High sensitivity: one word, three stories
Many people recognise themselves in the word "highly sensitive". It is often used in care settings and in self-help books. Still, it is important to know: it is not an official diagnosis. It is not in the handbooks that doctors and psychologists use.
On top of that, "highly sensitive" does not mean the same thing for everyone. Behind that one word hide different patterns. They look alike, but they work differently — and so they call for a different approach. This page untangles three of them.
What high sensitivity is and is not
The American psychologist Elaine Aron coined the term "Highly Sensitive Person" (HSP) in 1996. In scientific research the same phenomenon is called Sensory Processing Sensitivity (SPS). It describes a disposition: stimuli from your surroundings come in more deeply, feelings are stronger, and both pleasant and unpleasant influences have more effect.1
What high sensitivity is not:
- Not a diagnosis. A doctor or psychologist cannot establish "high sensitivity" the way they establish an illness. It is not in the DSM-5-TR or the ICD-11, the two big diagnostic handbooks.
- Not an either-or matter. Large-scale research (Lionetti et al., 2018) shows that sensitivity runs gradually. Roughly divided: about 3 in 10 people are barely sensitive, 4 in 10 average, and 3 in 10 strongly sensitive.2 So the well-known "20%" rule of thumb is a simplification.
- Not a test for other disorders. A high score on a high-sensitivity questionnaire proves nothing. It is no proof of autism, ADHD, or an anxiety disorder — and it does not rule those out either.
Researchers take the idea seriously. Greven and colleagues (2019) wrote an important review article about it.1 At the same time there is debate. Because the trait looks a lot like existing personality traits: above all sensitivity to stress and low mood, and openness to beauty and art.3 Whether "high sensitivity" really is something new, or a new name for something familiar, has not yet been settled.
Note
In Dutch, "hoogsensitiviteit" (high sensitivity) and "hooggevoeligheid" (high emotionality) are often used interchangeably. Professor Elke Van Hoof (VUB) makes a distinction: high emotionality is a strong emotional reaction that anyone can have now and then; high sensitivity is a lasting character trait. On this page we follow the scientific usage and use "high sensitivity" for the trait that researchers call SPS.
Three stories under one word
The biggest problem with the word "highly sensitive" is that it covers too many different things at once. Research into heritability suggests that its parts stand partly apart from one another.1 In practice you see three patterns. They look alike — all these people can call themselves "highly sensitive" — but they work differently. And so something different helps in each case.
| Feature | Story A: deep processing, sensitive to atmosphere | Story B: quickly overstimulated | Story C: sensitivity with a difficult history |
|---|---|---|---|
| What it rests on (research) | sensitivity to beauty and atmosphere; linked to openness | getting overstimulated quickly and a low stimulus threshold; linked to sensitivity to stress | the smaller group in Aron's work (about a third): sensitivity plus an unsafe childhood |
| What happens in the brain | reads context extra strongly; processes meaning deeply | filters too few stimuli; everything comes in unchecked | sensitivity plus early insecurity that set the alarm system |
| How it feels | "I notice a lot, think in several layers, am deeply moved" | "everything comes in too hard, I am quickly worn out" | "I feel a lot and I am quickly thrown off balance, especially under stress or conflict" |
| Place on the context spectrum | high-contextual end | low-contextual end | stands apart from it: can sit at different points |
| Sometimes looks like | no diagnosis; sometimes confused with oversensitivity | (often missed) autism, ADHD, anxiety, trauma, burnout | the effects of trauma, attachment problems |
| What helps | rest and recovery time, boundaries, acceptance, room to reflect | structure, predictability, fewer stimuli — and figuring out properly what is going on | therapy aimed at trauma, restoring safety — not just "learning to cope with your sensitivity" |
| What does not help | turning an ordinary character trait into a problem | using "HSP" instead of a diagnosis | ignoring the past and blaming everything on "disposition" |
Important: these three stories do not exclude one another. Someone can have parts of several patterns at once. They are not new boxes or diagnoses. They are an aid to see how differently people can vary under the same word.
Story A: deep processing, sensitive to atmosphere
These people process everything a bit more deeply. They notice small things that others miss. They think in several possibilities at once. And they are deeply moved by music, art, nature, or a good conversation. In research this is linked above all to openness and to strongly enjoying pleasant experiences — not to anxiety or being overwhelmed.3
This looks a lot like what we call high-contextual thinking on this site: automatically reading the atmosphere, the undertone, and the bigger whole.
Case
During a meeting, a teacher notices that a colleague seems absent. No one else has seen anything, but she feels the tension behind the smile. After the meeting she asks how things really are — which leads to an open conversation. That same sensitivity makes her strong in dealing with her pupils. But a busy school day also costs her more energy than her colleagues: she processes a lot, even without choosing to.
Story B: quickly overstimulated
For these people, everything comes in too hard: light, sound, crowds, lots of people. Stimuli are barely filtered, they get through right away. In a shop, at a party, or in an open-plan office they are quickly exhausted. In research this is linked to inward-facing complaints, such as anxiety, low mood, and vulnerability.3
This looks like what we call low-contextual thinking on this site: not deeper processing, but a filtering problem. You can read how that works exactly on Sensory overload and coping.
It is precisely with this pattern that the word "highly sensitive" is risky. Because sensory overload also belongs to autism, ADHD, anxiety, trauma, and burnout. Whoever says "HSP" too quickly can miss the right help for years.
Case
A thirty-year-old man comes home completely empty after a day in an open-plan office. He recognises himself in an HSP book and decides that he is "simply highly sensitive". He does not adapt his work and keeps struggling with exhaustion. Only after three years — and a burnout — does he get the diagnosis of autism. It puts his whole life course in a different light, and gives him a right to accommodations at work. The HSP label felt reassuring, but it kept him from looking further.
Story C: sensitivity with a difficult history
Already in her first research (1997), Aron saw that about a third of the high scorers showed a different picture. They had more trouble adapting, were more often introverted and emotional, and had strikingly more often had an unhappy childhood.4 Aron's conclusion: that emotional vulnerability is largely added on. It is not sensitivity in itself that makes someone vulnerable, but sensitivity on top of an unsafe childhood.
This pattern calls for a very different approach from the first two. "Learning to cope with your sensitivity" is not enough here. What is needed is the restoration of safety — often with therapy aimed at trauma. Here the word "highly sensitive" can even cause harm, if it covers up the real cause: a difficult history.
Case
A forty-five-year-old woman strongly recognises herself in HSP books and goes to a coach who teaches her to take better care of her boundaries. It helps for a while, but the core remains: panic at conflict, poor sleep after every confrontation, a deep sense of insecurity in close relationships. Only when therapy addresses her childhood does her sensitivity take on a different meaning. Not only disposition, but also a body that once had to learn to be always on guard.
Why the confusion causes harm: a bidirectional error
The core criticism of the popular use of "highly sensitive" runs as follows: a non-recognized category is used to rule out a recognized diagnosis. "It is not autism, it is high sensitivity" — a statement that is regularly heard in psychological practices — uses a popular label without formal status to close off a differential diagnosis. Methodologically that is a strange manoeuvre: you cannot rule out a recognized diagnosis on the basis of a trait characteristic that itself has no diagnostic status. Dividing people into separate labels is itself a form of box thinking here (see Context and the DSM).
But the error runs in both directions. Equally problematic is the opposite: a child who in reality fits pattern A (aesthetic-reflective, high-contextual) is wrongly assessed as autistic because it shows signs of intense emotion, a need for rest, or difficulty with busy environments. Greven and colleagues point to this explicitly: the phenotypic resemblance between SPS and autism can lead to misclassification in two directions, especially when a sensitive child in a demanding environment develops social withdrawal.1
In both directions the error is the same: choice of label replaces differential diagnosis. Whether it is a psychiatrist who ticks autism too quickly, or a coach who says "HSP" too quickly — what is missing is the careful exclusion of alternative explanations and the recognition that different mechanisms call for different approaches. The Bergsma/Van De Voorde/Vermeulen communiqué (2025) points, within the HSP field itself, to this bidirectional confusion and argues for caution in both directions.5
The context-sensitivity lens
The contextual framework disentangles the three stories in a way that the HSP label on its own does not:6
- Story A sits at the high-contextual end of the spectrum: the brain integrates context above average, resulting in a richer but also more tiring form of processing.
- Story B sits at the low-contextual end: contextual filtering falls short, stimuli come in undampened. Here lies overlap with autism, ADHD, and related presentations — not as a synonym, but as related mechanisms.
- Story C, in this logic, sits largely orthogonal: it is not a position on the context spectrum but a layer that lies on top of it — sensitivity combined with an attachment history that helped shape the nervous system.
In this perspective the label "highly sensitive" becomes less relevant. What you really want to know about someone who recognises themselves in it is:
- Where does this person sit on the context spectrum?
- Which mechanism best explains what he or she experiences?
- Is there an attachment or trauma history that plays a role?
The answer to those three questions provides a far better starting point for support than a tick after "HSP" or not.
Practical pointers
For those who recognise themselves in "highly sensitive": let the label be a starting point, not an endpoint. It can help to give your experience a name and to realise that you are not the only one. But do not use it as an excuse to avoid further differentiation. Ask yourself honestly which of the three stories fits best — and know that a combination is also possible. When "learning to cope with your sensitivity" does not move you forward, that is a signal that there is probably more going on than a trait characteristic.
For care providers and coaches: avoid statements like "it is not X, it is high sensitivity". A non-recognized category cannot rule out a recognized one. When someone presents with "I am highly sensitive", that is not a diagnosis but a conversation opener. Systematically explore overload patterns, social cues, sensory profiles, attachment history, and functioning in different contexts — and be prepared to look further with differential diagnosis when functioning is under pressure.
Conclusion
High sensitivity is not a disease, but neither is it a homogeneous characteristic. Beneath the same label live at least three mechanistically different stories, with different therapeutic implications. The construct as a whole is scientifically contested, formally not recognized, and empirically strongly overlapping with existing personality dimensions. That does not make it worthless — but it does make it unsuitable to function as a diagnostic alternative. The context-sensitivity lens helps to separate the different stories within the label, and to ask the right questions for each of them.
References
- Greven, C. U., Lionetti, F., Booth, C., Aron, E. N., Fox, E., Schendan, H. E., Pluess, M., Bruining, H., Acevedo, B., Bijttebier, P., & Homberg, J. (2019). Sensory Processing Sensitivity in the context of Environmental Sensitivity: A critical review and development of research agenda. Neuroscience & Biobehavioral Reviews, 98, 287–305. doi:10.1016/j.neubiorev.2019.01.009
- Lionetti, F., Aron, A., Aron, E. N., Burns, G. L., Jagiellowicz, J., & Pluess, M. (2018). Dandelions, tulips and orchids: evidence for the existence of low-sensitive, medium-sensitive and high-sensitive individuals. Translational Psychiatry, 8(1), 24. doi:10.1038/s41398-017-0090-6 — PubMed 29353876
- Bröhl, A. S., Van Leeuwen, K., Pluess, M., De Fruyt, F., Bastin, M., Weyn, S., Goossens, L., & Bijttebier, P. (2022). First look at the five-factor model personality facet associations with sensory processing sensitivity. Current Psychology, 41(8), 5034–5047. doi:10.1007/s12144-020-00998-5
- Aron, E. N., & Aron, A. (1997). Sensory-processing sensitivity and its relation to introversion and emotionality. Journal of Personality and Social Psychology, 73(2), 345–368. doi:10.1037/0022-3514.73.2.345
- Bergsma, E., Van De Voorde, S., & Vermeulen, P. (2025). Hoogsensitiviteit versus autisme — en waarom iedereen het onderscheid zou moeten kennen (communiqué). Hoogsensitief.nl, October 2025. PDF — official source
- Thomeer, K., & Vermeulen, P. (2026). Context en contextblindheid: nieuwe begrippen voor een dimensionele aanpak in de huisartsenpraktijk. Huisarts Nu, 55, 94–98. Huisarts Nu