The Sting of Rejection: RSD, Eating Disorders, and Neurodivergence

For many people with eating disorders, one of the hardest parts of recovery isn't about food at all - but rather an underlying fear of being judged, criticised, or rejected. This is where Rejection Sensitivity Dysphoria (RSD) comes in. The word dysphoria stems from a Greek word meaning “difficult to bear”. RSD describes an extreme emotional response to real - or perceived - rejection or criticism. While it isn’t a formal diagnosis, RSD is a clinical construct that is increasingly recognised and experienced by individuals in neurodivergent communities, particularly among people with ADHD and autism. Intrinsically linked to our innately human need to belong, RSD is like an internal alarm system that signals to us when our sense of belonging is threatened. But instead of gently nudging us, it blares like a siren - signalling something in our social sphere is out of balance. Social rejection, even if uncertain or vague, causes similar brain activity to pain, leading to intense and overwhelming feelings of shame, anxiety, or anger. This can prompt us to ‘protect’ ourselves through avoidance, people-pleasing, or perfectionism.  
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What RSD Feels Like

Individuals with RSD often struggle to describe their experiences of what it feels like, due to the intensity, and dissimilarity to other forms of pain (emotional or otherwise). Living with a constant radar for rejection, people with RSD sometimes show signs of low self-esteem and trouble believing in themselves, and can be prone to ‘people pleasing’ to avoid disapproval from others. It is also common for individuals with RSD to have emotional regulation difficulties when feeling rejected. Some may react with sudden bursts of anger (often noticeable in children and teenagers), others may burst into tears, and some may turn their feelings inward - which can look like a snap onset of severe depression. Individuals with RSD may avoid starting tasks, projects, or goals, due to fear of failure, which they often compensate for by striving for perfection. This perfectionism can perpetuate anxiety, and lead to neglected self-care or downtime. Living with RSD means navigating life with a hypersensitive social alarm system - one that often misfires and cuts straight to the heart of identity and self-worth. 
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ADHD, Autism, and RSD

RSD is especially common in ADHD due to neurological differences in emotional regulation, but it is also widely reported in autistic communities. Both ADHD and autism involve differences in brain connectivity that affect how social signals are processed, making criticism or exclusion feel especially intense. Being neurodivergent in a world built for neurotypical brains often exposes neurodivergent individuals to more experiences of systemic and social rejection, invalidation, and bullying. These experiences don’t just leave emotional scars - they can fuel and reinforce RSD, making the fear of rejection both an internalised expectation, and a lived reality. 
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RSD, Neurodivergence, and Eating Disorders

People with ADHD and autism are at higher risk of developing eating-disorders. For ADHDers, several factors can contribute to this, including impulsivity (which can affect eating patterns), emotional dysregulation (which makes food a common coping mechanism), and high rates of rejection sensitivity (amplifying shame and body image concerns). For individuals on the autism spectrum, sensory sensitivities, rigidity, monotropism (deep focus on specific interests), and difficulties with interoception (sensing hunger/fullness) may also contribute. When rejection sensitivity, neurodivergence, and eating disorders overlap, the impact can be profound. 

Eating disorders and RSD share a common language: shame, fear of judgement, and longing for acceptance. Yet, this connection is rarely discussed - and it may explain why recovery can feel so overwhelming, or why treatment doesn’t always stick. Shame is a powerful fuel for eating disorders. Many individuals with eating disorders describe cycles of secrecy, guilt, and the fear of “not being good enough”, which can be triggered and perpetuated by RSD. Individuals with RSD may turn to perfectionism, seeking control or acceptance through restriction or chasing a certain body type or size. Eating (or restricting) food may also become a strategy of conflict avoidance, leading to people-pleasing, or ‘fawning’, as a way to gain approval, control, and avoid the risk of rejection. Perceived rejection - like an offhand comment about food or eating behaviours - may also trigger disordered eating behaviours and impact self-esteem. Even the body viscerally responds to perceived rejection - with feelings of nausea, tightness in the chest, or physical pain potentially impacting an individual’s ability to eat, absorb, and digest food adequately. For individuals on the autism spectrum, rejection tied to sensory needs, communication differences, or masking pressures can intensify these patterns, making recovery feel even more daunting. These factors create challenges for both the client’s relationship with food, and the therapeutic alliance. 
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Clinical and Recovery Implications - What Helps? 

The overlap between RSD and eating disorders poses challenges for treatment. RSD can heighten sensitivity to clinician feedback, which may be misread as judgement. This can lead to break-downs in trust, and/or treatment dropout or disengagement. Fortunately, there are existing care approaches that can help to ease the complex burden of RSD and EDs. Compassion-Focused Therapy (CFT) is a psychotherapy that addresses and minimises shame and self-criticism. Fostering self-compassion can help individuals with RSD counteract the cycle of rejection. Trauma-informed and neurodiversity-affirming care can help create safe spaces for clients, where  individuals are validated and supported rather than judged, sensory/communication needs are honoured, and the risk of re-triggering rejection wounds is actively mitigated. Collaborative, autonomy-supportive approaches can foster trust between clinicians and clients, further reducing the fear of judgement in treatment. This may lead to better treatment engagement and adherence, as a strong therapeutic alliance is a key predictor of eating disorder treatment success. Treatment can also involve medications, such as those typically used to treat ADHD (which influence the same brain areas responsible for RSD symptoms). 
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Navigating RSD at Home - Strategies for Acceptance

In terms of navigating RSD on a daily basis, the individual can work to identify triggers around RSD, and food and eating. Developing awareness of triggers and recognising moments when rejection fears flare up can reduce their power. Individuals with RSD can practice radical acceptance of themselves, sitting with and allowing themselves to feel the sensations and emotions that arise with RSD without judgement or criticism. This can help prevent avoidance behaviours and shame spirals. Nervous system regulation can be an effective way to alleviate RSD in the short-term. Regulation strategies could include mindfulness or breathwork, cold water wet-cloth on the back of the neck, moving your body, stimming, humming or singing. For individuals on the autism spectrum, these regulation strategies should be mindful and respectful of differing sensory profiles - mindfulness may be grounding for some, but triggering for others. 
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Moving Forward: Why This Connection Matters

Understanding the overlap between RSD, ADHD, and EDs does more than validate lived experience - it opens the door to better care. It can open up a conversation at the intersection of neurodivergence, emotional regulation, and eating disorders, validating individuals who may have this complex, under-researched combination. This connection highlights the importance of looking beyond weight, and to identity-based factors in recovery. Recovery isn’t merely about eating “the right foods” or reaching a certain weight - it’s about feeling safe in your relationships, confident that your needs won’t be dismissed, and free from the constant fear of rejection. 

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