Rejection Sensitivity Dysphoria in Autistic Adults: A Scoping Review

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.