What challenges exist in diagnosing RSD in ADHD? 

Many people with ADHD describe feeling crushed by even small rejections or criticism, a reaction often called Rejection Sensitive Dysphoria (RSD). Although the term is widely used online and in clinical discussions, it is not a formal diagnosis in the DSM-5 or ICD-10/11. According to NICE guidance (NG87), emotional dysregulation is recognised as part of ADHD, but RSD itself remains a debated concept rather than an official subtype. 

Why RSD is difficult to diagnose 

Clinically, the main challenge lies in distinguishing RSD from emotional dysregulation, a well-established feature of ADHD. Research shows that both involve similar neurological mechanisms such as underactivity in the prefrontal cortex and overactivation in the amygdala, leading to strong emotional responses to perceived rejection or failure. 

A 2024 study in Biological Psychiatry Reports found that adults with ADHD show reduced prefrontal control and heightened limbic activity when facing frustration, making minor setbacks feel deeply personal (Ojha et al., 2024, PubMed). 

Because RSD overlaps with anxiety and depression symptoms, clinicians often struggle to decide whether the distress is a separate condition or part of ADHD’s broader emotional profile. NICE currently advises professionals to assess mood, self-esteem, and social difficulties holistically rather than treating RSD as a stand-alone disorder. 

The impact of clinical uncertainty 

This lack of diagnostic clarity can leave people feeling misunderstood. Some adults report that traditional ADHD assessments overlook their emotional experiences, while others find comfort simply in having their rejection sensitivity acknowledged. 

The NHS England ADHD Taskforce Report (2025) highlights this gap and calls for better clinician training to recognise emotional regulation difficulties as part of ADHD care. 

Supporting emotional regulation 

Although RSD is not a formal diagnosis, its symptoms are real and distressing, and there are effective ways to manage them. NICE recommends cognitive behavioural therapy (CBT), mindfulness, and skills-based coaching to help people build emotional awareness and resilience. 

UK services such as Theara Change are developing behavioural and coaching programmes based on these evidence-informed approaches, offering structured tools for emotional regulation and self-understanding. 

Other therapies such as dialectical behaviour therapy (DBT) and compassion-focused approaches have also shown benefits in reducing emotional reactivity, helping people reframe rejection and recover more quickly from setbacks. 

Takeaway 

RSD is a useful descriptive term but not a recognised medical diagnosis. The real challenge lies in identifying and supporting emotional dysregulation within ADHD, which is an established and treatable part of the condition. With the right psychological strategies and compassionate clinical support, many people learn to respond to rejection with resilience instead of despair.