Sara Szal MD<\/span> <\/span><\/p>\n Five years ago, I sat opposite my psychedelic-assisted psychologist talking about vacuum cleaners. Once a week, when the housekeeper came to clean the house, the sounds from cleaning and especially from the vacuum landed like a physical blow. I built a system around dodging it: walk the dog, wear earplugs and get in the sauna, wait it out like weather.<\/span><\/p>\n I was in <\/span>the second year of quarterly MDMA-assisted psychotherapy, confessing this process to my psychologist with the shame of a woman who suspects she\u2019s being unreasonable about a necessary household ritual.<\/span><\/p>\n He didn\u2019t treat it like a quirk. He asked me: <\/span>\u201cAre you an HSP?\u201d<\/em><\/p>\n I\u2019d heard the term before, in passing, years earlier, as part of writing books like <\/span>The Hormone Cure<\/em>. I\u2019d never taken the test. My medical training didn\u2019t recommend it or even acknowledge it. <\/span><\/p>\n It was 2021. I took the HSP quiz right there, on my phone, while he waited. Twenty-four out of twenty-six were positive. <\/p>\n I am a highly sensitive person. Twenty-five years into practicing gynecology, I finally had a name for something I had been treating in other women for decades without once turning the instrument on myself.<\/span><\/p>\n Here is what I do for a living. Women sit across from me and describe pain they have carried quietly for years, sometimes decades, often after being told by a doctor before me that it was normal, or in their head, or simply the tax on being female. <\/span><\/p>\n I built an entire career on refusing that answer, so it is humbling to admit I spent nearly fifty years accepting that same answer about my own body.<\/span><\/p>\n Here is my own chart, the short version. <\/span><\/p>\n Disordered eating in my teenaged years until age 39, the kind that gets called discipline right up until it isn\u2019t. <\/span><\/p>\n<\/li>\n PMS severe enough that I tried everything.<\/span><\/p>\n<\/li>\n Postpartum depression after my first daughter, that I often confused with what new motherhood was supposed to feel like. <\/span><\/p>\n<\/li>\n Subthreshold PTSD I never technically qualified for on paper but recognized instantly once I learned what to look for.<\/span><\/p>\n<\/li>\n Hypervigilance, always. <\/span><\/p>\n<\/li>\n Adenomyosis, when the uterine lining grows into the uterine muscle wall instead of staying put, causing heavy, painful periods and an enlarged, tender uterus.<\/span><\/p>\n<\/li>\n Menorrhagia heavy enough to cause anemia. Fibroids, plural, until a hysterectomy two years ago finally closed that chapter.<\/span><\/p>\n<\/li>\n<\/ul>\n I did not go looking for a theory that would tie all of that together but I found one anyway, and once I did, I could not unsee it in the women sitting across from me every day.<\/span><\/p>\n Here is what I believe I am here to do, and it is bigger than any single diagnosis. Take the trait that gets women written off as too sensitive, too much, too easily overwhelmed, and instead of managing it quietly into a smaller life, read it as an instrument that has been picking up signal the rest of the culture is still too dulled to register.<\/span><\/p>\n Women who are highly sensitive pick up the signal early in the culture of a problem. I believe the same nervous system that cost me decades of private suffering is the one built to notice what is broken, in a body, a marriage, an institution, before anyone else in the room has caught up. <\/span><\/p>\n My work is not to help highly sensitive women manage ourselves into compliance, it is to help us stop mistaking our own sensitive calibration for a malfunction and start reading it like the sacred data it has always been. That is cultural leadership, and it starts with the body you already have.<\/span><\/p>\n Share<\/span><\/p>\n I was not taught in medical training anything about sensitivity. What I now know is that sensory processing sensitivity, SPS, is a measurable, heritable architecture, not a personality quirk and not a polite word for anxious. It carries no DSM code and does not trigger a prescription pad. <\/span><\/p>\n SPS breaks into three parts: <\/span>ease of excitation<\/span><\/strong><\/em>, how quickly you get overwhelmed when a lot is happening at once; <\/span>aesthetic sensitivity<\/span><\/strong><\/em>, how deeply you get moved by music, art, or beauty; and <\/span>low sensory threshold<\/span><\/strong><\/em>, how easily strong input, bright light, loud sound, floods your system outright. [1]<\/span><\/p>\n An estimated one in four or five people you already know qualifies as highly sensitive. [1,2] <\/span><\/p>\n A landmark study using latent class analysis on hundreds of adults found the trait sorts into three groups rather than a simple high or low: dandelions, tulips, and orchids, meaning low, medium, and high sensitivity, with orchids landing around thirty-one percent of the sample. [3]<\/span><\/p>\n Most women score higher than men on nearly every SPS measure researchers have run. One study of over five hundred employees found a large effect size separating women\u2019s average sensitivity scores from men\u2019s. [4] <\/span><\/p>\n A separate analysis of nearly ten thousand participants confirmed gender as a significant predictor of who lands in the high-sensitivity group in the first place. [5]<\/span><\/p>\n Age changes the picture, and not in the direction most people assume. The subfactors tied to overwhelm, ease of excitation and low sensory threshold, the vacuum cleaner problem, decline across the lifespan, meaning younger adults carry more of the raw overstimulation. <\/span><\/p>\n Aesthetic sensitivity runs the opposite direction, climbing higher the older you get. [6] Children and adolescents show the same three-group structure adults do, with high sensitivity showing up in as much as a third of some samples, which means the parents of a highly sensitive nine-year-old are very often raising a highly sensitive nine-year-old without a single adult in the house having a name for what anyone is managing. [7]<\/span><\/p>\n If you are wondering if you are HSP, you can find the full <\/span>HSP quiz here<\/span>.<\/span><\/p>\n Here is where my own chart stops being a personal anecdote and starts looking like a pattern the literature has already documented.<\/span><\/p>\n Depression is the most consistently linked psychiatric comorbidity. High ease-of-excitation is significantly associated with developing depressive symptoms under stress, with real structural correlates on brain imaging. [8] In pregnancy specifically, this same vulnerability predicts perinatal depression on its own terms, not depression in general. [9] I had postpartum depression that nobody, myself included, ever connected to a nervous system trait. It would\u2019ve helped me to know it.<\/span><\/p>\n Anxiety and something close to trauma follow a similar line. In a study of adults surveyed a year after a mass collective trauma, high sensitivity significantly predicted both PTSD symptoms and somatization, and a secure attachment style did not protect against it. [10] That finding landed closer to home than I expected. My own version never crossed into a full PTSD diagnosis. It sat below the threshold, hypervigilance without a single flashback attached, which happens to be exactly the kind of presentation this population produces, sensitive enough to carry a trauma response without always checking every box a diagnostic manual requires.<\/span><\/p>\n Burnout<\/span><\/strong>… a study of more than 600 female speech-language pathologists found over three-quarters reporting moderate or high burnout, with highly sensitive clinicians significantly more vulnerable than their peers. [11] Related research found that ease of excitation specifically worsens burnout symptoms, while aesthetic sensitivity, that same appreciation for beauty, works the other way and protects against it. [4] I ran a full clinical practice while quietly burning out for years and called it a demanding job. The demanding job and the nervous system underneath it turned out to be two separate problems wearing the same coat.<\/span><\/p>\n Then there is <\/span>alexithymia<\/span><\/strong>, which translates roughly to <\/span>no words for emotion<\/span><\/em>. Picture an instrument with every gauge fully operational except the one telling you what any of it means. I could tell you with total precision what was happening in a woman\u2019s pelvis and take considerably longer to tell you what was happening in my own chest. Alexithymia shows up disproportionately in high ease-of-excitation and high low-sensory-threshold individuals and functions as what researchers call a transdiagnostic marker, present across a wide range of conditions, which is an academic way of saying a lot of us have spent years fluent in everyone else\u2019s feelings and functionally illiterate in our own. [1]<\/span><\/p>\n The physical toll is documented just as thoroughly and discussed far less. Highly sensitive adults report significantly more gastrointestinal symptoms, reflux, abdominal pain, indigestion, diarrhea, and constipation, even after controlling for the usual demographic suspects. [12] Constipation is the least glamorous item on that list and, in my own case, the most reliably present one, which I mention partly for the humor of it and partly because nobody puts chronic constipation on a vision board and it deserves acknowledgment anyway.<\/span><\/p>\n Dysmenorrhea<\/span><\/strong>, the clinical term for period pain severe enough to interrupt your actual life rather than the kind a heating pad and a stiff upper lip resolves, connects to this same architecture. A large study of women with dysmenorrhea found that a broader pattern researchers call generalized sensory sensitivity, combining widespread pain, interoceptive sensitivity, and environmental sensitivity, tracked closely with comorbid bladder pain, bowel pain, and overall pain severity. [13] My own history of adenomyosis, menorrhagia, and fibroids did not happen next to a highly sensitive nervous system by coincidence. Increasingly, I do not think it happened separately from it at all.<\/span><\/p>\n Underneath most of this sits an stress-response system running hotter than it should. Too much time spent in fight-flight-freeze-fawn. We are meant to spend about 90 second in fight or flight. Let me know in the comments if you want to hear more about this.<\/span><\/p>\n Sensory processing sensitivity predicts a decline in physical health specifically through perceived stress as the mechanism, [14] and newer research has found elevated cortisol, both the single saliva-sample kind and the hair-sample kind that reflects months of accumulated exposure, in high-SPS individuals. 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