moment working with a client who described her RSD experiences. As she spoke, I found myself nodding along with such vigour that she paused and asked, "You get it too, don't you?" That genuine connection – the shared understanding between two neurodivergent minds – sparked something in me. What if I could transform this painful personal experience into something helpful for others?

The RSD Experience: More Than Just Feelings

RSD isn't merely emotional – it creates a full-body response:

• Physiologically: Your heart races, breathing becomes shallow, muscles tense, stomach churns (hello, vagus nerve activation!)

• Cognitively: Your thoughts spiral into shame narratives and worst-case scenarios

• Behaviourally: You might withdraw, people-please, perfectionism-spiral, or lash out defensively

Many of my neurodivergent clients describe RSD as "emotional quicksand" – the more they struggle against it, the deeper they sink.

Why Traditional Advice Falls Flat

"Don't take things so personally" "You're overthinking it" "Just focus on the positive"

If you've heard these well-meaning but utterly unhelpful snippets of advice, you'll know they're about as useful as telling someone having an asthma attack to "just breathe normally." They fundamentally misunderstand the neurobiological nature of RSD.

I still wince remembering a former colleague who, after witnessing my disproportionate reaction to some feedback, advised me to "just grow a thicker skin." I smiled weakly while mentally calculating how many layers of skin I'd need to grow to stop feeling like I'd been emotionally flayed alive. Roughly the thickness of a rhinoceros hide, I reckoned.

What I actually needed – what we all need – was understanding and practical tools designed specifically for our neurodivergent brains.

A Different Approach to RSD

After 30 years as a mental health nurse and interpersonal psychotherapist, combined with my lived experience, I've discovered that managing RSD effectively requires a three-pronged approach:

1. Rewiring your automatic thought patterns through targeted awareness

2. Stabilising your nervous system when triggered

3. Desensitising yourself to rejection triggers over time

Let me share a small glimpse into each area:

Rewiring

Our neurodivergent brains create neural shortcuts – when something triggers feelings similar to past rejections, your brain efficiently jumps to "DANGER: REJECTION IMMINENT" before your conscious mind has processed what's happening.

A simple but powerful rewiring technique is the 90-second pause. When you feel that familiar RSD surge:

1. Notice the physical sensation first (racing heart, tight chest)

2. Say to yourself: "This is my RSD response activating"

3. Breathe slowly for 90 seconds without attaching to thoughts

4. Only then assess the situation

This creates a tiny gap between trigger and response – a gap that can expand with practice.

I use this technique myself during therapy sessions when I sense a client might be dissatisfied with our work together. Instead of immediately launching into anxious people-pleasing mode (my default!), I pause, name the sensation, and breathe. It doesn't eliminate the discomfort, but it gives me space to respond thoughtfully rather than reactively.

Stabilising

Your body's state directly influences your emotional experience. When rejection hits, your autonomic nervous system activates instantly, flooding your system with stress hormones.

One quick stabilisation technique is the "vagal brake," which activates your parasympathetic nervous system:

1. Place one hand on your heart

2. Exhale slowly through slightly pursed lips (as if cooling soup)

3. Make your exhale longer than your inhale

4. Feel your feet firmly grounded

This signals safety to your nervous system, reducing the intensity of the RSD response.

I remember using this technique after receiving an email that triggered my RSD spectacularly. It was a simple message from a colleague questioning an approach I'd suggested for a client. Nothing dramatic – just normal professional discourse – yet I felt physically ill reading it.

I stepped away from my computer, placed my hand on my heart, and focused on lengthening my exhale. Within minutes, I could feel my heart rate slowing and my shoulders dropping from around my ears. The trigger hadn't disappeared, but its grip on my physiology had loosened enough for me to respond professionally rather than from a place of panic.

Desensitising

Through gradual, compassionate exposure to triggers, we can reduce their power over time. This isn't about forcing yourself into uncomfortable situations, but rather creating a gentle ladder of exposure paired with self-compassion.

For example, if criticism in meetings triggers you intensely, you might start by:

1. Imagining receiving mild feedback while practicing regulation techniques

2. Role-playing feedback scenarios with a trusted person

3. Gradually working up to real-world situations

With each experience where you remain regulated, your brain updates its prediction: "Maybe this isn't as dangerous as I thought."

RSD Isn't Your Fault, But It Can Be Your Project

Living with RSD as a neurodivergent person can feel exhausting, but it doesn't have to dominate your life.

While we can't eliminate rejection sensitivity completely (nor would we want to – sensitivity has many gifts), we can significantly reduce its impact through targeted techniques designed specifically for neurodivergent brains.

This is precisely why I've developed my new mini-course, "Soothing RSD: Rewire, Stabilise, Desensitise." It distills decades of professional expertise and lived experience into practical, accessible tools that actually work for neurodivergent folks.

The course includes bite-sized videos, downloadable PDFs, and audio practices designed to fit into your life without overwhelm. No toxic positivity, no "just get over it" – just genuine understanding and strategies that acknowledge the real neurobiological differences in how our brains process rejection.

Creating this course has been deeply personal for me. Each module reflects not just my professional knowledge, but techniques I've personally tested in the trenches of my own RSD experiences. The havening technique I teach? That's what got me through a particularly brutal bout of RSD after a tricky roundtable workshop where I felt I had said too much. The thought-reframing exercises? They've helped me rewrite the inner narratives that once kept me trapped in shame spirals for days.

If RSD has been stealing your peace and confidence, know that there are tools that can help. You don't have to live at the mercy of others' words and actions.

Your sensitivity isn't a flaw – it's part of your neurodivergent wiring. But with the right approaches, you can transform RSD from a controlling force into simply one aspect of your richly textured neurodivergent experience.

If you're interested in learning more about the "Soothing RSD" mini-course, you can find details [here]. $47 for lifetime access to all materials.

What's your experience with RSD? I'd love to hear in the comments!