Why Criticism Hurts So Much: Neurodiversity, RSD, and the Pain of Perceived Rejection

At work, I’m known for my calmness in the face of considerable opposition and challenges. As a leader, I take the responsibility to guide and coach my team members seriously, particularly when it comes to managing their reactions to criticism. I will pose the question, "Is this a battle you want to win?" to encourage them to consider whether their responses are driven by emotion or rationale and what outcome they perceive to be reasonable.

This is especially crucial in the high-pressure environment of an aerospace company, where I've managed numerous large projects tied to critical deadlines for aircraft deliveries or government grants. I say this not for the prestige but because I recognise my ability to work under these pressures at ease. Despite my capacity to manage high-pressure situations, I find myself reacting intensely to feedback: both positive and negative. It may sound unusual, but this visceral response remains consistent:

When my team achieves success and receives recognition, my rational mind acknowledges and values it, yet my emotional mind resists and even recoils from it. Conversely, when I receive constructive criticism, even when I intellectually recognise it as well-intentioned, my emotional response is overwhelming. A single well-meaning critique can feel as devastating as being told I’ve lost my job—leaving me drained, stripped of all feeling, and filled with an overwhelming sense of worthlessness and dread.

These feelings have been the driving force behind my continuous efforts to adapt and improve in every aspect I hyperfocus on. I am self-critical of failures, vowing never to experience such painful feelings again and committing to making amends. In essence, I've developed a monitoring algorithm in my mind to recognise similar situations and apply myself to learn and improve—even if it is unfortunately driven to avoid the fear of making mistakes twice. 

What is Rejection Sensitivity Dysphoria and relationship to ADHD?

Rejection Sensitivity Dysphoria (RSD) was first coined by Dr. William Dodson[1.]. RSD can be triggered by anticipated social rejection, whether through perceived rejection or self-criticism, leading to a dysphoric mood.

note the word dysphoria originates from the Ancient Greek word "δύσφορος" (dúsphoros) meaning "hard to bear".

Historically, rejection sensitivity was primarily associated with atypical depression. However, in 2019, the European Consensus Statement expanded ADHD diagnostic criteria to include Emotional Dysregulation (EmD) as a core feature, acknowledging the emotional challenges faced by adults with ADHD.

Dr William Dodson's case series examined four adults with ADHD who experienced significant and distressing RSD. Their extreme emotional responses to perceived rejection could not be attributed to other conditions such as mood disorders, anxiety disorders, personality disorders, or autism spectrum disorder. Additionally, the first author has observed this pattern in over 300 patients, with similar confirmations from other clinicians in the ADHD community worldwide. I should note that I see many website quote 99% of ADHDers suffer from RSD, but I have been unable to find a clear source, but I think the aforementioned case study indicates towards a high percentage..

Building on the understanding of RSD and its connection to EmD in ADHD, research[2.] has long recognised that many individuals with ADHD struggle with regulating emotions. However, the lack of consensus on how to clinically define this issue has made it a complex area of study.

Three key findings emerge from the literature:

• EmD is prevalent across the lifespan and significantly contributes to impairment in ADHD.

• EmD in ADHD may stem from difficulties in processing emotional stimuli, linked to dysfunction in brain regions such as the striatum, amygdala, and medial prefrontal cortex.

• While ADHD treatments can also improve EmD symptoms, a targeted focus on emotional difficulties could lead to more effective therapeutic strategies.

Researchers propose three models for the relationship between EmD and ADHD:

1. Correlated but distinct dimensions: EmD and ADHD are related but separate issues.

2. EmD as a core feature of ADHD: Suggesting it should be formally recognized as part of the diagnosis.

3. A separate nosological entity: A distinct condition combining elements of both ADHD and EmD.

These perspectives provide a foundation for future research and potential advancements in ADHD treatment, particularly for those whose emotional challenges remain underserved.

What else impacts RSD?

Receiving criticism can be daunting for most people, as it often involves receiving feedback on areas where improvement or change may be needed. How people respond to being critiqued is influenced by various factors, including past experiences—especially during childhood—where negative feedback could significantly influence future reactions. Personality traits also play a crucial role: those who are resilient view feedback as an opportunity for personal growth, while others who are more anxious or emotionally sensitive may find criticism more challenging to handle. Additionally, cultural and societal norms impact how criticism is perceived and responded to; some cultures value direct and candid feedback, whereas in others, criticism may be seen as impolite or disrespectful.

How does RSD related to Autism?

While considering how RSD relates to autism I think it is logical to highlight the high-levels of co-occurrence between autism and ADHD, research studies[3.] indicate a significant overlap in occurrence. Between 30 to 50% of autistic individuals diagnosed exhibit traits associated with ADHD, while over 60% of those diagnosed with ADHD display traits associated with autism. Both disorders commonly involve challenges related to emotional dysregulation potential pointing to overlapping traits. 

For Autistic individuals we can add in several more reason:

• Unfiltered sensory sensitivity: Many autistic individuals have heightened sensitivity to sensory stimuli, including auditory input. Criticism, especially when delivered with a harsh tone or loud volume, can be overwhelming and distressing for individuals who are sensitive to sound.

• Difficulty with social cues: Autistic individuals may struggle to interpret nonverbal cues such as facial expressions, body language, and tone of voice, making it challenging for them to understand the intentions behind criticism. They may perceive criticism as a personal attack rather than constructive feedback.

• Literal interpretation: Autistic individuals tend to interpret language literally, which means they may take criticism at face value without understanding the underlying intentions or context. This can lead to feelings of confusion or hurt when criticised, as they may not recognise the speaker's attempt to provide feedback or guidance.

Other factors affecting ADHD and Autistic individuals are:

• Desire for perfection: Many neurodivergent individuals strive for perfection or have rigid expectations for themselves, and criticism can feel like a failure to meet those expectations. They may be particularly sensitive to criticism that challenges their sense of competence or accomplishment.

• Past experiences: Negative experiences with criticism or bullying in the past can heighten sensitivity to criticism in the future. Neurodivergent individuals who have been criticised unfairly or repeatedly may develop a fear of judgement or rejection, leading to increased sensitivity to criticism.

These emotional responses may include feelings of sadness, worthlessness, shame, anxiety, anger, or despair, and it can be triggered by a wide range of social, academic, or professional situations.

Overall, the sensitivity to criticism stems from a combination of factors related to sensory processing, social communication, emotional regulation, and past experiences. It demonstrates that RSD has inherent genetic origins to the neurological conditions of ADHD and Autism but also the societal influences to response to repeated experiences of exclusion and misunderstanding.

It's important for others to be mindful of these factors and to provide criticism in a constructive and supportive manner, taking into account the individual's unique needs and sensitivities.

How do you react to criticism?

Some atypicals adopt different strategies to avoid failure, often due to overwhelming emotions and feelings of worthlessness. This tendency can be further intensified by traits such as perfectionism, difficulty coping with uncertainty, indecisiveness, and social anxiety

To give a sense of perspective the intensity can be similar to being told you failed your exams even though the real situation may actually be insignificant.”

I consider myself fortunate that the sensation of rejection serves as a powerful motivator for me. It has led me to develop a reasonable level of self-awareness, which I believe contributes to better decision-making on my part. However, I recognise an unfortunate consequence in individuals with atypical neurology, as this intense feeling of rejection can often drive protectionism and victim behaviours:

• Protectionism: Protectionism refers to the tendency to shield oneself from criticism, failure, or discomfort by avoiding challenging situations, seeking reassurance, or adopting defensive strategies. Individuals who exhibit protectionism may resist feedback, avoid taking risks, or engage in behaviours aimed at preserving their self-esteem or avoiding negative outcomes. Protectionism can manifest in various areas of life, including personal relationships, work environments, or academic settings. While protectionism may provide temporary relief from discomfort or anxiety, it can hinder personal growth, learning, and resilience in the long run.

  
  

• Victim behaviour: Victim behaviour refers to the tendency to perceive oneself as powerless or unfairly treated by others, circumstances, or external forces. Individuals who exhibit victim behaviour may blame others for their problems, avoid taking responsibility for their actions, or adopt a passive or helpless attitude toward life's challenges. Victim behaviour can stem from past experiences of trauma, abuse, or adversity, but it can become a learned pattern of coping with stress or discomfort. While acknowledging and processing one's experiences of victimisation is important for healing and recovery, perpetuating a victim mentality can prevent individuals from taking proactive steps to improve their circumstances and regain a sense of agency and control over their lives.

  
  

• Catastrophising: Catastrophising involves overanalysing social interactions and interpreting minor criticism as evidence of total failure or rejection. Individuals who catastrophise may replay conversations repeatedly, searching for hidden negative meanings or assuming the worst possible outcome. This heightened emotional response can lead to increased anxiety, avoidance of social situations, and difficulty distinguishing between constructive feedback and actual rejection.

Referring back to Dr. Williams Dodson's case study, which involved observing 300 individuals with ADHD, the following summary was provided::

Clinicians often report that the efforts exerted by people who experience episodes of RSD can profoundly influence their development and interpersonal relationships. For example, some people become perfectionistic so that they will be protected by being above criticism or reproach. On the other hand, some people become “people pleasers” to avoid potential rejection. Still, others give up on trying anything that is not guaranteed quick and complete success because the possibility of failing or falling short makes trying new things too frightening and painful, to the point of being disabled.

Both protectionism, victim behaviour and catastrophising can have negative consequences on an individual's mental health, relationships, and overall well-being. Recognising these patterns and seeking support from mental health professionals, friends, or support groups can be helpful in developing healthier coping strategies and building resilience in the face of adversity.

Self-Help Strategies for Managing RSD

Dealing with hypersensitivity to criticism can be challenging, especially when the symptoms can be incredibly debilitating. Listed below are several strategies that may help you manage these feelings more effectively. The key is not to travel this journey alone; to understand your reactions is vital to have someone to talk to and explore the feedback; focus on the rational aspects avoiding the autistic trait to lean towards the injustice of the situation and playing the victim role.

• Develop self-awareness: Take time to reflect on your emotional responses to criticism and try to understand the underlying reasons for your sensitivity; check-in with others that were present for their interpretation; espeically consider thought distortions e.g. "Everyone hates me" transforms to "One moment doesn’t define me".

  
  

  Recognising your triggers and understanding your emotional reactions can help you develop healthier coping strategies. A wise Australian friend once shared, "When someone criticises another, it says more about them than the person they are criticising." This resonated with me as a profound truth and I have to remind myself in social situations.

  
  

  I hear people exchanging social stories, where someone effortlessly puts another in their place, replaying the dialogue triumphantly, the storyteller is portrayed as the strong character, while the antagonist appears weak and bumbling in response to the high-witted retorts. However, real life seldom unfolds this way. If you catch yourself recounting such stories, consider taking a moment to pause, reflect, and ponder what it reveals about you and your life perspective.

  
  

  In my experience, the majority of people are inherently good and hardworking. Just like us, they make mistakes. Let's foster a culture of support and collaboration, recognising our shared humanity. Instead of focusing on perceived weaknesses, let's embrace the opportunity to help one another and build a more compassionate community.

  
  

• Communicate RSD to others: Create example scripts for communicating to loved ones, friends, and colleagues; emphasising that your reaction to criticism is intense but temporary, not manipulative or overdramatic. Encourage them to provide compassionate responses e.g. reassurance, considerate communication.

  
  

• Practice mindfulness: Mindfulness techniques, such as deep breathing, meditation, or grounding exercises, can help you stay present and calm when faced with criticism. These practices can help you observe your thoughts and emotions without judgement, allowing you to respond more calmly and rationally.

  
  

• Separate feedback from self-worth: Remember that criticism is about your behaviour or actions, not your inherent value as a person. Try to detach your sense of self-worth from external feedback and focus on learning and growth instead. For instance if a task fails, it may be due to not being aware of the latest process; this does not make you inept, just a need to learn and develop.

  
  

• Seek constructive feedback: Actively seek out constructive feedback from trusted sources, such as mentors, colleagues, or friends, who have your best interests at heart and are aware of your sensitivity. Constructive feedback is intended to help you improve and grow, so try to approach it with an open mind and a willingness to learn.

  
  

• Set boundaries: If you find that certain types of criticism are particularly triggering for you, consider setting boundaries to protect your emotional well-being. This might involve limiting your exposure to negative or unsolicited feedback, or politely declining feedback from individuals who do not have your trust or respect. Consider putting Rejection “buffer” strategies in place e.g. preparing for feedback, setting emotional boundaries; add the 24-hour rule—delaying reactions to rejection to gain perspective.

  
  

• Challenge negative beliefs: Notice and challenge any negative beliefs or assumptions you may have about yourself in response to criticism. Replace self-critical thoughts with more balanced and realistic perspectives, focusing on your strengths and areas for growth. Be aware when you play the victim or hold yourself back due to protectionism.

  
  

• Focus on self-care: Take care of yourself physically, mentally, and emotionally by engaging in activities that help you relax and recharge. Prioritise self-care practices such as exercise, healthy eating, adequate sleep, and spending time with supportive friends and family.

  
  

• Seek support: Don't hesitate to reach out to professional help with a therapist for support if you're struggling to cope with sensitivity to criticism. Talking to someone who understands can provide validation, perspective, and helpful strategies for managing your feelings.

  
  

By implementing these strategies consistently and with patience, you can gradually reduce your sensitivity to criticism and build greater resilience in the face of feedback. Remember that change takes time, and be kind to yourself as you work towards growth and self-improvement.

As a final note on managing emotion dysregulation in ADHD, some medical treatments[2.] show promise, but of course always seek professional advice:

• Psychostimulants (e.g., methylphenidate, amphetamines) help core ADHD symptoms but have mixed effects on emotional regulation—some improve, while others experience increased irritability.

• Non-stimulants like atomoxetine may be beneficial for both ADHD and emotional symptoms.

• Mood stabilizers (e.g., divalproex) and guanfacine show potential for managing severe emotional dysregulation, particularly in children with aggression.

• Modafinil and omega-3 supplements are being explored for their impact on emotional regulation.

  
  

A multi-modal approach, combining medication with environmental and behavioural strategies can create an effective path forward.

Conclusion

Rejection Sensitivity Dysphoria (RSD) is a deeply personal and often overwhelming experience for neurodivergent individuals. While it may sound simple to channel your one's sensitivity into self-awareness and continuous improvement, the reality for many is the emotional toll of perceived rejection can lead to protective behaviours such as avoidance, victim mentality, and catastrophising. These responses, though understandable, can limit personal growth and create additional barriers in relationships, work, and self-confidence.

Understanding the neurological and psychological roots of RSD, its links to emotional dysregulation, perfectionism, and past experiences, can help reframe it as a challenge to be managed rather than an inherent flaw. Through self-awareness, communication, and practical strategies, individuals can develop resilience and healthier coping mechanisms.

It is also crucial to foster compassionate environments, where feedback is given constructively, and individuals feel supported rather than judged. Just as we expect others to be mindful of our sensitivities, we must also recognise the importance of challenging negative beliefs, setting boundaries, and seeking support when needed.

Ultimately, while RSD may never fully disappear, it can be understood, managed, and even used as a driving force for self-improvement.

By embracing strategies that separate self-worth from criticism and focusing on growth rather than avoidance, individuals can move beyond the fear of rejection and develop a stronger, more confident sense of self.

Reference

1. Dodson, William & Modestino, Edward & Ceritoğlu, Handan & Zayed, Basel & Modestino, Edward & Laboratory, Behavior. (2024). Rejection Sensitivity Dysphoria in Attention-Deficit/Hyperactivity Disorder: A Case Series. Acta Scientific Neurology. 7. 23-30. 10.31080/ASNE.2024.07.0762.

2. Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry. 2014 Mar;171(3):276-93. doi: 10.1176/appi.ajp.2013.13070966. PMID: 24480998; PMCID: PMC4282137.

3. Leitner Y. The co-occurrence of autism and attention deficit hyperactivity disorder in children - what do we know? Front Hum Neurosci. 2014 Apr 29;8:268. doi: 10.3389/fnhum.2014.00268. PMID: 24808851; PMCID: PMC4010758.

4. Rejection Sensitive Dysphoria and Social Behaviours in Autism and ADHD. Lead Research Organisation: University of Nottingham. Department Name: Sch of Psychology.Student: Isabelle Chastney Period of Study: Sept 23 - Sept 27.