How does RSD interact with anxiety disorders in ADHD individuals? 

For people with ADHD, emotional intensity is often part of everyday life. Rejection Sensitivity Dysphoria (RSD) refers to the overwhelming emotional pain that can follow perceived criticism or rejection. While not a separate diagnosis, it is increasingly recognised by the NHS and the Royal College of Psychiatrists as part of ADHD’s emotional regulation difficulties. These challenges often overlap with anxiety disorders, creating a powerful cycle of emotional reactivity and fear of failure. 

The emotional and neurobiological connection 

According to NICE guidance (NG87), many people with ADHD experience comorbid mood and anxiety disorders linked to impaired emotional regulation. Brain imaging studies in Frontiers in Psychiatry and ScienceDirect show that both RSD and anxiety share common neural mechanisms. When the amygdala (the brain’s emotional centre) becomes overactive and the prefrontal cortex struggles to regulate it, individuals become more sensitive to perceived threat, evaluation, or criticism. This explains why rejection sensitivity can so easily turn into social or generalised anxiety. 

How RSD fuels anxiety 

Repeated experiences of misunderstanding or criticism can condition the brain to expect rejection, reinforcing fear and hypervigilance. NHS educational materials describe how this pattern often develops into social anxiety or performance anxiety, particularly in adolescents and young adults with ADHD. Research in Frontiers in Psychology found that interpersonal sensitivity acts as a key driver of anxiety and emotional instability. In practice, this means that a critical comment, poor exam result, or social disagreement can trigger physiological symptoms of panic or avoidance behaviours that mirror clinical anxiety. 

Managing RSD and anxiety together 

Treatment approaches endorsed by NICE and the Royal College of Psychiatrists recommend integrating ADHD management with emotional and anxiety-focused interventions. 

• Cognitive Behavioural Therapy (CBT) helps reframe rejection-related thoughts and reduce anticipatory worry. 

• Dialectical Behaviour Therapy (DBT) improves distress tolerance and emotional control. 

• Mindfulness-based interventions have been shown to reduce overactivity in emotion-processing circuits, helping individuals feel calmer under pressure. 

• Medication, such as stimulants or non-stimulants, may stabilise attention and arousal, while SSRIs can be considered for persistent anxiety under psychiatric supervision. 

Private services such as ADHD Certify provide structured ADHD assessments and medication reviews that can support individuals navigating emotional regulation challenges alongside anxiety. 

The takeaway 

RSD and anxiety are deeply interconnected in ADHD. Both stem from the same emotional regulation pathways and are reinforced by lived experiences of rejection or criticism. Recognising this overlap allows for more compassionate, effective support, helping individuals manage fear, rebuild confidence, and strengthen resilience in daily life.