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Are Genetic Factors Involved in RSD Among ADHD Individuals? 

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

Rejection Sensitive Dysphoria (RSD) describes the sudden and intense emotional pain that can follow perceived rejection or criticism in people with ADHD. Although RSD is not a formal diagnosis, research suggests that genetics may influence how emotional sensitivity and reward processing develop in the ADHD brain. 

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Genetic Links Between ADHD and Emotional Reactivity 

According to NHS guidance, ADHD often runs in families, indicating a strong genetic component. These same genes are thought to influence the brain’s dopamine and serotonin systems, which regulate emotional response and reward. The Royal College of Psychiatrists notes that people with ADHD are more prone to emotional impulsivity and low frustration tolerance, both of which are shaped by neurobiological traits inherited from parents. 

How Genetics May Shape RSD 

Studies in The Lancet Psychiatry and PubMed suggest that variants in dopamine transporter (DAT1) and dopamine receptor (DRD4 and DRD5) genes, which are associated with ADHD, may also contribute to heightened sensitivity to social feedback. This means that individuals with these genetic profiles may react more strongly to rejection because their brains process reward and punishment signals differently. The Cleveland Clinic explains that this dysregulation can cause emotional “spikes” following rejection, which fade once dopamine levels stabilise. 

Environmental and Developmental Influences 

While genetics play a role, environment also matters. Childhood experiences of misunderstanding, criticism, or exclusion can reinforce genetic tendencies toward emotional sensitivity. This combination of inherited traits and early experiences can make RSD more likely to appear in individuals with ADHD. 

Managing Genetic Vulnerability 

NICE guidance on ADHD (NG87) emphasises a holistic approach to managing emotional dysregulation. Effective support may include: 

  • Medication to regulate dopamine activity and improve focus 
  • Cognitive behavioural therapy (CBT) to address rejection-related thinking patterns 
  • Mindfulness and emotional regulation techniques to reduce reactivity 
  • Therapeutic coaching, such as Theara Change, to build resilience and self-understanding 

Takeaway 

Genetic factors likely influence RSD by affecting how the ADHD brain processes emotion and reward. However, genes are only part of the picture. With the right treatment, therapy, and self-awareness, people with ADHD can learn to manage rejection sensitivity and improve emotional balance. 

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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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