Therapy for Highly-Sensitive People

Introversion/Extroversion is a personality dynamic on a continuum...meaning, people can be on either end or anywhere in-between. It is not static.

There might be an assumption that HSPs are introverted, but tHSPs can land anywhere on the continuum. There is also a sub-category of HSPs who are distinctly Extroverts & Sensory Seekers.

HSPs may need more alone or quiet time to calm the impact of sensory inputs, but that is different than being introverted.

Autism is a neurological, developmental-based diagnosis. It is often mis-diagnosed (undiagnosed) if big behavioral presentations or developmental delays are not obvious in childhood.

Many Autistic individuals have sensory processing challenges & one can be an HSP & Autistic.

Please note that not all researchers agree that a person can be both HSP & Autistic. Some people in the Autism community think HSP is an ableist interpretation of Autism.

I am in the camp of thought that a person can be HSP & Autistic & that they are two different neuro-differences that overlap.

Autism is much more than sensory issues, so careful assessment or diagnosis is recommended.

ADHD is a neurodevelopmental difference.

ADHD is a recognized diagnostic category defined by challenges in modulating attention. When the “H” is present there will also be challenges in “hyper-activity” (examples: challenging to sit still for periods of time or a wanting to “chatter”). Sometimes HSPs get mislabeled with ADHD because of how easily they can be over-stimulated in classrooms or group situations.

Research indicates that ADHDers can also be HSPs, but the two have different & often opposite signatures in presentation, so it may actually make it harder to identify ADHD when a person is HS. No two people are alike...it may be complex to tease out.

AuDHD is Autism & ADHD. It can sometimes be confusing to recognize because Autistic traits can be “cancelled out” by ADHD traits or vice versa.

One can be AuDHD & Highly-Sensitive…further complicating figuring out neurotype.

Variable Attention Stimulus Trait describes all people with ‘ADHD’ traits even if not meeting the full criteria for an ADHD diagnosis.

There is a movement to adopt the term VAST over the term ADHD because the name itself “attention deficit” is inaccurate to describe what is happening for all who experience attentional issues.

SPD is a distinct diagnosis that HSPs can have, but is not the same as the trait of high-sensitivity. There are several categories within SPD that may include balance/coordination issues, Sensory Modulation & Sensory Discrimination. SPD also can be an indication of the presence of ADHD, Autism & other developmental disabilities. Treatment often falls into the field of Occupational Therapists & other sensory integration specialist, especially in childhood.

Misophonia is not a recognized diagnosis at this time. It is defined by strong, emotional responses to specific sound triggers (example: the sound of others chewing) & can trigger panic attacks & limit an individuals socializing among other things.

Misophonia & high-sensitivity can both be present.

HSPs (like others) can develop OCD, which is an anxiety-based diagnosis. Some HSP sensory overwhelm can present similarly to OCD, but does not meet diagnostic criteria. Usually what looks like OCD is the result of sensory overload & decreases or ceases when sensory overwhelm is absent.

Perhaps HSPs & Neurodivergent folks might be prone to developing OCD (obsessional thinking &/or compulsive actions) due to the nature of a mind that is highly imaginative & prone to connect things that are not necessarily connected (causal).

There are other reasons one might be prone to developing OCD, that are a bit too extensive to expand upon here.

Synesthesia is when your brain routes sensory information through multiple unrelated senses, causing you to experience more than one sense simultaneously.

For example, certain musical notes/tones are experienced as specific colors to the person.

All HSPs have high empathy (picking up other people's emotions, body sensations & sometimes thoughts), but not all who have high empathy are HSPs. This is because high empathy does not always come with high sensory experience, a rich internal life, attention to detail, etc.

2 kinds of Empathy to consider:

Emotional empathy:  feeling same emotion, feeling distress in response to another’s plight, feeling compassion for another…

Cognitive empathy:  perceiving & understanding another’s emotions…

HSPs (like others) can develop & meet diagnostic criteria for Anxiety, Depression, Trauma & PTSD. The main difference is that HSPs may be more vulnerable to mental health issues & ESPECIALLY if their childhood was not one of increasing confidence, boundaries & emotional intelligence. HSPs are more negatively impacted by a negative environment. For example, not being emotionally supported by caregivers can cut deeper & manifest emotional issues that non-HSPs would not relate to.

Sensory Burnout can be misinterpreted as Depression & Anxiety Disorders leading to pharmaceutical intervention where lifestyle changes are needed.

C-PTSD stands for Complex Post Traumatic Stress Disorder. C-PTSD is not a DSM diagnosis, but has been widely adopted by the trauma community.

C-PTSD can complicate identifying many diagnoses & neuro-developmental differences. Also, individuals with sensory challenges are more prone to develop trauma (even if the events don't "seem that serious compared to others").

Sensory issues, Autism & ADHD are often misdiagnosed as BPD or Bipolar when these things are not identified in childhood.

While these presentation CAN overlap, care must be taken to tease apart neurodivergence, sensory trauma & developmental trauma.

Persistent Demand Avoidance or Pervasive Drive to Autonomy is not an official diagnosis, but is studied as a dynamic associated with Autism, ADHD & AuDHD & having too much outside pressure to do things in a certain way.

PDA is believed to a be a response to imposed social expectations & the sensory & emotional overwhelm that result from that pressure. PDA may also be a trademark of when individuals experience ADHD + Autism.

This result may look similar to HSP sensory or emphatic overwhelm, but is different in source.

Rejection Sensitivity is not an official diagnosis & not part of any official diagnostic criteria. It is most talked about in the ADHD community & is recognized by an out-of-proportion emotional reaction to perceived or actual rejection.

The overlap for RSD & high-sensitivity is that HSPs, being as perceptive as they are, can often “get in their heads” about other people’s behavior & reaction to them. HSPs might perceive judgement or rejection where non is conscious to the other person.

PCOS is a reproductive/endocrine syndrome, but research is beginning to uncover links with neurodivergent categories such as Autism.

PCOS gets mis-diagnosed often & sensory issues are not always recognized as a possible indicator.

Podcast on the topic

Premenstrual dysphoric disorder (PMDD) is a hormonal health condition that causes severe mood and functioning issues, and disproportionately affects people with ADHD or autism.