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Rejection Sensitive Dysphoria and Autism: Is There a Link?

December 22, 2021


An overview of rejection sensitive dysphoria, a condition that causes an intense emotional response to real or perceived rejection, and its possible connection to autism spectrum disorder.

Rejection Sensitive Dysphoria and Autism: Is There a Link? https://www.autismparentingmagazine.com/autism-dysphoria-link/

I watched in slow motion as my son Owen fell head first into the side of the open french door. The blood curdling screams that followed were nothing compared to the anger that erupted from his little body. He had been having so much fun, just moments before, as he chased his best friend Lilith around the living room.

I expected him to be upset, he was obviously hurt, but what he was angry about the most baffled me. He started yelling at Lilith and me, exclaiming that Lilith made him fall and it was all her fault.

As I said before, I had watched the whole thing, Lilith had done nothing wrong. Yet, Owen, convinced she hurt him on purpose, refused to even speak to her, even as she and her mother left our home.

Lilith was in tears saying she was sorry over and over. Owen, his back turned to her, continued in his outrage all the way to his room and slammed the door.

Many of the most challenging situations parents of autistic children face are the result of misunderstandings in social situations that can really hurt their children. Feelings of helplessness can take over when people in your child’s world misinterpret their intentions, actions, words, or tone of voice. This often results in emotional pain and is truly heartbreaking.

Not being able to bridge the gap of communication for our children on the spectrum to make an already difficult world just a little easier is frustrating. We just want our children to be understood and valued, and any threat to this goal is worth fighting if at all possible.

But what happens when it is our child’s misunderstanding of social cues that is threatening them? What happens when our child is deeply disturbed or hurt by something they perceive to be happening, but actually isn’t? What if these misinterpretations cause an extreme emotional reaction which hinders them from forming lasting relationships with friends and family?

Children with rejection sensitive dysphoria (RSD) can experience just that. This article deals with the realities of RSD and how it can interfere with the lives of children on the spectrum.

What is rejection sensitive dysphoria?

Rejection sensitive dysphoria is a condition that causes an intense emotional response to real or perceived rejection. Children with RSD tend to have extreme emotional sensitivity, leading to low self esteem and social withdrawal. 

A perceived slight may lead them to treat their friends, family, or a romantic partner badly. Damage to the relationship could mean their loved one actually begins to turn away from them.

The term dysphoria comes from a Greek word meaning “hard to bear”. While no one likes rejection or being offended, individuals with RSD literally find it unbearable in the extreme.

What does rejection sensitive dysphoria feel like?

While none of us want our child to experience pain, knowing the pain could be avoided by a simple understanding of social cues, yet being able to help them understand can be especially difficult. For the child, the emotional pain is debilitating.

For all human beings, the need to connect with others is of utmost importance. Though technically someone can physically survive a solitary existence, happiness, another primary need, may be greatly reduced. Therefore, the existence of RSD is a threat to happiness and the ability to survive on a basic human level.

A person with RSD may have an overwhelming emotional response to their RSD symptoms, which could cause them to react in an aggressive manner. Emotional regulation is incredibly difficult for someone with RSD, and may leave them at the mercy of their symptoms. Official symptoms could include:

  • an overwhelming sense of being purposely excluded, even if the other person didn’t even know they wanted to be involved
  • intense anger
  • “irrational” fear
  • feelings of worthlessness
  • refusing to acknowledge or respond to the person who they feel hurt them
  • reacting to accidents as being the other person’s fault
  • outrage at others for not interceding on their behalf
  • uncontrollable outbursts of tears, yelling, or throwing things when they believe they have been wronged
  • hitting, biting, or running away (a result of the fight or flight response being activated)
  • being people pleasers (to avoid RSD episodes related to criticism or actual rejection)
  • social phobia, social withdrawal
  • being over sensitive in social settings

Of course this list is not complete. No two people are alike. How they deal with their feelings could be different and could also be affected by things like age, high or low functioning social skills, ability to reason, and the level of relationship they may have with others involved.

For example, a child with RSD may react differently to a parent who they feel has wronged them, than they would a new friend.

What does RSD look like to others?

Symptoms of rejection sensitive dysphoria can have a wide range of consequences in relationships with others. A person may view the actions or inactions (such as refusing to talk to or be around them) of a child with RSD as being spoiled, rude, hurtful, or all of the above. Attempts to explain our child’s behavior can often be written off as excuses.

Teasing is one way RSD episodes are triggered. Many family members enjoy teasing quite a bit. A child with RSD may misinterpret teasing as criticism and take it personally. They may also be easily embarrassed and lash out.


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The family members may identify it as the child being overly sensitive, and tell them they are being ridiculous, not realizing that it is a big deal and has a deeper root cause. These instances can have a snowball effect on the child’s mental health.

It is understandable to want to facilitate our child’s relationships with others. Often this requires us to foster understanding on both sides of the equation.

The way each person behaves can lead to actual rejection, fear, criticism, and loss of friendships. If the other person views the way your child behaves as offensive, how they handle it matters. If the other person is actually behaving in a way that is hurtful, it is important that our child with RSD understand the difference.

Having a private conversation with the adult, parent of a friend of our child, the friend, and our own child separately and together may be a good idea. This can help resolve misunderstandings and can help establish boundaries, trust, and restoration to relationships.

Possible Dangers of RSD

The emotional response to rejection, real or perceived, can have serious consequences. A child that reacts with rage may accidentally hurt themselves or others in their anger. There is a flip-side though, which I feel is important to mention.

Sometimes a child with RSD will try to people please. This can be a response to overwhelming emotional reactions to possible rejection. This can be taken advantage of by other children, as well as adults.

Rejection sensitivity and emotional dysregulation can lead to possibly dangerous situations. Educating our children on what is ok and not ok when wanting to be nice to someone else is especially important when dealing with romantic relationships, interactions with other adults, and peer pressure type situations.

It is important to remember, some people are unwilling to understand, and their behavior is important, too. We don’t owe anyone access to our children if they will not put their best interest at heart, or cause harm to them.

How is Rejection Sensitive Dysphoria linked to autism?

RSD’s link to autism is similar to other conditions that are not direct symptoms of autism, but rather, commonly occur in individuals with autism or other neurodivergences. Conditions such as Attention Deficit Hyperactivity Disorder (ADHD), commonly linked to autism, is often, and almost exclusively associated with RSD symptoms.

The link between ADHD and RSD is widely known. The link between autism and ADHD is also widely believed to be real. It would stand to reason then that the link between autism and RSD is also real. The studies seem to be inconclusive in their quest to prove it.

People on the autism spectrum often have difficulty reading social cues, such as facial expressions and body language, that neurotypical people understand more quickly. Because of this, a person who is on the spectrum of autism, presenting with RSD, may have extreme reactions to what they perceive when reading another’s demeanor. Meanwhile a person on the spectrum without RSD may have a more typical reaction to the perceived emotion detected.

If a child on the autism spectrum also has ADHD or RSD or both, the symptoms of each can have a profound effect on their mental health, and on their relationships in general.

Is there treatment available for RSD?

Treatment for RSD begins with a visit to a licensed mental health professional. Though an official diagnosis may not be possible as rejection sensitive dysphoria is not a medical diagnosis, symptoms can be analyzed, and can result in connections with professionals who can provide medical advice.

What can parents do to help with their child’s symptoms?

Personally, while researching this topic, I became aware of ways my son Owen deals with perceived rejection, extending to his family. He cannot handle it if he thinks a member of his family is hurt by someone. His reactions confused me before I knew RSD existed and believed it affected my kid.

One day I was speaking with my sister about getting a tattoo. I was very excited about it. When I got off the phone my son said: “Mom, please don’t get a tattoo.” Before the words were all the way out of his mouth he was sobbing uncontrollably.

It never occured to me that he would take it so personally, and be so worried for pain it could cause me. Once I explained it to him, he felt better about it.

Sometimes all it takes is a bit of understanding. How we respond to our children with RSD can go a long way to helping them overcome their symptoms in each situation.

Rejection sensitive dysphoria causes reactions, not just responses. The child is reacting to the feelings they are having. Understanding this can help us teach them how to respond appropriately when they are experiencing rejection.

Asking questions, at a time when it is appropriate, is so very important. Identifying the hurt behind the actions is imperative if we are going to help our child through the pain triggered by RSD.

Another example from my own experience was when my husband and oldest son took an epic road trip. One day they called all excited to share how their morning had gone. They had woken up to snow covering everything. For us, living in Florida, snow is not something we see unless we travel.

I put the phone on speaker so we could all share in the excitement. When Owen heard what was going on he became very angry, then started screaming and crying and throwing himself on the ground. I could not understand what was the matter.

After he calmed down, and at the risk of igniting the anger again, I inquired about what he was thinking and feeling about the call, and why it had upset him so much. He confided to me, through more tears, that Daddy and Johnny had gone to see snow without him. He was angry with them.

I explained to him that they did not choose to see snow without him, that it had happened to them and they had called to share it with him. They didn’t mean to rub it in or to make him feel excluded, quite the opposite in fact.

Though he was still unhappy, understanding the truth of the situation did help. When they returned and shared pictures, we revisited the situation. He started getting upset, but I gently reminded him of the truth. He calmed down and didn’t have another outburst.

That is important, but even more important is his relationship with his dad and brother being salvaged and preventing further damage or trauma he could have experienced. Big emotions in our children can make us as parents struggle with our own fear. This can lead us to try to shut down the behavior instead of investigating its source. Feelings are just temperature gauges.

The way our child with RSD treats us can make us feel rejected by them. We must remember our children are looking to us as an example. Children with RSD may initially reject our help because they are overwhelmed by their emotions.

For a child who already feels rejected, punishment or misunderstanding can further exacerbate the problem. This can lead to damage to our relationship with them.

Children with RSD sometimes misinterpret our intentions. We must commit to fostering understanding of them, and with them.

Summary

Some children on the autism spectrum may also exhibit signs of rejection sensitive dysphoria. As parents there are things we can do to protect our children, foster good relationships with their loved ones, and get professional help with their behaviors.

Teaching them social behaviors and understanding through words and examples, on a level they can understand is one of our most effective tools. When we strive to understand the deeper meaning behind their fears, we can build their trust.

As our children grow, they can discover ways to explore the world of relationships in a safe way, and find themselves surrounded by people who truly love them and will go the extra mile when necessary to be there for them.

In turn, they can learn how to be there for others. We can share in their joy as they experience true friendship and love.

References:

Berenson, K. R., Gyurak, A., Ayduk, O., Downey, G., Garner, M. J., Mogg, K., Bradley, B. P., & Pine, D. S. (2009). Rejection sensitivity and disruption of attention by social threat cues. Journal of research in personality, 43(6), 1064–1072. https://doi.org/10.1016/j.jrp.2009.07.007

McPartland et. al. Temporal dynamics reveal atypical brain response to social exclusion in autism. Developmental Cognitive Neuroscience, Volume 1, Issue 3. https://www.sciencedirect.com/science/article/pii/S1878929311000247

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