Rejection Sensitivity Dysphoria in Autistic Adults: A Scoping Review

Abstract

On social media, autistic adults use the term Rejection Sensitivity Dysphoria (RSD) to describe extreme responses to rejection and criticism. Because RSD is not an established research construct, the evidence base is fragmented. This scoping review mapped evidence related to emotional, physical, and physiological responses to rejection and criticism in autistic adults and adults with high autistic traits. Following PRISMA-ScR guidelines, we searched for peer-reviewed journal articles, conference papers, and dissertations published through May 2025. Two authors independently screened 1,285 titles/abstracts and 37 full texts, identifying 12 eligible studies (four qualitative, six experimental, and two cross-sectional). Conceptualizations and operationalizations of rejection-related distress varied considerably, and no studies examined responses to criticism or evaluated interventions. Quantitative findings on the intensity of this distress were inconsistent, while some studies linked this distress to negative outcomes such as depression and anxiety. Qualitative studies consistently described rejection experiences as highly impactful. While preliminary evidence suggests that some autistic adults may experience profound responses to rejection, inconsistent findings and study heterogeneity obscure a coherent understanding. Future research should clarify the conceptualization of RSD and its relation to adjacent frameworks (e.g., social pain), examine responses to criticism, identify contributing factors, and guide the development of tailored interventions.

Lay Abstract

On social media, many autistic adults use the term Rejection Sensitivity Dysphoria (RSD) to describe how intense and distressing rejection and criticism can feel. However, this term is rarely used in scientific research, which makes it difficult to know what has already been studied. To explore this, we reviewed research on how autistic adults and adults with high levels of autistic traits respond emotionally, physically, or in other body reactions to rejection and criticism. We searched scientific databases and found 12 relevant studies. Four used interviews or written accounts from autistic adults, six used experimental tasks that simulated rejection, and two were survey studies. None investigated responses to criticism or tested ways to reduce rejection-related distress. Definitions and measurements varied widely between studies, making it challenging to compare results. Some studies found that autistic adults respond more strongly to rejection than non-autistic adults, while others found weaker reactions or no clear differences. Still, several studies linked rejection-related distress to mental health challenges such as anxiety and depression. Interviewed autistic participants also consistently described these experiences as very distressing. Altogether, the current preliminary evidence suggests that some autistic adults experience rejection in ways that can feel very intense and distressing. However, studies use different definitions and methods and often reach mixed conclusions. This makes it hard to understand what RSD really means or how best to support autistic adults who experience it. We hope these findings will encourage researchers to study RSD more directly, define the concept more clearly, and examine how it relates to similar concepts (such as social pain), and examine which personal or situational factors may influence these reactions, and work together with autistic adults to develop ways that help reduce this distress.

Negative social experiences can be deeply distressing. Whether it involves being rejected (e.g., social exclusion, ostracism, or romantic rejection) or criticized (e.g., negative feedback, error correction, or sarcastic comments), such events can trigger intense stress responses (Leary, 2015). According to William' (2009) need-threat model, these stress responses may be adaptive, as they serve to restore four threatened fundamental human needs: belonging, self-esteem, control, and meaningful existence. However, they have also long been known to significantly impact mental health (Slavich, 2020). For instance, in the nineteenth century, William James (1890/1950) described the despair of rejection as worse than physical torture. Modern neuroscience supports this view, as rejection and criticism have been found to activate brain regions associated with physical pain, leading to both emotional and physical sensations (Eisenberger, 2012). This overlap is reflected in a contemporary scientific term for these experiences, social pain, as well as in everyday metaphors such as “hurt feelings,” “broken heart,” and “heartache” (Eisenberger, 2012). Nevertheless, people differ in how intensely they respond to such experiences (Williams & Nida, 2022). For instance, on social media, autistic adults describe their responses to rejection and criticism as intensely distressing. To better understand and support them, this scoping review mapped available scientific evidence related to these experiences in this population.

Due to their distinct preferences and negative societal attitudes, autistic individuals frequently face rejection and criticism. To illustrate, a recent review and meta-analysis reported disproportionately high lifetime rates of bullying (46%–69% vs. 2%–17%), violence (27.1% vs. 4.5%, d = 1.13), emotional abuse (d = 0.60), and adverse interpersonal encounters (49.4% vs. 22.4%) among autistic individuals compared to allistic peers (Cooke et al., 2025). However, autism research has historically focused on autistic individuals’ more outwardly visible experiences and behaviors labeled as problematic, meaning relatively little is known about how they experience these negative social events internally (Pellicano et al., 2014; Silberman, 2015). In recent years, however, the neurodiversity movement and social media have given autistic individuals platforms to draw attention to these inner experiences, offering new ways to understand how they navigate social challenges and inform research on how they can best be supported (Leadbitter et al., 2021).

One particularly salient internal experience may be Rejection Sensitivity Dysphoria (RSD), sometimes also referred to as Rejection Sensitive Dysphoria. The term was popularized by the American psychiatrist William Dodson (2016), who used it to describe what he characterized as an extreme emotional sensitivity and pain in response to perceived rejection or criticism specifically among individuals with Attention Deficit Hyperactivity Disorder (ADHD). Based primarily on his clinical observations, to our knowledge, Dodson (2016, 2023) provided five key arguments for adopting this term: (1) the “extreme, unbearable intensity” of the emotional response in individuals with ADHD relative to other clinical populations, noting that “dysphoria” is Greek for “unbearable” (although “unease” may be a more precise translation); (2) its predominantly genetic and neurological basis, which he attributed to differences in brain regions involved in emotion regulation (e.g., reduced prefrontal cortex volume); (3) its exclusive occurrence in response to perceived rejection and criticism, rather than also in anticipation; (4) its resistance to psychosocial interventions, such as cognitive and dialectical behavioral therapies; and (5) a “dramatic improvement” following treatment with certain ADHD medications, particularly guanfacine and clonidine (Dodson & Modestino, 2024).

At present, the conceptual boundaries and specificity of RSD remain uncertain. RSD is not included in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) or the International Classification of Diseases (11th revision; ICD-11), and direct scientific evidence remains limited to a set of four case studies (Dodson et al., 2024) and a few studies mentioning it in passing (Beaton et al., 2022; Ginapp et al., 2023). Despite this limited scientific grounding, the term has nevertheless gained substantial traction in neurodivergent communities on social media. This includes autistic individuals who do not identify with ADHD and who link the experience to traits more commonly associated with autism, such as alexithymia, interoceptive difficulties, and detailed processing of social cues (e.g., Weller, 2023). On social platforms, RSD is used to describe a broad spectrum of intense reactions to rejection and criticism, including low self-esteem, fear, shame, upset, anxiety, negative self-talk, overwhelm, self-blame, and anger (Sandland, 2025). These diverse interpretations highlight both the significant impact these experiences can have and the need for greater understanding of what exactly they entail.

Furthermore, while not using the term RSD, the intensity of autistic individuals’ responses to rejection and criticism has been highlighted as a topic of scholarly debate. For instance, Wing (1996, p. 131) observed that “many children with autism are extremely distressed at any experience of failure and hate to be corrected if they make an error,” whereas Sahi and Eisenberger (2021, p. 620) suggested that autistic individuals’ “inability to properly process social evaluative cues” might result in a “lack of awareness […] about their experience of rejection.” In addition, two systematic reviews (Reinhard et al., 2019; Venturini & Parsons, 2018) examined studies that used experimental rejection paradigms in autism research. However, these reviews focused exclusively on laboratory-induced rejection, meaning other relevant studies (e.g., surveys and qualitative research) were not included.

Moreover, research on the intensity of responses to rejection and criticism has drawn on a wide range of distinct constructs, such as hysteroid dysphoria (repeated episodes of depressed mood in response to perceived rejection; Liebowitz & Klein, 1981), ostracism distress (negative affect and threatened needs following exclusion; Yaakobi, 2022), and social pain sensitivity (heightened emotional distress in response to negative social interactions; Umeda & Park, 2024). Other commonly studied constructs similar to RSD, such as rejection sensitivity (the disposition to anxiously expect, readily perceive, and intensely react to rejection; Downey & Feldman, 1996), may appear relevant but are often operationalized through self-report scales assessing anticipatory anxiety or heightened perceptions of rejection rather than reactive responses (e.g., London et al., 2007). Finally, rejection and criticism are typically examined under separate paradigms. Taken together, although rejection-related distress has been studied in autistic adults, the available evidence related to experiences described as RSD is likely to be fragmented and difficult to identify without a structured synthesis.

Given the growing use of the term RSD by autistic adults on social media to describe intense rejection-related distress, together with the fragmented conceptual landscape surrounding such experiences, we conducted a scoping review to map existing research relevant to these experiences in autistic adults. Because direct empirical research on RSD is scarce and interpretations vary between Dodson's definition and community discourse, we adopted a broad working definition for study inclusion, encompassing reactive emotional, physical, and physiological responses to rejection and criticism. In addition to studies of formally diagnosed or self-identified autistic adults, we also included studies examining associations between autistic trait levels and these rejection-related responses in general population samples. We made this decision to reflect the dimensional distribution of autistic traits and to capture informative findings from high-trait samples, which are common in related research (e.g., Lin et al., 2022). The findings may serve as a reference and guide future research on how responses to rejection and criticism in autistic adults are conceptualized, operationalized, and measured; the extent to which they are empirically supported; the contributing factors and consequences involved; and potential strategies to alleviate associated distress.

Thus, the main research question guiding this review was: What is currently known about the emotional, physical, and physiological responses to rejection and criticism in autistic adults and in adults with high levels of autistic traits within the scientific literature?

The subquestions included:

How are these responses conceptualized, defined, operationalized, and measured?

What is known about the intensity of these responses?

What lived experiences, contributing factors, and consequences have been reported?

What evidence exists regarding strategies or interventions to alleviate these responses?

Methods

Design

The purpose of our scoping review was to synthesize the available research relevant to experiences commonly described under the label of RSD in autistic adults. Scoping reviews aim to systematically examine and map the extent (volume), range (diversity), and nature (characteristics) of the available research evidence on a particular topic (Munn et al., 2018). We chose this approach given the emerging nature of RSD, the heterogeneity of related constructs, and the need to identify knowledge gaps to guide future research. We followed the PRISMA-ScR guidelines for scoping reviews, which include 20 essential and two optional reporting items, as outlined by Tricco et al. (2018). We included a completed PRISMA-ScR checklist in the Supplemental Files and preregistered this review on the Open Science Framework (https://osf.io/nm4uw). Two authors (AvA and DR) are autistic, ensuring that our study was informed by lived experience. This positionality shaped several methodological choices, including the adoption of a broad working definition that was informed by the diverse lived discourse surrounding RSD, the inclusion of qualitative evidence and studies examining autistic traits and self-identified autistic adults, and the use of a difference-oriented rather than deficit-based framing when synthesizing and discussing the findings. To reflect on potential bias related to this positionality, methodological decisions, and interpretations were regularly discussed with the third author.

Eligibility Criteria

To comprehensively review findings relevant to our research questions, we included a broad range of sources. Our search covered all peer-reviewed qualitative, quantitative, and mixed-methods articles, as well as conference papers and dissertations, published up to and including May 2025, without restrictions on publication year. To be eligible, studies had to report original empirical outcomes on emotional, physical, or physiological responses associated with experiences of rejection and criticism in autistic adults or examine associations between autistic traits and these responses in the general population. Accordingly, we included studies examining conceptually adjacent constructs (e.g., social pain and ostracism distress) as well as qualitative descriptions of rejection-related experiences when these studies addressed reactive responses to perceived rejection or criticism, even when these constructs may not capture the full scope of RSD as described in lived discourse.

Studies were eligible regardless of participants’ intellectual ability or level of support needs, provided that at least 50% of the sample was aged 18 years or older to ensure that conclusions were primarily drawn from adult populations. Examples of eligible designs include experimental rejection paradigms, surveys, and qualitative investigations on lived experiences, and outcomes included perceived distress, neural activation patterns, and skin conductance. Consistent with scoping review methodology (Tricco et al., 2018), we also included studies if they reported relevant findings not part of the primary research questions (e.g., in bivariate or exploratory analyses).

We excluded studies that (a) did not have full texts available in Dutch or English, the authors’ main languages; (b) were theoretical, conceptual, or editorial in nature, or were reviews and meta-analyses, as they did not report original empirical findings (although they were screened for forward and backward references); (c) mentioned responses to rejection or criticism only briefly without describing or analyzing them, as such references did not provide sufficient empirical detail to inform our research questions; (d) focused exclusively on nondirect responses, such as anticipated responses (e.g., fear or expectation of rejection), indirect or prolonged responses (e.g., social isolation or loneliness), vicarious responses (i.e., reactions to others being rejected or criticized), or external behaviors (e.g., prosocial behavior and eye gaze). We applied criterion (d) to exclude studies that did not report immediate, internal, and self-related responses, which correspond to the core features in both Dodson's conceptualization of RSD and community discourse (e.g., Sandland, 2025).

Search Strategy

We conducted a systematic search in June 2025 in EBSCOhost, Web of Science, and PubMed. We selected these platforms because they contain results from multiple research databases, including PsycArticles, PsycINFO, and MEDLINE. Our search strategy was based on a preliminary search on Google Scholar by AvA, which included variations of the terms “rejection,” “criticism,” “rejection sensitivity,” “rejection sensitive dysphoria,” “rejection sensitivity dysphoria,” “RSD,” “social pain,” and “autism,” alongside a consultation session with a librarian from GGz Centraal, a Dutch mental healthcare provider. Following these steps, AvA and DR collaboratively refined the search strings. For example, we added the term “social threat.”

The full search string used in EBSCOhost, Web of Science, and PubMed included (autis* OR asd OR asc OR pdd OR pdd-nos OR “pervasive developmental disorder*” OR “neurodevelopment* disorder*” OR “neurodevelopment* condition*” OR asperger*) in the title, AND (reject* OR critici* OR ostraci* OR “social* exclu*” OR “social evaluat*” OR “social* threat*” OR rsd OR “interpersonal sensitiv*” OR “social pain” OR “emotion* dysregulat*”) in all searchable fields. To prevent the volume of results from becoming unmanageable (e.g., over 60,000 hits in EBSCOhost), autism-related terms were restricted to the title field. Apart from this restriction, we did not apply any other filters to minimize the chance of excluding potentially relevant studies. To validate the search strategy, we confirmed that all eight eligible studies identified in the preliminary Google Scholar search were also retrieved using our search string.

Following the database screening, AvA conducted supplementary Google Scholar searches using newly identified relevant terms (e.g., “social threat”). This step allowed us to extend our search beyond the selected databases. AvA also manually carried out forward and backward citation searches and screened relevant reviews for further eligible studies. We did not conduct a consultation stage with experts or stakeholders, as we focused on mapping only publicly available evidence.

Screening Process

We exported the database search results into Rayyan (Ouzzani et al., 2016), a free web- and mobile-based screening tool that automatically removes duplicate records. We then screened titles and abstracts for relevance by AvA and DR, based on the inclusion and exclusion criteria described above. To avoid prematurely excluding potentially eligible studies, we handled the eligibility criteria loosely during this phase. Subsequently, we jointly reviewed the first 20 titles and abstracts to calibrate the screening process. AvA and DR then screened the remaining titles and abstracts independently in sets of 50 to 100, ordered alphabetically by title. We excluded records deemed ineligible by both reviewers from full-text screening, while we discussed disagreements after each set until consensus was reached. The third researcher (YR) was available to resolve any remaining discrepancies; however, such consultation was not required.

Full texts of the studies that passed the initial screening phase were then independently reviewed by AvA and DR. If a full text was unavailable, we attempted to contact the corresponding author. We included studies in the final review if both reviewers determined them to be eligible, with discrepancies resolved through discussion after all full texts had been evaluated. To assess inter-rater reliability, we calculated Cohen's kappa (κ) and interpreted its magnitude using the guidelines proposed by Landis and Koch (1977). Agreement was substantial across all sets of title and abstract screening, and also during the full-text screening phase (κ > .60), except for the first independently screened set of 50 to 100 titles and abstracts, which showed moderate agreement (κ = .52).

Data Charting and Synthesis

From each eligible study, AvA charted the following characteristics in a Microsoft Excel table: author(s), year of publication, type of publication, country of origin, study aim, population (including inclusion and exclusion criteria), sample size, participant characteristics, method of autism identification (e.g., self-identified and formally diagnosed), construct examined (e.g., threatened needs and social pain), definition of the construct, operationalization of the construct, manipulation (if applicable, e.g., experimentally induced rejection), outcome variable(s), type of analysis, key findings related to our study questions, limitations (as reported by the original study author(s)), and additional notes (e.g., limitations identified by us). To enhance readability, we ordered the chart by study design (qualitative, experimental, and cross-sectional). Where relevant data (e.g., means and test statistics) were publicly available but not explicitly reported in the original publication, we calculated these values manually and verified them with an independent research assistant.

Once AvA completed the first draft of the data chart, its contents were cross-checked by DR for accuracy and discussed by the research team, which led to several adjustments. For example, we added study limitations discussed in the main text but not explicitly listed in the “Limitations” section. AvA then developed a summary table outlining key elements relevant to the research questions. Both the full final data chart and the summary table are available in the Supplemental Files. Based on these materials, AvA wrote a narrative synthesis of the studies, organized by subquestion to provide a structured overview of the findings.

Results

Study Characteristics

Figure 1 shows the flow diagram of the study selection process. Starting with 1,285 records, we screened titles and abstracts and assessed 37 full texts, resulting in 12 studies that met the eligibility criteria (Basargekar et al., 2024; Beck et al., 2024; Fekih-Romdhane et al., 2025; Gurbuz, 2020; Levi et al., 2023; Lin et al., 2022; Maroney et al., 2025; Nelson, 2023; Peristeri & Tsimpli, 2014; Reich & Pond, 2023; Safran, 2025; Trimmer et al., 2017). One dissertation (Gurbuz, 2020) reported on two relevant studies; however, since both were conducted in the same session with the same participant group, we treated them as a single study. Overall, the 12 studies represented six experimental, four qualitative, and two cross-sectional designs. One study (Basargekar et al., 2024) was part of a larger experimental study; because only the cross-sectional data were relevant to our review, we classified it as cross-sectional.

Figure 1.

PRISMA flow diagram of screening process.

With respect to publication characteristics, most studies were journal articles (eight), followed by three dissertations and one conference paper. Study locations were diverse, with nearly half (five) conducted in the United States, followed by two in the United Kingdom. The remaining investigations took place in Israel, Greece, China, Australia, and across 12 Arab countries. Notably, over half of the included studies were published in 2024 or 2025 (range: 2014–2025).

Regarding sample characteristics, across the 12 studies, 10 samples consisted of autistic adults, although one (Nelson, 2023) included only two autistic participants. Eight of the 10 studies required a formal autism diagnosis, while two allowed self-identification. The remaining two studies used allistic adult samples to examine associations between autistic traits and relevant outcomes, or to compare groups high and low in autistic traits. Overall, samples tended to be young, white, and highly educated, with mean ages typically in the 20s or 30s. Gender distributions were generally balanced, though most samples included more men than women. Information on co-occurring conditions was rarely reported: only one study (Gurbuz, 2020) provided detailed information, indicating that 13 of 20 autistic participants reported at least one co-occurring diagnosis, including 8 of 20 reporting unspecified mental health disorders, and in Nelson (2023), 9 of 57 participants in the predominantly non-autistic sample reported a disability beyond autism. No study explicitly included autistic adults with intellectual disabilities.

Overall, the studies reflect a small, heterogeneous, and relatively recent body of research. Participant characteristics were more homogeneous, consisting primarily of Western, young, and highly educated individuals. Information on co-occurring conditions was sparsely reported.

How Are the Responses to Rejection and Criticism Conceptualized, Defined, Operationalized, and Measured?

Four studies explicitly examined social pain, though only two provided an explicit definition. Another four studies used broader or more descriptive terms (e.g., responses to social rejection or threatened social needs following exclusion), while one study examined responses to social exclusion as a proxy for social motivation. Three qualitative studies did not define a related construct at all, as rejection or criticism was not their primary focus. None of the studies explicitly used the term RSD, and no study directly investigated responses to criticism.

Among the four qualitative studies, three used semistructured interviews, and one employed an expressive writing task. The six experimental studies relied on two paradigms: Cyberball, a virtual ball-tossing game in which participants believe they are gradually being excluded by two other players (Williams & Jarvis, 2006); and the Social Judgement Task (SJT), in which participants receive preprogrammed social feedback (e.g., “this person likes/does not like you”) that appears to come from peers (Somerville et al., 2006). Four studies used only Cyberball, one used only the SJT, and one used both as separate conditions. In addition to self-report outcomes—most commonly threatened needs and mood—two experimental studies monitored skin conductance, two recorded brain activity, and one measured cardiac slowing. The two cross-sectional studies asked participants to rate their social pain following hypothetical scenarios. One used the Social Pain Questionnaire (Stangier et al., 2021), while the other relied on an unvalidated 10-item measure.

In short, conceptualizations, definitions, operationalizations, and measurements varied considerably across the studies. Definitional clarity was limited, no single framework was dominant, and responses to criticism were entirely unexamined.

What is Known About the Intensity of These Responses?

Across the qualitative studies, participants described rejection using emotionally charged terms such as “misery,” “suffering,” and “horribly rejected.” Quantitative findings, however, were mixed. Three studies reported greater distress in autistic adults or those with higher autistic traits on one or more measures, such as hurt feelings and skin conductance, compared to allistic adults or those with lower traits. In contrast, two studies reported lower distress in specific threatened needs, two reported mixed findings (i.e., greater or lesser distress depending on the measure), and one found no group differences. We did not observe any consistent methodological or sample characteristics (e.g., paradigms, sample size, age, and gender) that could account for these divergent outcomes.

Altogether, although qualitative accounts suggest that rejection can be experienced as intensely distressing, quantitative comparisons provide no consistent evidence that autistic adults experience systematically stronger or weaker responses than allistic adults.

What Lived Experiences, Contributing Factors, and Consequences Have Been Reported?

In the qualitative studies, apart from explicit rejection, exclusion, and negative evaluation, participants reported several additional sources of rejection-related distress. These included a sense of being different from others; misunderstandings with allistic people, including family, friends, and colleagues; other people's intolerance of autistic differences; and being unmatched or ghosted on dating apps. Reported consequences of these experiences included loneliness, feelings of being unseen and unprotected, increased self-consciousness, and heightened anxiety about future rejection. These outcomes, in turn, led participants to mask autistic traits and to avoid situations that might result in rejection. Two major barriers to coping with these experiences emerged: a lack of social safety, and the absence of clear explanations for rejection—particularly in the context of online dating—which left them confused and unable to make sense of what had happened.

In the quantitative studies, self-reported social pain or hurt feelings were associated with depression and anxiety, as well as with physical pain intensity. Additionally, Gurbuz (2020) found that autistic adults scored higher than controls on anxiety, social anxiety, depression, and stress following experimental exclusion, although the study did not control for baseline levels, making it unclear to what extent these differences were caused by the exclusion. The same study also found that cardiac responses to rejection were not associated with these outcomes or with expectations of rejection. Finally, one study conducted in the general population reported that social pain mediated the association between autistic traits and psychotic symptoms by 3% (Fekih-Romdhane et al., 2025).

Taken together, qualitative studies suggest that rejection-related distress is embedded in broader social-contextual experiences and may contribute to masking and avoidance, whereas quantitative studies have mostly linked this distress to internalizing symptoms.

What Evidence Exists Regarding Strategies or Interventions to Alleviate These Responses?

No studies evaluated strategies or interventions to alleviate rejection-related distress. Some insights can be drawn from a single qualitative study (Levi et al., 2023) that explored how autistic adults cope with social pain. This study identified three inward-focused coping strategies: avoidance, negative emotional responses, and increasing self-understanding; and three outward-focused strategies: asking for help, forming friendships with other autistic people, and connecting with the broader autistic community. However, the study did not assess the perceived effectiveness of these strategies.

In summary, no intervention studies were identified, and available evidence is limited to one qualitative study describing coping strategies without evaluating their effectiveness.

Discussion

This scoping review provides an overview of evidence related to emotional, physical, and physiological responses to rejection and criticism in autistic adults and adults with high levels of autistic traits. While most studies examined the construct of social pain, conceptualizations, operationalizations, and measurements varied considerably, with only 2 of 12 studies providing an explicit definition. Moreover, these studies were conducted in primarily homogeneous populations (e.g., in Western countries, without explicitly including adults with intellectual disability), and none evaluated strategies or interventions to alleviate rejection-related distress, nor did any specifically focus on responses to criticism. Quantitative findings on the intensity of rejection-related distress were inconsistent (3 greater/2 lower/2 mixed/1 null compared to allistic control groups or lower-trait groups), and this distress was related to negative outcomes such as depression and anxiety. Yet, interviewed autistic adults consistently described rejection experiences as profound.

Our findings show that responses overlapping with descriptions of RSD in autistic adults have been studied, with over half of the studies published in 2024 or 2025, reflecting growing scholarly interest in autistic adults’ social-evaluative experiences (Leadbitter et al., 2021). However, substantial heterogeneity across studies limits the comparability of the outcomes. The limited use of construct definitions further made it difficult to determine whether studies were examining the same underlying phenomenon or distinct processes. Although determining the scientific validity of RSD is beyond the scope of this review, this fragmentation obscures a coherent understanding of what rejection-related distress in autistic adults represents. As a result, it remains difficult to determine whether RSD reflects a distinct phenomenon or a constellation of related processes. Importantly, this ambiguity also prevents clear conclusions about whether findings from adjacent research—such as intervention studies conducted in other populations—are relevant to autistic adults.

To advance the field, future research would greatly benefit from better conceptual alignment. Therefore, we recommend first systematically exploring the lived experiences of RSD in autistic adults to identify whether, and in what ways, these experiences align with established constructs. Although we identified four studies reporting lived accounts of rejection-related distress, these studies did not explicitly examine RSD and therefore may not have comprehensively captured the range of self-described RSD experiences. Given that 4 of the 12 included studies were conducted within a social pain framework, directly comparing the construct of social pain sensitivity with these experiences may be particularly informative. At the same time, in the included qualitative studies, autistic adults identified additional sources of distress, such as feeling different from others, which elicited responses similar to those triggered by rejection. Therefore, related constructs may differ in scope, and an exclusive focus on social pain sensitivity or other existing frameworks may not fully capture lived experiences of RSD. We note that, since conducting this scoping review, one qualitative study has reported on how neurodivergent adults experience and make sense of RSD (Sandland, 2025), which may provide an initial step toward greater conceptual clarity and boundaries.

Beyond broader conceptual fragmentation, a specifically noteworthy gap is the absence of studies that investigated autistic adults’ responses to criticism. While both rejection and criticism involve negative social evaluation, they may be qualitatively distinct experiences. For instance, rejection typically elicits negative emotions (Gonsalkorale & Williams, 2006), whereas criticism can sometimes be interpreted positively, such as when it is constructive (Fong et al., 2018). However, many autistic adults experience challenges in understanding others’ intentions, including when receiving criticism (Fatima & Babu, 2023). For example, one study found that autistic adults had more difficulty than allistic adults in distinguishing praise from sarcasm (e.g., “that was fantastic parking!”) (Barzy et al., 2020). Thus, the lack of research on how autistic adults experience distress from criticism highlights an important gap in the literature, which limits knowledge on the range of events that may be associated with experiences of RSD.

Several studies compared the intensity of responses to rejection between autistic and allistic adults, or between adults with higher versus lower levels of autistic traits, offering some preliminary insights. Findings were mixed: some studies indicated heightened responses among autistic adults, whereas others found weaker responses or no significant differences. In contrast, qualitative studies more consistently pointed toward more intense or impactful experiences. These inconsistencies may reflect the substantial heterogeneity across studies or the possibility that current paradigms are not sufficiently sensitive to capture these experiences in autistic adults. For instance, self-report questionnaires used to measure threatened needs following rejection may have limited sensitivity in autistic samples due to co-occurring alexithymia, or experimental designs simulating rejection may not fully capture differences in how autistic people interpret social situations. Alternatively, the qualitative research may have been prone to selection bias, with those who have more distressing experiences being more likely to participate. Taken together, these considerations highlight the need for greater validation of research methods to study rejection-related distress within autistic populations.

Regardless, the inconsistent findings suggest that individual differences may better explain responses to rejection than diagnostic status or autistic trait levels alone. However, the limited reporting of co-occurring conditions, together with the scarce examination of associated factors, limits a clear understanding of which characteristics play a role in these experiences. It therefore remains unclear, for example, whether such experiences are primarily associated with co-occurring ADHD or whether specific autism-related characteristics also contribute. Future research should therefore place greater emphasis on collecting data on co-occurring conditions and on investigating potential mechanisms and determinants. Based on the reviewed studies, two potentially relevant factors include pre-existing psychological vulnerabilities (e.g., threatened needs or symptoms of depression or anxiety), and sensory sensitivity, supported by the observed positive association between social and physical pain in one included study (Basargekar et al., 2024).

In addition, the role of cumulative negative social experiences warrants further investigation. The qualitative studies suggest that social and contextual factors, such as low perceived social safety and intolerance of autistic differences, may contribute to heightened rejection-related distress. These factors resemble minority stressors, such as stigma, discrimination, and social marginalization, which minority stress models link such social experiences to heightened vigilance to rejection and amplified affective responses (Baams et al., 2019; Feinstein, 2019; London et al., 2020). Similarly, most general population models of rejection-related distress emphasize that repeated negative social experiences shape heightened reactivity (Romero-Canyas et al., 2010). Because the experimental and cross-sectional quantitative designs included in this review did not assess participants’ cumulative exposure to social adversity, variability in such experiences may partly explain the inconsistent findings observed across studies. Clarifying the contribution of such adversity would also help to evaluate Dodson's (2023) claim that RSD is not primarily trauma-based, or whether RSD instead reflects a broader social-contextual vulnerability across populations frequently exposed to negative social experiences.

Finally, another substantial research gap concerns interventions. None of the reviewed studies evaluated strategies to alleviate responses to rejection or criticism, leaving it unclear how to support autistic adults who experience RSD. Once conceptual clarity about RSD and its contributing factors has been established, we suggest prioritizing research to address this intervention gap. Research in other populations may offer helpful starting points for future intervention development. For example, a recent systematic review of randomized controlled trials found that mindfulness-based interventions and pharmacological treatments (specifically, psychedelics and acetaminophen) have the strongest evidence for reducing social pain (Brooks et al., 2025). Macrolevel interventions (e.g., antistigma programs and inclusive employment policies) should also be considered, as reducing the frequency of rejection and criticism may lessen the need to manage its associated distress. Across all approaches, we strongly recommend co-creating interventions with autistic adults to ensure they align with lived experiences of RSD, are responsive to autism-specific needs, incorporate autistic adults’ insights into effective coping strategies, and remain neurodiversity-affirmative.

Strengths and Limitations

A key strength of this study was its focus on a topic widely discussed within autistic communities yet underexplored in academic research, supporting autistic adults’ calls for more research on their mental health challenges (Cage et al., 2024; Pellicano et al., 2014; Putnam et al., 2023). Moreover, two of the three authors are autistic, ensuring that the study was informed by insider perspectives. Nevertheless, we acknowledge that our positionality may have influenced aspects of the research process, such as how we defined eligibility criteria, selected studies, or prioritized findings, as some decisions may have subconsciously aligned with our lived experiences.

Other potential limitations of our review concern the eligibility criteria. Since RSD is typically described as an immediate response to perceived rejection and criticism, we adopted this narrow definition and excluded studies that focused solely on anticipated, behavioral, vicarious, or prolonged responses. As a result, we may not have captured some broader experiences of RSD in autistic adults. In particular, we excluded numerous studies that assessed anticipated responses using instruments such as the Rejection Sensitivity Questionnaire (Downey & Feldman, 1996), the Interpersonal Sensitivity Measure (Boyce & Parker, 1989), or the Trier Social Stress Test (Kirschbaum et al., 1993). Although these anticipated responses are sometimes included in descriptions of RSD (e.g., Dodson et al., 2024), research in allistic adults indicates that they are not or only weakly associated with reactive responses (Beekman et al., 2016; Dambreville, 2019; López et al., 2024). One study included in our review similarly found no association between expectations of exclusion and cardiac responses during exclusion (Gurbuz, 2020). Therefore, we suggest that anticipatory and reactive rejection responses may represent distinct constructs that warrant separate investigation.

In addition, we included three studies whose samples consisted entirely or predominantly of allistic adults. While this decision may limit the generalizability specifically to autistic populations, we note that the results of these studies were consistent with those from autistic samples and therefore did not substantially affect our conclusions. Furthermore, our search strategy relied on identifying autism-related terms in article titles, which means we may have missed studies examining autistic adults or autistic traits that were mentioned only in the abstract or main text. Finally, although the inclusion of dissertations and conference papers further enhanced the comprehensiveness of our review, these sources may not meet the methodological rigor and reporting standards of peer-reviewed journal articles. As a result, the reliability of some findings may be reduced.

Conclusion

While not universal, the reviewed studies suggest that some autistic adults may experience profound and distressing emotional, physical, and physiological responses to rejection. Nevertheless, inconsistent findings and heterogeneity in conceptualizations, operationalizations, and measurement approaches obscure a coherent understanding of what exactly these responses represent, whether they warrant recognition as a distinct construct of RSD, and how these experiences relate to adjacent frameworks. This fragmentation prevents the field from building on prior findings and makes it difficult to determine how best to understand and support autistic adults who describe experiences of RSD. Establishing conceptual clarity is therefore a necessary foundation for future work. Future research should also examine the currently understudied responses to criticism, identify contributing factors, and ultimately guide the co-creation of tailored, neurodiversity-affirmative interventions.

Supplemental Material

sj-docx-1-ndy-10.1177_27546330261441753 - Supplemental material for Rejection Sensitivity Dysphoria in Autistic Adults: A Scoping Review

Supplemental material, sj-docx-1-ndy-10.1177_27546330261441753 for Rejection Sensitivity Dysphoria in Autistic Adults: A Scoping Review by Alvin van Asselt, Desiree Reekers and Yvette Roke in Neurodiversity

Supplemental Material

sj-docx-2-ndy-10.1177_27546330261441753 - Supplemental material for Rejection Sensitivity Dysphoria in Autistic Adults: A Scoping Review

Supplemental material, sj-docx-2-ndy-10.1177_27546330261441753 for Rejection Sensitivity Dysphoria in Autistic Adults: A Scoping Review by Alvin van Asselt, Desiree Reekers and Yvette Roke in Neurodiversity

Supplemental Material

sj-xlsx-3-ndy-10.1177_27546330261441753 - Supplemental material for Rejection Sensitivity Dysphoria in Autistic Adults: A Scoping Review

Supplemental material, sj-xlsx-3-ndy-10.1177_27546330261441753 for Rejection Sensitivity Dysphoria in Autistic Adults: A Scoping Review by Alvin van Asselt, Desiree Reekers and Yvette Roke in Neurodiversity