On Lindsey Mackereth, perfectionism, and the surprisingly good research on what’s actually going on under the armour
Today ago I read a Substack piece by Lindsey Mackereth called “Perfectionism Is Just RSD in a Blazer,” and it has been bothering me in the good way ever since. The way that makes you want to argue with someone, but constructively, the way you argue with a friend who is mostly right but missing the bit you want to add.
Her argument, in essence: for a lot of high-functioning neurodivergent adults, rejection sensitive dysphoria—RSD—doesn’t show up looking like sensitivity. It shows up looking like sharpness. Like impossibly high standards. Like the uncanny ability to spot exactly what’s wrong with something before anyone else has finished their coffee. The critic, in other words, is RSD wearing a really good outfit. And underneath the outfit, what’s actually happening is that the mind has learned to do the rejecting first, on the cheerful logic that if you can find the flaw before anyone else does, no one can hurt you with it.
I think she’s right. I also think she stops short of where the argument actually goes, and I want to use this post to take you a few steps further, with some help from the research, because there’s a fair bit of decent science on this that most people haven’t met.
Quick warning. I’m going to mention some studies. I promise to keep them friendly. If at any point I sound like I’m reading from a journal abstract, please assume someone has temporarily taken me hostage and is making me do it.
What’s actually under the blazer
Mackereth’s central move is this: the critical faculty is doing two jobs at once. One of them is the legitimate thing it was designed for—pattern recognition, analysis, noticing what doesn’t add up. The other is emotional defence. And the reason it’s so hard to spot from the inside is that the two jobs use the same machinery, and the analysis is genuinely accurate, so you can’t easily tell when you’ve stopped doing analysis and started doing pre-emptive self-protection.
It’s a clever observation, and it has more empirical company than her piece suggests.
The bigger story—emotion regulation in adult ADHD—has come a long way in a short time. A systematic review in PLOS ONE in 2023 by Soler-Gutiérrez and colleagues concluded that there’s now strong evidence for emotion dysregulation being a fourth core symptom of ADHD in adults, alongside the famous three (inattention, hyperactivity, impulsivity). A 2020 meta-analysis in BMC Psychiatry by Beheshti and colleagues found a difference between adults with ADHD and controls so large that statisticians, who are not paid to get excited, get a little excited about it.
In plain English: if you have ADHD as an adult, your emotions are part of the diagnosis. They are not the optional extra they were treated as for the first forty years of ADHD research. Anyone who has ever tried to explain to a sceptical relative why a perfectly reasonable-looking adult is currently crying in a car park over a minor email already knew this. The science has now caught up.
RSD specifically is a bit messier. It’s a clinical construct that’s hugely popular in ADHD circles and hasn’t yet made it into the diagnostic manuals. This is normal—clinicians often spot patterns years before the research catches them. A 2025 paper actually titled “Rejection Sensitive Dysphoria in ADHD: Myth or Reality?” tells you everything you need to know about where the field currently is. The myth-or-reality question is now formally being asked, which is what happens just before answers start arriving.
The honest answer for now: RSD is real enough that clinicians use it every day and work with it productively, and provisional enough that no one has fully nailed down how to measure it. Müller and colleagues in 2024 found a strong link between ADHD scores and rejection sensitivity in a sample of 304 college students. Rowney-Smith’s 2024 qualitative study found that people experiencing rejection sensitivity often try to mask the bodily evidence of it, which has the unfortunate downstream effect of cutting them off from themselves. So Mackereth’s foundation is solid. The roof is still being built.
Where she stops, and where I’d keep going
Three things her piece doesn’t quite handle.
One: the “neurodivergent” umbrella is too wide. She talks about “neurocomplex” people, lumping ADHD, autism, giftedness, and various sensory profiles together. As a hug, that’s lovely. As a diagnosis, it’s a bit of a problem, because the mechanism she’s describing—RSD getting rerouted through the critical faculty—is mostly an ADHD-and-AuDHD pattern, not a pure-autism one.
Autism on its own tends to produce a different rejection signature. Less pre-emptive sharpness, more shutdown. The autistic burnout literature is now substantial enough to make this case properly. Raymaker and colleagues in 2020 defined autistic burnout as chronic exhaustion, loss of skills, and reduced tolerance to stimulus. A 2025 systematic review by Ali and colleagues synthesised 48 studies and confirmed sensory and social overwhelm, masking, and alexithymia as the dominant drivers.
The headline is: where ADHD-flavoured rejection sensitivity tends to fire outward as sharpness, autism-flavoured overwhelm tends to fold inward into shutdown. AuDHD presentations—people with both—can do either, sometimes in the same week, occasionally in the same morning. Useful to know if you’ve ever wondered why your neurodivergent friend was a precision-guided missile on Tuesday and a duvet on Wednesday.
Two: the closing of her piece is the kind of sentence that should come with a warning label. Mackereth ends with: “You were not too much. You were too much for the specific containers you were placed in.” This is gorgeous. It is also exactly the sort of sentence that ends up cross-stitched onto a cushion in someone’s living room while the same person continues running the same exhausting protective software the next morning, only now with a more comforting story wrapped around it.
This isn’t her fault. It’s the structural problem with insight on its own. Understanding why you do something does not, in itself, make you stop doing it. If it did, therapy would be a single appointment.
Here’s where the research gets a bit cheerfully grim. A 2024 study in the Journal of Psychiatry & Neuroscience by Sklivanioti Greenfield and colleagues looked at whether the standard ADHD medication actually fixes the emotion dysregulation part. It doesn’t. The medication treats the disorder. The medication does not treat the disorder’s worst feature. If even Ritalin can’t think its way out of this one, the suggestion that reading a really good Substack post is going to dismantle a defensive structure built over thirty years starts looking optimistic.
This is not a counsel of despair. It’s a counsel of being honest about what insight can do. Insight can locate the problem. Insight can change how you feel about the problem. The actual machinery, though, doesn’t dismantle itself just because you’ve understood it. Something else has to happen.
Three: the missing piece is context. Mackereth mentions, near the end, that finding spaces where your sensitivity can land safely matters. She underweights this. It is the work. It is, in my experience and in the research, what actually moves the needle.
There’s a body of work called social baseline theory, developed by Coan and Beckes over the last fifteen years. The headline finding is one of those things you read and then can’t unsee. The human nervous system, it turns out, is not designed to regulate itself alone. It’s designed to regulate itself in proximity to safe other people. The whole apparatus is set up to outsource a large portion of the regulation work to nearby relationships.
Which is why, after a hard day, you don’t actually feel better by lying down on your own. You feel better by sitting next to someone you trust who doesn’t need anything from you. The nervous system, in technical terms, is going “ah, there it is, the rest of the operating system.” Asking it to regulate in solitude is roughly like asking a fish to walk to work. Possible, yes, in unusual cases. Exhausting, always. Never the point of the design.
This matters enormously for defended cognitive perfectionism—which is the name I’d give to the pattern Mackereth is describing, with credit to her for the original observation and apologies in advance to anyone whose paper I haven’t yet found that already named it something else. Because if the protective structure is being held in place by an environmental signal—by the sense that vulnerability isn’t safe here, in this room, with these people—then the way to dismantle the structure isn’t to think harder about it. It’s to be somewhere different. With different people. Where the signal stops arriving.
This is why moving house can sometimes do more for a person’s mental health than two years of therapy, and why two years of therapy can sometimes do more than moving house, and why the people who got really well usually did both, in some order, with some luck.
A more honest picture
Pulling this all together, here’s the pattern as I’d describe it for anyone who recognises themselves in any of it.
You are running on a nervous system that picks up more signal than other people’s. This is not a flaw. It is the cost of admission to a particular kind of insight, creativity, and care. At some point in your childhood, expressing the resulting feelings produced consequences you didn’t like, so you compressed them. The compression had to go somewhere. It went into your thinking. Specifically, it got recruited by the part of you that’s good at noticing flaws, and that part started doing two jobs at once—the actual analysis, plus an early-warning system designed to find the flaw in you before anyone else could.
The system has been running on this dual mandate ever since. It’s produced a lot of good work. It has also produced a particular kind of exhaustion, a particular kind of loneliness, and a particular kind of difficulty with intimacy, because people can feel when they’re being subtly evaluated even when you don’t know you’re doing it.
Now the good news. There’s a way out. There’s even research telling you what it looks like, though it doesn’t fit neatly on a coffee mug, which is why it’s not as famous as the cross-stitch sentence.
It involves three things, in combination, none of which work on their own.
The first is understanding what’s happening. Reading something like Mackereth’s piece, or this one, and recognising yourself in it. That’s the part insight can do. It doesn’t fix anything by itself but it reorganises the furniture of how you think about yourself, which is the necessary first step.
The second is patient, slow work on what to do when the feeling shows up without immediately routing it through the critical faculty. This is what good therapy can do, and what acceptance-and-commitment work in particular has decent evidence for. It doesn’t make the feeling smaller. It changes what happens next.
The third is the one no one wants to hear, because it’s the hardest one to manualise into a self-help book. It’s contextual change. Finding, building, or moving toward environments where the original protective structure stops being necessary. Relationships where your sensitivity can land. Sometimes communities. Sometimes literal places. Sometimes a complete reorganisation of work, partnership, geography.
You don’t necessarily need to change everything. But you almost certainly need to change something. Because the blazer is heavy, the wool is hot, and you have been wearing it for a very long time in a room that no longer requires it.
The point isn’t to throw the blazer away. The blazer was a good blazer. It saved your life, possibly, in a previous decade.
The point is to notice it’s a blazer. To notice you’re wearing it. And to notice that, some days, you could go outside without it. Because.
A small confession
I should tell you, before I sign off, that I am aware of the recursive irony of writing a careful, citation-rich, formally argued response to Mackereth’s piece that is, in part, an attempt to demonstrate that my framework is more rigorous than hers. The defended cognitive perfectionist in me has been having the time of his life this entire post.
The improvement, such as it is, is that I noticed.
That’s most of the available progress, in the end. Not perfectionism dismantled. Not the critical faculty silenced. Just the critic, working away as it always has, with someone occasionally turning around in the chair and saying G’day, mate, I see you, carry on.
It does carry on. The point is the turning around.
References
Ali, D., Roestorf, A., Hull, L., Mandy, W., & Happé, F. (2025). Burnout as experienced by autistic people: A systematic review. Clinical Psychology Review. https://consensus.app/papers/details/945424a75f395660b01c96c32cc475e5
Beckes, L., & Coan, J. A. (2011). Social baseline theory: The role of social proximity in emotion and economy of action. Social and Personality Psychology Compass, 5(12), 976–988. https://consensus.app/papers/details/885e0ac329dd5573a177336d51610b07
Beheshti, A., Chavanon, M.-L., & Christiansen, H. (2020). Emotion dysregulation in adults with attention deficit hyperactivity disorder: A meta-analysis. BMC Psychiatry, 20, 120. https://consensus.app/papers/details/9a25e1abfa965e6f852e2d77a110f18b
Coan, J. A., & Sbarra, D. A. (2015). Social baseline theory: The social regulation of risk and effort. Current Opinion in Psychology, 1, 87–91. https://consensus.app/papers/details/96e4a2c6ec2c5011a3063b621ccd0320
Mackereth, L. (2026, May 18). Perfectionism is just RSD in a blazer. Lindsey Mack’s Complexity Edge. Substack. https://lindseymackereth.substack.com/p/perfectionism-is-just-rsd-in-a-blazer
Müller, V., Pikó, B. F., & Mellor, D. (2024). Associations between ADHD symptoms and rejection sensitivity in college students. Learning Disabilities Research & Practice. https://consensus.app/papers/details/cdd2c7b5356a512c849708677f594300
Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout. Autism in Adulthood, 2(2), 132–143. https://consensus.app/papers/details/c353549cf15059d080d1146e58d2ba29
Rowney-Smith, A., et al. (2024). The lived experience of rejection sensitivity in ADHD: A qualitative exploration. https://consensus.app/papers/details/01873b70a9fc52e6b9771bebc3aa70e3
Sklivanioti Greenfield, M., et al. (2024). Emotional dysregulation and stimulant medication in adult ADHD. Journal of Psychiatry & Neuroscience. https://consensus.app/papers/details/5fc85e443d2b516695abfbd68bb46429
Soler-Gutiérrez, A.-M., Pérez-González, J.-C., & Mayas, J. (2023). Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review. PLOS ONE. https://consensus.app/papers/details/f96ff4fdeadd5cfb9e84a818428fdad6
Sterecka, K., et al. (2025). Rejection Sensitive Dysphoria in ADHD: Myth or reality? International Journal of Psychophysiology. https://consensus.app/papers/details/29d0f67ffb395291b45fc42bb301a3cd
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