ADHD and Emotional Regulation: The Link to BPD and RSD Explained

This video explores the critical yet often overlooked role of emotional dysregulation in ADHD and its overlaps with Borderline Personality Disorder (BPD) and Rejection Sensitive Dysphoria (RSD).
Emotional dysregulation isn't just an extra symptom of ADHD-it’s a defining feature that shapes behaviour, relationships, and overall functioning.
In this episode, Dr Sanil Rege unpacks the neurobiology of emotional regulation, focusing on how the frontostriatal-limbic circuits link emotion, cognition, and behaviour.
You'll learn how these circuits underlie shared traits across ADHD, BPD, and RSD and why these conditions often blur together in clinical practice.
We’ll also explore practical strategies for managing emotional dysregulation in ADHD, the developmental roots of these overlaps, and how understanding the brain's pathways can improve treatment outcomes. Whether you're a clinician or simply curious about the intricate links between mental health conditions, this video will provide valuable insights.
Join us on Psychiatry Simplified as we break down complex topics into clear, actionable knowledge. Don't forget to subscribe for more engaging content on psychiatry, neuroscience, and mental health!
#ADHD #EmotionalDysregulation #BPD #BorderlinePersonalityDisorder #RSD #RejectionSensitiveDysphoria #Neurobiology #PsychiatrySimplified #DrSanilRege #MentalHealth #Psychiatry #ADHDManagement #EmotionalRegulation #Neuroscience #ADHDAndEmotions #ADHDOverlap #ADHDTreatment
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[@sharonaumani8827]

"Each experience of rejection embeds increasing sensitivity to future rejection." Perhaps a ray of hope to some is: Just as that is true, it can also be said that each experience of being able to learn from feedback [direct or indirect, over time] one's tendencies and ultimate misperceptions can have a profound healing impact. It may not eliminate your vulnerability to that, but having the insight really helps you to take it [biology] for what it is, have some strategies, and most importantly, incorporate self-compassion and acceptance for one's own differences [so as not to keep putting yourself in the same situations, expecting a different result and then beating yourself up for not being able to function to the same level as everyone else].

[@MS-pm9fe]

As a therapist with adhd and having clients with adhd, I have observed these trends but could never explain them...until now! One of the best videos on YT. Thank you!

[@PsychiatrySimplified]

Thanks for the feedback 🙏🏼

[@solutions4tenants141]

CPTSD is part of this and some confuse that with Borderline, Aspergers and ADHD. All in all, it’s a behavioral issue of getting along with others without lashing out, fleeing, freezing or fawning. Skills most of us need to learn anyway to get along in society. Just like a war vet coming back to his homeland after being deployed in a war zone, he or she are mentally hammered and the brain needs to learn to self regulate and rest.

[@nukedpancakes3_863]

i love this channel he breaks it down so well, i find neuroscience so interesting

[@PsychiatrySimplified]

Thanks for the feedback. Appreciate it 🙏🏻

[@skeptik-ci5xo]

So interesting. I love your videos; I always learn something new that no one else in the field is talking about.

[@PsychiatrySimplified]

Thanks so much for the feedback. Really appreciate it 🙏🏼

[@studentaccount4354]

Thank you! This was helpful. This reminds me of prior research but adds in some new dimensions. I have read a lot on mindfulness meditation practice resulting in increased frontal cortex functioning shown on fMRI’s as well as studies on sleep. On a similar note I read on epigenetic studies on the offspring of mothers that went through famine or other adversity causing permanent and lasting neurocognitive changes in their progeny at higher rates than populations not subjected to the adversity. Thanks again!

[@solutions4tenants141]

This is such a good video. Thank you for the effort putting it all together. I’ve had sleep anxiety since I was a tiny child… I’ve had different therapists in different parts of the country where I had moved to for work, label me different things when I did not have my records transferred to each new state I moved to. One of them labeled me ADHD, another labeled me quiet BPD, yet another labeled me Aspergers and yet another therapist labeled me CPTSD. Over 10 years ago I started to read about nutritional support from Elliot Overton nutrition online. I learned how the very many decades of very low levels of magnesium and potassium AND Thiamine (B-1, Benfotiamine) can wreak havoc on our nervous system and create a host of electrical disturbance problems in our brain. B-1 Along with lack of enough magnesium potassium and iodine just make a waterfall of issues in our body. As soon as I got my supplements of minerals correctly sorted out AND CUT OUT CARBS… my brain has regulated and I sleep like a baby for the first time in over 60 years. General anxiety has dropped to almost nonexistent by going from Keto to Carnivore and I finally found inner peace and deep rest each day. If I have a cheat day or two eating the standard American diet, my brain dysfunctions and my old behaviors like overthinking and restless leg disorder comes roaring back with a vengeance. The processed food is not worth the trade off.

[@PsychiatrySimplified]

Glad you found a solution that works for you

[@Blueflameintegration]

How come medical professionals have misdiagnosed me as being bipolar and tried doping me up on that medication when later come to find out I have adult ADHD. Yet won’t give me ADHD medication which has helped me tremendously regulate my mood and emotions.. Pray tell me why.

[@PsychiatrySimplified]

Sorry to hear. There is a range of ADHD medication. So difficult to know. Hoping you can discuss it with your doctor

[@JustEye_La]

Very well explained. Thank you 🙏

[@PsychiatrySimplified]

Glad it was helpful!

[@meraloguz2672]

Very usefull video. Thankyou 😊

[@vrouwvantlommerrijck311]

Dank u. Ik ken een man waarbij het er uit ziet dat NPD, ADHD, RSD and BNP allemaal bij elkaar komen, ik blijf zo ver mogelijk uit de buurt maar het is in wezen heel verdrietig. Zelf heb ik erg last van slaapproblemen waardoor het onmogelijk lijkt echte vorderingen te maken met RSD en het brede gebied van AD(H)D, ondanks alle inspanningen.

[@PsychiatrySimplified]

Sorry to hear. Please see the video on clonidine and another one on insomnia. You may want to discuss this with your doctor. Ps not advice

[@noBodyuNope]

Dr Rege, why is there a great deal of symptom overlap between sleep apnea and ADHD? I see a lot of patients that are diagnosed with ADHD and sleep apnea that resist CPAP treatment

[@TheAussieHobo]

I had the insight many months ago after going down the rabbit hole of finding who I am and who I was. Too much overlap for BPD to exist. BPD is CPTSD at its core and u believe possibly the cause for neurodiverse personalities. I believed it's the opposite of narcissism but is so misunderstood. It's understandable given how similar they can look. The intention is another story.

[@keturahspencer]

Is BPD genetic or merely behavioral? If it is genetic or physically developmental, than why is it labeled as a personality disorder rather than a Neuro Developmental Disorder?

[@arrogantpublisher]

It's a personality disorder that has a genetic component but manifests only through emotional neglect and/or childhood abuse/trauma.

[@PsychiatrySimplified]

It is both. Borderline Personality Disorder (BPD) can be conceptualised as a combination of: 1. Neurodevelopmental changes resulting from allostatic load (such as trauma or other 'inconsistencies' in early experiences) leading to heightened emotional responses, emotional dysregualtion etc. 2. Personality development, where emotional regulation and behavioural patterns consolidate alongside neurodevelopmental changes. These have consolidated at a time of upheaval which means the default behaviours are safety / fear / mistrust driven. There are genetic underpinnings. psychscenehub.com/psychinsights/borderline-personality-disorder/

[@unlistedandtwisted]

Just a CNA here: Like most mental illnesses, BPD certainly has a genetic component as proven by high hertiability between 1st degree relatives. I've never heard it described as a developmental disorder. I know personality disorders are defined by the distinction from other mental/behavioral disorders by the fixed, consistent, rigid and typically destructive pattern of thinking and behaviors that define all PD's. Your personality - OCEAN (Openess, Concientiousness, Extraversion, Agreeability, Neuroticism) are hallmarks of one's personality in the psych world - and usually in place at the age of 3. I don't think what a mental/behavioral health issue is labeled helps with treatment. It helps your doctor get insurance reimbursements and you get treatment. Many psychopathologies receive similiar talk therapy treatments - CBT, DBT, EMDR - and even receive similiar psychoactive therapies. If calling yourself "neurodivergent" or whatever helps you, go ahead. Just know early treatment and PROPER treatment is huge. It's not just the right psych meds. It's diet, exercise, and ruling out any physiological issues before concluding a Dx that by no means defines your identity.

[@solutions4tenants141]

Yes even the psychiatrist and psychologist need therapy. It’s good for all of us.

[@indigentphd]

@@PsychiatrySimplifiedI wish folks would talk about non-parental forms of trauma in personality disorders. My daughter was born premature and experienced a lot of medical trauma during a months long hospital stay. From the time she came home to this day, she has struggled with emotional regulation and anxiety. Of course I did not have all the information I needed to parent a child like that, so parenting errors also played a role, but early emergence of issues certainly suggest those very traumatic experiences in the hospital mattered.

[@MrDcrules]

Another fascinating tour into the human mind, Dr. Rege. Thank you again. Are there medications that target a strengthening of the Prefrontal Cortex (PFC)? it seems like these conditions share an under-developed PFC that is not properly or fully regulating an often over-active amygdala. Do meds like the ADHD stimulants and alpha 2 agonists like Guanfacine function to strengthen the PFC? Any other meds that help the PFC do its job more effectively? All the best. thanks.

[@PsychiatrySimplified]

You mentioned are appropriate ones. PFC - D1, ALPHA 2 A receptors, glutamatergic So stimulants, guanfacine, bupropion, modafinil and some ‘Antidepressants’ . But other ways of improving PFC fxn is via reducing excessive arousal, reducing anxiety, improving sleep etc. And of course diet / lifestyle factors alcohol, exercise etc

[@MrDcrules]

@@PsychiatrySimplified Thanks Dr. Rege. Excellent points. We know that exercise helps to promote brain derived neurotrophic factor (BDNF) and that supports a stronger PFC. Appreciate your responses. Have a nice weekend. Don

[@RaviGupta-r2c]

Sir can 25 mg amitriptylline increase noradrenaline.

[@PsychiatrySimplified]

Not prominently

[@katierenae4848]

Would a SSRI help with ADHD? My husband has ADHD anxiety and PTSD and the ddr put him on a SSRI but it doesn't seem to be helping him much?

[@PsychiatrySimplified]

Depends on what is being targeted. There are specific symptoms that the medication can address. So discussing the key targets with the doctor and then choosing the medication is appropriate. Wish your family well

[@katierenae5537]

​@PsychiatrySimplified thank you so much. I appreciate the reply

[@NuclearAnNoahlation]

Why is the audio mainly for the left 😭

[@PsychiatrySimplified]

?

[@elizabethkelsey8087]

I have combined type ADHD and severe RSD. Stimulant medication ( or supplements) hasn't helped me with focus at all, but clonidine and gabapentin have helped me with some aspects of the emotional component. Guanfacine did nothing, unfortunately. I also have sleep issues ( delayed wake sleep cycle) and OCD and anxiety. RSD is terrible and I wouldn't wish it on anyone. It's a physical and emotional pain. It usually feels like being stabbed in the chest.

[@PsychiatrySimplified]

Its a common issue that its difficult to address the RSD with medication only. It often needs psychotherapy to explore the underlying origins of RSD

[@elizabethkelsey8087]

@ Thanks for getting back to me! I’ve worked with a therapist for years, along with the medication. Therapy has probably worked the least actually as the RSD is very sudden and just goes away on its on, despite how intense it is. I think if I could increase my medication it would help as it has helped thus far about 40 percent but the side effects ( fatigue) is too much so I’ve had to stay on the lowest dose.

[@sharonaumani8827]

Interestingly, RSD was never physical for me, probably related to alexithymia etc. related to autism/ADHD. It was "painful" in a psychological/despairing way. Even if this [RSD] made it into the DSM, I don't see it as a "permanent" sort of label/diagnosis. It's just an increased vulnerability that one can become educated about and learn to work with/overcome.

[@elizabethkelsey8087]

@ There is a psychiatrist ( forgot his name; he may be the guy who coined the term RSD) who talks about 30 percent of people who have RSD have it really severe. It’s a scale for sure, and I’d fall in the severe category. Additude magazine has a few articles with people talking about how it feels to them and quite a lot have the physical and emotional pain experience I have. Medication is the most helpful for it over therapy, per him and others. But not everyone responds the same to it. He theorizes it has to do with the hpa axis.

[@sharonaumani8827]

@@elizabethkelsey8087 I can relate to what you are saying. I found it helpful when I worked with someone I could briefly interact with, as things came up. I know there can be a lot of security issues with emails/texting, etc. Yet, the brief interaction with writing, back and forth can be so helpful. You really need that extra support in the moment. Writing it out also gives the responder a chance to think about their best response to the situation. It can be mutually quite helpful. But [sigh] this is not a standard. I am fortunate to have had that support for a good portion of my adult life. Med's are important, but they certainly have their limitations! Even when they seem to work miraculously, there is typically some other toll to consider [subtle or otherwise]. Vyvanse and Buproprion [together] have been helpful. I don't care what studies support or don't support. Vyvanse is really the only effective ADHD med for me [and not as effective as I would like, but it DOES make a difference and affects the quality of my life, even at almost 66 years of age]. I would prefer quality of life over quantity [years], so let me have my medication! [just putting that message out there]

[@demaskatorr]

[@takiyaazrin7562]

Penis drawing. Love your explanations btw Dr Rege

[@PsychiatrySimplified]

? First part? Didn't get it. Thanks for the feedback

[@petervanrun4626]

hmm, its people like you give psychiatry a good name! Simplified? well my wife says the smartest people are the ones who can put things simply, this isnt simple n seems a huge growth industry, " where a biopsychosocial, cultural,diet,lifestyleapproach becomes benifital, haha, you should be on the team to help make Australia healthy, i think you are there, goodonya

[@Thatsbannanas-d8c]

What nonsense. Labels are for jars. You are nuts.

[@PsychiatrySimplified]

i’m not sure if you viewed the video but that’s kind of what the video is about to move beyond the labels

[@sharonaumani8827]

I understand that reaction, because of how that was stated in the video, something like how these experiences can lead to BPD [sorry, I have crappy memory to repeat exactly]. Those who struggle with these challenges, "labels", "diagnosis,"....are also still struggling with the stigma and shame attached to those [including that which is sometimes imposed on them by those who are treating them for their diagnosis, yet not to judge, because we are not easy to work with when highly dysregulated!].

[@PsychiatrySimplified]

@@sharonaumani8827 “Borderline Personality Disorder is a diagnosis that serves as a crucial construct. Yet, it is often misunderstood and misused, an irony that mirrors the internal conflict of splitting inherent to the disorder. The very nature of BPD’s diagnosis reflects the paradox of the condition it seeks to define. Understanding the complex interplay of emotional dysregulation, impulsivity, and interpersonal difficulties is key to developing effective interventions for BPD, which remains a significant challenge for mental health professionals. The recognition of BPD as a distinct and chronic condition rather than a transient state is critical for providing appropriate care and improving outcomes for individuals affected by this disorder.” psychscenehub.com/psychinsights/bpd-diagnosis-management-strategies/

[@PardeepJindal-b7v]

Just try to talk to me or come near me I tell u wht I can do