BPD and Rejection Sensitive Dysphoria: The Overlap
By Brian Nuckols, MA, LAPC
LAPC · Center for Discovery · Gottman Trained · EFT · DBT · Depth Psychology · Pittsburgh, PA
STUB — outline only. Expand before publishing.
Outline
Open with the patient mislabeled with BPD whose actual picture is ADHD + RSD
RSD: history (Dodson), phenomenology, association with ADHD
BPD: structural features per Kernberg, the broader pattern
Where they overlap (intense rejection sensitivity, affective lability)
Where they diverge (identity, abandonment fear, chronic emptiness, splitting)
Diagnostic implications
Treatment implications
Internal links: any existing BPD or ADHD posts; check dbt-a-vs-standard-dbt
Frequently Asked Questions
What is the difference between RSD and BPD?
STUB — RSD (rejection sensitive dysphoria) is an affective-experiential phenomenon associated primarily with ADHD; BPD is a structural personality organization with broader features including identity disturbance, fear of abandonment, unstable relationships, and chronic emptiness.
Can you have both RSD and BPD?
STUB — yes; the two can co-occur, particularly in patients with both ADHD and borderline-spectrum features.
Is RSD a real diagnosis?
STUB — not in DSM-5; clinical construct primarily associated with ADHD literature, particularly Dodson's writing.
How do you treat RSD vs BPD?
STUB — RSD often responds to ADHD treatment (stimulants, alpha-agonists) plus targeted CBT skills; BPD requires structural treatment (DBT, MBT, TFP, schema therapy).