Dr. Elayne Daniels

Eating disorders are complicated in origin, presentation, and treatment. Observers see the physical and behavioral effects, if anything at all. But those who suffer, with or without an eating disorder diagnosis, have a complex mental and psychological experience that others don’t see. 

For Highly Sensitive People (HSPs) with an eating disorder, everything about the experience is magnified, intensified, and deeply processed.

That’s because the highly sensitive brain is wired for extra amperage in the very same areas responsible for processing, emotional feeling, and sensory sensitivity.

The price for this always-on responsiveness is the propensity for overstimulation and overwhelm.

When HSPs feel overwhelmed by the world around them, they may turn to their relationship with their bodies and food for comfort and control. This form of coping quickly becomes a dangerous cycle.

And nowhere is that more true than in Diet Culture.

For both HSPs and nonHSPs, an eating disorder is a way to cope with emotions.

Eating disorders can have a profound emotional impact. 

HSPs, with their heightened sensitivity to stimuli, already struggle with feelings of anxiety and stress. How, then, do they deal with receiving an eating disorder diagnosis?

HSPs: What they are, and what they’re not.

HSPs are NOT:

  • sensitive by choice.
  • sensitive because of weakness or lack of social skills.
  • sensitive because of introversion.
  • sensitive because of a mental illness or psychological aberration.

They live in ‘extra’ mode, as if their world is in high-def. They don’t choose it. Their hardwiring is just set up that way.

And, because most of the world isn’t familiar with high sensitivity, the onus of adaptation continues to fall on the HSP: Stop being so sensitive! 

And yes, this existence of “being misunderstood” — and pressured to be something s/he is not — plays into the eating disorders script.

High Sensitivity and personality types

In psychology, personality is usually understood according to the Big-Five model of personality traits:

  1. Openness to Experiences 
  2. Conscientiousness 
  3. Extroversion
  4. Agreeableness
  5. Neuroticism

Research on High Sensitivity (HS) and personality traits, however, has shown that HS can’t be explained entirely by this model.

Where does it have similarities, if at all?

Interestingly, only in two areas:

The first is Openness to Experiences (especially as it pertains to artistic interests, imagination, and emotionality). The second is Neuroticism (especially with regard to anxiety, vulnerability, and propensity to feel stress).

The Neuroticism is what dots the most i’s and crosses the most t’s. At least in terms of similarities, especially in the context of negative circumstances.

What does all this have to do with HSPs and their response to an eating disorder diagnosis?

A lot, actually.

Dealing with an eating disorder diagnosis: the impact of sensitivity.

The typical reaction when diagnosed with an eating disorder can vary greatly depending on the individual. 

Some common reactions include feelings of shock, disbelief, and shame. Denial of the illness’s severity and impact (or even its validity) is also common.

The difficulty of having an eating disorder starts well before diagnosis — for anyone.

But HSPs, by their very nature, are more vulnerable to eating disorders in the first place. And their response to diagnosis will most likely reflect the tendencies of their personal sensitivity. 

Remember, everything for HSPs is magnified and more intense.  They are especially sensitive to criticism and negative comments. Translation? “I don’t want to be judged. I hate being judged.” 

Fear of judgment makes them particularly likely to feel shame and guilt once their disorder is acknowledged and named. 

Receiving an eating disorder diagnosis can trigger a range of intense emotions in HSPs, including:

  • Disbelief: HSPs may be surprised to receive an eating disorder diagnosis. They may feel a sense of disbelief or confusion. A common reaction is something like, “I do not have an eating disorder! My symptoms aren’t severe enough.”
  • Shame: HSPs may feel ashamed or embarrassed about their struggles with an eating disorder, particularly given their heightened sensitivity and tendency to be self-critical.
  • Embarrassment: HSPs may feel embarrassed to discuss their eating disorder with others and fear the stigma that surrounds such conditions.
  • Guilt: HSPs may experience feelings of guilt, particularly if they believe they’ve caused harm to themselves or others as a result of their eating disorder. They may feel as though they have failed to maintain control over their eating habits. And this sense of failure can quickly swell to a belief that they are a burden to those around them.
  • Fear: HSPs may be afraid of the unknown and may feel uncertain about what the future holds.
  • Isolation: HSPs may feel isolated and alone in their struggles with an eating disorder. Especially if they’re reluctant to seek support from others.

Just as the reaction to an eating disorder diagnosis can vary greatly between HSPs and non-HSPs, it can also vary between HSPs.

For some HSPs, the diagnosis brings relief and validation. Finally there’s an explanation for the symptoms they’ve been experiencing. And a path toward treatment and recovery. 

They may feel a sense of hope and courage, knowing that they’re not alone and that there is finally a way to overcome their struggles.

For others, as discussed above, the diagnosis can be a source of shame and guilt. 

Another area of discomfort is the treatment process itself. HSPs are far more accustomed to and comfortable with being the givers of care, not the recipients of it.

It’s  difficult for anyone to seek help and make changes. But the HSP’s makeup is a perfect storm for the challenges of eating disorders and their recovery

HSP Biology: how the 4 pillars of High Sensitivity factor into eating disorders.

HSPs are born with a trait called sensory processing sensitivity.

Its 4 pillars, conveniently known by the acronym “DOES,” have specific characteristics that play into the HSP experience of eating disorders and their diagnoses:

  1. Depth of Processing:

    HSPs have keen awareness and are able to process information in greater detail than other people can. This depth of processing can be both a blessing and a curse.

    With regard to eating disorders, HSPs may have a heightened awareness of their own bodies and eating habits, allowing them to identify patterns and triggers that others miss.

    However, their depth of processing can lead to heightened self-criticism and a tendency to fixate on perceived flaws and imperfections. They may have an even more difficult time than non-HSPs seeing their own bodies in a positive light. This then leads to feelings of shame, guilt, and self-loathing.
  2. Overstimulation:

    HSPs are easily overstimulated by their environment. The demands of daily life can be overwhelming, causing HSPs to feel exhausted and burnt out.

    Overstimulation makes it challenging for HSPs with an eating disorder diagnosis to manage their symptoms. They may, for example, struggle to find the energy and motivation to maintain recovery.

    Additionally, HSPs may be more reactive to the effects of diet and exercise. This can intensify feelings of overstimulation and exhaustion.
  3. Empathy:

    HSPs often have high levels of empathy, which can be both a strength and a weakness in the context of eating disorders.

    On the one hand, HSPs may be more attuned to others’ emotions and experiences than to their own. While this helps them connect with others who are struggling with similar problems, it can distract them from their own self-care.

    On the other hand, HSPs may also feel guilty that their eating disorder is causing harm to loved ones and friends.

    Additionally, they may feel overwhelmed by the weight (pun intended) of their own emotions and the suffering of others. And this tendency makes them vulnerable to feelings of hopelessness and despair.
  4. Sensory Specific Sensitivity:

    HSPs are highly responsive to sensory input such as light, sound, touch, and taste.

    This sensitivity can play a role in the development of an eating disorder, as HSPs may become overly focused on the sensory aspects of food and eating.

    For example, HSPs may be preoccupied with the texture, flavor, or appearance of food. This could lead to a regimen of eating only certain types of foods.

    The sensitivity can also make it challenging for HSPs to eat in social situations. They may, for example, feel overwhelmed by the sights, sounds, and smells of food. The end result can be eating in isolation. Or not at all.

Differential susceptibility and eating disorders

The concept of differential susceptibility is the idea that some people may be more biologically or genetically susceptible to the effects of environmental factors, both positive and negative, compared to others. It has been applied in different areas, including the study of high sensitivity and eating disorders.

Research suggests that people who are highly sensitive are more susceptible to the impact of environmental stressors. 

They may be more likely to have symptoms of anxiety, depression, and other mental health issues as a result. 

They’re also more responsive to positive environmental influences, such as nurturing and supportive relationships. And they’re more likely than their non-HSP counterparts to benefit from them. 

In the context of eating disorders, differential susceptibility research suggests that some people may be more susceptible to the development of an eating disorder based on their genetic makeup or other biological factors. 

The increased susceptibility may be due to a heightened sensitivity to environmental cues related to body image and weight, for example.

It could also result from a greater susceptibility to stress and anxiety common for HSPs. (Remember the comparison of HSPs to the Big Five personality types?)

Overall, the concept of differential susceptibility highlights the importance of understanding individual differences in the way environmental factors influence mental health and behavior.

It also underscores the need for tailored and personalized approaches to treatment.

Despite these challenges, HSPs are highly resilient and resourceful.

What HSPs need to do after receiving an eating disorder diagnosis.

How can HSPs react better to an eating disorder diagnosis?

HSPs experience their inner and outer worlds intensely. As a result, their feelings of shame, guilt, fear, and isolation are “extra.” 

With support and strategies for managing emotions, HSPs can learn to cope and work toward recovery. 

By reaching out for support, practicing mindfulness, embracing emotions, focusing on self-care, and seeking professional help, HSPs can effectively manage their emotions and path to recovery.

The reaction to the diagnosis can be intense because HSPs deeply process information and emotions.

When they receive a diagnosis of an eating disorder, their entire world turns upside down. They may feel overwhelmed by the thoughts and emotions that come with the news and struggle to make sense of it all.

If you’re an HSP with an eating disorder, here are 5 common emotional responses you may have to a diagnosisand ways to respond more effectively:

  1. Emotional overwhelm: To better respond to intense feelings of shame, guilt, and fear, seek support. Friends, family, and mental health professionals can help you navigate your emotions.
  2. Sensitivity to criticism: In response to criticism and negative comments relating to your eating disorder, practice self-compassion. And remember that your worth is not defined by your eating disorder.
  3. Fear of judgment: We’ve already discussed the natural fear of judgment and being misunderstood that go along with being highly sensitive. Now, more than ever, it’s important to seek out supportive people who can provide a non-judgmental space. A place where you can talk about your experience and feelings.
  4. Struggle with change: Don’t be surprised if you have a difficult time adjusting to changes in habits and routines related to your eating disorder treatment. To better respond, focus on self-care and self-compassion, and reach out to others for support.
  5. Shame and guilt: You may convince yourself that you’re a burden to others because of your perceived failure to maintain control over your eating habits. But trust that you have people in your life who care about you, just as your natural empathy makes you care about others.

And here are some additional tips for managing intense emotions after an eating disorder diagnosis:

  • Reach out for support: Talking about your experiences and feelings can help you process and manage your emotions. You may find support from family, friends, mental health professionals, and/or support groups. But always seek someone who is able to listen to and validate your feelings and experiences.
  • Practice mindfulness: Mindfulness can be an effective tool for managing emotions, particularly if you struggle with overwhelm. It’s a powerful tool for bringing about a sense of calm and perspective.
  • Embrace your emotions: As difficult and uncomfortable as it can feel to step into your feelings, your high sensitivity actually benefits when you do. Embrace your feelings without judgment, and give yourself the gentle permission to experience and process them. Amazingly, doing so can both soothe and empower.
  • Focus on self-care: Prioritize your self-care by engaging in activities that bring you joy and relaxation. Gentle exercise, reading, and spending time outside in nature are all restorative choices.
  • Seek professional help: Professional help, such as psychotherapy, may help you manage your emotions and work through your eating disorder diagnosis.

    Research has shown that HSPs do better in therapy when their therapist is also an HSP or is knowledgeable about the trait.

Treating the HSP who has an eating disorder.

HSP treatment for eating disorders requires an approach that respects their sensitivity to stimuli. This can involve therapy, medication, and nutrition support.

Cognitive-behavioral therapy (CBT) has been shown to be effective to help HSPs identify and change thoughts and behaviors related to their bodies and food. 

With their innate depth of processing, HSPs may find CBT particularly helpful. 

On the other hand, they may find it unhelpful, serving to intensify an already overworked brain.

The “DOES” of High Sensitivity can actually be used to the HSP’s advantage in recovery.

HSPs don’t have to dig too deep to find the courage to move forward. Give them the motivation to get better, and make clear the benefits of the means, and they will rise to the task.

It may seem ironic that the same trait that predisposes HSPs to eating disorders can also be their hidden healing power. 

But that’s the beauty of embracing challenges with a shift in perspective. Relinquishing judgment – of self, of others – bestows a clarity of purpose and the ability to achieve it.

If you are an HSP dealing with an eating disorder diagnosis, remember to be gentle and compassionate with yourself. Setbacks, after all, are part of recovery, not an indication of failure.

If you are part of an HSP’s support system, remember that your ability to listen and validate means everything to the person going through eating disorder recovery.

An eating disorder diagnosis isn’t a label to be feared.

It’s a door opened wide with welcome and promise into the hope of recovery.

A shift in perspective really can change everything.

To read more about Disordered Eating, check out more blogs here.

To read more about Highly Sensitive People, check out more blogs here.

Dr. Elayne Daniels is an anti-diet, Intuitive Eating-certified psychologist, consultant, coach, and author specializing in eating disorders. She is passionate about helping people, especially HSPs, of all ages and genders recover and truly live their lives.

Contact her here to learn more. And, if you’re struggling with overcoming an eating disorder, this e-book might be useful.

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