Is there a link between RSD and borderline personality disorder in ADHD? 

Rejection Sensitivity Dysphoria (RSD) describes intense emotional pain triggered by perceived rejection, criticism, or failure. While not a formal diagnosis, clinicians recognise it as a pattern of emotional dysregulation that often occurs in people with ADHD. According to the Royal College of Psychiatrists, emotional instability is a common feature of ADHD and can resemble the traits seen in borderline personality disorder (BPD), leading to understandable confusion about where one ends and the other begins. 

Overlapping emotional patterns 

Both RSD and BPD involve heightened sensitivity to rejection and difficulties regulating emotions. In BPD, this pattern forms part of a persistent personality structure that affects identity, relationships, and self-image. In ADHD, RSD tends to be episodic and closely tied to perceived failure or social feedback rather than a fixed emotional pattern. Neuroimaging studies in Frontiers in Psychiatry and PLOS ONE show overlapping mechanisms involving amygdala overactivity and reduced prefrontal control, which increase reactivity to emotional cues. These shared brain circuits explain why individuals with ADHD may experience BPD-like symptoms, particularly when under stress or facing criticism. 

Distinguishing features 

NHS and NICE resources highlight key differences. In ADHD, emotional outbursts usually subside quickly once the situation resolves, whereas in BPD they tend to persist and affect long-term self-perception. People with ADHD and RSD may describe “feeling rejected” rather than “feeling empty,” a distinction often noted by psychiatrists assessing the two conditions. However, comorbidity does exist: studies in BJPsych Advances indicate that emotional dysregulation in ADHD can overlap with borderline traits, particularly impulsivity and fear of abandonment. 

Managing overlapping symptoms 

Treatment typically focuses on improving emotional regulation rather than separating the labels. 

• Cognitive Behavioural Therapy (CBT) and Dialectical Behaviour Therapy (DBT) can both help manage rejection sensitivity and distress responses. 

• Mindfulness-based interventions reduce reactivity and support self-awareness. 

• Medication for ADHD may improve impulse control and reduce emotional intensity, but therapy remains central when emotional instability persists. 

Private clinical services such as ADHD Certify offer assessment and post-diagnostic reviews, helping individuals understand overlapping ADHD and emotional regulation patterns. 

The takeaway 

RSD and BPD share emotional intensity, but their origins and patterns differ. RSD in ADHD reflects a reactive sensitivity to rejection, while BPD involves a broader and more enduring emotional instability. Understanding their overlap helps clinicians and individuals target treatment effectively, fostering stability, resilience, and self-compassion.