Rejection Sensitivity is – not – a symptom of Autism!

Autism: More and more are associating Rejection Sensitivity (RS) with Autism, but scientific evidence have proven that not to be the case. RS is related to BPD, not Autism!

Rejection Sensitivity (RS) is a personality trait, not a neurological defect, and is highly associated with Borderline Personality Disorder and Social Anxiety Disorder, but not Autism Spectrum Disorder.

NOTE: Terms like Rejection Sensitivity Disorder and Rejection Sensitivity Dysphoria are often presented as clinical diagnoses, but these are – not – official clinical diagnoses, and APA do not even have a definition of Rejection Sensitivity in their APA Dictionary of Psychology

Many people who write about Autism from the Neurodivergent Movement perspective are claiming the Rejection Sensitivity Dysphoria is associated with ADHD and Autism, stating things like:

Such statements as the above shows the lack of insight into what Rejection Sensitivity is, and it misrepresents how Emotional Dysregulation (EMDR) is misunderstood as something entirely unrelated to the factual emotional problems seen with Autism, since Rejection Sensitivity is highly related to other disorders, such as Borderline Personality Disorder and Social Anxiety Disorder, but not Autism!

Emotional Dysregulation (EMDR) is a – neurophysiological – defect in how persons with Autism interpret sensory and affective signals, whereas Rejection Sensitivity is a – psychological personality trait – caused by psychosocial factors (often due to childhood abuse or neglect).

No connection between Rejection Sensitivity and Autism!

Therefore, there is no causal association between Rejection Sensitivity and Autism, since one is a psychological insult which causes the afflicted person to become overly sensitive to (perceived) criticism from others, whereas emotional problems in Autism is due to Theory of Mind and Cognitive Flexibility impairments due to neurophysiological defect in the way persons with Autism processes sensory or neuronal signals.

Autism: Misinterpretation of Sensory/Neuronal Signals, Not of Intention or Content

In Autism, the emotional sensory or neuronal signals are misinterpreted at the neurophysiological level due to lack of ability to generalize incoming signals at the physical, nonconscious level.

RS: Misinterpretation of the Perceived Intention of Others, Not Sensory/Neuronal Signals.

The problem in Rejection Sensitivity is due to the a negative coping strategy of content of the perceived verbal or nonverbal signals of others, which are misinterpreted at the cognitive, conscious level.

Thus, the emotional difficulties in Autism is out of the willfull control of the person and cannot be attributed to any psychosocial or personality traits, it is a defect caused by developmental factors of genetic origin.

Rejection Sensitivity is due to a Psychological insult, EMDR in Autism is due to a Physical defect!

In Rejection Sensitivity the cause is related to early psychosocial insults which have created a dysfunctional coping strategy toward criticism, by being overly reactive to perceived critique from others, and is as such a psychological trait that can be treated through therapy, which is not possible for persons with Autism (here medication can help modify the neuromodulatory signals to decrease or inhibit emotional dysregulation; e.g., Guanfacine),

Scientific Facts About Rejection Sensitivity

Definition: Rejection Sensitivity – the tendency to expect, perceive, and overreact to rejection by others – is linked with individuals’ expectations that their romantic partners’ behaviors have negative intent, even if, perhaps, such behaviors could be considered neutral when observed by another. (Norona et al., 2014)

Key points

• Rejection Sensitivity (RS) refers to this processing disposition and consequent cognitive–affective responses, such as intense cognitive responses to perceived rejection (e.g., self-blame, defensiveness, or aggression. (Foxhall et al., 2019)
• Rejection Sensitivity is proposed to develop in response to childhood rejecting environments, including those characterized by neglect and abuse, and has an adaptive purpose of keeping individuals safe. (Foxhall et al., 2019)
• Rejection Sensitivity has been linked with reduced self-esteem and may give rise to significant psychopathology. (Foxhall et al., 2019)
• The Rejection Sensitivity model may be especially pertinent to Borderline Personality Disorder as several diagnostic factors subsumed within the DSM-5 diagnostic  criteria are similar to features of Rejection Sensitivity, including ‘fear of rejection’ and ‘anxious preoccupation with real or imagined. Furthermore, the early rejection experiences proposed to underlie Rejection Sensitivity may overlap within the invalidating environments frequently observed in the childhood of people with Borderline Personality Disorder. Finally, research indicates that people with Borderline Personality Disorder are hypersensitive to social exclusion, which may be explained by the cognitive–affective processing bias proposed in Rejection Sensitivity. (Foxhall et al., 2019)
• Outcomes from this systematic review and meta-analysis indicate that Rejection Sensitivity is linked with Borderline Personality Disorder across clinical and non-clinical populations. Some forms of childhood rejecting experiences are associated with Rejection Sensitivity, particularly emotional neglect and abuse, which may mediate the effect on later Borderline Personality Disorder. However, outcomes regarding the effect of childhood rejection and Rejection Sensitivity on Borderline Personality Disorder are inconsistent and raise questions about the proposed linear relationship. The moderate to high effect sizes are somewhat unsurprising given the similarity between Rejection Sensitivity and Borderline Personality Disorder diagnostic criteria. (Foxhall et al., 2019)
• Some researchers have argued that explicit, behavioural responses to perceived rejection may distinguish people with high Rejection Sensitivity who do and do not have a diagnosis of Borderline Personality Disorder. For example, elevated Rejection Sensitivity in people with low executive control may lead to maladaptive interpersonal responses that make relationships difficult to maintain, such as self-blame, defensiveness, and mistrust initiating a self-fulfilling prophecy that may appear similar to Borderline Personality Disorder presentations. This distinction is important when one considers the interaction with executive control. Rejection Sensitivity may only manifest as Borderline Personality Disorder in people with low levels of executive control. (Foxhall et al., 2019)
• Rejection Sensitivity (RS), the predisposition to defensively expect, readily perceive, and react strongly to interpersonal rejection, may be a transdiagnostic trait associated with a range of psychiatric symptoms and psychosocial dysfunction. Valid and reliable assessment of vulnerability factors is essential for individualized treatment and improving clinical outcomes. Limited research has examined the factor structure of the predominantly used self-report measure of Rejection Sensitivity, the Adult Rejection Sensitivity Questionnaire (A-RSQ; Berenson et al., 2009). Across two studies, we examined the factor structure of the A-RSQ in samples of adult U.S. residents and investigated associations with mental health correlates, including neuroticism, social anxiety, anxiety, depression, anhedonia, somatic arousal, and psychological distress. Study 2 also evaluated relations with interpersonal correlates, including introversion, submissiveness, and anxious and avoidant attachment. A two-factor solution with rejection expectancy and rejection concern representing separate factors consistently fit the data best. Distinct patterns of associations emerged suggesting that concern was more strongly associated with indicators of negative affect while expectancy was uniquely associated with diminished positive affect. Both concern and expectancy were associated with indicators of interpersonal dysfunction. Findings suggest that the current operationalization, and perhaps conceptualization, of Rejection Sensitivity as measured by the A-RSQ requires revision. Additionally, Rejection Sensitivity may be a clinically relevant transdiagnostic phenotype that influences symptom manifestation and psychosocial functioning. (Lord et al., 2022)
• Autistic traits-subclinical forms of characteristics associated with autism spectrum disorders-are associated with poor social interactions and high risks for mental health disorders. We hypothesized that altered sensitivity to social rejection is an important contributor to psychological distress observed among individuals with high autistic traits. Results showed that autistic traits affected depressive/anxious symptomatology partially through heightened rejection sensitivity. Therefore, autistic traits heighten sensitivity to rejection-induced social pain that leads to psychological distress. This finding will help facilitate the development of strategies for coping with social pain and improving mental health for individuals with high autistic traits. (Lin et al., 2022)
• Anxiety sensitivity (AS) is implicated in the development and maintenance of several psychopathological conditions. Non-clinical individuals with high autistic traits may develop anxiety disorders and depressive symptoms. Here, we investigated the relationships of autistic traits with AS dimensions and depression, considering sex. We referred to the two-factor model of the autism spectrum quotient to distinguish social and non-social autistic traits and assessed 345 university students on AS and depression scales. Results showed that only social autistic traits predicted general AS and anxiety-related concerns regarding social and cognitive domains. The present results emphasize the need of assessing multiple domains of anxiety in individuals on the autistic spectrum, differentiating social and non-social traits. (Baiano et al., 2022)

Conclusion

Rejection Sensitivity (RS) is – not – a core feature of Autism Spectrum Disorder (ASD). Rejection Sensitivity is a personality trait, most commonly associated with Borderline Personality Disorder (BPD), or Social Anxiety Disorder (ANX). Therefore, persons with RS symptoms should be evaluated for BPD or ANX before ASD to eliminate misdiagnosis, and RS do not indicate ASD.

References

Baiano, C., Raimo, G., Zappullo, I., Cecere, R., Rauso, B., Positano, M., Conson, M., Aversana, L. D., Di Rosa, A., Esposito, G., Milo, R., Polito, F., Raimondo, C., & Turco, A. (2022). Anxiety Sensitivity Domains are Differently Affected by Social and Non-social Autistic Traits. Journal of Autism and Developmental Disorders, 52(8), 3486–3495. https://doi.org/10.1007/S10803-021-05228-W

Foxhall, M., Hamilton-Giachritsis, C., & Button, K. (2019). The link between rejection sensitivity and borderline personality disorder: A systematic review and meta-analysis. British Journal of Clinical Psychology, 58(3), 289–326. https://doi.org/10.1111/BJC.12216

Lin, X., Zhuo, S., Liu, Z., Fan, J., & Peng, W. (2022). Autistic traits heighten sensitivity to rejection-induced social pain. Annals of the New York Academy of Sciences, 1517(1), 286–299. https://doi.org/10.1111/NYAS.14880

Lord, K. A., Liverant, G. I., Stewart, J. G., Hayes-Skelton, S. A., & Suvak, M. K. (2022). An evaluation of the construct validity of the Adult Rejection Sensitivity Questionnaire. Psychological Assessment, 34(11). https://doi.org/10.1037/PAS0001168

Norona, J. C., Salvatore, J. F., Welsh, D. P., & Darling, N. (2014). Rejection Sensitivity and Adolescents’ Perceptions of Romantic Interactions. Journal of Adolescence, 37(8), 1257. https://doi.org/10.1016/J.ADOLESCENCE.2014.09.003

Pernille Hebsgaard, (2023) Quotation from https://www.pernillehebsgaard.dk/