What Differentiates RSD from General Emotional Sensitivity?
Many people describe themselves as emotionally sensitive, but for individuals with ADHD, the reaction to perceived rejection or criticism can feel extreme and sudden. This experience is known as Rejection Sensitive Dysphoria (RSD). While it can resemble high sensitivity, RSD is rooted in ADHD’s neurological and emotional regulation differences rather than temperament.
What makes RSD different?
According to the Royal College of Psychiatrists (RCPsych), RSD describes sharp and overwhelming emotional pain in response to rejection or criticism. These reactions are intense, fast, and often disproportionate to the situation. In contrast, general emotional sensitivity tends to involve milder, more gradual responses that resolve more easily.
The NICE ADHD guideline (NG87) explains that emotional instability is part of ADHD’s functional impact. However, RSD represents a specific pattern of emotional dysregulation where perceived rejection rapidly triggers distress, avoidance, or anger due to ADHD-related differences in brain regulation.
The science behind RSD
Research has shown that RSD involves distinct neurological processes. A 2023 review in The Lancet Psychiatry found that people with ADHD have overactive amygdala and insula regions, areas that detect emotional threat, and reduced regulation from the prefrontal cortex, which normally calms emotional impulses. A JAMA Psychiatry analysis also linked dopamine imbalance to this pattern, suggesting that ADHD brains overreact to social threat but under-respond to reward or reassurance.
Clinicians at the Cleveland Clinic describe RSD as a “fight, flight, or freeze” response triggered by rejection cues. This makes it neurologically distinct from personality-based sensitivity or empathy, which do not involve the same dopamine or prefrontal control differences.
Managing RSD and emotional sensitivity
Because RSD is tied to ADHD’s neurobiology, it is managed through ADHD-focused care. The NICE NG87 guideline and RCPsych recommend cognitive behavioural therapy (CBT) and mindfulness-based interventions to build awareness of triggers and emotional control. ADHD medication, such as stimulants or non-stimulants, can also improve emotional regulation by enhancing dopamine signalling and prefrontal function. Psychoeducation and coaching help individuals reframe rejection experiences and develop tolerance to criticism.
The Mayo Clinic and Cleveland Clinic both highlight that coping with RSD involves structured emotional regulation techniques, whereas general sensitivity often benefits from relaxation or communication skills training.
Key takeaway
RSD differs from general emotional sensitivity in both cause and intensity. It is not simply about feeling things deeply, but about how ADHD affects brain circuits that regulate emotion and reward. Recognising this difference allows people with ADHD to access the right combination of therapy, medication, and support to manage emotional pain and strengthen resilience.
