No paper and pencil test should be treated as the final word on an innate temperament trait (this one), a personality trait, or a disorder. We developed the test for use in research studies of what we call in that setting “sensory processing sensitivity” (having nothing to do with Sensory Processing Disorder). Many studies have used this measure, often published in top “peer-reviewed journals,” although some researchers will call it something a little different, such as “biological sensitivity to context.” So one thing you can be sure of is that this trait is real and exists.
The point is, the tests on this website are most useful in a research study, where a few people miscategorized can occur without harm. For you, reading more about sensitivity will best allow you to decide for yourself or about your child. For example, to have a sense of the four facets of high sensitivity, which almost every HSP will have, whatever their background, read more about D.O.E.S (Depth of processing, easily Overstimulated, Emotional responsiveness/empathy and sensitive to Subtle stimuli) by clicking here or scrolling to the end of this article.
High sensitivity is a normal trait found in about 20% if the population. But mistakes can easily be made about who is highly sensitive and who is not, especially with small children, as we cannot ask them what is happening inside them and be sure we understand their answer. Sometimes we can only guess what a particular behavior means. If a child does not want to join in, is he shy? Afraid? Have low self-esteem, feel superior, have low intelligence, or find it too overstimulating? Or is she only watching first, cautious but not truly afraid? Someone who knows the child well, a parent, is probably the best judge of sensitivity. Still…
In fact, there are three possibilities:
- The trait can be mistaken for a disorder;
- The trait can be mistaken to be the issue when in fact this is not actually sensitivity, but really a disorder or serious problem of some sort; or…
- Of course sensitivity can and often does occur along with a disorder or serious problem.
I have written extensively about these subjects in Psychotherapy and the Highly Sensitive Person, throughout the book and then about specific disorders in the Appendix, but the book was mainly written for professionals. So I will try to put some of that information into simpler terms in some of these FAQs.
I will answer about specific disorders below, but first, the key ideas:
1. Mistaking HS for a disorder. Given HSPs are a minority, if they are compared to the other 80% they can easily look abnormal and be misdiagnosed as having a disorder. A disorder, according to the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, is only present when a “disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.” Of course distress or impairment may still be in the eyes of the beholders—the other 80%. Are you impaired if you find your office too overstimulating to continue working there? Or you can’t enjoy an evening in a noisy restaurant? Is a child “too shy” if he or she does not enter into social situations immediately? A non-sensitive professional might think so. I would probably not, although I would want to ask many questions before deciding for sure. It could be a different issue…
2. Mistaking you or your child to be HS when that is not true. Some people are sure they must be HSPs but actually are not. Some parents are the same. That is more difficult, as they usually wish sensitivity to be the only issue. Everything is fine. This is especially dangerous for parents who think their child is only highly sensitive when something else is actually the problem, because often problems are much more easily solved if caught early. But an adult certainly does not want to make this mistake either, and postpone treatment that could be very helpful. Furthermore…
3. Mistaking that it must be either HS or must be something different, when HS actually occurs along with a significant problem. Especially if you are uncertain about what is going on, high sensitivity is quite possibly there along with a real problem or disorder because sensitivity leads to “differential susceptibility.” (See more info here and read the research in PDF format here, and here.) That is, in a good environment, which is not too stressful, individuals with the trait actually thrive better than the other 80% But when things are stressful for HSPs or HSCs, they are more likely to be anxious, depressed, or shy, in particular.
4. Also, there’s mistaking yourself as not HS if you are a man, extraverted, or “high sensation seeking.” (See the High Sensation Seeking Self-Test.) Or thinking your child cannot be an HSC because he is a boy, or socially outgoing, or “into everything.”
We know that as many males as females are born HS, although they obviously will be different in many ways because of their gender and how their family and culture has viewed their sensitivity. However, in the case of adults, men score lower on the self-test. Even though every question was tested and used only if men and women answered “true” about equally, men still score lower on the entire test, as if they begin to sense they are uncovering their sensitivity and that makes them nervous. So men and the parents of boys need to think about this as they decide whether they or their child is highly sensitive.
Also, 70% of HSPs are introverts, so that sometimes the two are equated, when obviously if 70% are introverts, then 30% are extraverts—that is, enjoying being in groups, meeting strangers, and having a large circle of friends. If this is you or your child, this type of HSP is simply a different flavor—more outgoing, but needing plenty of down time too, unlike extraverts who are not also HS.
Finally, you or your child might be a high sensation seeker. This may seem impossible, because high sensitivity and high sensation sound like opposites. Actually, that is not the case. The opposite of being highly sensitive is actually being very impulsive, as that is the opposite of processing deeply and pausing before acting. (Although, sometimes HSPs are quick to act because they already know from past experience what’s going to happen.) Sensitivity and sensation seeking appear to be governed by two different systems in the brain, and how strong they are seems to be genetic. So you could be born with both being strong, which has its own advantages and disadvantages. (One person said, “It’s like living with one foot on the gas and the other foot on the brakes.”) Children with both traits may seem to take big risks, but they have usually thought the activity through first and are (often secretly) being careful.
If you are still not sure if your child is highly sensitive or has a problem or both, see below.
If you are an adult and still wondering about yourself, and especially if you are having problems in your life, you should of course seek professional help: Preferably you begin with the opinion of someone who knows you and who understands sensitivity or is open to your explaining it. (Read more in these articles: How can I describe being highly sensitive to other people?, Discussing Your Trait with Therapists, What To Say To The Professionals and For Highly Sensitive Teenagers: Dealing with the Rest of Your Family.) Then, if you want a second opinion, what I say about that for deciding about a child applies well to adults, too:
You can go to an expert for a particular problem or disorder you think you might have. But it may be wiser not to go to a specialist first. Instead, find someone very, very experienced, who can assess for a wide variety of causes of the behavior that concerns you. The problem is that a temperament or personality expert may only see a normal variation, a depression expert tends to see depression, an anxiety expert tends to diagnosis anxiety, an autism expert knows autism best, a sensory processing disorder therapist sees that, and those who treat environmental issues may see the problem as arising due to problems at home or at work or in your childhood.
If you cannot find a wise “generalist” and do go to a specialist, you may even want your next opinion from an expert in the second most likely issue and see if this person insists it is the problem he or she studies or agrees with the first expert’s reasoning.
If you are reading this as the parent of a highly sensitive child (HSC) and concerned that he or she might have a serious problem, you should especially certainly seek a professional opinion beyond this website. Do persist until you are sure you have it right, because, as I said before, it is usually true that the earlier a problem is treated, the more successful the outcome. The best place to begin might be someone who knows your child well and understands why you thought high sensitivity might be involved or is open to your explaining it (How can I describe being highly sensitive to other people?, Discussing Your Trait with Therapists, What To Say To The Professionals and For Highly Sensitive Teenagers: Dealing with the Rest of Your Family) and investigating the science behind it. If the professional who knows your child agrees with you that there might be a problem, but you are still unsure, you can seek a second opinion. Now you could go to an expert in a particular disorder, but it may be wiser to find someone very, very experienced with children, who can assess for a wide variety of causes of the behavior that concerns you. He or she should want to observe or at least learn about your child in a variety of situations—school, home—not just the office, and talk to your child’s teachers as well as you. The value of a person with a general background with children is that you will not have the problem that a temperament expert may only see a normal temperament variation, a depression expert may tend to see depression, an anxiety expert may tend to diagnosis anxiety, an autism expert knows autism best, a sensory processing disorder therapist sees only that, and those who treat environmental issues may see the problem as arising due to problems at home or at school.
It’s difficult for anyone to know all of these disorders really well, so if you do decide to go to a specialist right away, you may at least want your next opinion from someone who is an expert in the next most likely problem, and see if this person insists it is the problem he or she studies or agrees with the first expert’s reasoning!
It seems to me that there are a lot of negative items in the test for adults. I don’t think they describe me, but the others do.
You are right. Very sensitive of you. There really are too many negative items in the adults self-test. You can give them less weight if they seem too many for you. It was written over 20 years ago, when so much of what I knew was that we were bothered by overstimulation and sensitive to subtleties, but the emotional part and especially the depth of processing had not been well articulated. The scale still works fine for research, as it is less of a problem if a few people are miscategorized. Further, for research, we now “control” for negative affect. You can do the same. All HSPs have some negative affect when being overstimulated, but some people will say “true” to mostly the negative items because they are not HSPs, but loaded down by other problems that could cause them to be, for example, “unpleasantly aroused when a lot is going on around me.” This could be you If you said yes almost exclusively to the negative items (with words like “made uncomfortable,” “easily bothered,” “feel frazzled,” “rattled,” “annoyed,” etc.) but in other ways do not seem highly sensitive.
To have a sense of the four facets of high sensitivity which almost every HSP will have, whatever their background, read more about D.O.E.S (Depth of processing, easily Overstimulated, Emotional responsiveness/empathy and sensitive to Subtle stimuli.