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afwijzingsvoeligheid ADHD autisme
Why an unanswered text hurts so much
Karolien Koolhof •
Know that feeling? You send a text and no reply comes. Within a few minutes you’ve worked out what you did wrong and decided it will surely never be okay again. And your body joins in, because you feel a knot in your stomach. On the outside nothing has happened, but on the inside it seems as if an alarm has gone off. What is going on?
Many neurodivergent people recognize this. On social media it’s called “RSD”, or rejection sensitive dysphoria. But what is it exactly, and is there evidence for it? Psychologists call this rejection sensitivity. You quickly expect others to reject you, and you react strongly to it. It often develops through what you’ve experienced earlier in life. Someone who has been rejected often starts to expect rejection and becomes ever sharper at noticing signals of it (Downey & Feldman, via the University of Nottingham). Your alarm system gets set more sensitively. That can lead to social anxiety, withdrawing from others and loneliness (Gao et al., 2017).
Everyone knows this a little, but in some people it is strong. A review study of 75 studies showed that these people more often suffer from depression, anxiety and loneliness. That link remained when researchers followed people over a longer period. It is only a moderate link, though, so rejection sensitivity is certainly not the whole story.
Not a diagnosis
The term RSD became known through the American psychiatrist William Dodson, who links it to ADHD. It is not listed as a condition in the diagnostic manuals. The research on it is small: five studies, all based on interviews, with 4 to 43 participants. In the largest study, 33 of the 43 young adults with ADHD recognized themselves in it (Ginapp et al., 2023, via Kahn, 2026).
What people describe is remarkably consistent. In a study of five students with ADHD, three things kept coming back: physical pain, withdrawing and masking (Rowney-Smith et al., 2026, via Kahn, 2026). The pain led them to adapt to others. Withdrawal, loneliness and more anxiety followed. I know that pattern from my work with neurodivergent people. The harder you adapt, the further you drift from yourself.
There is not yet a questionnaire that measures RSD reliably. Researchers call that the first step (Kahn, 2026).
ADHD
Difficulty regulating emotions can be part of ADHD. In roughly a quarter to nearly half of children and in 30 to 70 percent of adults with ADHD, it is present (Shaw et al., 2014, via Kahn, 2026). People with more ADHD traits are, in research, more often sensitive to rejection, and they are also more often less kind to themselves.
Even so, researchers call the evidence limited and mixed. In adults with both borderline personality disorder and ADHD, ADHD contributed only a little, on top of anxiety and depression (study on borderline and ADHD). Those two often go together with ADHD and therefore explain only part of the link. And the figure that circulates online, that almost 100 percent of people with ADHD have this? That is not based on solid research.
Autism
In an interview study, 19 autistic adults described how exhausting it is to expect rejection or criticism. They themselves saw two causes: their autistic traits and a lifetime of rejection. The researchers suspect it is an underestimated cause of stress (Van Asselt et al., Autism).
In a large questionnaire study, 1,425 autistic adults scored higher than 187 people without autism, but the difference was small. And in a small study with 20 autistic and 40 non-autistic students, the autistic participants less often expected someone to like them. But across the whole group, social anxiety predicted the expectation of rejection better than autistic traits did (Gurbuz et al., 2024).
Chicken or egg?
People with ADHD and autism are more often rejected or misunderstood. That does indeed make them more sensitive. Long-term rejection early in life makes your brain react in an alert and defensive way (Frontiers in Psychology, 2015). But it can also work the other way around, and research cannot yet separate the two. So this is not only about a brain that works differently, but also about what that brain has been through for years.
There is not yet a study showing that a treatment reduces rejection sensitivity itself in ADHD or autism. ADHD medication does reduce emotional outbursts. But nobody has measured whether it also reduces the pain of rejection. In children the improvements lasted; in adults they were temporary and also occurred with a placebo. In autism, scores dropped equally in both groups in a small trial.
Therapy with ACT (acceptance and commitment therapy) worked in students with a different form of rejection sensitivity, but they did not have (diagnosed) ADHD or autism (Zhao et al., 2025). I have not found research on body-oriented approaches to rejection sensitivity. What otherwise seems to help is mainly understanding from the people around you (Beaton et al., 2022).
Do you notice that you suffer a lot from rejection sensitivity? It can help to talk about it. Feel free to contact me if you’d like to talk about this further.
About the author
- Karolien Koolhof is a coach for introverts and gifted individuals
- Author of the book Introvert Leadership
- Contact