When a patient with ADHD says “I know I’m overreacting, but I can’t stop,” they are not being dramatic. They are describing something neurobiologically real — a predictable consequence of dopaminergic prefrontal dysfunction interacting with the brain’s social pain circuitry. Rejection sensitivity is one of the most impactful features of ADHD and, in my experience, one of the most underaddressed in clinical training. This post on RSD covers what the research tells us about the underlying neuroscience, what it looks like when it walks into your office, and how to think about treatment when screening tools and symptom checklists have only told part of the story.