FAQ

We live in a society where being “able-bodied” is seen as the ideal, and where disabled people experience daily prejudice and discrimination and societal ableism. Every member of society is exposed to these subtle messages during their lives, which, if unchallenged, can develop into an unconscious negative bias, or ableism.

Disabled people are also exposed to these negative societal attitudes and, over time, can begin to believe them, viewing their disability as a flaw, seeing themselves as broken, and worrying that their needs are a burden on others. This common phenomenon is known as internalised ableism. Internalised ableism can lead an Autistic person or ADHDer to hide their authentic self, feel ashamed of their difficulties, and refuse to ask for help or accept accommodations.

Internalised ableism can include:

• Not asking for help or accepting it when offered
• Believing that your needs aren’t valid and that you don’t deserve help
• Believing other people have much greater barriers and problems compared to you, and this means you shouldn’t need help
• Believing in the “bootstrap mentality” and idealising willpower, determination, grit, resilience, or hard work rather than asking for help
• Masking or camouflaging your differences because you are ashamed of them or believe they are not socially acceptable
• Blaming your difficulties with executive functioning on your own “laziness”, “being disorganised”, or “carelessness”
• Rejecting disability and diagnostic labels because they would mean you are a “failure” or not “normal”
• Ruling out ADHD medications, because this would be “cheating” or “taking the easy way out”
• Believing that being diagnosed with Autism and ADHD would give you an excuse for poor work or behaviour
• Wishing that there was a cure for autism or that you were “normal,” or idolising people who are
• Setting unrealistically high, perfectionistic standards for yourself, to prove you are competent
• Avoiding failure by tightly controlling your environment, activities such as exercise and diet, and sometimes other people
• Working extremely hard to compensate for your difficulties to avoid being viewed as inadequate or disabled
• Avoiding talking about your difficulties and viewing your needs are a burden to others
• Feeling profoundly guilty or ashamed for inconveniencing others in any way and apologising excessively if you do
• Using person-first language or outdated terms such as Asperger’s in order to distance yourself from being Autistic

Unwinding Internalised Ableism

The antidote to internalised ableism is self-acceptance and pride in your unique neurodivergent identity. Challenging and unwinding internalised ableism is a process that continues over a long period. Even if you have a strong foundation of self-acceptance, you may still uncover deeply held internalised ableism embedded within longstanding beliefs and the expectations you have of yourself and others. When these show up, give yourself time to explore and challenge them without judgment. (Judging yourself for having internalised these unhelpful ableist beliefs is self-defeating and would reflect yet more internalised stigma.) In these moments, try to offer yourself compassion. Developing internalised ableism was an unconscious process; you did not choose it, and with patience and persistence, you can also let it go.

For a detailed worksheet outlining how to recognise and unwind your internalised ableism, see the Resources page.

We live in a society where there is a cultural ideal of “able-bodiedness” and pervasive negative stigma against anyone who doesn’t meet this standard. Driven by a medical model that views disabled people as “broken normal people”, there is deeply ingrained ableism in our society.

This perspective can be clearly seen in the ways we talk about disabled people. The “tragedy” narrative that describes a disabled person as “suffering” from their disability and their caregivers as “heroes” reflects a deeply ableist and “othering” perspective. So too does the patronising “superpower” narrative and euphemisms such as “differently abled,” “special needs,” and “physically challenged.” These perspectives invalidate and minimise the very real challenges faced by disabled people.

Disabilities are neither superpowers nor tragedies; they are valid human differences that should be respected and accommodated. Yet typically, the burden of adapting and coping in society and physical environments falls almost entirely on the disabled person. At the same time, abled individuals go about their daily lives experiencing very little (if any) inconvenience.

This needs to change. We need to create a society where individual differences are acknowledged, accommodated, and accepted, not minimised and invalidated. Our social and physical environments must be adapted to allow people not just to survive, but to flourish and thrive.

Misophonia is defined as a decreased ability to tolerate specific sounds, as well as the things or people associated with those sounds (Swedo et al., 2022). Misophonia triggers are often repetitive noises in the environment that become intensely unpleasant and distressing. Often, these come from another person and are produced by the human body, but they can also include other repetitive noises.

Common triggers include:

• Eating sounds, such as chewing, lip smacking, crunching, swallowing, slurping, gagging, teeth clicking, or gum popping.
• Bodily sounds, such as breathing heavily or loudly, clearing the throat, sniffing, coughing, sneezing, yawning, joint cracking, or loud walking.
• Repetitive sounds in the environment, such as clicking a pen, typing, nail clipping, a clock ticking, rhythmic humming or buzzing from fluorescent lights or electrical appliances, or dripping water.

Exposure to these triggers evokes powerful negative emotions and intense physical discomfort. Reactions can include meltdowns, shutdowns, agitation, and angry outbursts.

The response does not depend on the loudness of the noise, but on the specific pattern of noises and the meaning it has for the person. People with misophonia often find it impossible to distract themselves from triggers, resulting in significant distress that continues to increase for as long as they cannot escape the noise.

Misophonia often develops in childhood or early adolescence, and the severity of the sensitivity can range from mild to severe. Misophonia can affect a person’s ability to socialise with friends and family, work, or study. Some people are aware that the intensity of their reaction may be disproportionate to the trigger, but this awareness does not reduce their distress or make it easier for them to manage their response.

Reference:

Swedo, S. E., Baguley, D. M., Denys, D., Dixon, L. J., Erfanian, M., Fioretti, A., Jastreboff, P. J., Kumar, S., Rosenthal, M. Z., Rouw, R., Schiller, D., Simner, J., Storch, E. A., Taylor, S., Werff, K. R. V., Altimus, C. M., & Raver, S. M. (2022). Consensus definition of misophonia: A Delphi study. Frontiers of Neuroscience, 16, 841816. https://doi.org/10.3389/fnins.2022.841816

Executive functioning describes a set of mental abilities that allows you to adapt your behaviour to manage different situations, connect with others, and achieve your goals (Barkley, 2020).

Executive functioning abilities include maintaining attention, switching between tasks, starting new tasks, planning, organising, prioritising, decision-making, working memory (holding information in your mind), tracking and managing time, monitoring your behaviour and its impact on others, controlling urges and impulses (inhibition), and managing your emotions.

These abilities begin to develop in early childhood, and this continues into adulthood. However, your unique profile of strengths and difficulties in executive functioning is largely (99%) genetic (Friedman et al., 2008). This means that members of your family might share similar strengths and challenges to you.

No matter how well-developed your executive functioning abilities are, whenever the demands of a situation are greater than your capacity, you will feel stressed and overwhelmed. And, because these skills all work together, when one or more aspects of executive functioning are overloaded, the other aspects of executive functioning will be under strain, too.

Every person has a unique profile of strengths and difficulties. It can be helpful to understand your profile, because you can then identify strategies that can make your life easier. You can find free, valid assessments of executive functioning here.

References:

Barkley, R. A. (2020). Executive Functions: What They Are, How They Work, and Why They Evolved. Guilford Press.

Friedman, N. P., Miyake, A., Young, S. E., DeFries, J. C., Corley, R. P., & Hewitt, J. K. (2008). Individual differences in executive functions are almost entirely genetic in origin. J Exp Psychol Gen, 137(2), 201–225. https://doi.org/10.1037/0096-3445.137.2.201

To access the free resources on this website, you will need to create an account with a username and password. To create an account:

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Cognitive Behavioural Therapy (CBT) is the most widely used form of psychological therapy globally. CBT is often recommended by health professionals for a wide range of physical and mental health problems, including anxiety, depression, obsessive-compulsive disorder (OCD), eating disorders, sleep difficulties, chronic pain, chronic fatigue, irritable bowel syndrome, and substance use problems. There is extensive research evidence that supports the use of CBT for these difficulties.

CBT is founded on the theoretical framework that centres thinking (cognitive) problems and learned behavioural patterns as the primary causes of psychological problems. CBT therapists aim to improve well-being by helping people change unhelpful thinking and behaviour patterns using strategies that include the following:

• Cognitive restructuring: Challenging thinking “distortions” that contribute to problems such as “all-or-nothing thinking,” “black and white thinking,” “catastrophising,” “shoulds/oughts/musts,” “overgeneralising,” and “personalising”
• Exposure and response prevention (ERP): Unwinding avoidant patterns by encouraging the person to take action in the presence of fear and anxiety.
• Behavioural activation: Encouraging a person to engage in activities to improve their mood, such as increased socialising, exercising, or spending time in nature.
• Mindfulness and relaxation: Practising activities that can relax the body and quiet anxious thinking, such as progressive muscle relaxation and mindfulness activities.

CBT can be used with Autistic and ADHDer people; however, like all therapeutic approaches, it must be adapted to suit the person and remain affirming. If you are using CBT as a therapist, there are a few things it is helpful to consider:

Cognitive restructuring:

Many Autistic people describe cognitive restructuring (attempts to change thinking patterns) as feeling like “gaslighting.” For many Autistic people, this process may feel like they are being told their thinking is “wrong,” when it is just different. Autistic people and ADHDers frequently experience discrimination, stigma and prejudice. Be careful not to imply that this is “all in their mind” or that they are “catastrophising.”

Exposure and response prevention: 

If an Autistic or ADHDer person is in burnout they will have very few internal resources available to them to undertake challenging exposures and they will struggle to put the plans they make in therapy into action.

Many exposure activities involve sensory and social stressors that can be uncomfortable for Autistic people and do not get easier or more comfortable with time. ERP approaches must consider this and work to reduce stressors as much as possible. Such avoidance is protective and self-compassionate rather than problematic.

Behavioural activation:

Be careful not to set goals that focus on attaining normative ideals and expectations. An example of this would be encouraging an Autistic/ADHDer to socialise more with their friends in a restaurant or bar, when the sensory environment is uncomfortable and draining, and the activity triggers burnout and exhaustion.

Behavioural activation can be particularly unhelpful (and even harmful) when a person is in Autistic/ADHD burnout. In burnout, a person does not have the capacity to take on new activities and may feel like they are failing therapy. In fact, to recover from burnout, the person often needs to reduce what they are doing and change their expectations to accommodate their sensory, social and executive functioning needs.

Therapy with a person who is in Autistic/ADHD burnout can often be long-term. Recovery from burnout will typically take months or even years. It’s likely that the person will never get back to their original level of functioning, because this wasn’t sustainable for them. As a therapist you may begin to wonder if what you are doing is helping, and insurance may not cover the amount of support needed.

Mindfulness and relaxation:

Autistic people and ADHDers may find it more difficult to sit still and quiet their mind. They may also find it more challenging to establish a routine and practice this regularly, even if they find it helpful.

A good starting point is using everyday activities as opportunities to focus their attention, such as when walking, colouring, or brushing their pet. Incorporating movement into the activity can be helpful. Practices should also be short – just one minute is ideal.

Over 80% of the Autistic women remain unidentified as Autistic at 18 years old. This means that millions of Autistic women continue to “play life on hard mode” but do not understand why. Women who are high-achieving in their field who have not been identified as Autistic often experience daily challenges and hassles despite being seen as highly competent by others. This contributes to chronic anxiety, feelings of inadequacy, and the tendency to be highly self-critical and hard on themselves.

Some of the challenges and strengths you’ll see in high-achieving women are outlined below.

Interests, study and work

Autistic women often have:

• The ability to hyperfocus and quickly complete an enormous amount of work, when an activity is interesting or challenging
• Intense, long-lasting interests, resulting in deep understanding and expertise in these fields (monotropism)
• A limited number of interests or hobbies outside their deep interests, or many short-lived interests that become intensely fascinating but only for a very short time
• Been previously identified as gifted but are now chronically burned out

Yet, they will also:

• Feel inadequate despite success in their field, for example, having postgraduate qualifications but feeling like a social failure
• Have enormous difficulty doing things that aren’t deeply interesting, which triggers anxiety and shame

Mental health

Autistic women often experience:

• Chronic anxiety, worry, and the tendency to over-analyse everything
• Perfectionism
• Periods of low mood, depression, and self-doubt
• Meltdowns, shutdowns and episodes of being unable to speak
• Recurring or chronic Autistic burnout
• A profound sense of being overwhelmed and exhausted
• Chronic physical and mental fatigue
• Pervasive self-criticism and the tendency to be tough on themselves
• Obsessive-compulsive disorder (OCD)

Physical health

Autistic women have higher rates than non-Autistic women of:

• Body-focused repetitive behaviours, particularly painful ones such as skin-picking, nail-biting, and pulling out hair
• Eating disorders, particularly anorexia
• Sensory aversions to food, including avoidant/restrictive food intake disorder (ARFID)
• Chronic illnesses such as auto-immune disorders, metabolic, chronic pain, dysautonomia (POTS), and chronic fatigue

Sensory sensitivities/insensitivities

Autistic women often have:

• Sensory sensitivities, although they might not recognise them as such because they are usually able to avoid these things
• Intense reactions to specific sensory stimuli such as eating, slurping, chewing, breathing and sniffing (misophonia), finding them distracting, distressing, and intensely frustrating
• Difficulty with understanding and describing physical sensations in their body in ways others understand (interoceptive difficulties

Social challenges and communication differences

Autistic women will often:

• Hide their differences (masking) and adapt their social style to fit different groups and be accepted (camouflaging)
• Strive to compensate for their difficulties, such as being hyper-organised
• Be on the outer edge of friendship groups, with few or no close friends
• Have friendships that are built around their deep interests
• Get stuck in people-pleasing patterns, have difficulty maintaining boundaries, and have the tendency to be “the most helpful person in the room”
• Have difficulty identifying when people are being manipulative or exploitative
• Experience stress and mental preparation before social events
• After socialising, feeling completely exhausted and needing quiet isolation time away from others to recover
• The tendency to talk fast, include a lot of detail, go on tangents, get distracted, and have difficulty stopping themselves from oversharing, particularly when they are anxious

And, many will have an Autistic or ADHDer child, sibling, or parent, and this is how they realise they are Autistic.

While these patterns have sometimes been called “the female Autistic phenotype,” these experiences are not limited to Autistic women. Men, non-binary people and trans people can share many of these patterns, although they are particularly common among Autistic adult women.

Autism describes a group of neurobiological differences in information processing that define how a person perceives and responds to the world. Being Autistic is a valid social identity that connects you to other people who share these differences in information processing.

Each Autistic person has a unique “spiky profile” of strengths and difficulties, and needs that fluctuate depending on the environment they are in. The key differences in information processing are:

• Narrower and deeper range of interests: Autistic people tend to find things either intensely interesting or not at all interesting. This pattern of interacting with the world is known as monotropism, and Autistic deep interests are often called spins, which is short for “special interests.” Engaging in your spins can trigger intense joy and deep focus.
• Sensory hyper- and hypo-sensitivities: Autistic people tend to have sensory experiences at the extremes, being either highly sensitive or relatively unaware of their sensory experiences across all eight senses: sight, smell, taste, touch, hearing, proprioception, vestibular (balance) and interoception (internal sensations). This has a big impact on how an Autistic person feels when interacting with the world, with ongoing exposure to uncomfortable sensory experiences triggering sensory stress.
• Literal use of language: Autistic people tend to prioritise the literal meaning of words (language semantics) and focus on using language precisely and clearly.  This honesty and directness are valuable in situations where clarity is essential, but can also be misunderstood as blunt or even rude by others. Autistic people may find it more challenging to understand hints and sarcasm, and may not fully grasp the meaning behind body language, tone, and indirect language.
• Social expectations based on consistency, fairness, and honesty: Autistic people tend to have a strong sense of justice, deep dislike of dishonesty, and a preference for following the rules, but only if those rules are logical and fair. Autistic people may feel uncomfortable or distressed in situations where expectations are unclear or frequently change, or when people’s choices are unfair or unjust.
• Difficulties with emotion awareness and regulation: Due to differences in interoceptive sensory awareness, some Autistic people feel emotions intensely in their body, while others have a quieter, muted experience of their emotions. Approximately 75% of Autistic people have difficulty interpreting their emotions, which is known as alexithymia. These difficulties can contribute to mental health problems.
• Overloaded and under-resourced executive functioning: Our executive functions are a set of skills that include planning, organising, prioritising, focusing our attention, managing impulses, monitoring one’s behaviour, and keeping track of time. In an overlap with attention deficit hyperactivity disorder (ADHD), many Autistic people experience executive functioning overload, which contributes to Autistic burnout, stress, and meltdowns.
• Self-regulation through repetitive behaviours and interests: Autistic people tend to regulate their attention, emotions, energy levels, and impulses through repetitive behaviours and by connecting with their interests. Soothing sensory experiences and actively engaging in spins can be calming, focusing, and a source of comfort.

Many Autistic people hide their differences and difficulties and work hard to fit in with others. This is called masking and camouflaging, and Autistic women and non-cisgender individuals are more likely to mask, often so automatically that they don’t realise they are doing it. Many Autistic men mask, too.

It can be more difficult to identify people who mask as Autistic, and they are more likely to be denied a diagnosis of Autism if the assessor does not understand how to recognise more subtle, and sometimes hidden, Autistic differences. The key is to listen to the person’s experiences of life and take more time to explore their unique experience of the world.

Further reading:

There are several books that explore the more subtle and hidden expressions of Autistic differences. To explore these differences further, you may like to start with the following titles:

• Henderson, D., Wayland, S., & White, J. (2023). Is this Autism? A Guide for Clinicians and Everyone Else. Routledge.
• Kemp, J., & Mitchelson, M. (2024). The Neurodivergence Skills Workbook for Autism and ADHD: Cultivate Self-Compassion, Live Authentically, and Be Your Own Advocate. New Harbinger Publications.
• Price, D. (2022). Unmasking Autism: The Power of Embracing Our Hidden Neurodiversity. Hachette.

Autism is a diagnostic term and valid social identity that describes people who share a group of genetic, neurobiological differences in information processing. Approximately 3% of the world’s population is Autistic (Maenner et al. 2020), and although there has recently been a rapid increase in the rate of diagnoses of Autism in recent years, globally, the vast majority of Autistic people remain unidentified.

This is particularly true among mature and older adults who went through their childhood and adolescence before Autism was defined or understood. If these adults did not have other noticeable differences in addition to being Autistic, such as an intellectual disability or learning delay, they would never have been offered any additional support or accommodations. Instead, they have gone through life feeling different from those around them, but without understanding why.

Known as the “lost generation” (McDonald, 2020), these individuals are more likely to have developed problems with their mental and physical health, experienced interpersonal trauma and violence, and had greater difficulty achieving an education and gaining adequate, meaningful employment. Essentially, they have been “playing life in hard mode” with devastating impacts, including higher mortality rates and shorter lifespans (Catala-Lopez et al. 2020; French & Cassidy, 2024; Hirvikoski et al. 2016).

So, while on the surface, it may look like Autism has become more common, in reality, we have barely begun to identify people who have previously been overlooked and have remained unsupported for their entire lives. As long as health professionals base their assessments on outdated stereotypes, Autistic people experiencing difficulties will continue to be overlooked and not offered any support. Furthermore, as long as there continues to be harmful stigma, discrimination, marginalisation, and government policies that target Autistic people in negative ways, there will continue to be people who will not want to consider the possibility of Autism.

This narrative must change. Identifying that you are Autistic, at any age, creates new possibilities for self-compassion, self-acceptance, and well-being. As a community, we must extend acceptance, compassion and belonging to all Autistic people, as well as better access to health services and practical accommodations that improve their quality of life.

References:

Catala-Lopez, F., Hutton, B., Page, M. J., Driver, J. A., Ridao, M., Alonso-Arroyo, A., Valencia, A., Macias Saint-Gerons, D., & Tabares-Seisdedos, R. (2022). Mortality in persons with autism spectrum disorder or attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. JAMA Pediatrics, 176(4), e216401. https://doi.org/10.1001/jamapediatrics.2021.6401

Hirvikoski, T., Mittendorfer-Rutz, E., Boman, M., Larsson, H., Lichtenstein, P., & Bölte, S. (2016). Premature mortality in autism spectrum disorder. British Journal of Psychiatry, 208(3), 232–238. https://doi.org/10.1192/bjp.bp.114.160192

Maenner, M. J., Warren, Z., Williams, A. R., Amoakohene, E., Bakian, A. V., Bilder, D. A., Durkin, M. S., Fitzgerald, R. T., Furnier, S. M., Hughes, M. M., Ladd-Acosta, C. M., McArthur, D., Pas, E. T., Salinas, A., Vehorn, A., Williams, S., Esler, A., Grzybowski, A., Hall-Lande, J.,…Shaw, K. A. (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years: Autism and developmental disabilities monitoring network, 11 Sites, United States, 2020. MMWR Surveillance Summaries, 72(SS-2), 1–14. https://doi.org/10.15585/mmwr.ss7202a1

McDonald, T. A. M. (2020). Autism identity and the “lost generation”: Structural validation of the Autism Spectrum Identity Scale (ASIS) and comparison of diagnosed and self-diagnosed adults on the autism spectrum. Autism in Adulthood, 2(1), 13–23. https://doi.org/10.1089/aut.2019.0069

Perfectionism is a process that can have both helpful and unhelpful impacts on a person’s life. Perfectionism has become increasingly common in recent decades and seems to have flourished in a hyper-connected world where people can control and curate the image they present to the world.

Helpful perfectionism could also be described as healthy striving—the pursuit of excellence accompanied by a sense of satisfaction and accomplishment. People with helpful perfectionism set goals that can be adjusted when they are no longer useful or become unattainable. In helpful perfectionism, these efforts move the person towards their values, and this can be associated with positive mental health outcomes.

By contrast, in unhelpful perfectionism, the focus becomes striving to get away from feared outcomes such as failure or mediocrity (Kemp, 2021). There is an obsessive quality to unhelpful perfectionism where the standards the person is striving to achieve are rigid and inflexible. They are also often raised if they are ever achieved, creating a sense of never being good enough. A core feature of unhelpful perfectionism is relentless self-criticism when failures, or perceived failures, occur. Perfectionistic patterns develop to avoid failure and painful self-criticism, including avoidance, procrastination and repeated checking.

The five key processes of unhelpful perfectionism are:

1. Extremely high and rigid standards that tend to increase over time
2. Intense fear of failure
3. Relentless self-criticism
4. Persistent attempts to avoid failure and self-criticism
5. Long-term negative consequences resulting from these avoidance behaviours

Unhelpful perfectionism is a transdiagnostic process that can contribute to the development, persistence, and severity of a wide range of mental health problems and even interfere with the effectiveness of therapy (Egan et al., 2022; Egan et al., 2011). Mental health problems that can include perfectionistic patterns include anxiety disorders, depression, eating disorders, body dysmorphic disorder, obsessive-compulsive disorder (OCD), and burnout. Addressing perfectionism as a process on its own, even without directly addressing the overarching mental health problem, has the potential to relieve a person’s suffering and improve their quality of life.

For more information on perfectionism, including an e-book on unhelpful perfectionism in helping professionals, check out the other resources on this site.

References:

Egan, S. J., Wade, T. D., Fitzallen, G., O’Brien, A., & Shafran, R. (2022). A meta-synthesis of qualitative studies of the link between anxiety, depression and perfectionism: implications for treatment. Behavioural and cognitive psychotherapy, 50(1), 89–105. https://doi.org/10.1017/S1352465821000357

Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical psychology review, 31(2), 203–212. https://doi.org/10.1016/j.cpr.2010.04.009

Kemp, J. (2021). The ACT Workbook for Perfectionism: Build Your Best (Imperfect) Life Using Powerful Acceptance and Commitment Therapy and Self-Compassion Skills. New Harbinger Publications.

Acceptance and commitment therapy (ACT) provides a useful and evidence-based framework for helping people with unhelpful perfectionistic patterns. ACT is built on a foundation of functional analysis; the process of considering behaviour’s purpose (function) in its context. By focusing on the function of perfectionistic behaviours, you can identify unhelpful perfectionistic patterns and help people make choices that can move them towards what is important to them, their values.

ACT has been shown to improve well-being, decrease distress, and increase self-compassion in perfectionistic individuals (Ong, Barney, et al., 2019; Ong, Lee, et al., 2019; Ong et al., 2022). Instead of trying to control or avoid unwanted thoughts or feelings (which often perpetuates the problem), ACT encourages people to:

• Unwind avoidance: Perfectionistic behaviours often function to avoid failure and the uncomfortable internal experiences that come with this, including shame. ACT techniques can help people become more willing to experience these uncomfortable internal sensations and not let fear of these experiences control their actions.
• Transform self-criticism: ACT therapists use techniques that can help a person gain greater perspective on their thoughts (cognitive defusion) and develop a flexible sense of self that is more than their perfectionistic standards (self-as-context). This can create more distance from self-critical thoughts and alleviate the distress they can cause.
• Clarify values: When people understand what truly matters to them, it can help them to move in the direction of their values even in the presence of perfectionistic rules and fears.
• Committed action: ACT encourages people to take steps that align with their values rather than being controlled by the rigid demands of perfectionism.
• Increase flexibility and willingness to change: ACT helps people approach change with flexibility, understanding that discomfort and imperfection are inevitable parts of the human experience and that moving gently towards what’s important to you is more helpful than striving for unattainable ideals.

References:

Ong, C. W., Barney, J. L., Barrett, T. S., Lee, E. B., Levin, M. E., & Twohig, M. P. (2019). The role of psychological inflexibility and self-compassion in acceptance and commitment therapy for clinical perfectionism. Journal of contextual behavioral science, 13, 7–16. https://doi.org/https://doi.org/10.1016/j.jcbs.2019.06.005

Ong, C. W., Lee, E. B., Krafft, J., Terry, C. L., Barrett, T. S., Levin, M. E., & Twohig, M. P. (2019). A randomized controlled trial of acceptance and commitment therapy for clinical perfectionism. Journal of Obsessive-Compulsive and Related Disorders, 22, 100444. https://doi.org/https://doi.org/10.1016/j.jocrd.2019.100444

Ong, C. W., Lee, E. B., Levin, M. E., & Twohig, M. P. (2022). Online process-based training for perfectionism: A randomized trial. Behaviour Research and Therapy, 156, 104152. https://doi.org/https://doi.org/10.1016/j.brat.2022.104152

Rejection sensitive dysphoria (RSD) is an intensely painful experience that you can get stuck in for a long time, and it can take a long time to recover. It is possible to become stuck in a state of dysphoria that lasts for months or even years.

It can be hard to recover if you:

• Don’t understand how you feel (known as alexithymia)
• Have intense emotions and find it hard to soothe them
• feel confused about what happened and spend a lot of time conducting an ongoing “social autopsy” to work it out
• Feel ashamed because you believe what happened was your fault
• Criticise yourself harshly for what happened
• Keep your distance from other people and avoid social events
• Lash out angrily at others and push people away
• Do not have other relationships where you feel safe and accepted

The following strategies can help you recover from the pain of rejection:

Self-soothing: Practice self-soothing activities that deactivate your body’s stress response, such as deep breathing, relaxation, soothing repetitive movements (stimming) and engaging in your interests.

Emotional awareness: In RSD, you can feel many different emotions at the same time. Explore how you feel and identify these emotions using an emotions wheel, or by talking to a friend or licensed therapist.

Sense-making: Feeling confused can keep you stuck in RSD, so the key to recovery includes making sense of what happened. This can be difficult when you don’t have all the information, so as best as you can, make sense of what happened by talking to a friend or a therapist.

Perspective-taking: Feeling angry at the other person—or yourself—is a natural reaction. However, it will not help you recover. Look at the situation from different perspectives, including the person who rejected you. Being honest about the contribution each person made to the situation can be painful, but it can help you learn from the experience and make positive changes in the future.

Self-compassion: Rejection can trigger harsh self-criticism fuelled by anger, self-blame and shame, and this can keep you stuck in the pain of rejection. Consider how you would support a friend who was distressed and stuck. Acknowledge how hurt you feel, and practice saying kind and comforting things to yourself.

Reach out: It’s essential to give yourself some time to recover, but being alone in your distress for a long time can also keep you stuck. Socialising can be anxiety-provoking when you fear being rejected again, so start by reaching out to a supportive person or your therapist and share how you are feeling.

Safe relationships: Being in relationships where you feel safe and accepted is essential to your well-being. Connecting with others can help alleviate feelings of isolation and foster a more profound sense of belonging.

Rejection sensitive dysphoria (RSD) describes the intense, long-lasting, and unbearable emotional pain resulting from real, imagined, or anticipated experiences of rejection (Bedrossian, 2021; Błaszczak, 2023; Ginapp et al., 2023). RSD feels like a sudden, overwhelming wave of emotional distress. Many people also describe physical pain as if they have been wounded.

In RSD, rejection triggers a profound sense of worthlessness and vulnerability, as though it confirms your deepest fears about yourself. Emotions associated with RSD include:

• Anger
• Anxiety
• Confusion
• Despair
• Embarrassment
• Emptiness
• Frustration
• Hurt
• Loneliness
• Numbness
• Overwhelm
• Powerlessness
• Regret
• Sadness
• Shame
• Vulnerability
• Worthlessness

Physical sensations associated with RSD include:

• Agitation
• Brain fog
• Fatigue
• Heartache
• Muscle tension
• Nausea

RSD can cause you to react in ways that may be disproportionate to what happened, such as:

• Isolating yourself from other people
• Declining invitations to social gatherings
• Staying in your room or house for extended periods
• Becoming irritable, angry, hostile, or aggressive
• Getting into arguments
• Becoming violent or destructive
• Reassurance-seeking
• Trying to keep people happy
• Agreeing to do things you don’t want to do to gain acceptance and approval
• Apologising excessively, even when you are not to blame
• Forcing yourself to fake being happy
• Tolerating mistreatment or abuse from others
• Physically harming your body
• Using substances to numb how you feel

It is possible to get stuck in RSD for a long time, but you can recover. The pathway to recovery involves making sense of what happened (as best you can), understanding your complex emotions, reaching out to safe people for support, and offering yourself compassion.

References:

Bedrossian, L. (2021). Understand and address complexities of rejection sensitive dysphoria in students with ADHD. Disability Compliance for Higher Education, 26(10), 4–4. https://doi.org/10.1002/dhe.31047

Błaszczak, A. (2023). The comorbidity of attention deficit/hyperactivity disorder and rejection sensitive dysphoria as an impediment in foreign language learning. Acta Humanitatis, 1(2), 93–106. https://doi.org/10.5709/ah-01.02.2023-01

Ginapp, C. M., Greenberg, N. R., MacDonald-Gagnon, G., Angarita, G. A., Bold, K. W., Potenza, M. N., & Al-Yateem, N. (2023). “Dysregulated not deficit”: A qualitative study on symptomatology of ADHD in young adults. PLOS ONE, 18(10), e0292721–e0292721. https://doi.org/10.1371/journal.pone.0292721

Rejection sensitivity is the tendency to anxiously expect, easily perceive, and intensely react to rejection (Downey & Feldman, 1996; Romero-Canyas et al., 2010). If you are sensitive to rejection, you will tend to feel wary in situations where you might be rejected. You may experience things as a rejection that other people don’t see the same way, and have sudden changes in your mood as a result.

Rejection sensitivity is common among Autistic people and ADHDers; however, it’s also an experience shared with other minority groups, including sexual and gender minorities. Many adolescents are also highly sensitive to rejection.

Some of the common reasons why people develop rejection sensitivity include having a history of:
• Being bullied, excluded, criticised and judged harshly by caregivers, teachers, colleagues, or friends.
• People making negative assumptions about you based on stigma and stereotypes.
• Significant interpersonal trauma and rejection in your early life.
• Big, painful emotions and difficulty soothing them, leaving you scared of feeling this way again.

Having had these experiences in the past can lead you to expect that other people will judge you negatively again. If you look for further rejection, you’ll eventually find it, and may then experience rejection sensitive dysphoria (RSD).

References:

Downey, G., & Feldman, S. I. (1996). Implications of rejection sensitivity for intimate relationships. Journal of personality and social psychology, 70(6), 1327–1343. https://doi.org/10.1037/0022-3514.70.6.1327

Romero-Canyas, R., Downey, G., Berenson, K., Ayduk, O., & Kang, N. J. (2010). Rejection sensitivity and the rejection-hostility link in romantic relationships. Journal of Personality, 78(1), 119–148. https://doi.org/10.1111/j.1467-6494.2009.00611.x

Autistic burnout is a state of exhaustion that affects all aspects of an Autistic person’s life, including their health. It is much more than just feeling tired. Autistic burnout is caused by an accumulation of sensory stressors, social expectations, health problems, and executive functioning demands.

Common symptoms of Autistic burnout include:

• Feeling exhausted even after resting
• Having less interest in the things you usually enjoy
• Finding socialising more draining
• Needing more time alone
• Feeling physically stuck and unproductive
• Finding everyday tasks more difficult
• Being more sensitive to sensory inputs
• Becoming irritable
• Having more meltdowns or shutdowns
• Being more disorganised and forgetful
• Worsened sleep
• Worsened chronic health problems, including autoimmune diseases and pain
• An increase in headaches, migraines, stomach aches and digestive problems

Autistic burnout is often mistaken for depression, but the treatment approach is entirely different. To recover from Autistic burnout, you need to lower your expectations of yourself and others, reduce the demands on your executive functioning, alleviate sensory stressors, and advocate for your needs. Recovery can take months or even years. You may never be able to return to your previous level of productivity, as this was unsustainable, so the key is finding a new way to approach your life that better balances your needs.