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How is RSD diagnosed in individuals with ADHD? 

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

Many people with ADHD describe feeling intense emotional pain or shame when they believe they have been criticised or rejected. This experience, often called Rejection Sensitive Dysphoria (RSD), is increasingly recognised in clinical discussions about ADHD, but it is not a separate medical diagnosis. 

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Is RSD formally diagnosable? 

According to the NICE guideline NG87 (2025), RSD does not appear as a distinct disorder in diagnostic manuals such as DSM-5 or ICD-10. Instead, it is understood as part of the emotional dysregulation that commonly accompanies ADHD. Clinicians assess these difficulties during standard ADHD evaluations by exploring mood sensitivity, emotional reactivity, and self-esteem changes, rather than using a specific “RSD test.” 

How emotional dysregulation is assessed 

During ADHD assessments, practitioners often discuss triggers for strong emotional responses, such as criticism or social rejection. They may use validated tools such as the Conners Adult ADHD Rating Scales or the Barkley Deficits in Executive Functioning Scale to understand how emotional and executive symptoms interact. Recent findings from Frontiers in Psychiatry suggest that rejection sensitivity is linked to reduced regulation between the prefrontal cortex and the amygdala, which can heighten emotional responses even when feedback is mild (Frontiers in Psychiatry, 2022). 

What UK guidance and experts say 

Both the NHS England ADHD Taskforce Report (2025) and NICE guidance highlight the importance of recognising emotional dysregulation within ADHD presentations. NICE recommends cognitive-behavioural and psychoeducational approaches to help individuals manage emotional intensity and build resilience, rather than treating RSD as a separate condition. 

Getting help and support 

If feelings of rejection or emotional intensity are affecting daily life, a clinical ADHD assessment can help clarify the underlying causes. Alongside NHS pathways, private services like ADHD Certify provide ADHD assessments and post-diagnostic reviews with qualified clinicians in the UK. 

Takeaway 

RSD is not a separate diagnosis but a pattern of emotional dysregulation within ADHD. Recognising and addressing these emotional challenges through assessment, therapy, and self-awareness can help individuals manage sensitivity to rejection and improve emotional wellbeing. 

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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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