Unpopular Opinion: “Highly Sensitive Person” is More than Just Autism

Some 20% of people process sensory information especially intensely and deeply. Here’s why the most common type of neurodivergence isn’t synonymous with autism.

WARNING: This is a post about a pet peeve of mine. That may be reflected in the tone.

I’m tired of seeing articles on Medium claiming that the neurotype called the “Highly Sensitive Person” equals autism. (See: “The Highly Sensitive Person is Code for Autistic,” “The Highly Sensitive Person is Still Code for Autistic,” “The Highly Sensitive Person is Autistic Autistic Autistic,” etc.)

It doesn’t. I should know.

I meet the “Highly Sensitive Person” criteria, and while I’m neurodivergent — I’m not autistic.

And I can’t be the only one.

Every time I see one of these Medium headlines, it feels like a mini-slap coming out of my monitor. Because a stranger on the internet, usually someone I actually like, is (unknowingly) telling me, “you don’t exist.”

I get enough of that message in the neurotypical world. It’s an unexpected surprise coming from other neurodivergent people.

A Brief History of the Highly Sensitive Person Concept

Image above, showing the covers of “The Highly Sensitive Person,” “The Highly Sensitive Child,” and “The Highly Sensitive Person in Love,” comes from Ineffable Living’s resource page for highly sensitive people. I own the first 2 books.

For those unfamiliar with the “Highly Sensitive Person” label, it was coined by the neuroscientist Elaine Aron, who herself identifies with the label. It refers to people who “process information and reflect on it more deeply,” which can lead to overwhelm and exhaustion. You can find the official self-test here. She also has a test for parents to fill out about their children.

Elaine Aron does not use the word “neurotype.” However, she says:

• Your trait is normal. It is found in 15 to 20% of the population–too many to be a disorder, but not enough to be well understood by the majority of those around you.
• It is innate. In fact, biologists have found it in over 100 species (and probably there are many more) from fruit flies, birds, and fish to dogs, cats, horses, and primates. This trait reflects a certain type of survival strategy, being observant before acting. The brains of highly sensitive persons (HSPs) actually work a little differently than others’. To learn more about this, see Research.

An innate way that the brain develops, involving a consistent set of traits, is the definition of a neurotype. And I agree. The existence of a consistent profile across species suggests a neurotype that evolution not only failed to select against, but may have supported. Among animal species, the behavior of this 20% minority consists of “pausing to check” before approaching something new. That can be helpful if the new situation is dangerous.

Aron was dissatisfied with the pejorative way even researchers described these individuals — as “shy” and “inhibited” rather than “cautious” and “sensitive.”

• This trait is not a new discovery, but it has been misunderstood. Because HSPs prefer to look before entering new situations, they are often called “shy.” But shyness is learned, not innate. In fact, 30% of HSPs are extroverts, although the trait is often mislabeled as introversion. It has also been called inhibitedness, fearfulness, or neuroticism. Some HSPs behave in these ways, but it is not innate to do so and not the basic trait.

She reconceptualizes the problems highly sensitive people face as the negative consequences of a set of traits that can also be positive in the right environment:

• You are also more easily overwhelmed. If you notice everything, you are naturally going to be overstimulated when things are too intense, complex, chaotic, or novel for a long time.
• You are more aware than others of subtleties. This is mainly because your brain processes information and reflects on it more deeply.

She also, correctly, believes that some cultures, including current American culture, undervalue the positive aspects of having a highly sensitive nervous system.

• Sensitivity is valued differently in different cultures. In cultures where it is not valued, HSPs tend to have low self-esteem. They are told “don’t be so sensitive” so that they feel abnormal.

That denigration, of course, can lead to the shyness that people associate with high sensitivity. She was correctly convinced that there is nothing inherently pathological about “pausing to check” and processing information extra thoroughly. She also correctly observed some strengths many people with this neurotype have:

• I am deeply moved by the arts or music.
• I notice and enjoy delicate or fine scents, tastes, sounds, works of art.
• When people are uncomfortable in a physical environment I tend to know what needs to be done to make it more comfortable (like changing the lighting or the seating).
• I have a rich, complex inner life.

(OK, that last one is stupid to include, and not just because everyone will say they have a rich, complex inner life even if the deepest thought they ever have is “what’s for dinner?” There’s an implicit comparison here, and how can we possibly know how “rich” or “complex” our lives are compared to the average when we have no access to other people’s minds?).

Above image from Mind Help.

Many neurodivergent people, with a variety of diagnoses, recognize themselves in this description. Neurodivergent people tend to process sensory information intensely and react strongly to it. Neurodivergent people tend to be easily stressed, sensorily and emotionally overwhelmed by the stimuli around them.

We also take joy in sensory and emotional experiences when they’re not overwhelming. We’re often moved by art and music. We are mesmerized by things like shiny blue lights or comforted by spinning motions that most people ignore. Autistic people are known for lining things up — which creates a pleasing order and symmetry. Both the positive and the negative aspects of being a highly sensitive person apply to neurodivergent people’s experiences — but society, looking at us from the outside, only acknowledges the negative ones.

There aren’t a lot of labels or concepts that explain our sensory experiences. The available disability labels — Sensory Processing Disorder (SPD) and, since DSM-5, autism spectrum disorder — are disability labels with negative connotations. The “HSP” concept is revolutionary because it offers a positive perspective on our ways of processing information.

Seeing our sensory processing as a human trait like any other, with positive aspects, validates us and boosts our self-esteem. It also focuses our attention where it should be — on maximizing our strengths — rather than on feeling shame for how we’re made.

The “Highly Sensitive Person” Concept in my own Life

Originally by Shannon Rosenberg’s article “16 graphs that will help you understand your highly sensitive friends so much better” on Buzzfeed.

When I was in high school in the early 2000s, I identified with the person Pearl Buck described like this:

The truly creative mind in any field is no more than this: A human creature born abnormally, inhumanly sensitive.

To him…a touch is a blow, a sound is a noise, a misfortune is a tragedy, a joy is an ecstasy, a friend is a lover, a lover is a god, and failure is death.

Add to this cruelly delicate organism the overpowering necessity to create, create, and create — so that without the creating of music or poetry or books or buildings or something of meaning, his very breath is cut off from him. He must create, must pour out creation. By some strange, unknown, inward urgency he is not really alive unless he is creating.

Then I discovered the “HSP” concept. Meanwhile, I was reading about a similar, obscure concept in the gifted education world, “overexcitabilities.” The basic idea is that some people are wired to be especially intense in various areas, including:

• motor energy and drive to act (“motor overexcitability”)
• sensory processing (“sensory overexcitability”)
• emotional experience (“emotional overexcitability”)
• curiosity and drive to think (“intellectual overexcitability”);
• and more.

The implication: I wasn’t “too much.” I was a person wired with “extra helpings” of intensity in sensory processing, emotions, and (over)thinking. The change in perspective comforted me at a time when I felt different and isolated.

So, if “HSP” is so validating, why do so many autistic bloggers rail against it now?

The Taint of Ableism

Image above by Jillian Enright summarizes how Elaine Aron used to suggest distinguishing between autism and HSP. You’ll notice that these are just positive and negative reframings of the same traits.

Here’s the problem: the creator of “HSP” has left it tainted with ableism.

Elaine Aaron, in her drive to reverse discrimination against highly sensitive people, worked hard to distinguish HSP from disabilities, especially autism. And in the process, she made incredibly ableist arguments and threw autistic people under the bus.

Instead of seeing HSP as a positive way of viewing neurodivergence — including autism — she claims that HSP is a neutral-to-positive trait while sensory processing disorder, anxiety, ADHD, and autism are all uniformly-negative disorders. That is an unhelpful, prejudiced way of viewing autism and other disabilities.

ADDED 9/4/23: When Aron’s grandnephews were diagnosed with ASD, Aron had difficulty adjusting to the idea. She insisted they were HSP’s instead — as an alternative to diagnosis — not in addition, as the positive side of their atypical traits. This history is no longer represented on her web page, but you can find it in her books and it’s discussed in blog posts here and here.

Currently, most of Aron’s argument is in her page asking how HSP compares to sensory processing disorder, but also she refers those curious about anxiety, ADHD and autism to read the following:

“[SPD] is a neurological disorder. It involves the senses; the vestibular system; proprioception, motor control, balance and spatial awareness, and causes sensory information to get “mixed up” in the brain resulting in responses that are inappropriate in the context in which they find themselves. This can include random and disorganized processing of external stimuli, and can cause great distress, intensity and overstimulation. This overstimulation is sometimes confused with the overstimulation HSPs clearly experience, but it should be noted that the root cause of the overstimulation is not the same.

In contrast, many with Sensory Processing Sensitivity have found success by simply becoming educated about their genetic trait (or their child’s). They learn to create a proper balance in their day…learning which environments serve them best…

Perhaps the truest test of what differentiates SPS from not only SPD, but also other diagnoses such as Autism and Aspergers Syndrome, are the four things all HSPs have in common ~ the D.O.E.S. as defined and eloquently explained in Elaine Aron’s book, Psychotherapy and the Highly Sensitive Person.

D.O.E.S. refers to: Depth of Processing; Overstimulation; Emotional Intensity; and Sensory Sensitivity.”

A list of positive traits follows — again, ones possessed by many people with correctly diagnosed autism, ADHD, and other neurodivergences. It’s maddening.

Perhaps due to criticism from autistic people, she’s backed down from making strong distinctions between HSP vs. autism, and her website now says only,

“This area is not Elaine’s specialty, and she does not keep up on current research. This topic deserves accuracy and respect. Therefore, we advise those looking for more information to seek out autism experts. Just be certain they understand something about innate temperaments such as high sensitivity as well.”

Elaine Aron’s prejudices, and those of other self-proclaimed HSP “experts,” disappoint me and infuriate many people, for good reason.

Autistic bloggers make a crucial mistake, though.

They reverse Aron’s claims and say that Highly Sensitive Person equals [masked] autism.

I know that’s not true, because I’m a living counterexample.

Case Study

Let’s pretend I’m a case study and go down the HSP checklist.

Image showing mostly positive and neutral aspects of HSP from Hertelier

Image above, which lists both positive and negative characteristics of HSP’s, from Next Step Counseling.

1. I am easily overwhelmed by strong sensory input. (Y)
2. I seem to be aware of subtleties in my environment. (sometimes — yes when alert, no when exhausted, overwhelmed, or hyperfocusing)
3. Other people’s moods affect me. (Y)
4. I tend to be very sensitive to pain. (Y)
5. I find myself needing to withdraw during busy days, into bed or into a darkened room or any place where I can have some privacy and relief from stimulation. (Y)
6. I am particularly sensitive to the effects of caffeine. (somewhat. I rely on my morning cup of coffee to get through the day).
7. I am easily overwhelmed by things like bright lights, strong smells, coarse fabrics, or sirens close by. (Y)
8. I have a rich, complex inner life. (Y, but see my concerns about this item).
9. I am made uncomfortable by loud noises. (Y)
10. I am deeply moved by the arts or music. (Y)
11. My nervous system sometimes feels so frazzled that I just have to go off by myself. (Y)
12. I am conscientious. (Y)
13. I startle easily. (Y)
14. I get rattled when I have a lot to do in a short amount of time. (Y)
15. When people are uncomfortable in a physical environment I tend to know what needs to be done to make it more comfortable (like changing the lighting or the seating). (sometimes — I’m hindered by the fact that I know people differ from me in how sensitive they are and what they’re sensitive to).
16. I am annoyed when people try to get me to do too many things at once. (Y)
17. I try hard to avoid making mistakes or forgetting things. (Y)
18. I make a point to avoid violent movies and TV shows. (Y)
19. I become unpleasantly aroused when a lot is going on around me. (Y)
20. Being very hungry creates a strong reaction in me, disrupting my concentration or mood. (Y)
21. Changes in my life shake me up. (Y)
22. I notice and enjoy delicate or fine scents, tastes, sounds, works of art. (Y; that’s almost the same as another item on here, though).
23. I find it unpleasant to have a lot going on at once. (Y)
24. I make it a high priority to arrange my life to avoid upsetting or overwhelming situations. (Y, unless that’s the only way to do something important to me, like pursue a dream career).
25. I am bothered by intense stimuli, like loud noises or chaotic scenes. (Y)
26. When I must compete or be observed while performing a task, I become so nervous or shaky that I do much worse than I would otherwise. (Y)
27. When I was a child, my parents or teachers seemed to see me as sensitive or shy. (sensitive Y, shy N).

So, if we give 1 point to yes, 1/2 point to sometimes, and 0 points to no, I got: 23 Y, 4 sometimes, 0 no, for a total of 25/27. I’m pretty unambiguously an HSP.

So I must be autistic, right?

No.

I’ve undergone the gold standard test (the adult ADOS) within the past few years. I’ve had neuropsychology testing twice (once using DSM-IV, once with DSM-5). Over my adult life, I’ve been evaluated by therapists, psychiatrists, occupational therapists, developmental optometrists, auditory processing specialists, and SLPs.

Not to mention that I myself have followed autism research and changes in diagnostic criteria over the years. I also have some basis for comparison, having interacted with autistic people in person and virtually over the years, and taught a few autistic children as an SLP.

With that much self-awareness and that much evaluation from that many different professionals with that many different perspectives over that many years, someone would have noticed if I met the criteria for ASD.

I don’t.

Sure, that could change. If the next edition of the DSM makes significant changes to the criteria, or creates a separate set of criteria for adult women that better overlaps with my characteristics, maybe I’d become autistic.

But thus far, I’m what the late Mel Baggs called a “cousin.”

People with ADHD, dyslexia, dyscalculia, dyspraxia, Tourette’s, stuttering, migraines, traumatic brain injury, and other form of neurodivergence often have HSP characteristics. Not everyone with these conditions is autistic.

So, no. Many autistic people, diagnosed and otherwise, may be HSP’s, and that matters. But that doesn’t mean HSP equals autism.

The Place of the “Highly Sensitive Person” in a Neurodiversity Perspective

Here’s what I believe about “HSP”:

1. HSP itself is a neurotype. It’s found across many species, in about 15-20% of the population. It can be an advantage or disadvantage depending on the environment, just like any other neurotype. Because most disabilities are less common (with dyslexia and ADHD falling below 10% of the population according to many estimates, and ASD around 2% at most), HSP is probably the largest neurotype.
2. Many autistic people are HSP’s.
3. Many non-autistic neurodivergent people are also HSP’s.
4. It’s theoretically possible that otherwise neurotypical people could be HSP’s. Personally, I doubt there are many.
5. Elaine Aron says ableist things. She doesn’t understand autism. Yet, the HSP concept, used carefully by neurodivergent people, can still be useful and validating.
6. Finally: HSP =/= autism.

Did this post change your perspective about HSP’s, autism, or anything else? Comment and let me know.

Disagree? Tell me why I’m wrong in the comments. ;D

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EDIT: I’m still getting to all the wonderful comments. However, you got me thinking more deeply about the HSP label, and diagnostic overlap in general, and I wrote some more about it here. I also wanted to respectfully acknowledge the point of view of someone who wrote one of those “pet peeve” posts and took the time to comment here.

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