Rejection Sensitive Dysphoria (RSD)
What It Is
RSD is an intense emotional response to perceived or actual rejection, criticism, failure, or exclusion. The emotional pain is described as overwhelming and out of proportion by the person experiencing it — not a choice, but a neurological response.
How It Presents in Autistic People
In autistic people, RSD may contribute to school refusal, avoidance of new activities, difficulty accepting feedback, intense reactions to perceived social failures, and withdrawal from relationships. It can be mistaken for manipulative behavior.
Treatment and Support
Alpha-2 agonists (guanfacine, clonidine) used for ADHD have some evidence for RSD. Therapy focused on cognitive reappraisal and identifying RSD triggers supports management. Understanding that RSD is neurological — not character — reduces shame and enables more effective coping.