Innov Clin Neurosci. 2025;22(7–9):28–31.

by Edmund G. Howe, MD, JD

Dr. Howe is with Uniformed Services University of the Health Sciences in Bethesda, Maryland.

FUNDING: No funding was provided for this article.

DISCLOSURES: The author declares no conflicts of interest relevant to the content of this article.

A small proportion of people are exceptionally sensitive to slights from others, and they might then heap shame upon themselves and even consider suicide. Often, however, these patients might also have a “gift” that their sensitivity to feelings concurrently provides them. They might be especially able to accurately infer the more subtle, underlying feelings of others and with this capacity connect with them in ways that most other persons cannot. However, these individuals might have no idea that their sensitivity is the strength that it is. They might regard their sensitivity as only a liability. Viewing this trait as an asset can change how they see themselves and, therefore, their quality of life. This article will address how therapists can reduce these patients’ sense of liability and enhance their ability to make maximal use of their sensitivity. Keywords: Sensitivity, resilience, shame, therapy, expectations

Therapists commonly encounter patients who fret, cry, and even entertain thoughts of suicide after they feel demeaned by a person whose judgments they value. They might be exceptionally sensitive to such slights and imagine themselves to be more negative than most others would.¹ As an example, a young man arranged a special evening for a couple to join him for dinner, and at the very last minute, they said that they could not make it. He then believed that he should be honest and told this couple that he had felt hurt. This couple then chose not to speak to him. This patient, in response, heaped shame upon himself and found it difficult to carry on necessary daily activities. He considered suicide. After such a slight occurs, some patients, like this example, often conclude that the fault lies wholly within themselves. Often, however, these patients might also have a strength and “gift” that is somewhat rare.² They might be especially able to accurately infer the underlying feelings of others. Their capacity to understand what others feel might be exceptional.³

This exceptional sensitivity might therefore be a strength, at the same time that it is a personal liability, though these individuals might have no idea that their sensitivity is the strength that it is. They might see only their vulnerability and regard this with shame. Having a therapist convey to them that their sensitivity is also a gift could be life-changing; they might never have conceived of this liability concurrently being a positive trait prior to a therapist’s suggesting this. Moreover, the change that they might undergo once they have considered this might enable them to see themselves in other ways, even as a different, positive, and admirable person. These patients might then feel positively toward themselves, despite having felt negligible self-esteem prior to this time. This new insight might change the overall quality of these patients’ lives, literally, in one session. The effect could be transformative, like the reputed “Aha!” experience. The sudden insight that what seemed to be just an eradicable flaw is also a gift could also be generalized to how they see other traits about which they have felt only shame. For example, they might say to themselves and their therapist, “Yes, now that I think of this in this new way, I realize that I do understand others and can put myself in their position and imagine what they are feeling particularly well and better, I believe, than most or at least many others.”³

A recent book⁴ reviewing this topic’s edge-of-the-field findings speaks of children who have this exceptional sensitivity as having a “secret advantage.” They suffer more than others in “toxic or otherwise negative environments,” the authors state, but they also benefit more than others in supportive environments. They call this heightened positive response the Sensitive Booster Effect.⁴

The therapist’s task in such cases is, of course, in part to help these patients become more resilient so that they can be less vulnerable and, at the same time, come to appreciate and possibly also further utilize this gift of sensitivity. Therapists should tell them this explicitly so that they too are aware of these goals.

Resetting Patient Expectations

An approach that therapists might pursue to help these individuals become more resilient is to help them set realistic expectations regarding others. They might need to consider that persons like the couple discussed above might not be people who understand others to the degree that they have presumed.⁵ Other people who have a greater or at least average capacity to understand may have much appreciated this patient’s sharing how he had felt with them and might even have thanked him for being willing to share this. Persons like the couple above, though, might simply judge them and tell them that they are too sensitive. This might then hurt these more sensitive people all the more. These patients commonly report that they experience this again and again.^6,7

If we consider more closely the example wherein the couple shunned the patient when he told them that he felt hurt, we might conclude that it was the couple who were limited in their capacity to understand. They might preferably, for example, have been aware of their own thoughtlessness in cancelling at the last minute, and in response to this awareness, apologize. Rather than acknowledging this to the patient, however, they blamed him, seeing his pain as his limitation rather than their own. People like the patient in this example might not imagine that others’ hurtful behavior stems from others’ deficits, not their own. This, then, is an additional and possibly new point that therapists should consider sharing with these patients.

I also suggest to such patients that they might want to consider with whom they want to risk sharing their deeper thoughts and feelings, knowing that these people might, in response, distance themselves from them. Many other persons, I suggest to them, might be warm and friendly at first; yet, if these patients share with these people exceptionally personal thoughts such as that they feel hurt, their pain might be too much for these others to bear and to be willing to expose themselves to further. Thus, their attitude of caring might then change. They might distance themselves emotionally and thereafter avoid the patient, much as the couple shunned the patient after he told them that he felt hurt. These patients’ responses might even evoke feedback cycles of ever stronger negative experiences.² Others withdrawing from them might also add to their low self-esteem.

As another example, consider a man in his early 20s whose parents had both died in a car accident. He initially tended to share this fact with most others even just minutes after he met them. He described how he continued to experience his pain of losing his parents. He did this, he said, because he sought to convey honestly how and who he then was. He noticed after a time, however, that most people often seemed to be uncomfortable after he said this. In all too many cases, he said, they later made excuses to avoid meeting with him.

Patients Learning How to Cope with Their Hurt

I also explore with these patients how they respond when they believe that others are rejecting them.⁸ They often respond to this question by spontaneously acknowledging that when their hurt is triggered, they can’t get relief from these painful feelings for an unbearably long time. I then suggest that their emotional response might be largely or completely outside their immediate control, at least when these feelings first occur. I do this to try to make it less likely that they will heap additional blame on themselves for not being able to better prevent these painful feelings from occurring or lasting as long as they do.

I also indicate that there are approaches they can take to try to reduce the intensity of these painful feelings in both the short- and long-term. Short-term endeavors include breathing more deeply and slowly, which should reduce their physiological reactions to stress. There are a host of other such endeavors I share that also can help, the most touted among them being exercise.

I may also tell them that their emotional responses are outside their control to reinforce that the amygdala and other parts of the brain can create emotions as if they function independently and on their own.^9,10 This helps, I believe, to reinforce the concept that our control of our emotions is limited. This hopefully also helps to reduce the unjustified shame they might feel, as when they respond well to an “Aha”-like experience. Later, I suggest that they could make a practice of purposely seeking to quantify the amount of emotional pain that they are experiencing at any one time and then asking themselves, with whatever degree of curiosity they can engender, how long their pain will stay before it diminishes. Their asking this question may distract them and force them to use another part of their brain, thereby potentially reducing the intensity and duration of their pain.

Clarifying How Sensitivity Is a Strength

In these discussions, I predominantly highlight several ways in which the patient’s sensitivity is a strength. This alone may allow them to reduce their vulnerability to feeling rejected and their shame. Therapists can use different examples to illustrate how their sensitivity is an uncommon strength, until these patients genuinely regard themselves as lucky that they have acquired this strength. Ideally, they might come to realize that they have this exceptional capacity, though they might not have trusted their intuition sufficiently to be able to see this beforehand.

I might add that others who are as exceptionally gifted as they are may choose to work with children or adults who are extremely withdrawn in some way because their exceptional sensitivity may equip them to be especially able to help these individuals by sharing their understanding; this might also help them feel less alone. However, I also make it clear to them that it is not my intent to leave them feeling that they should find some means of using their gift to help others who could benefit exceptionally from their help. Rather, I share, I want them to know that they have this gift so that they can better choose what they want to do.

Helping to Better How They Respond to Ambiguity

These patients, despite being lucky to have this sensitivity, might be miserable. They might feel that they are outside most others in society and thus feel painfully alone.² They might also see themselves as being rejected, even when this isn’t the case, thus adding to their pain. These patients might respond in this way to communications from others that involve ambiguity. I begin this discussion by noting that both words and actions can often be interpreted in more than one way. Patients who are exceptionally sensitive might be more likely than others to see these different meanings, and then assume that the worst meaning that they perceived is the one that applies to them; this can further lower their self-esteem. This response is particularly likely if they feel anxious or depressed. When this is the case, they might be more prone to seeing plausible negative meanings and then assuming that these negative meanings apply to themselves. This response is thus another source of their liability. Consequently, they should seek to learn how, as a habitual practice, to check whatever they initially infer. They can then better determine whether there are other meanings in what another has done or said. They might then find a more benign meaning that more likely applies to them.^2,11–13

Experiencing Their new Gratitude for Their Being So Lucky

These people have a gift, but this might not be mostly due to their effort and thus to their credit. I point out that some infants are calmer or cry more than others from the time they are born. I note that their genetic endowment might be a contributing factor, like athletes born with extraordinary natural gifts, whether or not they then choose to use and develop them. Their exceptional sensitivity, I tell them, might be associated with genes that may result in their having more of the prosocial hormone oxytocin; this might contribute to their being more socially sensitive whether the effect for them is positive, negative, or both.¹⁴

I discuss, too, how a parent or other people in their lives might have helped them acquire their sensitivity, and add that they might owe these people some thanks. Patients might respond to this comment by pointing out to me that they have a parent who isn’t so nice. I respond that having even just one caring parent or other person could be enough to convey this sensitivity and that their having another person in their life who is not so nice might, counterintuitively, enhance their sensitivity even more. This might occur because they then become more aware of how others may easily feel hurt.¹⁴

These patients’ strength and their liability could both be genetically fueled and acquired. I note this in part because their knowledge of these sources might reinforce their coming to see themselves as lucky rather than unfortunate due to having only a flaw. Their recognizing the sources of their sensitivity could help further their seeing it as a gift rather than only or mostly the liability that they previously have taken this to be.

I discuss in detail how lucky they are to have this gift. I outline how they might have an exquisite capacity to feel, detect, and respond empathically to others’ feelings.^14–16 I explain that many other people relate to others primarily by assessing or guessing what they are feeling based on logic. They put two and two together and respond accordingly, much as reasoning would provide them answers in math. Feelings, however, tend not to work in this way.^17,18 Persons so fortunate as to be able to intuitively sense when others are hurting, I explain, can respond in an altogether different way.

I often ask these patients to think of 10 people they know at least somewhat, then ask them to think of who among them they would most want their most vulnerable loved ones to be able to see when medically ill. Invariably, virtually all patients to whom I ask this question immediately come up with the person they would most want and trust to care for their loved ones. We then discuss building on this, the luck that this immediate insight implies.

The ideal Results of These Interventions

Patients’ responses after discussing all this might be remarkable. They might report no longer having the feelings of despair and hopelessness that previously permeated their existence. This change makes sense. Therapists have shared with them that they are most likely rarely gifted in a way that can also profoundly enrich their emotional life. Upon hearing this, some patients express great emotional relief. “I felt alone, before,” they might say, “but now, I no longer feel this way.”³

Ideally, these patients learn to confront themselves every time they experience hurt in response to what others say or do. This especially can be the case if they are able to have subsequent sessions that help them recognize to a still greater extent the subtle contexts in which their responses of feeling slighted can occur. For example, they might describe the behavior of others who have slighted them as “possibly” or “probably” demeaning. Therapists who feel certain that this behavior is demeaning can point out to these patients that they qualified this effect. Then, these patients might progressively gain ever-increasing additional insight as to how their feeling hurt can reflect others’ limitations, not their own. Therapists can remind them, too, that what they initially infer might not be the only truth or even a truth at all. Patients might also consider what deeper feelings they would want to risk sharing with others. By enabling them to interact with all persons with greater integrity, these patients might become more aware that their sharing “all” is not always necessary or preferable.

Therapists may recall times that they have felt hurt. If so, they can share this, thus further suggesting that this response is not so uncommon. These patients might then see themselves as still less qualitatively different from others. I often tell them that while basically we are all the same in this regard, they might simply have more empathy neurons than many others; this might additionally help these patients feel less alone. They might see themselves more as “normal” and not as different from others or outsiders. They might, for the first time, feel free of the emotional burden of feeling somehow deficient, relative to most other people.³

I also share my own experiences on what I do to lessen my pain when I seek to get through times when I, like them, do not know when or whether my emotional pain will go away. This helps convey in still another way that we and our patients respond in similar ways. Therapists are sometimes urged to always maintain an appropriate distance from their patients. While this might be best in some cases, it might be that in others this isn’t the best approach. It might be that with patients who are more sensitive, the opposite is more likely; these patients might be more able to take what a therapist says as the therapist intends. For instance, when the therapist acknowledges struggles they too go through, these patients might see this as their therapist expressing empathy and common responses, as the therapist intended.

The greatest outcome is that these patients might come to see their exceptional sensitivity as a gift that they can use, if they want, to benefit others.³ With this revised view, patients initially riddled by pervasive self-doubt might find that their quality of life has wholly changed.^4,19 Patients might respond in this way and change even after only one session.

Disclaimer

The opinions and assertions expressed herein are those of the author and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences or the Department of Defense. Neither I nor my family members have a financial interest in any commercial product, service, or organization providing financial support for this research. References to non-federal entities or products do not constitute or imply a Department of Defense or Uniformed Services University of the Health Sciences endorsement. This work was prepared by a military or civilian employee of the US Government as part of the individual’s official duties and therefore is in the public domain and does not possess copyright protection (public domain information may be freely distributed and copied; however, as a courtesy it is requested that the Uniformed Services University and the author be given an appropriate acknowledgement).

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