Why RSD Looks Different in Women vs. Men
This matters for how the self-assessment lands.
In women and people who have spent years masking ADHD, RSD tends to manifest inward: shame spirals, withdrawal, crying, people-pleasing to prevent rejection, and extensive emotional suppression. The outward calm can make women doubt whether they "really" have RSD — because the explosion isn't visible.
In men and people with hyperactive ADHD presentations, RSD tends to manifest outward: sudden anger, defensiveness, verbal aggression, quitting before being rejected. Men with RSD may not recognize it as rejection sensitivity because the experience is filtered through anger rather than vulnerability.
Both patterns reflect the same underlying neurological mechanism. The expression varies; the origin doesn't.
If you're a woman who identified mostly with the inward items above, or a man who identified mostly with the outward items — your assessment is still valid.
RSD Assessment vs. BPD Assessment
Because RSD and borderline personality disorder (BPD) share surface features — rejection sensitivity, emotional flooding, intense reactions — this is one of the most important differentiations in assessment.
Three clinical questions that help distinguish them:
How long do episodes last? RSD episodes typically resolve within hours. BPD-related emotional states can persist for days or shift into other emotional states without returning to a stable baseline.
Is there a stable sense of self between episodes? People with RSD typically have a stable identity and self-concept outside of episodes. BPD involves chronic identity disturbance — not just during episodes but as an ongoing feature.
What is the relationship pattern? RSD causes avoidance of rejection — pulling back from relationships to prevent the pain. BPD typically involves intense relationship cycling (idealization followed by devaluation), not primarily avoidance.
Key Stat: Faraone et al. (2019) found that emotional impulsivity in ADHD — the core feature driving RSD — is neurological in origin and responds to different interventions than the emotional dysregulation in BPD, which responds primarily to dialectical behavior therapy.
What the ICD-10 Code Question Is Really About
"Rejection sensitive dysphoria ICD-10" gets 320 monthly searches — usually from people trying to bill insurance for RSD treatment.
The honest answer: there is no ICD-10 code for RSD specifically. Clinicians typically code the associated ADHD diagnosis (F90.x codes) and note emotional dysregulation as a feature, or use adjustment disorder, anxiety disorder, or persistent mood disorder codes depending on what's most prominent.
For insurance purposes, treatment for RSD is most effectively covered when it's framed as treatment for ADHD with emotional dysregulation — because that's what it is. A clinician experienced with ADHD billing can help navigate this.
What to Do If You Think You Have RSD
Step 1: Find an ADHD-informed clinician. Not all therapists or psychiatrists are familiar with RSD. Look specifically for clinicians who list ADHD in adults as a specialty. Ask directly: "Are you familiar with rejection sensitive dysphoria?"
Step 2: Bring your self-assessment results. Document your specific patterns — which triggers are most common, whether episodes are inward or outward, how long they last, and what behavioral impact is greatest. This gives a clinician concrete material to work with.
Step 3: Ask specifically about medication for RSD. If you already have an ADHD prescriber, ask whether alpha-2 agonists (guanfacine or clonidine) might be appropriate alongside your current medication. Many prescribers are unaware that these medications specifically target emotional reactivity in ADHD.
Step 4: Don't wait for a perfect diagnosis to start building supports. Community, accountability structures, and behavioral strategies can reduce RSD's impact while you pursue formal evaluation. Platforms like GetMotivated.ai offer structured support — buddy matching and group challenges — that directly address the isolation and avoidance that make RSD worse, without requiring a clinical diagnosis to get started.
The pattern recognition matters regardless of whether a clinician eventually says "yes, this is RSD." Knowing what you're working with changes what you do about it.
