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Can RSD be misdiagnosed as another condition in ADHD individuals? 

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

Rejection Sensitive Dysphoria (RSD) is not an official diagnosis but a way to describe intense emotional reactions to criticism or perceived rejection. In people with ADHD, these feelings can be so strong that they are sometimes mistaken for other conditions, especially mood or anxiety disorders. 

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Why RSD can look like other conditions 

According to the NICE guideline NG87 (2025), emotional dysregulation is a recognised part of ADHD. Because RSD involves deep shame, anger, or sadness after perceived rejection, its symptoms can overlap with conditions such as: 

  • Depression, when the emotional pain leads to hopelessness or withdrawal 
  • Social anxiety disorder, when fear of rejection causes avoidance of social situations 
  • Borderline personality disorder (BPD), when emotions shift rapidly or relationships feel unstable 
  • Generalised anxiety, when heightened worry and self-doubt accompany sensitivity to feedback 

Clinicians therefore assess emotional intensity, duration, and triggers carefully to distinguish RSD-like distress from these other patterns. 

What research shows about overlap and misdiagnosis 

Neuroscience research published in Frontiers in Psychiatry (2022) indicates that RSD symptoms stem from reduced regulation between the prefrontal cortex and the amygdala, leading to faster and more intense emotional reactions (Frontiers in Psychiatry, 2022). Because this brain circuitry also contributes to mood and anxiety disorders, people with ADHD may receive multiple or shifting diagnoses before emotional dysregulation is recognised as part of ADHD itself. 

What UK guidance recommends 

The NHS England ADHD Taskforce Report (2025) encourages clinicians to consider emotional and behavioural symptoms in context, rather than diagnosing additional disorders prematurely. NICE advises that treatment should address emotional regulation and self-esteem, regardless of whether RSD is formally diagnosed. 

Getting help and support 

If emotional sensitivity or rejection-related distress is being misinterpreted or causing confusion in diagnosis, discussing these experiences with an ADHD specialist can help. Alongside NHS options, private services such as ADHD Certify offer structured ADHD assessments and post-diagnostic reviews with qualified clinicians in the UK. 

Takeaway 

RSD can sometimes appear similar to depression, anxiety, or personality-related conditions, but in ADHD it reflects a pattern of emotional dysregulation rather than a separate disorder. Careful assessment by an experienced clinician can help clarify overlapping symptoms and guide effective 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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