What is Rejection Sensitive Dysphoria (RSD) in ADHD?
Many people with ADHD describe feeling emotional pain so intense it feels physical when they are criticised, left out, or fear rejection. This experience is often called Rejection Sensitive Dysphoria (RSD). Although it is not an official diagnosis, RSD is recognised in ADHD care as part of the condition’s emotional landscape.
Understanding RSD
According to the Royal College of Psychiatrists (RCPsych), RSD is not listed in diagnostic manuals such as the DSM-5 or ICD-10, but “emotional dysregulation including severe rejection sensitivity is a well-recognised feature in adult ADHD care.”
The NHS describes RSD as “strong emotional pain because of a failure or feeling rejected,” often seen in both children and adults with ADHD.
RSD reactions can appear suddenly, with overwhelming sadness, anger, or self-criticism, sometimes followed by withdrawal or perfectionism to avoid future rejection. The Cleveland Clinic explains that people may “shut down relationships or strive for constant approval” as coping strategies.
Why does it happen?
The exact cause is not fully understood, but evidence suggests RSD stems from how the ADHD brain regulates emotion. Studies have linked rejection sensitivity to overactive emotional circuits and difficulty filtering self-critical thoughts. A 2023 PubMed study described RSD experiences as “rumination, self-blame, and even physical discomfort following perceived rejection.”
In simple terms, RSD reflects a hypersensitivity to social pain, not weakness or overreaction. As UK clinician Dr Shyamal Mashru explains, “It comes on suddenly and they can’t control it.”
Managing RSD in ADHD
Although NICE guidance (NG87) does not list RSD separately, it recognises emotional dysregulation as an important treatment focus in ADHD. Recommended approaches include cognitive behavioural therapy (CBT), mindfulness-based interventions, and psychoeducation to strengthen emotional control. The Cleveland Clinic also highlights DBT (dialectical behaviour therapy) and ADHD medication review as part of broader management.
Some adults benefit from structured behavioural coaching or therapy programmes that focus on rejection resilience and emotional regulation. Services such as Theara Change are developing UK-based options for this kind of psychological support.
Key takeaway
Rejection Sensitive Dysphoria is not a formal diagnosis, but for many people with ADHD it is one of the most painful aspects of daily life. Recognising it as part of emotional dysregulation can help individuals find the right support, from therapy and medication to compassionate coaching. With the right strategies, emotional intensity can become a source of strength and self-awareness.
