If you’ve come across the idea of being a Highly Sensitive Person, you may have experienced the particular relief that comes when you finally find a description that seems to fit.
Perhaps you’ve always been unusually affected by noise, bright lights, smells or the texture of clothing. Perhaps other people’s moods seem to reach you before they’ve said anything. You notice things that other people seem to miss, think deeply about experiences long after others have moved on, and need considerably more time alone to recover after spending time with people.
You may have spent years being told that you’re too sensitive, or that you take things too personally. Perhaps you’ve instead come to see your sensitivity as one of your strengths: you’re perceptive, empathic, creative, thoughtful and deeply affected by music, beauty or the natural world.
I’ve written elsewhere about what that sensitivity is, and how much of it may trace back to your earliest relationships. This piece continues from there, looking at what happens when that explanation turns out not to be the whole story.
And then you discover autism, ADHD or AuDHD and find yourself recognising something else.
The sensory overwhelm sounds familiar. So does the need to withdraw after social contact. Perhaps you’ve always found changes of plan disproportionately difficult, spent years consciously working out how you’re supposed to behave socially, and struggled with all sorts of things that seem effortless for other people. Maybe you’ve become exceptionally good at appearing to cope, perhaps even becoming the person other people rely on, while privately finding ordinary life considerably more exhausting than anyone realises.
At that point, a reasonable question arises: am I highly sensitive, neurodivergent, or both? There isn’t always a simple answer.
In short: high sensitivity is a temperament, present in around a third of people, while autism and ADHD are classed as neurodevelopmental differences with formal diagnostic criteria. The two can overlap substantially, particularly around sensory overwhelm, but neither explains the other away.
High sensitivity, autism and ADHD can overlap, but they aren’t interchangeable explanations. High Sensitivity is generally understood as a temperament trait, while autism and ADHD are diagnosed as neurodevelopmental conditions. You can be highly sensitive without being neurodivergent, neurodivergent without identifying as highly sensitive, or both. Relational and developmental experiences can add another layer.
Why do HSP and neurodivergence look so similar?
The resemblance between High Sensitivity and neurodivergence isn’t imaginary. The psychological trait underlying the HSP description is usually referred to as Sensory Processing Sensitivity (SPS), and research does find areas of overlap between SPS and autistic traits.
But it’s also more complicated than saying that highly sensitive people are simply autistic people who haven’t recognised it yet.
Sensory Processing Sensitivity doesn’t describe a single experience. Research has identified several aspects of it, including becoming overwhelmed when there’s too much going on, physical sensitivity to things such as noise, light and texture, and a tendency to notice subtle details and be deeply affected by beauty, music and art.
A large twin study by Elham Assary and colleagues, for example, found that some of these aspects were more strongly associated with autistic traits than others. The association between high sensitivity and autism was stronger in relation to overwhelm and physical reactivity, while the tendency to notice and be moved by subtle or beautiful things was not associated with autistic traits in the same way (Assary et al., 2024).
This distinction is useful because it helps us understand why the descriptions can feel so similar without making them interchangeable.
You can be deeply affected by the world around you without being autistic. You can also be autistic and highly sensitive. And you can experience sensory overwhelm, social exhaustion and a need for recovery without already knowing exactly what accounts for them.
These aren’t simply different names for the same thing.
There is another important distinction. Sensory Processing Sensitivity is understood as a temperament trait: something that exists on a continuum across the population. It isn’t a diagnosis, and it doesn’t require a particular level of impairment.
Autism and ADHD, by contrast, are neurodevelopmental conditions which have formal diagnostic criteria. Understanding whether either forms part of your experience involves looking at your developmental history and at the ways these differences have affected your life.
So high sensitivity doesn’t, by itself, mean that you’re autistic or have ADHD. High sensitivity is not the same thing as autism or ADHD, although a person can be highly sensitive and neurodivergent at the same time. However, that doesn’t mean the choice has to be between two mutually exclusive explanations.
You might be highly sensitive and autistic. You might be highly sensitive and have ADHD. You might have AuDHD. You might have a sensitive temperament without being neurodivergent. You might also have a neurodevelopmental difference alongside a history of relational trauma or attachment difficulties.
For some people, several of these things are true at once. And this is where I think the question becomes more interesting than simply asking which label is the correct one.
When the HSP label doesn’t explain everything
Sometimes people come to therapy having understood themselves as highly sensitive for years, but with a growing sense that something is missing from that explanation.
Perhaps sensitivity explains why crowded places are exhausting, but not why changes to plans can be so difficult. Perhaps it explains why you notice other people’s emotions so readily, but not why you’ve spent your whole life consciously trying to work out what other people seem to understand intuitively about social situations. Perhaps you understand your need for solitude as simply being introverted, but you also recognise a much more pervasive history of masking, of monitoring how you’re coming across, suppressing natural responses and trying to appear as though and trying to appear as though everything is easier than it feels.
This matters particularly for people whose neurodivergence has been masked for much of their lives. Autistic women, for example, have often been missed in childhood and diagnosed only in adulthood. One reason is that the outward signs of autism can be quite different when someone has spent years learning to camouflage them (Bargiela, Steward and Mandy, 2016; Hull et al., 2017).
The old distinction that highly sensitive people are empathic and socially attuned while autistic people are not is much too simplistic. An autistic person can be extraordinarily interested in other people, highly empathic and very good at reading social situations.
What we cannot necessarily tell from the outside is how that attunement has been achieved. For one person, social understanding may feel relatively spontaneous. For another, it may involve years of consciously observing, analysing and imitating what other people seem to do naturally. Both people may look equally socially competent. The internal experience can be completely different.
This is one reason I would be cautious about dismissing the possibility of autism simply because someone is empathic, socially capable or apparently very attuned to other people.
And sometimes there is another layer
The confusion can run in the other direction too.
Sometimes someone may recognise themselves strongly in descriptions of autism, but when we look more closely at their history, we find that some of what they experience may have developed in response to what happened around them. This doesn’t mean that trauma or difficult childhood experiences ‘cause autism’. They don’t.
But sensitivity and environment interact in complicated ways. A recent study by Damatac and colleagues found that higher sensitivity was associated with greater autistic traits particularly among adults who had experienced threatening life events. In more supportive circumstances, sensitivity was instead associated with greater life satisfaction (Damatac et al., 2025). What this may mean for our therapeutic work is really important.
Imagine a child who is temperamentally sensitive and grows up in an environment that is frightening, unpredictable, emotionally unavailable or too much for the resources available to the family. That child may become exceptionally alert to other people’s moods. They may learn to monitor the atmosphere around them, anticipate what other people need, suppress their own needs, withdraw when things become overwhelming or become extraordinarily accommodating.
Some of those things can look, from the outside, rather like neurodivergence. But they may also be adaptations to relationship. Childhood adversity doesn’t usually arrive in neat categories. A frightening or chaotic home, a caregiver who is absent or overwhelmed, or a family under a strain the child has no way to understand can be both an environmental difficulty and a relational experience at the same time. Sometimes what looks like ‘sensitivity’ is partly temperament, partly neurodivergence, and partly what you learnt you had to do in order to stay connected to other people.
This is one reason I don’t find it particularly helpful to imagine three separate groups of people: highly sensitive people, neurodivergent people and people who have experienced relational trauma.
Real lives are rarely that tidy.
It’s perfectly possible for all three to apply to one individual. It’s true of me.
The same behaviour can have different meanings
One of the things that I’ve come to understand from my work as a psychotherapist is that the same behaviour can arise from very different experiences. You might be extremely attuned to other people’s moods because you’re naturally perceptive and empathic, or because, as a child, you had to know what mood someone was in before you could work out whether it was safe to relax.
Time alone might be what your nervous system needs to recover, or it might reflect a history of relationships that were exhausting or unsafe. Perhaps you find criticism intensely painful because you’re highly sensitive to emotional experience, or because you’ve spent years being told that you’re too much, too difficult, too disorganised or not trying hard enough.
And of course, these explanations aren’t mutually exclusive. A neurodivergent child can also learn to become hyper-attuned to other people’s reactions. A highly sensitive child may also be autistic. An autistic person can also experience attachment wounds. Someone with ADHD can spend years masking in response to being repeatedly told that they’re careless, lazy or not reaching their potential.
Sometimes there isn’t one underlying explanation waiting to be discovered. There are several threads, which have become woven together over time.
So how do you work out what is actually going on?
This is where my approach as a relational integrative psychotherapist differs somewhat from a quest to identify the correct label as quickly as possible. I’m interested in the labels because they can be useful. But I’m even more interested in your actual experience.
If you tell me that you need to be alone after spending time with people, we might become curious together about what makes social contact so depleting. Is it the sensory input? The effort of masking? The amount of emotional monitoring you’re doing? The difficulty of switching between different demands? Or something else? None of those questions has a single right answer; that’s the point. What matters is what you find when you look closely, not which category it belongs to.
This is also why the therapeutic relationship matters. We aren’t simply discussing an abstract version of you. We’re two humans together, paying attention to what happens as you describe your experience. Sometimes the way something feels in the room gives us information that isn’t available through explanation alone. For example, do you notice yourself becoming very concerned about whether I’ve understood you correctly? Maybe you find yourself apologising for taking up too much time. Perhaps you suddenly can’t find the words for something you seemed perfectly able to explain a few minutes earlier, or you realise that you’re telling me the version of the story that makes you look most competent.
None of these things proves anything. But they might be worth being curious about. This is one of the things I mean by relational therapy. We don’t simply look at what happened to you in the past or at the symptoms you have now. We also become interested in how you experience yourself and other people in the present, including in the relationship between us.
Why might it matter whether you find out?
If all of these things can overlap, you might reasonably wonder whether it matters what label you use. Sometimes it doesn’t. Sometimes it matters enormously.
If autism, ADHD or AuDHD forms part of the picture, assessment can provide an explanation for experiences that may have been misunderstood for years. It may also open up access to reasonable adjustments, community and a different way of understanding yourself and your past. For some people, self-identification provides a similarly important framework for understanding themselves.
Equally, understanding yourself as a highly sensitive person can be meaningful if that framework genuinely helps you make sense of your experience. And if early relational experiences have played a significant part, understanding those can also change the way you relate to yourself and other people. What is unhelpful is treating any of these explanations as a verdict on who you are.
There is something hopeful in the research on sensitivity, too. If some people are more responsive to their environments than others, that responsiveness isn’t necessarily only a vulnerability. The idea of vantage sensitivity suggests that people who are particularly responsive to their environments may also respond particularly well to positive experiences and psychological intervention (de Villiers, Lionetti and Pluess, 2018). In other words, being highly responsive doesn’t necessarily mean that you’re simply built to struggle. It may mean that the environments and relationships you find yourself in matter enormously.
What can relational integrative psychotherapy offer?
You don’t need to arrive at therapy with me already knowing whether you’re highly sensitive, autistic, ADHD, AuDHD, affected by early relational trauma, or some combination of these. You don’t need to have worked out which explanation is the right one. We can be curious about it together.
That might mean understanding how your nervous system responds to sensory and social demands. It might mean exploring the cost of years of masking or overriding your own needs. We might look at whether some of the things you struggle with are better understood as neurodivergent traits, as adaptations to relationships, or as a mixture of both.
We can also explore what happens in your relationships now: how easily you know what you need, whether you feel able to say no, how you respond to other people’s disappointment, and whether you find yourself taking responsibility for feelings that aren’t yours.
Sometimes there’s grief involved in this work too. You may look back and realise that something you had always considered a character flaw had another explanation. Or you may discover that something you had attributed entirely to neurodivergence also has roots in experiences of not feeling understood, accepted or emotionally safe.
That can be a complicated process.
My integrative training gives us different ways of approaching that understanding. Depending on what you bring, our work might involve paying attention to what’s happening in your body, exploring patterns in your relationships, working with parts of yourself that have developed around protection or adaptation, or using EMDR where past experiences continue to carry an intense emotional charge that hurts you in the present.
But these aren’t techniques applied to you from the outside. My starting point is always you: your experience, your history, what you need and what makes sense to you. The aim is to help you live well as yourself, not to make you less sensitive or more like everyone else. A label is only useful if it actually helps; it’s not the point of the work.
The type of relational integrative psychotherapy I practice aims to help you understand yourself more fully, including the ways your temperament, neurotype, relationships and life experiences have shaped you, so that you have more choice about how you live now. You don’t have to work all of that out before you begin.
If you’ve spent years wondering whether you’re just too sensitive, whether you’re neurodivergent, or whether there is something else going on that you haven’t yet found the language for, you’re welcome to bring that uncertainty into therapy.
I offer a free 20 to 30-minute initial conversation so that you can get a sense of whether my way of working might suit you, with no obligation to proceed beyond that.
Garthine Walker is a UKCP-registered psychotherapist based in Cardiff, offering online therapy across the UK. She specialises in trauma, attachment wounds, neurodivergence, burnout and maladaptive daydreaming.
References
Elham Assary, Olakunle A. Oginni, Genevieve Morneau-Vaillancourt et al. (2024). ‘Genetics of Environmental Sensitivity and Its Association with Variations in Emotional Problems, Autistic Traits, and Wellbeing’, Molecular Psychiatry, 29:8, 2438-2446. DOI: 10.1038/s41380-024-02508-6.
Sarah Bargiela, Robyn Steward and William Mandy (2016). ‘The Experiences of Late-Diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype’, Journal of Autism and Developmental Disorders, 46:10, 3281-3294. DOI: 10.1007/s10803-016-2872-8.
Christienne G. Damatac, Marleen J. ter Avest, Tom F. Wilderjans et al. (2025). ‘Exploring Sensory Processing Sensitivity: Relationships with Mental and Somatic Health, Interactions with Positive and Negative Environments, and Evidence for Differential Susceptibility’, Current Research in Behavioral Sciences, 8, 100165. DOI: 10.1016/j.crbeha.2024.100165.
Bianca de Villiers, Francesca Lionetti and Michael Pluess (2018). ‘Vantage Sensitivity: A Framework for Individual Differences in Response to Psychological Intervention’, Social Psychiatry and Psychiatric Epidemiology, 53:6, 545-554. DOI: 10.1007/s00127-017-1471-0.
Laura Hull et al. (2017). ‘“Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions’, Journal of Autism and Developmental Disorders, 47, 2519-2534. DOI: 10.1007/s10803-017-3166-5.