Highly Sensitive Person (HSP) Vs Autism

A prospective client contacted us recently about having an autism assessment...she ask if I might be able to tease apart autism and ‘HSP'.

So I thought: what a great blog post idea!

The term ‘Highly Sensitive Person’ (HSP) is an outdated ‘pop psychology’ concept that needs to be exited from our vernacular.

Why?

Because HSP lacks construct validity.

Because HSP is not a differential 'diagnosis'.

Because HSP is a comfortable way of denying and delaying the identification of autism, resulting in not getting the right kind of support.

Did you know that even the creator of the term HSP eventually realised she was Autistic?

Hahaha! What a joke! (no, for real- this is not a joke).

What does HSP mean anyway?

HSP is a term that was coined by Elaine Aron (who is 80 this year) in 1996. It was a helpful concept at the time that had good intention but has also resulted in the delayed identification of likely hundreds of thousands of autistic folk, (which means not getting the right kind of support).

Elaine based her research on her nephews (both of them were later identified as autistic as well), and admits that she knows very little about autism.

I can recall talking with therapy clients many years ago about HSP, and ideas around empaths and tools to ‘protect them’. What utter rubbish when I think about it these days! (Cringe!) I also identified as an HSP/empath myself.

Essentially, this pop psychology concept states that an HSP typically experiences deep processing of sensory information, becomes easily overwhelmed by intense stimuli, and exhibits strong emotional reactions. They often require quiet time to process experiences and demonstrate particular sensitivity to subtle changes in their environment.

These characteristics share remarkable similarities with common autistic traits.

HSP is simply a euphemism (and not a clinical term) for a particular internalised Autistic presentation, as well as constellations of traits like complex trauma. One reflection is that perhaps an HSP is just a well supported Autistic person? Maybe they have a number of what we call ‘protective factors’ (personality, family upbringing, etc).

It would be interesting to see the demographics of people who see themselves as an HSP. I’m going to guess that they have more protective factors, be female, higher SES, higher levels of intelligence, less trauma, less health issues, good role models, warm/naturally resilient personalities, etc......This could make a good PhD topic (sadly I have promised my husband that I will stop collecting degrees!)

Having said that, of course there are people in the world who are also more 'sensitive' in general, but that doesn't make them autistic.

What about autism?

Recent research has highlighted that autistic folk are deeply empathetic (often called 'excessive levels of empathy'), sensitive and often very kind people. Someone can still be Autistic and be social and have long term friends and be flexible....let me break that down for you! Under 'Criterion B', you only have to meet 2 of the 4 of the criteria (the four are- spins, stims, sensory, and routines). Plus they can be met historically.

So, for example, some say that the “rigidity” or need for certainty and structure aren’t there in HSP, but are in autism … However, as only 2 out of 4 criteria in B are required, someone can be Autistic without “rigidity” according to the DSM.

Another example is that you can be autistic and not have any ‘repetitive and restricted behaviours’ (stims). There are also generally less (and more subtle) 'repetitive and restrictive behaviours' (stims) in women than in men.

Also, many autistic folk have deep and wonderful friendships, and we connect in our own ways. I’ve had many wonderful and rich friendships for many, many years.

Some of my clients are surprised when I say that you can be an extrovert and be autistic… of course you can! It’s just that we need more time to recalibrate after socialising (I'm an example of an extroverted autistic person who is naturally quite bubbly).

People who are socialised as women are especially likely to have less social difficulties because we learn how to understand people (that's why so many autistic women become psychologists like me).

Autism and HSP can actually have 100% overlap. Having said that, a person can have a sensitive personality, and not be autistic.

Did you know that before 2013, Autism and ADHD were classified as differential diagnoses rather than co-occurrences? That means, you couldn’t be both autistic and have ADHD. So yes, this area of research has a long way to go, and this is part of the problem- it's all over the place like a dog's breakfast!!

So what is the problem again?

For myself and many of my colleagues, the term HSP continues the stigma around autism and prevents some people from getting the right kind of support.

An HSP is likely to meet criteria for autism when demand exceeds capacity (ie- they aren't coping anymore, and life stress has increased)...OR maybe they have had a child or a grandchild who has been identified as autistic, and they wonder if they too, are autistic...... OR they have had time to reflect, and perhaps identify traits of themselves in a warm and lovely media personality (such as Hannah Gadsby, Em Rusciano, Chloe Hayden, etc).

When working with clients in a neuroaffirming affirming way, I make it clear that HSP is not diagnostic and that many of the traits of HSP overlap with Autism.... having said that, not all sensitive and empathetic folk are autistic!! So it may be worthwhile getting an autism assessment- feel free to contact Brie and I today :)