Ep 15: Understanding AuDHD in the Real World - Rejection Sensitivity & Dysphoria

🎙️ Episode 14: Rejection Sensitivity & Dysphoria in ADHD, Autism & AuDHD

Episode Summary

In this episode of The AuDHD Psych Podcast, Aaron Howearth explores rejection sensitivity, emotional intensity, and rejection sensitive dysphoria through a neurodiversity-affirming lens. He explains why some autistic, ADHD, and AuDHD people experience emotions as suddenly overwhelming, especially when past experiences of rejection, exclusion, or social misunderstanding shape how current situations are interpreted.

Drawing from clinical psychology, Aaron describes emotions as a bodily response to our cognitive appraisal of context, then links that to fight, flight, freeze, fawn, and flop responses, as well as differences in interoception and alexithymia. He shows how rejection sensitivity can amplify ambiguous social cues, how anticipation of rejection can feel as painful as rejection itself, and why people may move quickly from calm to intense dysphoria without noticing emotion building in the background.

Aaron also discusses how these patterns can contribute to people pleasing, self-sacrifice, masking, burnout, and interpersonal stress, and how they can resemble some features often associated with borderline personality disorder without reducing people to a label. He then offers practical strategies, including using the NICE framework, redirecting attention toward novelty, interest, challenge, or emergency, and replacing “you’re too much” with a more compassionate understanding that people are responding to context, not failing as people.

Key Themes & Takeaways

• Emotions as Body + Context – How emotional intensity emerges from the body’s response to our appraisal of current and past context, not from feelings alone.
• Fight, Flight, Freeze, Fawn, Flop – How different threat appraisals map onto distinct survival responses, from fighting and escaping to shutting down or dissociating.
• Rejection Sensitivity – How repeated real or perceived rejection can prime people to interpret ambiguity as exclusion and to miss positive social cues.
• Rejection Sensitive Dysphoria – How the lived experience of intense distress around rejection is recognised in community, even though it is not a formal diagnosis.
• Alexithymia and Interoception – How difficulty identifying emotions, and differences in sensing internal states, can make emotions feel sudden or hard to regulate.
• People Pleasing V Self-Sacrifice – How prioritising others’ needs over one’s own can become a safety strategy shaped by exclusion, masking, and fear of rejection.
• Burnout and Interpersonal Stress – How chronic self-suppression and social threat detection can compound stress and contribute to autistic burnout.
• NICE Framework in Practice – How novelty, interest, challenge, and emergency can be used to anchor attention and support regulation when emotions become intense.
• Self-Compassion and Belonging – How replacing “you’re too much” with “you’re just the right amount” supports a more humane, community-based understanding of neurodivergent experience.

Transcript

SPEAKER_00 0:10

Hello friends, welcome back to the Audi HD Psych Podcast. I'm Aaron Hammer, the clinical psychologist, and we are different, not defective. And look at my pretty yellow coat. Thank you to everybody who's listened to our previous episodes. It has been fun monologuing and chatting and answering questions from Uma and Dan. And we have Dan here again today helping me out. And we really appreciate everyone's support on our social media Instagram, Facebook, uh, TikTok now. Iwe and those of you who have liked, um, followed, subscribed, and left us ratings on streaming platforms. If you haven't already and you have a chance, please do. We really appreciate it. Or follow us on our Instagram. Last week we had a bit of a chat about impacts in different areas of life. And this week we're sort of tuning in a little bit on rejection sensitivity and what we refer to as rejection sensitive dysphoria. As I mentioned, Uma's not here today, so I've got the delightful Dan is giving me a hand and gonna ask me questions and help keep me on track. So I'll hand over to Dan. Dan, what was that first question?

SPEAKER_02 1:12

So this one's about emotional dysregulation and rejection sensitivity. Can you talk about what emotional intensity actually feels like and what's happening in your body when emotions hit?

SPEAKER_00 1:22

So emotional intensity, that experience is different for everybody, as is every experience. What emotions are actually in our body in my clinical practice, when I'm trying to describe emotions to people, the framing that I use is emotions are our integrated experience of our body's response to our cognitive appraisal of our context. And by that, by context, I mean uh both my past history that leads into how I perceive things now, and my current context, my current perspective, the current environment that I'm in. Uh so for example, if I perceive a challenge in the environment, my body needs to respond to that challenge in some way. That's a cognitive appraisal to see that it's a challenge. But it could be a positive challenge, a motivational challenge, a growth opportunity, or it could be a threat, a physical threat to my safety or a perceived threat to my safety. If it's positive, I'll experience excitement. If it's negative, I'll experience the fight, flight, fear, fauna, flop responses. Um if I cognitively appraise that I'm stronger than the threat, I'm probably going to fight it off to keep myself safe. If I appraise that it's stronger than me, but I'm strong enough to get away, I move into flight. If I perceive that I'm not strong enough to get away, but I can hide, I'll hit the freeze response and hope that it doesn't see me. If none of those are my perception of myself, if I appraise that I'm not going to get away, I can't hide from it, I'll lean into a bit of social accountability. I'll beg, I'll beg for my life. And finally, and here we're moving from that activated side into what we see depression underpinned by hopelessness. If I believe I can't get away, um, and the predator, for example, in an evolutionary sense, has got me, I'll not be there. I'll dissociate and my body will cease responding. In those first couple of activated um safety responses and excitement, my body wants to do very similar things. I need to activate and move. Heart rate increases, breathing increases, and that's to get oxygen into my blood and pump that oxygen around my body, to my muscles, to my brain for thinking. There are cognitive differences that come into play. My eyes do different things. Interesting for those of you out there who experience IBS and similar gut issues. One of the biological responses to activation for fight, flight, um, pardon me, fight and flight particularly, is digestion costs a lot of energy. And so I want to use that for the fight or the runaway. So I'm probably going to stop digesting. Uh, but also if I need to run away, I want to weigh as little as possible. So I'm probably going to try and evacuate what's in there as well. If I need to fight, I'm probably going to want that energy later. I don't need to get rid of it. So I'll have a slightly different experience in my stomach there. But that probably links into why a lot of neurodivergent people experience IBS because it is probably consistent with our body's anxiety response. So bringing myself back on track, um there are those responses that we that are literally our body getting ready to do something or not in response to what I see about myself in my context. Um, how I see my current context is influenced by my past, CBT core beliefs, schematherapy schemas, uh, that type of influence on how I experience the world now. Could you ask me the question again? Because I went on a massive tangent there.

SPEAKER_02 5:02

Okay, I think you've actually covered it quite well. Um, so the uh the question was about emotional dysregulation and rejection sensitivity and the emotional intensity, what it feels like.

SPEAKER_00 5:13

Ah yeah. Um so just topping into the emotional intensity, so that will vary by person, but also um, you know, the there's so many different parts to that rejection sensitivity. One, it's a really I have lots of experiences of rejection in the past. Often as a neurodivergent kid, that's one of the most common complex stresses that I see. We have this recurrent history of real and perceived rejection, um, to the point that we will be impulsive and say the first thing that comes to mind. Uh one, because we're impulsive, two, because we don't clock that you have a different social expectation about how to respond to how do you like my new haircut that somebody did with a blindfold on. And I respond in a really direct way with the first thing that comes to mind, where you're kind of expecting me to go, oh, it's lovely, and look away to politely let you know that it's not something that I would choose for an enemy. Very freaking. I love that. But um, so I get lots of these uh experiences. They teach me to read ambiguous situations through that same lens of negative feedback. They also prime me to see that negative social feedback and to not see or to dismiss the positive social feedback. So I then wonder where I was going with that. I'm then more likely to experience that social rejection. I take it into mind now. But then if I have some introspectices, like many neurodivergent people do, uh, which probably contributes to alexophymia, that I think in before recording, you and I have heard this stat about a million times because I keep repeating it. I think 50-ish percent, around half of neurodivergent or autistic kids in some research have been found to be alexophymic. And between 30 and 70%, I think was the the range of adults uh experience alexithymia, which is well, thank you for asking that. Um, alexithymia is difficulty in the experience of emotions, often in naming and identifying the emotion, which changes the way we experience and express it.

SPEAKER_01 7:28

Okay.

SPEAKER_00 7:29

So if I don't if I don't understand, if I can't name, if I don't know what it is that I'm experiencing, it's much more difficult for me to rein my emotions in. If I don't realize that I'm becoming super anxious until I reach panic, then I'm gonna go from apparently calm to panic. Really suddenly, if I'm an Audi HDR and I'm also emotionally impulsive for whatever reason that is, that's gonna be amplified.

SPEAKER_02 8:01

Yeah.

SPEAKER_00 8:02

Then if I've got a history of social difficulties and I'm suddenly going, if I'm suddenly really angry for no reason to everybody else, it's gonna amplify my social difficulties and my predisposition to those emotional difficulties that we just described for that process. So what does emotional intensity feel like? Like that. I actually remember part of the question. Um, it feels different for everybody. Some of us don't have alexophic difficulties and don't have significant introspective difficulties, so we do feel it building up, but we might have an intentional difference that's like, I know I'm getting anxious, but also my attention's over here because that's more salient right now. And then all of a sudden the anxiety is at a level that it overtakes the thing that's dominated my attention, and I appear to have suddenly had a really big response that applies to the anxiety around rejection as much as to anger or to other anxieties. So in rejection sensitivity, it can feel like a little thing is read through the lens of a past experience of many rejections, and then my emotions either I don't notice them building or they just bounce high through impulsivity, emotional impulsivity. Suddenly I go from, oh hey, how are you? to you're like, I'm okay with a funny tone, and I experience significant rejections, I perceive significant rejection, and I experience significant dysphoria around that.

SPEAKER_02 9:24

Um, so sort of tying into how that might be responded to, some Audi HD people get told you feel things too deeply or you're a lot. So can you speak to that?

SPEAKER_00 9:34

So the feeling things too deeply, I think, really taps into that past history. Uh there's a technique called the affec bridge that I'll use to demonstrate this point. And it's where if you have uh an anxiety now and we're not sure where it came from, and we want to try and process that. I can say you call up the image, the mental representation. I don't like using the phrase mental image because a lot of people either see in different variations of pictures, um, or some people don't think in pictures at all. So that mental representation of the experience recently, I get you to tap into all of your senses to make it as real for your brain as possible in the now. And then I get you to tap into the emotional, that introspective kind of the emotional experience as you're recalling that. And then I say, let the rest of that representation disappear. Keep your attention solely on the emotional content. Now tell me about a time earlier in your life when you felt that way. And what it does is it uses the emotion as a bridge back to past experience. Usually in the MDR, we talk about the first or worst. Often it is either the first time you experience that or the worst time you experienced that. So that emotion is a connector to all of those past experiences that you've had. So when you feel rejected now, your brain will go, Oh, all of these other rejection experiences. So because they're so salient to us and there's so many to connect in, we're experiencing a much bigger emotion because it's connected to so many more past experiences. I don't know if that answered the question, but uh I hope you touched on.

SPEAKER_02 11:10

Just quickly, do you think that also ties into the anticipation of being rejected, sometimes feeling worse than the rejection itself?

SPEAKER_00 11:17

So I think the anticipation of being rejected can lead to dysphoria because of that, absolutely. And then the rejection, whether the rejection happens or not, doesn't change the experience of what we call rejection-sensitive dysphoria. And I hasten to point out rejection sensitivity is a construct that's quite well accepted. Rejection sensitivity dysphoria is more of a conversation in community. It's not a formal diagnosis. Pardon me, it's a lived experience that we recognize as being truly impactful on people. And when we sit with that lived experience, we often see that it does come from both uh a complex stress history, but also those cognitive differences that underpin a lot of our neurodivergence, the impulsivity or difficulty managers impulses, the attentional differences we have where the most salient thing has more control over our attention than we appear to. And I'll leave that there.

SPEAKER_02 12:13

Um so we've spoken before uh about it feeling going from zero to hero in intensity. Uh, how does that tie into maybe people pleasing or self-sacrifice?

SPEAKER_00 12:26

So let me count the ways. Um let me think of the most succinct way to answer this, which is not my go-to. How does that sort of history and rejection sensitivity play into people pleasing? So, first of all, I'd start off with I do not have an issue with people pleasing at all. I'm a people pleaser for a living. As a psychologist, my job is to make people or to try and assist people in having a better experience of their life in their context. That is, are people pleasing? I think when we talk about people pleasing more broadly, what we actually mean is self-sacrifice. When I'm meeting your needs without meeting mine anyway, and often without a real sense of agency in that, often it's not I'm choosing to self-sacrifice because I have the privilege to. It's more I feel that I have to self-sacrifice to keep myself safe.

SPEAKER_02 13:26

Yeah.

SPEAKER_00 13:27

So if I've experienced social exclusion my whole life, then I might feel that for me to be included, my social needs don't need to be met or they need to be deprioritized. Because I have to keep you feeling important or prioritized, and so doing deprioritized myself, for me to be included, and when I do that across my entire life, it is a contributor to all of the stress and masking and the burnout ingredients that lead to autistic burnout and the significant difficulties in recovering from that.

SPEAKER_02 14:03

Um, so you've talked in previous episodes about Audi HD thinking overlaid with interpersonal stress, looking a lot like borderline characteristics. Does rejection sensitivity feed into that same pattern?

SPEAKER_00 14:14

So I think absolutely. I think that I've talked also about sort of an Audi HD state of mind before, where we tend to think not just about the thing immediately, but about the orders of effect, the things connected to that. It's not I've got to take my computer to the shop to get fixed. It's I've got to take my computer to the shop to get fixed. And if I'm in burnout, for example, it's oh, but then I've got to get up, and then I've got to have a shower, and then I've got to choose clothes, and then I've got to dress, and then I've got to work out how to get to the new computer shop because my old computer shop's closed. So we're not thinking about a simple task like I've got to get to the shop. We're thinking about all of the little tasks in between now and then, and them all as one massive thing, so that can become problematic. Um I have lost my train of thought.

SPEAKER_01 15:04

What was the question again?

SPEAKER_00 15:05

Oh sorry, I found it again. Thank you so much. So that kind of Audi HD style of thinking in rejection sensitivity. If I have that past history, um, sorry, so I'll bounce back to the borderline description to give a bit more context for people who haven't seen that episode or listened to that episode. So, and by no means do I suggest that borderline does not exist exclusive of this. However, um there is uh there are a number of people that I have come across clinically and personally who have been diagnosed with borderline personality disorder. And when we look at their characteristics and their expression of their neurodivergent characteristics in the context of their early life or chronic or ongoing interpersonal stress and trauma, it expresses very much as borderline personality disorder expresses. And arguably, what we call personality is probably the expression of cognitive characteristics in a context, but that's not an evidence-based research thing. That's literally my observations. So that's the kind of framework we're looking at here. Now, looking at rejection sensitivity, can that work in the same way? I would say yes, and rejection sensitivity, we do actually see that experience in a lot of people with borderline personality disorder. Borderline comes with this central self-belief, self-concept that I'm broke and then I'm not good enough, and um, you know, I'm excluded and rejected, and I fear that rejection, so I do what I need to do to be included. Um, we talk about idealization and devaluation in borderline. And as long as you kind of make me feel good about myself, and this is not people being deliberate about this, this is a defensive structure that's that's been built up. Um, as long as you make me feel good, I think you're amazing. I paint you as an angel, but if you disagree with me, then you kind of feed into this negative self-belief and you reinforce that, and you suddenly become a demon to me. And that must be so hard. That's such a difficult space to live in for people. And I don't want to buy into this dreadful narrative about borderline people being somehow bad people because they're not. They're they're people with a really significant history that that's they're doing their best to manage. It just happens to be hard for the people around them. So rejection sensitivity in borderline and outside of very much the same thing because my rejection anxiety that leads to that sensitivity is also related to my self-concept and my self-esteem. How valuable do I think I am to other people and myself? And how tall do I think I am? If it's a negative response or an unhelpful response to both of those, then my anxiety is going to fill in the gaps and I'm going to read ambiguous situations through the lens of exclusion and rejection. But I'm also, as disgusted, I'm not only just primed to see the rejections and to read ambiguous cues as rejections, I'm also more likely to dismiss positive social cues. I'm going to walk into a room, see three people looking up and frowning, or looking up and looking away, and read those as rejection. And miss the two people that looked me in the eye and smiled, probably because I have some social anxiety as well, so I looked down and didn't see their eyes. I'm more, I'm so I'm doubly more likely, quadruply likely, to actually experience rejection. One part through actual rejection, one part through non-rejection that could have been rejection, ambiguous, and one part through not receiving that positive inclusion cue.

SPEAKER_02 18:58

Um, so you've talked about the nice framework before. Novelty, interest, challenge, emergency. I love the nice framework. It makes me more say, it makes me so happy. Um anchoring ADHD attention. Can the same framework be used for emotional dysregulation?

SPEAKER_00 19:13

So absolutely, and I love that. I uh I love the throwback to anchoring attention for the ADHD is out there. Novelty, interest, challenge, and emergency. And if we think about those things, we can actually tie a bit of them back into that conversation about emotions and our body's response to our cognitive appraisals. But I'll leave that link there. If Dan wants to send us an email or question that one, I'm happy to answer. It's really good for those of us who are not importance-based with our attention, we're more salience-based. Um, and by that I mean planning an organization requires me to notice what are the important things to do right now and prioritize those. Salience-based attention or interest-based attention, sometimes we call it. I see the thing that stands out to me right now. That's what my attention goes to. Um as ADHDers and Audi HDers, we are innately really good at whether it's through disorganization or whatever the cause is, getting to the last minute and having to do the thing really quickly, really suddenly. That's the emergency part of the nice framework. That's anxiety kicking in. I need to get it done so I can anchor my attention. So making the thing the most salient to me because there are repercussions. Uh, but I can use novelty, new things, I can use interest, and I can use challenging things that are growth challenge, not anxiety challenge. So that's to anchor my attention, which can help motivate me. In the context of rejection sensitivity or big emotions that a lot of us can have, regardless. If anyone's wondering about the noise that I just make, it's because a dog Cersei is just sitting on Dan's lap and is being gorgeous, and Dan is kicking me. So um, yeah, it's a nice framework. Not only can it be good to anchor our attention and motivate, when I've got big emotions, for a lot of neurodivergent people, just calm down is the opposite of help. Um, just bring your attention to your breath can actually be really triggering for some neurodivergent people. Um, just you know, ground yourself can be really unhelpful because again, salience-based attention, the biggest problem right now is the thing that's made my emotions big. But we can divert my attention to something that's novel, interesting, or challenging rather than something that's threatening rather than the emergency. We can divert my attention to you know, a lot of the people that I work with can have such significant anxiety. Uh, and I'll use an example of my own where we don't want to look stupid because that's threatening. I will never ask a dumb question if I perceive it to be a dumb question. In a class for myself. However, if I see you struggling with an idea and it's clear to me what the idea is, I'll put my hand up and ask. So I can do this thing for you that I can't do for myself.

unknown 22:12

Yeah.

SPEAKER_00 22:13

I think it probably taps into what we call the justice orientation, probably taps into the focus that a lot of us have on contributing to community. There's something there. It's probably what made me want to become a psychologist. I've had some shit times. So I wanted to try and make sure that other people had a minimized risk of having the same shit times. We can use that. If somebody's emotions are really big, but they're really community in care of others oriented, we can convert their attention to something that they find rewarding and will also pay for their attention to help bring those big, unhelpful emotions down. Or we can use novelty or interest as well. And it can help as emotional regulation. Let's not use some mindfulness or breathing retraining or attention or distraction.

SPEAKER_02 23:01

Now we discussed this last night, and I thought it was a really good discussion we had was really good. If we could retire one phrase from the way people talk about neurodivergent emotions, what would it be?

SPEAKER_00 23:13

Oh, it's you're too much. You're not too much. Like I said it last night sort of jokingly, but also if I'm too much, does that not also mean that you're too little? Like it's not about being anyone being too much or too little, really. It's about differences. And if you're in a room full of people who say you're too much, I wonder how bored you are in that room. And hop on over to ours for a couple, like come on into our clinic and have a chat. Move in spaces with community. Um, that comes with its own um exigencies, its own difficulties, because sometimes when you've got five emotionally impulsive people in a room, that can lead to conflict. If we're also five respectful people who go, oh actually, I can feel myself getting really angry, so I'm just going to take a breath and we can come back to this in a minute, can actually be really helpful. One, in doing that, we can model that for community who might not have had that before. We can also just feel like the normal, that just doesn't exist actually. We can feel not excluded, not like something that's on the outer. We can recognize that within community, we're not too much. Within community, we usually just write. The thing I love about the neurodivergent community is I work with some people who I absolutely adore and I think I would love to put you up on a pedestal and go, look at this person for this, and this other person for this. And these people that I really resonate with have such different characteristics. And I think the um the benefit of being around community is we also find that we don't have to be a set in a particular box to be socially appealing or socially attractive to other people because community is community. The general community kind of has some expectations, and we have expectations of it. But our own community, we tend to be more liberal, more open. Hmm. Clock that, check that one. We can also be much more closed in some ways, but we tend to be more forgiving about the neurodivergent people and our quirks because we have quirks too, and we're like, oh, you're quirky like me. I see that. Yeah, yeah. What's the I love this phrase that a lot of people use lately, and that's like neurokin. Oh, neurokin. You are the you are the sibling of my brain. Um and that was a lovely uh, we're almost at time. Yes.

SPEAKER_02 25:34

Uh so the final question, um, for the people or anyone listening right now who maybe just heard themselves described accurately for the first time, what's one small concrete thing they can do this week that allows for some self-compassion?

SPEAKER_00 25:48

Uh, self-compassion. Remember that you're if you're experiencing rejection sensitivity, for example, remember that this is not a thing that's just come out of nowhere. Remember that you've experienced similar things, again, real or perceived, and you probably haven't experienced the positive social feedback because of what we discussed earlier. And you're just a person responding in an understandable way to your context. You're not too much. Um, does the response sometimes not serve us? Yeah, sure it does, but it's not coming out of nowhere. It's coming from somewhere that we can probably track if we look hard enough. And recognizing that that just makes you human, like everybody else in the world. And in that we are included because everybody can be a bit extra from time to time. So just yeah, honor you and who you are, and the fact that you're not doing this on purpose. You're not trying to make the world inconvenient to the people around you, which is the implication of your too much. Say it before I want to say it again. You're just the right amount. Awesome. Thank you. Well, on that note, it's uh come to the end of this week's uh chatslash monologue slash deviation from deviation tangents. Thank you everybody for listening in again, and we look forward to a chat next week. See ya.