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How Does Emotional Regulation Differ in ADHD with RSD? 

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

Emotional regulation can be challenging for many people with ADHD, but when Rejection Sensitive Dysphoria (RSD) is present, emotions can feel even more intense and harder to manage. Understanding how emotional control differs in ADHD with RSD helps explain why reactions to rejection can be so strong and difficult to calm. 

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Emotional Regulation in ADHD 

According to NHS guidance, people with ADHD often experience difficulty managing frustration, disappointment, and emotional impulses. This is due to differences in brain networks that control attention, inhibition, and emotional processing. The Royal College of Psychiatrists highlights that these difficulties can lead to emotional outbursts or sudden mood shifts, particularly in response to criticism or perceived failure. 

What Changes When RSD Is Involved 

Research in The Lancet Psychiatry and PubMed shows that RSD involves increased activation in the amygdala, which processes emotion, and reduced control from the prefrontal cortex, which helps regulate those emotions. This means emotional reactions occur faster and with greater intensity before logical reasoning can intervene. The Cleveland Clinic explains that people with ADHD and RSD often describe going from calm to overwhelmed within minutes, followed by exhaustion or withdrawal once the emotion passes. This differs from typical ADHD emotional dysregulation, where feelings build more gradually and are easier to moderate. 

How to Improve Emotional Regulation 

NICE guidance on ADHD (NG87) recommends managing emotional instability as part of ADHD treatment. Helpful strategies include: 

  • Cognitive behavioural therapy (CBT) to identify and challenge rejection-related thought patterns 
  • Mindfulness and grounding techniques to slow emotional responses 
  • Medication for ADHD to improve dopamine balance and reduce impulsivity 
  • Structured coaching and psychoeducation, such as programmes from Theara Change, which teach emotional awareness and self-regulation skills 

Takeaway 

Emotional regulation in ADHD with RSD is marked by faster, stronger, and more distressing reactions to rejection or criticism. Recognising these patterns and learning practical tools for calming and reframing emotions can make daily life more stable and less overwhelming. 

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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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