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What Causes RSD in Individuals with ADHD? 

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

Rejection Sensitive Dysphoria (RSD) is not an official diagnosis but a well-recognised emotional pattern seen in many people with ADHD. It describes the intense emotional pain that follows real or perceived rejection, criticism, or failure. While the experience feels deeply personal, research shows that RSD has biological, psychological, and social roots. 

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The Neurological Basis 

According to NHS guidance, emotional sensitivity and low tolerance for criticism are common features of ADHD. These responses are closely linked to how the ADHD brain processes emotion. Research in The Lancet Psychiatry and PubMed has shown that people with ADHD often have increased activity in the amygdala, the brain’s emotional alarm centre, and reduced prefrontal control, which regulates impulse and emotion. This combination means that rejection or disapproval can trigger a much stronger emotional reaction. Neurochemical factors also play a part. Dopamine dysregulation, which underlies ADHD symptoms, affects reward processing and can make social feedback feel more intense and painful. 

Psychological and Social Triggers 

The Royal College of Psychiatrists notes that many people with ADHD experience repeated setbacks in school, work, or relationships, which can lead to shame, fear of criticism, and hypervigilance for rejection. The Cleveland Clinic explains that RSD reactions can appear almost instantly after perceived rejection, causing physical tension, emotional flooding, or sudden withdrawal. Over time, this can create avoidance patterns or perfectionism as individuals try to protect themselves from further hurt. 

Managing Underlying Causes 

NICE guidance on ADHD (NG87) recommends addressing emotional dysregulation as part of ADHD management. Helpful approaches include: 

  • Cognitive behavioural therapy (CBT) to manage self-critical thinking and emotional triggers 
  • Mindfulness or emotional regulation techniques to slow reactive responses 
  • Medication for ADHD to improve focus and emotional stability 
  • Therapeutic coaching or psychoeducation through programmes such as Theara Change, which support resilience and self-awareness 

Takeaway 

RSD develops from the way ADHD affects emotional regulation and reward systems, combined with lived experiences of rejection. Understanding these causes helps people see RSD not as a character flaw but as a neurobiological and emotional response that can be managed with the right support. 

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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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