Can RSD Occur Without ADHD? 

Rejection Sensitive Dysphoria (RSD) is often discussed alongside ADHD, but it can also appear in other mental health or neurodevelopmental conditions. While RSD is not an official diagnosis, many clinicians recognise it as a pattern of intense emotional pain triggered by perceived rejection or criticism. 

Is RSD exclusive to ADHD? 

According to the Royal College of Psychiatrists (RCPsych), RSD is most commonly described in people with ADHD because it reflects that condition’s challenges with emotional regulation and impulse control. However, rejection sensitivity can also appear in other conditions such as autism spectrum disorder (ASD), borderline personality disorder (BPD), social anxiety, and trauma-related disorders. 

The NICE ADHD guideline (NG87) notes that emotional dysregulation and rejection sensitivity are part of ADHD’s functional profile, but these symptoms are not unique to ADHD. They are better understood as transdiagnostic experiences that can occur across different mental health conditions. 

Shared but distinct mechanisms 

Research in The Lancet Psychiatry and JAMA Psychiatry shows that rejection sensitivity involves overactivity in the brain’s amygdala and reduced prefrontal control, leading to exaggerated emotional responses. These patterns are seen in ADHD, BPD, and trauma-related disorders, but ADHD-related RSD is distinguished by differences in dopamine regulation and executive control. 

The Cleveland Clinic explains that while RSD most often affects people with ADHD, individuals with high emotional reactivity or a history of trauma may experience similar distress. Clinicians differentiate ADHD-linked RSD by assessing attention patterns, impulsivity, and executive functioning. 

Treatment approaches when ADHD is not present 

When rejection sensitivity occurs without ADHD, care focuses on improving emotional awareness and resilience. The Mayo Clinic recommends cognitive behavioural therapy (CBT), dialectical behaviour therapy (DBT), and mindfulness-based strategies to help individuals manage emotional responses and build tolerance to social feedback. For ADHD-related RSD, treatment may also include stimulant or non-stimulant medication to support dopamine balance and emotional regulation, as noted in the NICE NG87 guideline. 

Key takeaway 

RSD is not exclusive to ADHD, but ADHD remains the condition where it is most commonly identified and studied. Similar rejection-related distress can appear in autism, personality, or trauma-related conditions, often for different reasons. Understanding the underlying cause, neurological or psychological, helps determine the best approach, whether that involves ADHD-focused medication, therapy, or emotion regulation skills training.