Are you anxious because you’re hypersensitive?
Or are you hypersensitive because you’re anxious?
This is a question that a paper I’m reading now dares to address [1] and it does so in a respectful and mindful manner, which I appreciate.
[1] — The perceived causal relations between sensory reactivity differences and anxiety symptoms in autistic adults, Isabelle Verhulst, Keren MacLennan, Anthony Haffey, Teresa Tavassoli, 10.1089/aut.2022.0018
We need more good research into autism and autistic folks and people who are aware of the pitfalls of “traditional” research in this area.
That said, what do you think? Does being hypersensitive to everything around you make you more anxious or does growing up anxious (whatever that may mean in practice) make you more sensitive to stimuli? Please tell me in the comments.
I, as an autistic individual, am pretty sure that in my case it’s neither. I am not anxious because of being inundated by sensory stimuli because I can very well be anxious in a dark, silent room.
However, loud noises do make me jump out of my skin (figuratively speaking, although I always have one of those Tom & Jerry flashbacks when using/ hearing this phrase, even though I’m not sure that’s a thing) and fast moving vehicles do make me afraid that something nasty’s going to happen.
I am sure that’s not a cultural thing, people in my culture like to drive with abandon, disregarding all traffic laws and common sense, so it’s something specific to me, that I’ve grown with.
I am not afraid (if you could lump fear in with anxiety) of many things in general, I’m OK with heights and darkness and people not liking or accepting me, I like snakes and insects, spiders and other “creepy crawlies” because I find them fascinating, including touching them or being touched by them (I do feel them, though, so it’s not like I’m hyposensitive, I’m hypersensitive to touch).
A phrase in the paper made me wonder, so I had to stop reading to write this article.
How do the people writing the papers cited by this one that I’m reading (I’m not going to read them all) decide who’s hyposensitive enough to be categorized as such, so all their anxieties end up appearing as if unconnected with their sensory differences?
As far as I’m aware, each of us has an array of sensitivity differences, some being hyposensitive to certain stimuli and hypersensitive to others, some being hypersensitive to only emotional/social cues, some being hyposensitive to the same and hypersensitive to physical stimuli.
How do you separate the sensory “perceived” stimuli from the emotional “felt”, but also “perceived” (by us hyperempaths)? How do you decide that person X is hyposensitive and their anxiety comes from wiring in their amygdala?
Isn’t the amygdala supposedly malleable, like the rest of the brain?
I’m pretty sure my amygdala was fried for a few years there because of the amount of stress I’d been under for about a decade before it decided to just turn the rest of my brain into mush (that’s how I’d define an autistic burnout nowadays, if you were to ask me).
It was due to sensory overstimulation (loud, cold, bright workplace), but also due to masking so intensely that I forgot who I was. I was also using sugar as a pick-me-up (I didn’t know how harmful it would turn out to be) because I was so exhausted and nothing else helped me keep floating (I don’t use caffeine or other drugs to keep my brain in working order).
Until my burnout, which resulted in anxiety and deep depression, I had not been anxious. I didn’t have intrusive thoughts, or if I had I’d think they were silly, instead of feeling them burn through my soul.
No, I did not see a specialist because 1. I was a broke PhD student, 2. there’s practically no such thing as mental health care in Romania, 3. even if there were, I’d have probably been gaslit and told I’m fine and maybe potentially fed some drugs that I couldn’t afford anyway (see point 1) and that wouldn’t have worked anyway because I’m autistic and ADHD and there are no specialists who understand what these two concepts are and what they mean in a therapeutic practice (I’m not saying in general, there might be a handful across the globe, but I’m pretty sure they are not located in Romania).
What’s my point?
You can’t separate physical sensitivity from emotional sensitivity, you can’t say “this autistic person is hyposensitive” in general, because we all have our own spectrum of sensitivities (yes, we can be “on the autistic spectrum” and have “a spectrum” of traits, these are two different things, but they essentially boil down to the same idea).
So you can’t say that there’s no link between the sensory profile of “hyposensitive” people and anxiety, be it GAD (generalized anxiety disorder) or something else.
Oh, I forgot something. Being sensory seeking for a specific stimulus does not equate “hyposensitive” for that specific stimulus (although they do talk a lot about “reactivity” as opposed to “sensitivity”, which to me smells a lot like behaviorism, because the feeling is not taken into account, only the resulting behavior…).
What does that mean? If you are not sensitive to noise at all, why would you go out of your way to search for specific noises? It doesn’t make sense that you’d be interested in something that brings you no joy.
However, if a certain stimulus generates pleasant feelings, aren’t you likely to search for it, regardless of how sensitive you are to it?
If, for example, spinning on the spot with your arms held out creates a pleasant tingling in your fingertips and an exhilarating feeling in your whole body, a joy that creeps up from the tips of your toes to the top of your head, wouldn’t you do that again and again?
Even if being in a car that is driven by a maniac, sorry, by a person who doesn’t know how to drive, wait, by someone who accelerates excessively and then breaks every three seconds, makes you extremely sick because you’re hypersensitive to motion (inner ear stuff)?
Being sensitive to a type of stimulus has nothing to do with being or not being sensory seeking for that type of stimulus.
This was related to the phrase in the introduction about paper 36 from their reference list. OK, back to the paper.
I have an issue with RRBs (restricted and repetitive behaviors). Not with the behaviors, but more with the emphasis put on the idea that behaviors that don’t conform to what neurotypicals consider “normal” are “restricted and repetitive”, even though some of them are probably progressive or don’t bother anyone.
It’s an ableist phrase. Can we phase it out of scientific language? Maybe replace it with “repetitive and progressive motions” or something along those lines. Not so judgmental.
But we must keep in mind that this paper is written with reactivity in mind, rather than sensitivity. It essentially misses the mark by such a small margin, it’s so close, yet so far…
“Qualitative research in autistic adults has indicated that sensory seeking can be a soothing or calming strategy in times of stress.” — What are stims?
I am waiting to see if there is any mention of the parasympathetic nervous system, vagus nerve involvement and all that.
Methods
So you don’t like self-identified autistics to participate in research, is that it?
“Using a method such as PCR brings the perspectives of autistic individuals into research”, but only if you are privileged enough to have a paper from someone that judged you different enough to give you the title of “autistic”.
Let’s leave out those poor autistics (literally poor, not “oh dear me, poor”) who don’t have access to mental health, all the women who are told they have BPD or some other nonsense, all the people in countries where mental health practice is so far behind that Freud would be a great innovation. /rant over
Wait, there’s more. “We did not record specific data on race and ethnicity, socio-economic status, and educational attainment levels”. How can you be inclusive if you have no idea of the distribution of your chosen population?
No control group? Hm…
“Questionnaires of anxiety validated in the general population are commonly used in autism research due to the lack of population specific measures”, but why?
If you know that the two populations don’t have that much in common when it comes to very specific things, like what may cause anxiety and how anxiety might manifest itself internally or externally, why use an unvalidated questionnaire?
They even mention this in the Limitations section “there is growing evidence to suggest that anxiety presentations differ in autistic individuals compared with the general population, such as social fears that are not related to negative self-appraisal”. So why, then?
Results
“We found that sensory hyperreactivity was significantly correlated with total anxiety, sensory hyporeactivity was significantly correlated with total anxiety, and sensory seeking was significantly correlated with total anxiety”.
So being more or less reactive to stimuli has no influence on whether you have anxiety = you’re probably anxious no matter what if you’re autistic and have a diagnosis in the UK. What does that tell us?
“We found that sensory hyperreactivity was perceived to be a significantly greater cause of anxiety” — yes, that makes sense, when the world hits you from all directions, you tend to learn to be aware and protect yourself, which can escalate into anxiety.
“However, we found that sensory seeking was perceived to be a significantly greater effect of anxiety” — what do you do when you feel like the world is ending, but know that it’s only a feeling? Do you not resort to soothing activities and do you not seek out safety? Stims are safety.
This is not something specific to autistic folks, it’s just that we do it more often or more visibly because we are anxious due to more causes than the general population.
Being blasted by loud noises, bright lights and strong smells causes anxiety, and moving and touching soothing things helps bring down the anxiety. Yes, thank you. It is known, and now backed up by Science™.
Discussion
“Sensory hyperreactivity may cause anxiety…” — who says hyperreactivity causes anything?
Hyperreactivity is a manifestation of a hypersensitivity (but in this case, it is the natural response to a stimulus of a specific scale or perceived at a specific scale by a hypersensitive sensory system of an autistic person).
It does not cause anything but maybe distress in folks who are around the “hyperreactive” person, who need to either listen to, watch or judge the person doing the “reacting” (as if the opinions of someone watching or listening to someone else go through painful experiences are at all relevant).
OK, let’s fix that phrase “Sensory hypersensitivity may cause anxiety due to autism-related difficulties with the unpredictability of aversive sensory input, which may lead to anxiety developing through context conditioning from increased hypervigilance, negative bias, and avoidance of generalized contexts.” (emphasis mine because I changed a word).
Now this makes sense, in a general way of looking at things. Anxiety can be learned and this may be one of the mechanisms leading to anxiety in autistic people, but it’s incomplete, since the social aspect is just as important, if not more, and it’s never even considered at all.
The social aspect means that sensory sensitivities translate into social sensitivities with no way out:
- “The bright lights and the fluorescent buzzing and my colleagues talking loudly hurt me, but if I tell the teacher, I’ll be ridiculed in front of the class”;
- “This place stinks like beer and cigarette smoke, but I thought these people invited me along because they also liked *insert interest* and they wanted us to discuss it, but instead they changed the subject and started talking loudly over me, so maybe I shouldn’t ever bring up the subject”;
- “I wanted to dance with this person, but there’s too many people going around, too much noise, the music is too loud, too much movement, I’m going to be sick, what if I embarrass myself in front of this very important person”.
There are so many instances that I can come up that are just anxiety bombs ready to explode because of the emotional pressure attached to performing in a certain way in an environment that disables hypersensitive folks. It’s not all about the direct stimulus.
We can deal with the stimuli if we get support, accommodations, understanding. Anxiety is generated by social interactions and the judgement, the ridicule, the emotional pain associated with expressing your pain through “hyperreactivity”.
If I’m in pain while I’m on my own because the sun is too bright when I’m in the forest, I don’t feel anxiety. I feel pain, yes. I feel a migraine coming, also yes. Zero anxiety. Nobody will judge me in the forest for putting my shirt over my head to shade my eyes and reduce the heat on my scalp.
When I’m near a waterfall and all I can hear is the pounding of tons of water falling, all the separate sounds appearing individually in my brain as distinct as notes on a keyboard, I don’t feel anxiety. The waterfall doesn’t care that I put my hands to my ears and press and enjoy the nice smell of the fresh water while protecting my brain from the barrage of noise.
But if I jump when someone starts their car right next to me while I’m walking on a busy street, I do feel anxiety. Did anyone see me jump at this non-threatening noise that they didn’t even perceive? Will they laugh at me? Some drivers do, they laugh because I jump at the noise. Their judgement is what gives me anxiety. I don’t fit in this world where people walk by starting engines and don’t care. I am different and people laugh at my differences, so I must be wrong. Well, at least that’s what anxiety tells me.
And no amount of dialectical or another kind of Behavioral Therapy will take those thoughts away from me, even if I were to go to such therapy. Trust me, I’ve tried. I’ve done all the behavioral therapy on myself before I even knew what autism is and that there is such a thing as ABA. You cannot remove from yourself something that is not generated in yourself.
Until the day when I can be myself on the street and “hyperreact” to everything that hurts me, be it natural or artificial, without judgement and scorn and othering by the neurotypicals, until everyone, autistic or not, is able to do the same, we will not have peace from anxiety. We, the society.
Until we stop judging people for what we perceive them doing (what they are doing and what we think they are doing are sometimes very different things), anxiety will continue to be a thing.
Conclusions
These are my conclusions, not those of the paper, which I pretty much already discussed.
Why did I have such high expectations from this paper? It started out well enough (actually, not really, once you realize that they do mean behavior instead of feeling, pretty early on).
I did enjoy the section about limitations of the study, which should inform further studies, and did appreciated that we now have something to point to when we tell people that stims are good and they should stop judging people for stimming, look, the science says that stims are an effect of anxiety.
Hey, wait a minute! Stims are not an effect, they are a coping mechanism for anxiety, much better than CBT or DBT or any BT, and we who stim know this because we have lived with our bodies our whole lives.
I wonder when stimming will not only not be judged any more, but prescribed by therapists to neurotypicals. Oh, I wait for the day…
Until then, I’ll get angry at research papers with good intentions and I’ll continue to write articles that will change nothing, but maybe, who knows, one day a fellow scientist will read these words and think and a lightbulb will go on in their brain (not a literal one!) and they will start to think about what autistic people feel as opposed to do when certain things happen to them or around them…
Oh, what a joy that would be!
