Feedback is an important part of workplace development, but traditional methods like the “feedback sandwich”, giving a more constructive comments between two positives, don’t work for everyone. For people experiencing Rejection Sensitive Dysphoria, this style can actually lead to confusion, stress or even emotional (and physical) harm.
What is Rejection Sensitive Dysphoria?
Rejection Sensitive Dysphoria (RSD) is an intense emotional sensitivity and response to actual or perceived rejection or criticism, commonly experienced by neurodivergent people. It can result in heightened emotional responses to feedback, even when well-intentioned, and can show up in ways that aren’t always visible. For example, someone might say “yes” impulsively to avoid disapproval, forget boundaries they’ve set, or place others’ needs before their own, only realising too late that they’ve overcommitted themselves.
RSD is not exclusive to neurodivergent people; however, research has shown strong connections between RSD and autistic people and ADHDers, specifically. For those with ADHD, it has been found that the pre-frontal cortex which manages impulse control and emotional regulation often functions differently and as such, leads to increased susceptibility to intense emotional responses to rejection (Carpenter Rich et al., 2010). Furthermore, whilst neuroimaging has found that the vast majority of autistic people have typical neural responses to physical pain, their brains have much more complex neurological responses to social pain (such as embarrassment or rejection) (Krach et al., 2015).
Those who experience RSD may overthink feedback for days or may even need time off work to recover. Rejection (actual or perceived) has also been found to trigger the same neural circuits that process physical injury, bringing to life the phrase “rejection hurts” (Kross et al., 2011; Babur et al., 2024; Brooks et al., 2025). This is why it’s crucial to reconsider how we give feedback in inclusive and trauma-informed ways.
Why the feedback sandwich falls short
While the feedback sandwich may seem gentle, it can create ambiguity. If someone is particularly sensitive to perceived rejection, they may fixate only on the negative part, missing the positives altogether. Alternatively, they might struggle to understand what you’re really trying to say if the message feels overly padded. For some, this structure triggers confusion or mistrust: Was that praise genuine, or just a lead-in to something bad?
What works better?
It is also essential to ask the individual how they prefer to receive feedback. This could include written formats, verbal check-ins, or even audio recordings they can process in their own time. Consider timing too. Someone who experiences RSD may need space before or after feedback to emotionally regulate. Ask them if they’d prefer feedback in-the-moment, or after some reflection time. Also, separate developmental feedback from praise, combining both in one conversation can muddle the message and dilute either point.
Tips for managers and colleagues
- Give context before meetings where you might be giving feedback: share agendas early to reduce anxiety.
- Be factual and specific: avoid vague or emotional language.
- Offer feedback regularly: don’t save it all for one meeting.
- Clarify boundaries and expectations up front.
- Check in on how feedback landed and adjust your approach if needed.
What people who experience RSD say
Clients have shared that they often develop their own coping strategies for managing their rejection sensitivity. These include:
- People pleasing strategies:
- Writing out what they should and shouldn’t say ‘yes’ to
- When a request for extra work is made, providing red, amber or green cards to others to indicate their workload (or perceived workload)
- Changing phone wallpapers to remind them to pause and think before saying yes
- Task avoidance strategies:
- Breaking tasks into micro-steps and writing down each step on the to do list (and then ticking them off!)
- Using the Pomodoro timer technique to work in short stints towards completion of a task.
- Engaging in body-doubling to ensure accountability.
- Perfectionist strategies:
- Having a “bad draft” or a “draft zero”, which is essentially a messy first version.
- Writing down what “good enough” is, ensuring that clarification is sought if needed.
- Allocating a fixed amount of time for a task so as not to continue to work on it or re-draft or delete!
Further learning
This summer we’re running several webinars which can help improve your understanding of this topic:
- 23rd July & 29th July (10:00 – 13:00) – Neurodiversity for line managers
- 28th July & 31st July (10:00 – 11:00) – Managing performance and absence
You can see what else we’re offering in our Neurodiversity Summer Camp. The webinars start from just £25 (ex-VAT).
Final thought
Feedback should be a tool for growth, not harm. With a little intention and flexibility, we can shift from a one-size-fits-all model to something far more respectful and effective. For those who experience RSD, that might mean ditching the sandwich and serving up something clearer, kinder, and much more digestible.
References
- Babur, B., Chang Leong, Y., Pan, C. X. and Hackel, L. M. (2024) Neural responses to social rejection reflect dissociable learning about relational value and reward. Proceedings of the National Academy of Sciences of the United States of America, 121 (49) DOI: https://doi.org/10.1073/pnas.2400022121
- Brooks, B. M., Cordero, F. J., Alchermes, S. L. and Brooks, B. M. (2025) Social pain: A systematic review on interventions. F1000 Research. DOI: https://doi.org/10.12688/f1000research.159561.1
- Carpenter Rich, E., Loo, S. K., Yang, M., Dang, J. and Smalley, S. L. (2010) Social functioning difficulties in ADHD: Association with PDD risk. Clinical Child Pychology and Psychiatry, 14 (3). DOI: https://doi.org/10.1177/1359104508100890
- Krach, S., Kamp-Becker, I., Einhauser, W., Sommer, J., Frassle, S., Jansen, A., Rademacher, L., Muller-Pinzler, L., Gazzola, V. and Paulus, F. (2015) Evidence from Pupillometry and fMRI Indicates Reduced Neural Response During Vicarious Social Pain but Not Physical Pain in Autism. Human Brain Mapping, 36. DOI: https://doi.org/10.1002/hbm.22949
- Kross, E., Berman, M. G., Mischel, W., Smith, E. E. and Wager, T. D. (2011) Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of Sciences of the United States of America. 108 (15) DOI: www.pnas.org/cgi/doi/10.1073/pnas.1102693108