What mental health conditions commonly co-occur with RSD in ADHD? 

Rejection Sensitivity Dysphoria, or RSD, describes the intense emotional pain or shame that follows perceived rejection or criticism. It is not a separate diagnosis, but NHS and Royal College of Psychiatrists resources recognise it as part of ADHD’s emotional regulation profile. According to NICE guidance (NG87), many people with ADHD experience co-existing conditions such as anxiety, depression and personality difficulties that can make emotional distress more severe. 

How emotion and rejection interact 

Emotional dysregulation is thought to be the underlying mechanism linking RSD with other mental health conditions. Neuroimaging research in Frontiers in Psychiatry shows that adults with ADHD who experience emotional volatility often display higher rates of depressive symptoms and interpersonal stress. These difficulties arise because of altered brain connectivity between the prefrontal cortex and amygdala, which makes emotional recovery from rejection slower and more intense. 

Common co-occurring conditions 

Several mental health conditions are more likely to occur alongside RSD in people with ADHD: 

• Anxiety disorders, affecting almost half of adults with ADHD, are linked with constant worry about rejection or criticism, as outlined in NHS education materials. 

• Depression often develops from chronic self-criticism and feelings of failure related to emotional sensitivity. 

• Social anxiety disorder is frequent in adolescents and students who have faced peer rejection, according to a 2024 study in Learning Disabilities Research and Practice. 

• Borderline personality traits, particularly emotional instability and impulsivity, overlap with RSD symptoms and are discussed in BJPsych Advances. 

• Substance use and eating disorders sometimes emerge as coping mechanisms for unregulated emotional distress. 

Managing RSD and co-existing conditions 

Evidence from NICE and the Royal College of Psychiatrists supports a combined approach that targets both ADHD and emotional dysregulation. Cognitive Behavioural Therapy (CBT) helps reframe rejection and reduce rumination, while Dialectical Behaviour Therapy (DBT) improves distress tolerance and emotional mindfulness. Mindfulness-based practices have been shown in MRI studies to strengthen emotion-control circuits and reduce reactivity. Medication may assist with focus and arousal control, but therapy and psychoeducation are usually essential for long-term stability. 

Private services such as ADHD Certify provide structured assessments and medication reviews in the UK, which can support people managing ADHD alongside emotional regulation challenges. 

The takeaway 

RSD magnifies the emotional and interpersonal difficulties already present in ADHD, often overlapping with anxiety, depression and emotional instability. Understanding this connection enables a more compassionate and integrated approach to care, helping individuals build resilience, confidence and healthier emotional responses.