More Answers to Some of Your Questions

Originally published in Comfort Zone Newsletter: February 2009.

I’m enjoying answering your questions, as long as I do not have to feel guilty about not responding to those that are very specific, esoteric, or personal, or if there are just too many. So please accept my apologies if I do not answer yours.

Nicely, I am receiving questions on subjects that I or a contributor has already covered over these nearly 12 years. Here are a few topics you have asked for that have already been written about (always in relation to HSPs):

• Aging (email Nov. 2007)
• Trauma (email Nov. 2007)
• Being too out or too in (covered in The Highly Sensitive Person).

What is the Difference between Sensory Processing Sensitivity, your academic term for high sensitivity, and Sensory Processing or Sensory Integration Disorder (actually, the first term has replaced the latter)?

Simply put, high sensitivity is not a disorder. It is found in about 15 to 20% of humans. Further, some trait like it, usually termed differently but with close to the same ratio, is found in almost every animal species studied. So it is a normal temperament variation that has evolved for a reason. It is one of two strategies that works for individuals. One is “look before you leap” or “do it once and do it right” (our strategy). The other is “the early bird gets the worm.” Act fast and be first–the first to get the food or to be the food. In other words, neither way of behaving is really dysfunctional, and each is a sort of impairment in one type of situation and an advantage in another. Different strategies for different folks.

We HSPs know, however, that “normal” can be in the eyes of the beholder. HSPs and HSCs can seem strange and even dysfunctional to non-HSPs–always a problem when a non-HSP is making a diagnosis.

The term Sensory Processing Disorder (SPD) was first applied to children, but now it is used to describe certain adults as well. It was discovered by occupational therapists working with children. They noticed that certain individuals have unusual difficulties due to being too sensitive or not sensitive enough in various sense modalities, or having poor balance and coordination. To help these children, occupational therapists use a variety of one-on-one treatments plus various equipment.

You can learn about SPD on many websites from different sources. If you go to an “official” site you will find the symptom checklists. You are going to see considerable overlap with what I would call normal sensitivity. This has led to some skepticism about SPD, some likening it to the “new ADHD,” and you can find this on the web too. Still, also on the checklist are behaviors that are obvious red flags about a child’s development, such as not rolling over by 7 months or not walking by 18 months and these would need more evaluation.

If I were seeking such an evaluation, one that might lead to a serious diagnosis and costly treatment, I would want it done by someone with years of experience observing both normal behavior and its normal temperament-related variations, as well as a vast experience in recognizing non-normal development of all types and evaluating both its possible innate and environmental contributors. I would not have a diagnosis made by someone working within one specialty, whether that be ADHD, autism spectrum disorders, or SPD. This is true for myself as well. I do not evaluate children overall because my natural bias and lack of broader experience could easily cause me to miss a problem in a child, thinking it was only due to normal sensitivity.

As for treatment, I have heard many parents rave about what occupational therapists have done for their child after he or she was diagnosed with SPD. Still, before sinking money into it, I would ask to see studies on its usefulness that were done by researchers not in any way associated with its treatment. These studies should have had a control group in which children received equal amounts of individual attention by a caring adult, but one who was not familiar with SPD and not using any special methods. There may well be such well-controlled research, but I have not reviewed the scientific literature on it so I cannot say.

There is a well funded SPD foundation, and part of its purpose is to educate the public and professionals about SPD. Part of that effort is to advocate with the American Psychiatric Association to make SPD a disorder in the next, fifth, Diagnostic and Statistical Manual, the official manual used for all medical diagnoses involving in any way mental health. This will mean medical insurance will cover its treatment, allowing a great expansion of this occupational therapy specialty and many more children to be treated. Those lobbying for this are almost certainly doing so in all good faith and in the best interest of children. But while it may be best for some children, we who deal with HSCs may find they are being given a DSM diagnosis simply because the diagnosis exists and includes some behaviors HSPs exhibit. It may be forgotten at times that these are normal and highly functional for those having this particular temperament variation. So it will be one more thing for parents of HSCs to deal with. Indeed, since the diagnosis has been expanded to adults, all of us may hear more about it.

You say that HSPs are prone to high levels of cortisol chronically if they are constantly dealing with overstimulation. Is this true in the moment as well? Are we quicker than others to respond with a high cortisol level because we are overstimulated? And as a result, do we too often judge ourselves for “not being able to let go of our feelings” when this is really just chemical, a sign of our body trying to protect itself? Perhaps we are all “willing ourselves to think and behave in a more open and loving way (or something else)” when this is contrary to our natural response and thus in the end keeping us more anxious and overstimulated?

Moment to moment variations in cortisol definitely play a role in how an HSP, or anyone, processes information and communicates about it to others. We need moderate levels of cortisol to energize us. Cortisol in large amounts is usually in response to a threat that seems serious or cannot be avoided. One such threat can be the sense that one is getting overstimulated.

Once cortisol levels are high, it serves to focus us much more on threat, which is reasonable, but can lead us to feeling threatened by everything around us. In this way, it shortcuts logic, so that instead of thinking things through calmly, we make the instinctual response that humans have evolved to deal with that broad type of threat. Sometimes this is helpful, sometimes not at all. In the case of an argument with someone in which we want to be loving and open and find we cannot be, we are probably reaching that high level of cortisol that leads to an instinctual reaction to the threat of shame, abandonment, being controlled, or one of those other fears we can have regarding our closest others. Suddenly we are responding to the other, not as a fellow human, but as a dire threat. Usually we become wildly defensive.

Marital researcher John Gottman advises that a couple (or any pair of people) discussing an issue should monitor their pulse. If it goes over 100, they should go off alone and cool down for at least 20 minutes. I put this advice into The HSP in Love, where I discuss in detail how HSPs can handle conflicts in relationships.

The pulse is, of course, driven by the adrenal hormones, adrenaline and cortisol. Adrenaline acts in seconds and cortisol comes soon after if the original alert is perceived as a threat. This sort of acute cortisol response is highly functional, preparing us for something difficult. It is quite different from the chronic high level some people develop that cannot be turned down easily even when there is no “real” threat at the moment. Our history determines whether we have chronic high levels of cortisol.

For example, research with HS toddlers shows that when entering a strange, novel environment they will always have the adrenaline reaction other kids do not have, but will have the cortisol reaction according to how secure they feel with their mothers or the caretaker who is with them. So a history of insecurity in childhood might result in seeing everything as a threat and create high chronic levels of cortisol that are maladaptive and unhealthy.

Taking a Break versus Repressing your Feelings

The acute, self-protective cortisol response is something for HSPs to think about. “Let’s sleep on it” is especially good advice when an HSP is involved. That lets things settle down and rationality return. However, we have to be sure not to bury real complaints because we no longer feel the angry emotion itself or think it was too strong and therefore wrong. That rapid, cortisol-driven instinctual response to threat–to fight back in this case–may have had some wisdom in it.

On the other hand, we should not use a high cortisol level as an excuse for being cruel. “I was so overstimulated (or angry) that I couldn’t help myself.”

Instincts have wisdom in them. They push for the response to a given situation that caused your ancestors to survive better than others–on the average. But instincts are often wrong. They can be wrong for you or wrong for the other person or the group you want to be included within.

If we know obeying an instinct is wrong, all humans can resist it to some degree, whether the instinct is to run, fight, have sex with someone, eat, run from a tiger, or anything else. We call it will power. The trick is knowing when to obey an instinct or impulse, to be angry for example, and when to try to cool it. What is moral behavior is, of course, one of life’s great questions.

Even if you decide you should control your instinctive response, you will not always be able to do it. The instinct may be too strong, too intensified by cortisol or reinforced by past learning. If it is better for others or yourself in the long run, you should certainly try to control yourself. But the message here is not be too down on yourself if you cannot. Everyone fails at this sometimes. And yes, HSPs could have more trouble, in a given situation, controlling an instinctual response to be angry, resentful, afraid, or anything else simply because they could reach a high level of cortisol faster and turn on an instinctual response sooner than someone else. In the end, your own situation and values determine what you will try to do and how bad you feel if you fail. But perhaps you should err on the side of giving yourself a break, given that most HSPs have such a strong desire to do the right thing, whether we can or not.