Highly Sensitive People: an Update

In our daily life, it is easy to find that some individuals are more sensitive than others. Reportedly endowed with a rich inner world^(1.), individuals who are highly sensitive seem to be easily offended, upset, stressed, and overstimulated (exhausted) and have or display a quick and delicate appreciation of others’ feelings (empathy) and perspectives.

Variously called^(2.) weak nerves (aka neurasthenia, Beard, 1880), hyperactive emotional syndrome (Jaspers, 1913), and innate sensitiveness (Jung, 1961) in the past, modern researchers Aron and Aron (1997)^(3.) proposed the construct of sensory processing sensitivity (SPS) to differentiate highly sensitive people (HSP, as described in popular media^(4.)) from those elsewhere on the environmental sensitivity (see below) continuum.

Blessed with these characteristics on the one hand, on the other, they do not seem to have an easy life: per definition in minority, highly sensitive individuals struggle to find their place in societies whose members mostly do not share these characteristics.

The figure below illustrates this paradox:

Based on the Differential Susceptibility model^(6.) (more on this later) of sensitivity to environmental influences, higher sensitivity is associated with more negative outcomes in response to negative environmental influences, but also with more positive outcomes in response to positive environmental influences.

Notably, the self-attribution of HSP is associated with more self-acceptance, an improved sense of belonging to a community, and liberation from the feeling of being deficient or an outsider.

To wit, there is an ever-growing amount of world-wide popular literature on high sensitivity including an online self-administered SPS ‘test’^(9.), print and online guides and ‘tips’^(10.) for HSP, societies and conferences^(11.) for the highly sensitive, and advertisements touting ‘specialist’ HSP mental health products and services.

Specific subgroups^(7.), such as highly sensitive children, highly sensitive parents, highly sensitive boys and men, highly sensitive patients, highly sensitive employees, and even highly sensitive lovers now paint a multifoliate picture of this ‘special species’^(12.).

Additionally, HSP discourse is increasingly pervasive in disability activism^(7.) and debates, both academic/professional (nosographic i.e. diagnosis-related) and popular (e.g. the concept of neurodivergence).

In contrast, HSP has both been described philosophically as an example of the medicalisation of human suffering and, from a scientific perspective, as diffuse, with questionable validity and unclear distinction from other established psychological constructs^(11.).

Across populations, a continuum from low to high sensitivity to the environment is observed^(13.), with some individuals found to be more sensitive to their environment than others: they might be bothered by light, sounds, or smells more quickly and deeply than others, and can be stronger and more deeply affected by social situations.

These individual differences are captured by the concept of Environmental Sensitivity^(8.), (an umbrella term which includes the Differential Susceptibility^(7.), Sensory Processing Sensitivity, Biological Sensitivity to Context (A to C below), Vantage Sensitivity, and Diathesis-Stress^(1.) models) which asserts that individuals differ in their sensitivity to both aversive and supportive environments^(6,12).

The subject of this article, model B (SPS) above, proposes that, when faced with a new stimulus, individuals adopt one of two strategies^(14.): approach and exploration, or cautious attentiveness that may lead to avoidance. It asserts that one’s choice of strategy is related to the manner in which sensory information is transmitted to, and processed by, the brain.

Using an alternative model, these two strategies may be better understood as corresponding to an individual’s state of behavioural activation vs. inhibition (respectively) at a particular time, the proposition being that HSPs possess a greater ratio of inhibition : activation.

Part of the human brain, the Behaviour Activation System (BAS) is is associated with ascending dopaminergic pathways and the cortico-striato-pallido-thalamic loops, and is the source of goal-directed behaviour, positive feelings, and responses to conditioned and unconditioned signals of reward.

The Behaviour Inhibition System (BIS), on the other hand, consists of the septohippocampal system; its monoaminergic afferents from the brainstem and its neocortical projection in the frontal lobe are believed to be sensitive to punishment, non-reward and novelty.

Hyperactivity in the BIS as compared to the BAS (corresponding to the SPS trait) is believed to be accompanied by a subjective state in which one responds to threat (stimuli associated with punishment or non-reward) or uncertainty (novelty) with the reaction, stop, look, and listen, and get ready for action. (Importantly, this term is also widely equated with arousal, as discussed in previous articles).

At high levels of physiological arousal, the efficiency of this reaction decreases and the individual may become hypervigilant, allocating attention to both relevant and irrelevant stimuli.

In achieving the best balancing of, or negotiation between, the urge to approach and satisfy needs (BAS) and the urge to stop and consider risks, costs, or how best to make use of an opportunity, an individual who has a characteristically more active BIS (i.e. a HSP) may be more easily distracted, less focused, and more easily overwhelmed with even small levels of stimulation, as well as overly sensitive to negative stimuli and thus prone to anticipate danger unnecessarily.

Using this model, four sensory patterns have been determined. The first two of them are associated with low sensitivity:

1. Low registration, which means humans present high neurological thresholds and passive self-regulation strategies. It is known that they tend to have an uninterested appearance and to be under-reactive. Hence, sensory profile research studies have linked this pattern to low endurance for tasks and poor registration of environmental stimuli.

2. Sensation seeking, which is represented by people with high neurological thresholds and active self-regulation strategies. This pattern is recognised for presenting motor disorganisation and impulsivity.

The other two patterns are related to high sensitivity:

3. Sensation avoiding, which features exposure limitations to environmental stimuli. Individuals pretend to avoid the activation of their thresholds. Data from research articles have associated it with emotional reactivity.

4. Sensory sensitivity, which is characterised by discomfort and overwhelming sensations in individuals. These people have low neurological thresholds, so they tend to be overreactive.

To reiterate, this article primarily sources the research related to pattern 4 that has informed our current understanding of ‘Highly Sensitive People’ as a phenotypic trait^(8.) (see below), that is, the 15-20% of people testing ‘high’ for Aron and Aron’s^(7.) 1997 ‘Sensory Processing Sensitivity’ (SPS) construct as described above.

SPS is an innate temperament/personality trait equally distributed between males and females^(4.) thought to be a survival strategy found in a minority of individuals (approximately 15-20%)^(13.) and in over 100 other species^{(16, 8.)}.

It captures individual differences in sensitivity to internal and external stimuli and has been reported as a marker of behavioural plasticity in response to the environment^(21.), with fMRI studies showing it to be associated with prominent activation of the brain regions implicated in social processing, empathy and reflective functioning^(21.).

Regarded as an identity-forming characteristic by its originator^(7.), the SPS framework asserts that individuals higher in the trait perceive stimuli of lower intensity more easily than others. By contrast, when confronted with stimuli of higher intensity, highly sensitive individuals are more easily overwhelmed and distressed.

Thus the trait is characterised^(4.) by deeper processing of information, noticing subtle environmental details, having stronger both positive and negative emotional responses (such as intense positive emotions when surrounded by beautiful art, music, and nature, as well as intense negative emotions when surrounded with noisy and overcrowded locations), increased empathy, and being easily overstimulated (e.g. demonstrates poor performance when exposed to multiple tasks simultaneously).

Beyond the scope of this article and included here for interest only, recent research^{(1, 2.)} aimed at further refining the SPS construct suggests the existence of three different sensitivity facets/subscales:

• Ease of Excitation (EOE), that is, being easily overwhelmed by external and internal stimuli (e.g., experiencing a negative response to ‘having a lot going on at once’ or performing worse at a task when observed);
• Aesthetic Sensitivity (AES), which captures aesthetic awareness (e.g., being deeply moved by the arts and music); and
• Low Sensory Threshold (LST), reflecting unpleasant sensory arousal to external stimuli (e.g., experiencing a negative reaction to bright lights and loud noises).

Put simply, ease of excitation and low sensory threshold generally relate to some negative outcomes such as negative emotionality and anxiety, and aesthetic sensitivity on the other hand is related to positive outcomes such as better communications skills and higher well-being.

Why are Highly Sensitive People The Minority?

Thus far, evolutionary biology has supplied the most plausible reason that HSP individuals form a minority of the general population, in that:

..when a minority of individuals are highly responsive to the environment, they gain advantages that are worth the biological costs of this responsiveness, but if all individuals were more responsive, there would be no advantage for any of them… The more responsive individuals there are around, the lower the value of these opportunities, as more individuals (all responsive) compete for them^{(17, 18.)}.

Put another way, the high-responsive strategy is an advantage only as long as most individuals do not use it, as when a short cut to avoid a traffic jam is useful only as long as most people do not know about it and consistently use the usual route.

Thus in technical terms, SPS is considered a negative-frequency dependent trait– (advantageous when rare but disadvantageous when common): it promotes the coexistence of a minority of responsive individuals along with the majority of non (or less) responsive individuals to enhance overall species survival^(6.).

It is simply not possible for everyone to be a HSP!

Indeed, researchers^{(16, 18.)} comparing the neural regions associated with SPS versus seemingly related clinical disorders (e.g. Autism Spectrum Disorder^(22.), schizophrenia, post- traumatic stress disorder and alexithymia^(17.)), have found SPS to be distinct from these disorders, because in response to social and emotional stimuli they found that SPS differently engages brain regions involved in empathy, reward processing, physiological homeostasis, self-other processing, and awareness.

Notwithstanding this, sensitive people may be at higher risk of developing mental health problems when exposed to stressors than less sensitive individuals^(6.). That is, in interactions with negative environments, high SPS may increase risk for maladaptation and negative developmental outcomes, including mental and physical symptoms^(17.) (more on these below).

Furthermore, research has related SPS to a range of other negative outcomes including lower levels of subjective happiness and life satisfaction, and higher levels of disorder-related traits, internalising problems, anxiety, depression (difficulties in emotion regulation partially mediate the link between SPS and depression), and traits of autism spectrum disorders (ASD) and alexithymia.

It is also related to factors associated with poor stress management including difficulties in emotion regulation, a greater but more accurate perception of home chaos, increased levels of stress, physical symptoms of ill health, and greater work displeasure and need for recovery.

Are you a Highly Sensitive Person?

1. The ‘signs & symptoms’

The following purported indicators (touchstones) of a highly sensitive person appear consistently in the lay literature:

• Do you often pick up on things others are oblivious to?
• Are you easily startled by surprises?
• Do you get “hangry” when hungry i.e. you don’t tolerate ‘small, everyday’ stressors well?
• Do you feel everything deeply and more intensely than others, whether joy or sadness, pleasure, or pain?
• Do you ever feel emotionally exhausted by your acute awareness of your environment?
• Is your ability to pick up on subtle changes in the moods of people around you overwhelming?
• Do you have many intense emotions that affect you physically and psychologically e.g. empathy for others, fear of failure, or difficulty self-regulating emotions?
• Do you dislike crowds and feel a need to retreat to a place of quiet, privacy, and peace to reach a calm state?
• Do you take great joy in the simple pleasures in life, thrive in silence, and need a slower pace of life?
• Do you take longer than others to make decisions and usually proceed with caution?
• Are you often described by others as ‘very sensitive’, ‘fragile’ etc.?
• Do you consider yourself more a loyal follower than an extroverted leader?
• Do you have trouble saying ‘no’ and strongly anticipate the disappointment you feel others’ would experience?

..and are often reformatted as ’checklists’:

• Frequently experiences sensory overwhelm e.g. produced by loud noises, bright lights, crowds, strong smells, rough fabrics, etc.
• Has heightened empathy and intense emotions in response to other people’s feelings.
• Has difficulty sleeping due to worry.
• Is described by others as shy, sensitive, or withdrawn as a child.
• Often avoids violent/graphic movies and TV shows as they tend to cause overwhelm and feelings of unease.
• Experiences strong and intense emotional reactions that cause feelings of being off-kilter or dysregulated.
• Experiences anxiety and distress when facing many things to do during a short amount of time.
• Has a strong need and desire for downtime and ‘me-time’ after a busy day.
• Intensely observes environment and surroundings; notices subtle cues that others miss.
• Is deeply moved and affected by art, nature, music, beauty, etc.
• Is highly attuned to injustice.
• Is prone to perfectionism (may worry about ability, performance, and disappointing others), yet demonstrates insight as to the maladaptive and irrational nature of this and other cognitive distortions.
• Consciously avoids experiences that could be overwhelming or upsetting.
• Has a rich and complex inner life, with strong feelings and deep, creative thoughts.
• Has a greater awareness of feelings and emotions in themself as well as others around them.
• Has a tendency to think deeply about life’s puzzles.
• Is excited by, yet simultaneously fearful of, novel/challenging events.
• Is prone to the stress of social comparison.

Also prevalent (with even some creep-back evident in the ‘scientific’ literature) is the ‘Orchid-Dandelion’ metaphor^(17.) which emphasises the continuum (i.e. sliding scale) nature of the SPS trait, where Dandelions reflect the majority of the population (around 80%) who are less sensitive to the influence of either positive or negative environments, whereas Orchids (the remaining 20%) are more strongly affected by environmental adversity but also flourish more in positive environments.

2. Take the Test

Scientifically validated surveying of many individuals who have used the above test for self- attribution/diagnosis has garnered additional insights into the HSP ‘type’, e.g.:

…they have an active imagination and an affinity for daydreaming (Fantasy), enjoyment, fascination of, and interest in music and art (Aesthetics); strong emotions, appreciation and recognition of emotions, and empathy (Feelings). Additionally, they were anxious and showed depressive symptoms. At the same time, they were not gregarious^(8.).

Health and Other Quality of Life (HQOL) Implications

The SPS trait is consistently associated in the literature with both positive and negative outcomes in several HQOL domains including physical, cognitive, emotional, and social areas^(15.).

In one meta-analysis^(22.) (see figure above), higher SPS was found to be a risk factor (orange lines) for stress related and somatic symptoms, being associated with worse mental health (i.e., more stress, depression, anxiety, burnout), worse somatic health (i.e, more medications and health complaints), and higher environment variable severity (i.e, more childhood trauma, hassles, life events).

Notably, it was found to correlate poorly (blue lines) with neurodevelopmental disorder traits, reiterating the neurobiological findings enumerated above.

In unfavourable environments, higher SPS related to worse health while, in favourable environments, it related to better health, supporting the theory of SPS as a factor for differential susceptibility to environments.

In addition, limited research has found that high sensitivity can increase the existence of physiological differences in stress-response systems and self-perceived stress, predisposing for physical symptoms and bodily sensations such as pain.

Sensory processing is also linked to cognitive processing and the interpretation of environmental subtleties. For instance, abilities such as decision-making and cognitive flexibility could be affected due to changes in the neural stream while processing environmental inputs.

Importantly, promoting greater depth of processing but allowing greater attention to irrelevant information, the HSP trait was also found to result in more errors of judgement.

Moreover, high levels of sensitivity in sensory processing could be related to low compassion satisfaction and high cognitive fatigue due to deep cognitive processing, perfectionism, mental rigidity, and attention deficits.

Distractions too, may feel more frustrating for the HSP who is trying to concentrate, for example, or unpleasant smells in one’s environment may be felt more strongly and make relaxation more elusive for an HSP.

In the emotional area, people who are hypersensitive can be fearful and become easily upset or even negative and defiant because of their emotional self-regulation difficulties. Researchers hypothesise that the frequency of such emotional outbursts is higher for HSPs because they feel uncomfortable meeting their neurological thresholds.

Hypersensitivity is also manifested in the interpersonal domain e.g. social distraction, isolation, and lack of communication skills. These individuals’ sensory sensitivity can also interfere with daily living, academic and occupational performance, and leisure participation.

Further sources^(2.) cite positive correlations with social phobias, anxiety and depression, and avoidant personality disorders, and assert that:

…in adverse childhood environments, individuals with high SPS scores may shift from typical to atypical development, with a negative impact on well-being, and higher risk for behavioural problems and psychopathologies in childhood and adulthood^(17.).

Recently, SPS has also been proposed^(17.) as a trait associated with frequent nightmares and vivid images in dreams, a hypothesis that has yet to be tested, and has been reported to be higher in individuals with type 1 diabetes.

HSPs in Relationships

A critical factor affecting close adult relationships, especially romantic relationships, several studies have demonstrated^(23.) that sensory sensitivity is significantly associated with insecure attachment (anxiety and  avoidance subtypes), leading to decreased satisfaction in relationships through experiencing more negative emotions and by using inappropriate conflict resolution strategies in their relationships (including voice-raising and directly confronting their partner about their perceived weaknesses).

Findings^(23.) also demonstrate that HSPs differ from non-HSPs in terms of relationship satisfaction through experiencing more negative emotions and as a result of using inappropriate conflict resolution strategies in their relationships.

Indeed, data^(17.) suggests that high SPS individuals may more readily intuit, feel and integrate information and respond to others’ affective states, in particular to positive emotional states of a close partner (relative to a strangers’, and to neutral affect). The results are consistent with cardinal traits of SPS as they highlight depth of processing, awareness and being more affected by others’ moods and affective displays.

Regarding relationship conflicts, HSPs may be more aware of trouble brewing in a relationship (including when things just feel a little off, or if a communication problem is perceived) and more susceptible to being stressed by conflict with their partners or spouses. On the other hand, their greater sensitivity to criticism or rejection may lead to the HSP partner misinterpreting unrelated signals as signs of conflict or anger.

Additionally, the highly sensitive may feel the loss of a relationship more acutely as well and engage in rumination^(10.).

Sidenote: Parenting

SPS mothers have been shown^(17.) to score significantly higher on scales of parenting difficulties (e.g. ‘Each day is full of hassles’; ‘I don’t get enough time to myself’; ’I regret having become a parent’) and attunement to child (e.g. ‘I know what my child needs even before he lets me know’; ‘I stay calm with my child no matter what’; ‘One of my strengths is the creativity I bring to parenting’); whereas high SPS fathers scored significantly higher only on the latter scale.

Similarly, other studies have found a negative association between well-being and the transition to parenting in highly sensitive individuals.

These findings suggest that for those high on SPS it is particularly important for their well-being to have ways to manage their perceived overstimulation of parenting, especially given that it could facilitate the expression of their self-reported benefit of the trait, i.e. their greater attunement to their children.

Now the good news!

Many authors have reported the benefits^(15.) of high SPS:

• Greater subjective well-being, greater attention to detail and better communication skills, and higher levels of ‘openness’^(2.) (one of the ‘big five’ personality traits).
• The ability to perceive subtle stimuli and delicate environmental stimuli can make HSP more alert to opportunities and rewards.
• The ability to search deeply for similarities between current situations and previous ones can improve problem-solving and coping strategies.
• The enhancement of positive aspects of emotionality such as greater insight and empathy towards others and a ‘smart sense of humour’.
• Better complex/high-order reasoning/learning: consistent with the idea that greater automatic attention may support greater awareness of subtle information, studies^(17.) suggest that high SPS groups have a greater ability to become more consciously aware of subtle higher-order, structured information during an implicit learning task.
• Higher levels of creativity, empathy, pleasure/enjoyment (positive valanced stimuli), intuition, and self-care^(17.).

Although hypersensitive people who have grown up in adverse conditions are likely predisposed to suffer negative health consequences, the opposite is true for HSPs who report a supportive childhood environment vis:

…individuals high on SPS exposed to positive events in life may flourish and perform exceptionally well, for example showing more positive mood and intervention responsivity, a result with important implications for policy makers and practitioners^(17.).

These results provide a suggestion for how positive childhoods may have long-term impacts on individuals’ susceptibility to stimuli, namely through mechanisms related to self-regulation and by buffering individuals from dampened reward effects in response to negative stimuli.

Indeed, a “sensitivity factor” among gifted individuals is now widely accepted.

Since the 1920’s, giftedness has been primarily viewed as a cognitive characteristic that can be most reliably assessed by intelligence tests^(13.). The cut-off for giftedness generally used in this regard is an IQ of 130, implying a greater ability to learn things faster, master complex ideas, and reason at a higher level of abstraction.

In their paper from 1997, Aron and Aron suggested^(13.) that it would be valuable to explore the association between HSP and giftedness in various domains.

In line with this, several authors have pointed out a number of similarities between the manifestation of giftedness and high SPS, which has led to the assumption that gifted individuals are also likely to be characterised by high sensitivity.

The common features reported in the literature include an increased sensitivity to various kinds of sensory stimuli, increased perceptivity, and excitability, seeing and feeling more than others, experiencing feelings of being overwhelmed and a need for solitude, higher emotional and moral sensitivity, and over-sensitiveness.

In addition, the results of research on the link between giftedness and openness to experience on the one hand, and, between SPS and this same variable on the other, provide an indirect indication of a possible link between giftedness and high sensitivity.

Openness, (one of the Big Five personality traits/temperaments), is characterised by curiosity, receptivity to new ideas, imagination, creativity, thinking outside the box, and the ability to look for, detect and use complex information.

Interestingly, several of the Big Five have been shown^(7.) to reflect individual differences in environmental sensitivity, with considerable overlap found between SPS and neuroticism and introversion (or low extraversion)^(13.) in this regard.

Additionally, findings^{(5, 18.)} indicate that the HSP construct and several negative personality traits are substantially related, including hypersensitive narcissism (a high sense of self‐importance and entitlement), and sub-personality traits are usually accompanied by depressive/melancholic states (e.g. low self-esteem, unrealistic perfectionism, a pessimistic attitude^(19.)).

1. Neurobiological differences

The sensory processing sensitivity theory suggests that brain regions/processes involved in awareness of and attention to subtle stimuli, emotional responsivity, empathy to others’ affective cues and depth of processing of the stimuli, best capture the underlying mechanism of heightened environmental sensitivity (see figure below).

The results above and from other neuroimaging studies^(24.) suggest that SPS is characterised by a hypersensitive brain, reflected by heightened reactivity of the areas indicated in response to social-emotional or other environmental stimuli. Together, the activity patterns in the brain of high SPS individuals point towards deep information processing (e.g. precuneus, prefrontal cortex, inferior frontal gyrus), and increased emotionality and empathy (e.g. insula, claustrum, amygdala, cingulate cortex), the core facets that characterise SPS (see figure above).

Interestingly, these clusters of brain regions correspond to the Default Mode and Salience Networks, respectively, which together mediate internal mentation and attention towards salient and emotional stimuli and modulate empathic processing and facilitation of rapid intuition of others’ goals.

Perhaps (eerily) unsurprisingly, the modelling of SPS appears a close fit for the Salience construct as described in the Triple Network (Tripartite) model of hyperarousal (notably associated with SPS)^(27.), thus providing a possible alternative explanation for the symptomatologic overlap evident between SPS and several (neurodivergent) ‘disorders’ as discussed above:

The figure above shows the cortical representations of the salience network (SN; orange), default mode network (DMN; red), and central executive network (CEN; blue) in healthy individuals. The asterisk denotes an altered between-network connectivity.

According to this tripartite functional neuro-network model , alterations within and between the SN, the CEN, and the DMN may underlie many forms of psychopathology^(25.).

The theory further proposes that these forms of mental distress occur when the SN is hyperconnected and hyperactive and has a low threshold for perceived saliency (underlying symptoms of hyperarousal) and is incapable of efficient DMN-CEN modulation (i.e., switching between task-relevant and task-irrelevant behavior); the CEN is a weakly interconnected and hypoactive (paralleling impaired cognition) and is incapable of top-down SN regulation; finally, the DMN is a weakly interconnected and hypoactive resulting in disrupted ability to maintain a calm inner state (intrusive symptoms), altered sense of self/world (dissociation), and fear generalization (avoidance; mediated by the hippocampus).

Other studies^(17.) have shown that higher levels of SPS are associated with increased reaction times and increased activation of brain areas implicated in high-order visual processing and attention, such as the right claustrum, left occipito-temporal, bilateral temporal and medial and posterior parietal regions in response to detecting minor (versus major) changes in stimuli.

The differential susceptibility theory^(6.) (as already described above) has mainly emphasised the involvement of dopaminergic and serotoninergic circuitry, that is, implicated in responsivity to reward and punishment, and amygdala reactivity as one of the several central nervous system manifestations of SPS.

Variations in these systems are suggested^(4.) to positively correlate to reward threshold, differences in information integration, visual processing and attention, orientation of response, response planning and regulation, and emotional reactivity, all-important domains in the extent of responsivity/reactivity to environmental stimuli.

Furthermore, since information integration is dependent on the balance between excitation and inhibition in the brain^(17.), and mediated by the neurotransmitters glutamate and GABA, respectively, the excitation-inhibition balance in the brain may well be the basis of the neural mechanisms driving increased sensitivity to environments.

Finally, recent research supports the possibility that the increased excitability extends to other regions beyond the somatosensory cortex, given that GABA system components are also found in the somatosensory cortex, prefrontal cortex and hippocampus.

2. Stress response and immune system differences

The Biological sensitivity to context model (as described above) has emphasised the role of stress response systems such as autonomic, adrenocortical, or immune reactivity in response to psychosocial stressors, with variations in such psychobiological reactivity being thought to reflect individual differences in environmental sensitivity.

Besides the brain, peripheral systems may contribute to sensitivity to environments^(17.). The hypothalamus-pituitary-adrenal (HPA)-axis is implicated in the bodily response to environmental insults, allowing the organism to respond in an adaptive manner.

Additionally, environmental factors may influence HPA-axis reactivity through epigenetic mechanisms in the brain.

3. Neurocognitive differences

Neurosensitivity mechanisms, especially lower inhibition and automatic attention, may contribute to creative abilities in individuals high in SPS^(17.).

Indeed, SPS (measured with the 11-item HSP scale- see above) is significantly associated with increased activation in brain regions that coordinate attention and action planning (in the cingulate and premotor area).

Furthermore, results showed that SPS is associated with a stronger reward response (in the ventral tegmental area and nucleus accumbens) to positive stimuli; and this effect was especially amplified for individuals reporting higher quality childhoods.

4. Genetic and epigenetic factors

Studies^(1.) have found SPS to be moderately heritable, with about 50% of the variance explained by epi/genetic factors and the residual 50% interpreted as being caused by environmental influences.

Beyond the scope of this article, genes and gene pairs that clearly distinguish individuals with high SPS from those with low SPS have been identified^(19.) and include the serotonin transporter 5-HTTLPR gene and gene polymorphisms in the dopamine system (e.g. TH, DβH, SLC6A3, DRD2, NLN, NTSR1, NTSR2)^(17.).

Notably, SPS has also been correlated to telomere length, a biomarker of cellular aging and disease^(20.).

A review of the lay literature reveals a plethora of ‘tips’, including the following favourites:

• Create a calming, low-stimulus environment around you where possible, especially in your home.
• Make space in your schedule for down/me time where possible.
• If caffeine/sugar/alcohol affects you more than others, look to reduce your intake.
• Consider exercise, journaling and/or meditation as tools to help you cope with sensory overload.
• Plan ahead and take any precautions you can when you know you have a potentially overwhelming event to attend.
• Avoid or minimise multitasking.
• Embrace your creativity and use this as an outlet.
• Reach out to loved ones or a professional if you’re struggling.
• Create positive experiences in your schedule to balance out the more frequent/intense stress you’re likely facing as a HSP.

See wiki for elaboration of quote sources

Aron & Aron (2010) state that around 50% of patients seeking psychotherapy are HSPs, often due to the difficulties they face in relationships with others who misunderstand their trait, and the patient’s framing of their SPS as a set of undesirable symptoms.

Interestingly, individuals with high levels of SPS are shown^(17.) to benefit more from psychological intervention than their non-highly sensitive counterparts.

Psychological intervention may therefore not only be particularly vital for individuals high in SPS, given the association of SPS with psychopathology and stress-related problems, but also particularly effective.

Proposed interventions for individuals high in SPS experiencing psychological distress mainly include those approaches that focus on 1. increasing an individual’s self-efficacy regarding dealing with emotions (emotion regulation strategies), and 2. interventions aimed at increasing resilience amongst those who are highly sensitive^(6.), in order to better equip them to identify triggers and implement adaptive response strategies.

To these ends, psychologists are both aware of the ‘HSP factor’ in their choice of therapeutic approaches/tools, and equipped to deliver effective coping strategies to deal with sensory overload, including:

• Developing strategies and self-care techniques for recognising and managing overwhelming emotions.
• Building emotional resilience and feelings of safety and comfort in life situations.
• Learning tools for navigating social situations – such as work, school, or family gatherings – without Becoming overwhelmed.
• Assistance with common HSP issues, such as overwhelmed emotion and persistent fatigue.

Mindfulness techniques, sensory grounding exercises, or the development of personalised strategies tailored to your specific sensitivities (e.g., to sounds, fabric quality, perfume smell) can all be helpful. Indeed, much research links meditative/contemplative practices with reduced activation of the amygdala and other rostral brain centres implicated in dysregulated arousal/sensation.

Techniques from Acceptance and Commitment Therapy (ACT), can also be useful to address the internalised shame that may result from consistent self-judgement/criticism and labelling (e.g. odd, different) by others. ACT emphasises self-acceptance of thoughts and feelings while fostering self-committment to actions that align with the emergence of an authentic and unique self.

Schema Therapy has elements that help you identify and challenge distorted thought patterns. By addressing the underlying schemas (your self-in-world views/beliefs/pictures etc), you can (again) develop an authentic and realistic view of yourself.

Because of its emphasis on practical strategies, positive goal-setting, and building on existing strengths, Solution Focused Coaching/Counselling (SFC) can be especially beneficial for Highly Sensitive People. Solution-focused counselling fosters a problem-solving mindset and can assist you in breaking down problems into manageable steps and making them more approachable and less intimidating.

Finally, it has been recently proposed that Mindfulness-based Cognitive Therapy (MBCT) may ameliorate psychological distress in individuals with high levels of SPS through addressing cognitive reactivity, and that MBCT may have transdiagnostic intervention effects through mediation by cognitive reactivity of individuals high in SPS.

Conclusion

If you or someone you know is interested in HSP counselling or you just want more information regarding the content of this article, please feel free to email us, or call 07 3831 4452 to speak to one of our friendly and helpful receptionists.

Please note: the text and images comprising this article are for educational purposes only and do not necessarily represent the views of Brisbane Counselling Centre P/L. They are not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy.

References

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3. Aron, E.N., Aron, A. (1997). Sensory-Processing Sensitivity and Its Relation to Introversion and Emotionality. Journal of Social Psychology, Vol 73, No. 2, 345-368.

4. Zubcevic, C.R. (2023). The Neural Correlates of Sensory Processing Sensitivity – a Systematic Review. Degree Project in Cognitive Neuroscience, preprint.

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