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By Lisa Poole: Co-Creator of the ATTUNED Approach
📄 Autoethnographic hypothesis available on Open Science Framework:
🧠 The Heart Feels Rejection: An Autoethnographic Hypothesis (Poole, 2025)
Many neurodivergent individuals experience significant emotional reactions to criticism or rejection. This is known in the community as Rejection Sensitivity (RS), with more severe experiences referred to as Rejection Sensitive Dysphoria (RSD). Despite this, people are often told they’re “too sensitive” or “overreacting.”
Not all rejection experiences are the same. Rejection sensitivity exists along a continuum of emotional and physiological responses shaped by individual neurobiology and lived experience. Rejection sensitivity is often related to individuals with ADHD, however, there is growing awareness in all neurodivergent neurotypes about the intense emotional and physical responses to social threat, disapproval, or perceived exclusion.
This may present as:
While distressing, these experiences can often be managed with awareness and support. However, repeated invalidation or trauma can intensify this response.
RSD involves:
RSD can derail functioning and is often misinterpreted as overreaction, when it may in fact reflect a physiological stress cascade. Effects of RSD can span the lifespan, affecting self-worth, self-esteem and both relational and mental health.
RSD is not a recognised clinical diagnosis.
Yet Dr. William Dodson estimates 99% of people with ADHD experience it, with a third citing it as the most debilitating part of their condition. Because it’s not officially recognised, many people lack validation, appropriate support and potentially disadvantages in assessments for diagnosis due to lack of recognition in the clinical criteria.
While researching for the ATTUNED neurodiversity coach training and in our coaching and therapeutic work with thousands of neurodivergent individuals, we consistently hear the same thing: emotional pain that feels physical. Words like “crushing,” “stabbing,” or “heartache” are used literally, not metaphorically.
In the midst of one of the many hyperfocussed hours immersing ourselves in this research, the curiosity question of “Can you actually die of a broken heart?” graced the Google search engine box. Leading us to our first awareness of a little known condition called Takotsubo Syndrome.
Takotsubo Syndrome, or “broken heart syndrome,” is a temporary heart condition caused by a surge of catecholamines (adrenaline, noradrenaline) in response to emotional stress events such as a break up, loss of a loved one or loss of a job.
Symptoms include chest pain, changes in heart shape and function, and biomarker elevation, but mysteriously, with time, symptoms often subside without lasting effect and only in rare cases does it cause permanent damage or loss of life. This is most likely due to the fact that the demographic most likely to present in hospital with Takosubo syndrome is post-menopausal females. Needing medical intervention in these cases is likely due to their potential for age-related cardiac vulnerability.
But…
Guess what else involves a catecholamine surge? Rejection Sensitive Dysphoria
Rejection Sensitive Dysphoria also involves catecholamine surges. We propose that the same brain-body cascade occurs in people with RSD, at varying intensities, in neurodivergent people who experience rejection sensitive dysphoria and perhaps even to a lesser extent rejection sensitivity. There will be different outcomes depending on age, cardiac health, and neurobiology. In neurodivergent individuals, this may manifest as somatic distress or shutdown rather than full-blown cardiomyopathy.
Research shows that emotional and physical pain activate the same brain regions. Studies show that individuals with ADHD may experience up to 10 times more pain activity in the brain in response to emotional stimuli.
This is not a character flaw, but a neurochemical and physiological process.
Takotsubo involves left ventricle ballooning, cardiac biomarker elevation, and changes in heart function. Neurodivergent individuals experiencing RSD may show similar somatic patterns, such as baroreceptor activity and autonomic dysregulation, even without clinical cardiac damage.
Autistic individuals often describe shutdowns without the chest pain typical of RSD in ADHD. This may relate to interoception and baroreception, how the body perceives internal signals. Some may have muted or misinterpreted interoception, leading to confusion or anxiety rather than clearly labeled pain.
These differences underscore the need for nuanced, personalised models of care.
Could neurodivergent individuals in distress show subclinical cardiac biomarker changes, similar to Takotsubo patients? It’s plausible. Understanding this could help explain the effectiveness of medications like guanfacine, which regulate both emotional and cardiovascular responses.
If confirmed, this hypothesis could:
🧠 The Heart Feels Rejection: An Autoethnographic Hypothesis (Poole, 2025)
🌐 www.attunedapproach.co.uk
📩 [email protected]
🔗 LinkedIn: Lisa Poole
Emotional sensitivity is not weakness. It is not drama. It is not failure.
It might be cardiac. It might be chemical. And above all – it is real.
