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Can RSD Lead to Anxiety or Depression in ADHD Patients? 

Posted
Updated
ByMy Patient Advice
Author: Dr. Rebecca Fernandez, MBBS

Rejection Sensitive Dysphoria (RSD) is one of the most emotionally painful aspects of ADHD. It involves intense distress after perceived rejection, criticism, or failure. While RSD itself is not a formal diagnosis, repeated episodes can have a strong emotional impact and may contribute to anxiety or depression over time. 

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Emotional Overload and Fear of Rejection 

According to NHS guidance, people with ADHD often experience heightened emotional sensitivity and may struggle to manage criticism or social disappointment. The Royal College of Psychiatrists notes that this emotional dysregulation can create ongoing worry about rejection, which may evolve into social anxiety or avoidance. When these fears repeat, individuals can begin to anticipate rejection before it happens, leading to chronic tension and reduced confidence. 

How RSD Links to Depression 

The Cleveland Clinic explains that RSD reactions are brief but can feel overwhelming. Over time, frequent episodes can lead to feelings of helplessness or low mood. Research in The Lancet Psychiatry and PubMed suggests that ADHD-related RSD is connected to changes in the brain’s dopamine and stress-response systems. These same pathways are also involved in anxiety and depressive disorders, which helps explain why the conditions often overlap. NICE guidance (NG87) highlights that emotional instability in ADHD should be monitored, as persistent low mood may signal coexisting depression that requires further assessment. 

What Can Help 

Support usually focuses on managing both the emotional reactivity of RSD and the secondary anxiety or low mood that may develop. Recommended approaches include: 

  • Cognitive behavioural therapy (CBT) to identify and reframe negative thinking patterns 
  • Mindfulness or emotional regulation techniques to manage stress responses 
  • ADHD medication to improve impulse control and emotional stability 
  • Therapeutic coaching or structured support through programmes such as Theara Change, which help individuals build confidence and coping skills 

Takeaway 

RSD does not directly cause anxiety or depression, but the repeated emotional strain of rejection can contribute to both. With early recognition and the right support, people with ADHD can manage emotional sensitivity and reduce the long-term impact on mental health. 

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Dr. Rebecca Fernandez, MBBS
Author

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy. 

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