Therapists and most other mental health professionals have an ethical responsibility to stay informed about the latest research in our fields. For this reason, I’m often shocked about the total lack of education among colleagues and in the field generally about sensory processing sensitivity or highly sensitive personality trait – what we’ve started to call HSP.
Over the course of the next few weeks, I’ll be blogging about HSP, and working to update my website to reflect my work in this area.
HSP is a trait. It’s not a diagnosis. It’s a difference in brains that is found across more than 100 species. It’s an adaptive trait, meaning, this trait has made it possible for the species where its been found to survive and thrive on the planet, making it incredibly valuable. Yet, because 80% of the population lives without this trait, the view toward it is often pathological.
The 20% of people with it are often ostracized with labels like “shy,” or “anxious,” or even “borderline,” or “bipolar”. In some cases that label expands toward “autistic.” It’s true that having high sensitivity trait may mean that a person is more likely to experience more stimulation in an environment because they are more likely to pick up on subtle cues and contexts and then to process those deeply – and this can create intense emotions (like those we see in borderline personality disorder or bipolar disorder), and it can create anxiety (like what we see in social anxiety or generalized anxiety disorder), it can even cause someone to blank out and shut down or require loads of quiet time to process what 80% of people don’t think twice about (like the ‘shy’ and ‘autistic’ labels we see).
It’s also true that having HSP trait doesn’t mean that you can’t also experience any number of diagnoses. People with HSP trait can absolutely experience genuine mental health concerns and diagnoses and may even be more likely to experience them because of how deeply they process, how many subtleties in an environment they pick up on, and how emotionally empathetic they are.
When I first heard the term “highly sensitive person” my mind immediately whipped out the DSM, flipped through to a handful of diagnoses wherein boundaries are an issue, wherein processing is a biological and environmental issue, and a host of trauma classifications. I read through some information on it and thought: This isn’t a thing; this is poor boundaries; this is poor emotional regulation; this is pathological.
That was me skimming the surface. That was also me wanting to take control over some things within myself. As a therapist and a science-minded person to begin with, I really don’t like things I can’t easily categorize, put into a color-coded filing system, and then draw up a treatment plan for. I don’t like not being able to step into a problem with a game plan. If someone is just born with this trait that means they pick up on more, which they then process more deeply, which then results in deeper felt emotions and more intense emotional displays – well, my tool kit wasn’t on point for that. Not yet.
It also meant that my own personal struggle with boundaries, with my relationships, with being able to engage with the world around me weren’t things that I could smack some CBT techniques on (cognitive behavior therapy) and walk away from; which is precisely what I’d been trying to do for years.
I realized something very few scientists really want to own up to, even though we try and try to find the bias in our thinking and that of others. I realized my own desire to control these “flaws” I felt like were a part of me was making my willingness to understand and evaluate the research on HSP trait very narrow.
Then I did something they tell us to do in grad school: I leaned into the discomfort.
Holy cow, did I lean.
It was easier for me to think I was just this person who had endured a trauma or two and wound up with some serious anxiety; that I was just this person who had been forever weird about textures, food, smells, lights, sounds, etc.
It was easier for me to believe what other people had said about me my entire life:
She’s willful. She’s stubborn. She won’t listen. She’s in her own little world. She’s so sensitive. You can’t live your life being so sensitive. There’s more to the world than books. There’s more to the world than what goes on in your own head. If you can’t toughen up and get a thicker skin, you’ll never survive. No one else does X this way! What is wrong with you? Why can’t you remember xyz, yet you can remember abc? I think she has ADHD, maybe she needs Ritalin. No, maybe she’s depressed. She can’t possibly be learning anything, she’s staring out the window! Well, the doctor said she is just spoiled and coddled too much.
I bought into the narrative that something was wrong with me. I was overly sensitive, picky, and bound and determined to cause problems for others.
When I finally read through Dr. Elaine Aron’s research studies on the trait she identified as SPS (sensory processing sensitivity) also called HSP, everything I had learned about myself from the exasperated exclamations of others throughout my life (and I mean no insult to those in my life – they didn’t know what HSP was either!), was cast into doubt. These parts of HSP trait that Aron identified were parts of me.
After visiting with a therapist specializing in identifying this trait, what I suspected was confirmed. I had a new lens for understanding myself and how I fit with the world, what I need to do to best care for myself and others, and I can understand better now that not everyone does or will understand what it’s like to live in my skin because only 20% of the population experiences it.
It also helped to stop pathologizing myself. I wasn’t wrong, I wasn’t in need of fixing. I was certainly in need of my own compassion, understanding, patience, and allowance for self-care and space to be myself in (over the constant insistent rush that I felt like most of the world expected of me). It also doesn’t hurt that I was able to find and connect with others who have HSP trait.
Some ‘Signs’ You May be an HSP
- You’re easily overwhelmed by sensory input (anything going on around you – noise, lights, conversations)
- You’re aware of subtleties in your environment (you notice things in an environment others don’t)
- You pick up on other people’s moods (even when they don’t say anything and others tend to not notice how they may be feeling)
- You’re more sensitive to pain (when compared to other people – doctors or others tend to scoff when you ask for pain meds or cite others not needing them)
- You find yourself needing to withdraw during busy days where you can have privacy and relief from stimulation
- You are particularly sensitive to the impacts of caffeine and other drugs
- You’re easily overwhelmed by bright lights, coarse fabrics, loud noises, and strong smells
- You have a rich inner life (you think a lot, you process things deeply – you’re an ocean, not a puddle)
- You’re deeply moved by the arts or music
- Your nervous system sometimes feels frazzled so that you have to go off by yourself or at least to some place with someone who lets you have quiet
- You’re conscientious (you care about issues and the feelings of others)
- You startle easily
- You get easily rattled when you’re on a time deadline
- When people are uncomfortable in a physical environment you tend to notice and then know what needs to be done to make them more comfortable
- You feel annoyed when people try to get you to do too many things at once
- You try hard to avoid making mistakes or forgetting things (which may make you late or even feel indecisive sometimes)
- You make it a point to avoid violent movies or tv shows
- You become unpleasantly aroused (anxious) when a lot is happening around you
- Feeling very hungry creates a strong reaction in me that interrupts your concentration or mood
- Changes in life really throw you for a loop
- You notice and enjoy delicate tastes, sounds, works of art or scents
- You find it unpleasant to have too much going on at once
- You make it a priority to arrange your life to avoid upsetting overwhelming situations
- You are bothered by intense stimuli like loud noise or chaotic scenes
- When you must be observed while performing a task you get so nervous or shaky that you do much worse than you might otherwise do
- When you were a child parents or teachers described you as ‘sensitive’ or ‘shy’
Mislabeling, Misdiagnosis, and Mental Health Pros
This blog is intended to get people more aware of what SPS and HSP are (by the way, Dr. Aron uses these terms interchangeably), how they present, and how these things have snuck into our sciences in the relatively recent past with mostly little fanfare. There is a plethora of research and writing available on SPS and HSP.
I have encountered dozens of clinicians who hear me discuss HSP and have no clue what it is. I try to always use those opportunities to describe the trait and refer them to the research. One of the most common arguments that I’m met with is that I’m simply describing “high functioning autism” or that I’m describing “poor boundaries”.
This simply isn’t true. There is fMRI imaging that shows a difference in the responses of brains that are SPS/HSP and brains that aren’t when exposed to stimuli. 20 percent of the population, folks. Observed also in animals.
There is no way such a thing found in so many people and across multiple species is maladaptive or pathological.
I encourage you, if you’re a mental health professional of any type – I implore you, evaluate the research that Dr. Aron has produced, and that others have reproduced. Please. Don’t dismiss it, and don’t dismiss those that come to you for help by trying to categorize, file, and color code because that’s what fits best within your own pre-existing framework. Don’t let this be something that you’re wrong about.
Labeling others with a diagnosis they may not have is damaging. Diagnostic labeling is dangerous period – but when it’s incorrect, even more so. Our rule of nonmaleficence – first do no harm applies here. If you have dismissed HSP research out of hand because it doesn’t fit with what you learned in school 5, ten, or 20 years ago – you are choosing the potential of harming every client that walks through your door. Every single one.
Up Next & More Information
Next on the blog in this series – the 4 parts of HSP trait and how they manifest and may show up differently in each person with HSP trait, some tips on undoing the damage that false labeling and other people’s narratives have done, and identifying HSP in children and infants.
For questions and more information, I encourage you to check out hsperson.com and take the self-test written by Dr. Aron, who identified this trait. I also encourage you to check out any of her books or the wealth of research articles available on this topic via pubmed.gov or via hsperson.com.
Some References for Ya!
Greven CU, Lionetti F, Booth C, Aron EN, Fox E, Schendan HE, Pluess M, Bruining H, Acevedo B, Bijttebier P, Homberg J.Neurosci Biobehav Rev. 2019 Mar;98:287-305. doi: 10.1016/j.neubiorev.2019.01.009. Epub 2019 Jan 9.PMID: 30639671 Free article. Review.
Acevedo B, Aron E, Pospos S, Jessen D.Philos Trans R Soc Lond B Biol Sci. 2018 Apr 19;373(1744):20170161. doi: 10.1098/rstb.2017.0161.PMID: 29483346 Free PMC article. Review.
Lionetti F, Aron A, Aron EN, Burns GL, Jagiellowicz J, Pluess M.Transl Psychiatry. 2018 Jan 22;8(1):24. doi: 10.1038/s41398-017-0090-6.PMID: 29353876 Free PMC article.
Acevedo BP, Aron EN, Aron A, Sangster MD, Collins N, Brown LL.Brain Behav. 2014 Jul;4(4):580-94. doi: 10.1002/brb3.242. Epub 2014 Jun 23.PMID: 25161824 Free PMC article.
Homberg JR, Schubert D, Asan E, Aron EN.Neurosci Biobehav Rev. 2016 Dec;71:472-483. doi: 10.1016/j.neubiorev.2016.09.029. Epub 2016 Sep 30.PMID: 27697602 Review.
Lionetti F, Aron EN, Aron A, Klein DN, Pluess M.Dev Psychol. 2019 Nov;55(11):2389-2402. doi: 10.1037/dev0000795. Epub 2019 Aug 15.PMID: 31414847
Pluess M, Assary E, Lionetti F, Lester KJ, Krapohl E, Aron EN, Aron A.Dev Psychol. 2018 Jan;54(1):51-70. doi: 10.1037/dev0000406. Epub 2017 Sep 21.PMID: 28933890
Aron EN, Aron A, Jagiellowicz J.
Pers Soc Psychol Rev. 2012 Aug;16(3):262-82. doi: 10.1177/1088868311434213. Epub 2012 Jan 30.PMID: 22291044 Review.
Aron EN.J Anal Psychol. 2004 Jun;49(3):337-67. doi: 10.1111/j.1465-5922.2004.00465.x.PMID: 1514944
Jagiellowicz J, Xu X, Aron A, Aron E, Cao G, Feng T, Weng X.Soc Cogn Affect Neurosci. 2011 Jan;6(1):38-47. doi: 10.1093/scan/nsq001. Epub 2010 Mar 4.PMID: 20203139 Free PMC article
Aron A, Ketay S, Hedden T, Aron EN, Rose Markus H, Gabrieli JD.Soc Cogn Affect Neurosci. 2010 Jun;5(2-3):219-26. doi: 10.1093/scan/nsq028. Epub 2010 Apr 13.PMID: 20388694 Free PMC article
Aron EN, Aron A, Davies KM.
Pers Soc Psychol Bull. 2005 Feb;31(2):181-97. doi: 10.1177/0146167204271419.PMID: 15619591