ADHD, Rejection Sensitivity, and the Spotlight Effect on Steroids
Tuesday, April 15, 2025.
People with ADHD sometimes experience rejection sensitivity dysphoria (RSD) — a term popularized by Dr. William Dodson to describe the exquisitely painful emotional reaction to perceived criticism or social judgment. It’s not an official DSM diagnosis, but it shows up in clinics, relationships, and therapy rooms every day.
Where the spotlight effect makes a neurotypical person slightly self-conscious, RSD says: Everyone saw me mess up, they now hate me, and I can never show my face again. In essence, it's the spotlight effect with gasoline poured on it.
And this becomes even more complex when you factor in emotional dysregulation, a common trait in both ADHD and autism. The fear of being seen making a mistake — or worse, being too much — can lead to avoidance, masking, people-pleasing, and burnout. These aren’t quirks. These are survival strategies.
Sensory Processing and the Overwhelm of Being Observed
Another key piece is sensory processing sensitivity — a trait shared by many neurodivergent folks.
When your nervous system is already taking in more detail, more noise, more subtle shifts in facial expression, being looked at isn’t just a social moment. It’s data overload.
Some neurodivergent folks report being hyperaware of the micro-reactions of others.
A raised eyebrow. A slight shift in tone. A glance that feels off.
This isn’t paranoia. It’s perceptual vigilance. And it can make ordinary social encounters feel like walking through a field of tripwires.
So when neurodivergent people express discomfort with being looked at — or participating in public performance — it’s not a failure of social development. It’s a real-time recalibration of the nervous system trying not to short-circuit.
Masking: The Neurodivergent Art of Not Being Seen While Being Watched
And here’s where things get heartbreaking.
Many neurodivergent people become experts at masking — mimicking neurotypical social behaviors to fit in, avoid bullying, get the job, keep the peace. Masking involves rehearsed facial expressions, learned eye contact, scripted social phrases.
It’s theater, but the stakes are survival.
But here’s the twist: masking trains you to be visible in the wrong way. You’re looked at — and liked — but not truly seen.
The gaze becomes conditional. You become hypervigilant about how you’re presenting — not to connect, but to protect.
And over time, this leads to exhaustion, identity confusion, and yes — scopophobia. Because if being seen always means being misread, then of course the gaze feels like a threat.
What the Research (and the Lived Experience) Suggests
Recent qualitative research is starting to catch up with what neurodivergent communities have been saying for years.
Cage, Di Monaco, & Newell (2018) found that masking is associated with higher rates of anxiety, depression, and autistic burnout, particularly in women and late-diagnosed adults.
Livingston et al. (2019) observed that autistic souls who experience camouflaging fatigue often report a heightened fear of being judged or exposed as “inauthentic.”
Research on rejection sensitivity in ADHD populations shows increased self-monitoring, social withdrawal, and higher levels of performance anxiety (Surman et al., 2016).
What does all this mean?
It means scopophobia in neurodivergent folks isn’t irrational. It’s a body-level response to years — sometimes decades — of having one’s appearance, tone, volume, and behavior scrutinized, misread, or corrected. The “spotlight” isn’t imagined. It’s real. It’s historical. It’s cumulative.
Toward Healing: Seeing Without Piercing
If the fear of being seen is especially acute in some neurodivergent populations, then healing must involve new forms of witnessing — where the gaze is soft, curious, non-demanding.
Therapeutic models that show promise here include:
IFS (Internal Family Systems), which allows people to notice and validate the parts of them that fear exposure
Compassion-focused therapy, which acknowledges shame as a central driver and offers reparenting through warmth
Autistic-led peer support spaces, where eye contact is optional and connection happens through shared resonance, not performance
Solution -Focused Therapies have also been proven effective with neurodiverse couples.
And maybe most radically: environments where neurodivergent people can choose when, how, and whether they are seen — not for what they can do, but for who they are when no one is demanding anything.
Because in the end, being visible is only healing when being visible doesn't mean being judged.
Be Well, Stay Kind, and Godspeed.
REFERENCES
Cage, E., Di Monaco, J., & Newell, V. (2018). Experiences of autism acceptance and mental health in autistic adults. Journal of Autism and Developmental Disorders, 48(2), 473–484. https://doi.org/10.1007/s10803-017-3342-7
Dalton, K. M., Nacewicz, B. M., Johnstone, T., Schaefer, H. S., Gernsbacher, M. A., Goldsmith, H. H., ... & Davidson, R. J. (2005). Gaze fixation and the neural circuitry of face processing in autism. Nature Neuroscience, 8(4), 519–526. https://doi.org/10.1038/nn1421
Gilovich, T., Medvec, V. H., & Savitsky, K. (2000). The spotlight effect in social judgment: An egocentric bias in estimates of the salience of one’s own actions and appearance. Journal of Personality and Social Psychology, 78(2), 211–222. https://doi.org/10.1037/0022-3514.78.2.211
Livingston, L. A., Shah, P., & Happé, F. (2019). Compensatory strategies below the surface in autism: A qualitative study. The Lancet Psychiatry, 6(11), 766–777. https://doi.org/10.1016/S2215-0366(19)30224-X
Surman, C. B., Biederman, J., Spencer, T., Miller, C. A., & Faraone, S. V. (2016). Understanding ADHD in adults: Attention, emotion, and the therapeutic alliance. Journal of Clinical Psychiatry, 77(4), e486–e493. https://doi.org/10.4088/JCP.15m10163