Sensory Processing Disorder And Its Link To Mental Health Disorders

Some individuals who suffer mental health disorders, like anxiety and depression, find little to no change in their symptoms with psychotropic drugs or psychotherapy. One likely possibility for this failure might be that these individuals have sensory processing disorder (SPD).

What Is Sensory Processing Disorder?

Sensory processing disorder (previously known as sensory integrative dysfunction) is a neurological condition that causes, drives, contributes and mimics many mental health disorders, ranging from anxiety to depression to obsessive-compulsive disorder to social anxiety, and that does not respond to psychotherapeutic interventions.

It is defined by abnormalities in the modulation and processing of stimuli that interferes with daily functioning. A common, but relatively unknown condition, it causes sensory messages to get scrambled in the brain, creating a “traffic jam on the sensory highway,” and one cannot make sense of or respond appropriately to their world.

Mental Health Co-Morbidity

SPD might be a predictor of one’s mental health. Many studies have found a correlation between SPD and mental health disorders.

Researchers Laura A. Harrison and her team at the Brain and Creativity Institute, University of Southern California have suggested an addition to the Research Domain Criteria (RDoC) of the National Institutes of Health.

They state: “The time is ripe to integrate burgeoning evidence of the important role of sensory and motor functioning in mental health within the National Institute of Mental Health’s [NIMH] Research Domain Criteria [RDoC] framework), a multi-dimensional method of characterizing mental functioning in health and disease across all neurobiological levels of analysis ranging from genetic to behavioral.”

Narrow Research Perspective

While such inclusion is well needed, there’s a paucity of research into SPD and mental health disorders because of a limited focus. Most studies done on SPD and mental illness have focused on sensory over-responsivity (SOR). SOR describes an aversive response to sensations that most people ignore, for instance a tap on the shoulder, a siren whizzing by, a bright light. These studies have been done largely with special needs children, particularly those on the autistic spectrum (ASD), for whom SOR is a common symptom and is virtually almost always accompanied by anxiety.

This is a shortcoming for several reasons: adults with SPD suffer mental health issues as well; the link between SPD and mental health issues exists as well in a neurotypical population; mental health issues suffered by adults go beyond anxiety disorders; all conditions associated with SPD are linked with mental health problems, not just SOR.

Adults, SPD and Mental Health

Children grow up and tend to not outgrow their sensory difficulties. A study done by Kibby Li McMahon and colleagues in 2019 investigated whether high symptoms of SPD in childhood may lead to high SPD symptoms in adulthood, which then lead to high emotion dysregulation, ultimately conferring vulnerability for an anxiety disorder diagnosis. Results suggested that childhood SPD symptoms were significantly associated with a higher likelihood of a lifetime anxiety disorder diagnosis through difficulties regulating emotion.

Other than a few studies on adults with sensory processing disorder and anxiety, there’s a paucity of research in this condition in adults and its link to mental health issues. This paper will demonstrate a wide relationship between sensory processing disorder in adults that cause, exacerbate, and contribute to mental health illness.

Neurotypical Population and Mental Health Problems Associated with SPD

While the research that has been done has focused largely on those on the autistic spectrum, this paper will demonstrate how many who, for the most part appear neurotypical enough to function well enough in the world to get by, suffer mental health issues related to SPD.

Full Range of Mental Health Issues Linked to SPD

Anxiety is far from the only mental health problem linked with SPD. In addition to anxiety disorders, this paper will examine depression, bipolar disorder, substance abuse, cutting, depersonalization and other mental health disorders as described by adult sufferers of this disorder.

All SPD Conditions Linked with Mental Health Issues

Sensory processing problems go far beyond sensory over-responsiveness. They include sensory under-responsiveness and sensation seeking to planning and executing movement, all of which this paper will demonstrate are associated with mental health issues.

SPD Signs

Over-responsive to Sensation

• Touchy about light touch, textures, clothing, ordinary affection
• Picky about food
• Bothered easily by noise, odors, bright light
• Fearful from movement, like elevators, escalators, roller coasters, going fast, or spinning
• Avoid eye contact

Under-responsive to stimulation

• Slow to get moving; tire easily
• Seem oblivious to environment
• Seek intense sensation, like loud noise, spicy food, strong perfumes
• Crave roller coasters and fast movement
• May not notice if cut or bruised
• Hard to get up in morning
• Thrill seeker, ignoring potential danger
• Seek stimulants -- caffeine, tobacco, cocaine
• Hyperactive & fidgety

Coordination Problems

• Clumsy, awkward, or accident-prone
• Poor balance
• Rigid & tense posture or floppy & slouching
• Jerky movements
• Poor fine motor coordination – sloppy handwriting

Underachiever

• Fail to work up to capacity
• Learning problems but normal intelligence

Poor Attention

• Distracted
• Driven
• Perseverate on small detail
• Unaware/spaced out
• Hyperalert, not processing
• Turned inward

Poorly Organized Behavior

• Disorganized, distracted, spacey
• Problem following directions or adapting to new situation
• Frustrated, aggressive or withdrawn when encountering failure
• Compulsive, obsessed
• Impulsive
• Rigid, controlling, short-tempered

Poor Self-Concept

• Feel weird, crazy, different & inept
• Feel we disappoint, anger & frustrate
• Feel “lazy,” bored, unmotivated, depressed

Emotional Instability

• Unable to unwind & self-calm
• Emotionally labile
• Emotionally flat
• Withdrawn, shy
• Explosive
• Inappropriately loud, silly, attention getting

Physiological Vulnerability

One reason for the correlation between SPD and mental health might lie in physiological vulnerability. A study done by Rosann Schaaf and Lucy Miller at the SPD Foundation investigated parasympathetic nervous system (PNS) functioning in children with SPD. They found significantly lower vagal tone in SPD children than in a typically developing sample. Vagal tone is directly related to the state of the vagus nerve, our largest cranial nerve. This nerve fiber is central to the “rest and digest” functions of the PNS and gives us inner peace. Those with low vagal tone have difficulty maintaining a calm, PNS state and handling emotions. This makes them more likely to suffer depression and anxiety.

Another study done by Owen and colleagues found a correlation between reduced white matter microstructure (mostly affecting the posterior cerebral tract) and abnormal sensory integration between individuals with SPD and typically developing children.

History Of SPD

Sensory processing disorder was first recognized and researched in the 1960’s by occupational therapist A. Jean Ayres, whose theories and work with learning disabled children pioneered the theories, research, and therapies for the field known as sensory integration. Ayres defined sensory integration as “the neurological process that organizes sensation from one's own body and from the environment and makes it possible to use the body effectively within the environment."

For over fifty years, pediatric occupational therapists, along with other professionals have evaluated, treated, and researched special needs children with sensory processing problems. Nevertheless, SPD is not included in the Diagnostic and Statistical Manual of the American Psychiatric Association. This exclusion has happened because controversy exists over whether SPD is a distinct disorder or if abnormal sensory processing is a characteristic of other disorders, like autistic spectrum disorder.

Causes Of SPD

SPD results from an insult to the nervous system. Trauma is a major cause and can happen from prenatal insults, birth complications, prematurity, and trauma in the early weeks of life.

In others, later trauma to the nervous system such as head or brain trauma creates sensory processing problems, as does post-traumatic stress disorder (PTSD) when people become constantly hyper-alert and sensory over-responsive.

In some cases, genetics plays a part. One study looking at twins found similar tactile and auditory over-responsivity.

Our Eight Senses

To understand SPD and its relationship to mental health disorders, we must first explore our EIGHT senses and how each can cause, contribute, or exacerbate mental health disorders. We both receive and perceive sensory input through sight, sound, touch, taste, smell, movement and balance, body position, and muscle control.

• Vestibular. Located in the inner ear, this system keeps us balanced and coordinated.
• Proprioception. Our internal sense of body awareness, this sense helps us maintain posture and motor control. It also tells us about how we’re moving and occupying space.
• Interoception. This sense tells us what’s happening inside our bodies, for instance, whether we are hot or cold, tense or relaxed.
• Touch
• Sight
• Hearing
• Smell
• Taste

Vestibular/Sense Of Balance

Residing in the inner ear, the vestibular apparatus governs balance (gyroscope), orientation (compass), and movement to orient us in space as we move against gravity, automatically and without thought. It enables us to know where our bodies are in space, feel gravitational security so we feel in control of our movement, and to have a tripod for a stable visual field.

Signs Of Vestibular Dysfunction

A poorly functioning vestibular system is a frequent symptom of SPD and causes havoc. One might experience dizziness, lightheadedness, loss of balance when changing head position, abnormal eye positions when standing or laying in certain positions, dizziness, and nausea when eyes are closed, or car sickness.

Closing one’s eyes to fall asleep can feel frightening and some will suffer insomnia. After falling asleep some have reported nightmares related to falling, floating, and spinning.

The experience profoundly impacts daily functioning. Emotionally, one might suffer low self-esteem, loss, sadness, depression, frustration, desperation, anger, fear, and even hostility. Mentally, one might feel confused, disorganized, spacey, and unable to remember, and have phobias and even disassociation.

Space Related Phobias And Vestibular Dysfunction

The following space phobias might be related to vestibular dysfunction:

• Claustrophobia
• Fear of flying
• Fear heights, enclosed spaces or wide open vistas
• Fear falling, especially on uneven surfaces
• Dislike bending upside down or having head backward
• Dislike rapid, sudden, or rotating movements

These space related fears are likely to come from hypersensitivity to movement or gravitational insecurity, a severe reaction to change in head position, especially sudden. Gravitational insecurity creates dizziness, vertigo, light-headedness, or nausea, along with fear and anxiety as the slightest movement registers in the brain as “Falling!”

Such fears can start with or escalate to panic attack as vestibular dysfunction involves the same symptoms as panic attack:

• Disorientation
• Dizziness
• Lightheadedness
• Vertigo
• Depersonalization
• Floating sensations
• Imbalance
• Falling
• Nausea

Not knowing how to control what is happening, one might experience panic attacks in many different places. Phobias multiply and become pervasive. Some people might anticipate having a panic attack when venturing out the door and become agoraphobic, the most crippling phobia, where one becomes housebound.

Proprioception

Via receptors located in our joints, muscles, tendons, and ligaments, proprioception gives us our sense of body position and body awareness, our “place in space,” so we can coordinate movements without having to use vision, for instance buttoning our blouse.

Proprioception grounds us so we can feel our edges and know where our body ends, and the world begins. Such body awareness enables us to move in the world and be part of it, and yet have boundaries so we don’t loose ourself. Feeling a solid, strong physical presence in relationship to the earth translates into emotional security and confidence and lays the foundation for psychological self-awareness.

Proprioception and Serotonin

Our grand modulator, proprioception has a neuromodulatory effect on the central nervous system, meaning it can either facilitate or inhibit neural signals. When we are overstimulated, it calms us; when we are lethargic, it revs us up.

Such balance and stability from proprioceptive input comes in large part because input into our joints and muscles increases the neurotransmitter serotonin, the feel-good hormone. Serotonin influences mood, passivity, anger and aggressiveness and sets the firing level for all other neurotransmitters to help keep brain activity under control. For instance, serotonin can interfere with dopamine, our pleasure-seeking neurotransmitter that taps into the brain’s reward “opiate” system and allows us to experience passion and pleasure. When the brain has too little dopamine, one craves food, sex or stimulation, feels unsatisfied, becomes depressed and is unable to focus. When the brain has too much dopamine, one is driven toward non-stop pleasure seeking, the basis of obsessions and addictions. Researchers suspect that high dopamine leads to mania in those who are bipolar. Serotonin keeps this extreme behavior in check. An increase in serotonin also causes natural melatonin to be released in the brain creating even more tranquility and better sleep.

Poor Proprioception

Poor proprioception is a marker for sensory processing problems. It manifests as a loss of key information about how much tension the muscles need for good muscle tone. Unsure what muscles one is using to do what is necessary, the person feels clumsy, disconnected, uncoordinated, disjointed, and unsure of footing. In the dark or other times when the person can’t rely on vision, they feel afraid.

Not knowing where their body ends, and the other’s body begins, they seek pressure into their skin to find their edges. In the extreme, the person will feel shut off from their body and slightly numb. Emotionally, they merge with the other to feel whole and dependency characterizes their relationships.

Proprioceptive Modulation Problems

If a person is sensory over-responsive (SOR) to proprioceptive input, they will be clumsy, bump into things, move stiffly and lack coordination. If they are sensory under-responsive (SUR) to proprioceptive input, they will overly seek affection, crave bear hugs, and often invade the other’s space. Some SURs will grind their teeth throughout the day and night for jaw input, overeat, crack their knuckles, and even behave aggressively, especially as a child.

Interoception

Nerve endings are connected to our internal organs that send signals to the brain allowing us to interpret inner physical states. This enables us to know if we are hot or cold, hungry or satiated, alert or fatigued, tense or relaxed, needing to urinate or defecate, in pain or just experiencing uncomfortable sensation. Called interoception, this process enables us to sense the physiological condition of the body and to regulate that internal state. It includes a range of sensations such as pain, temperature, itch, tickle, sensual touch, muscle tension, stomach discomfort and intestinal tension.

According to Antonio Damasio, the “core self” is the summation of extero- and interoceptive stimuli that form the experience of the self as one integrated entity. Such awareness gives us the opportunity to stop and reset to maintain homeostasis, our balanced state. This in turn fosters better sensory modulation and translates into more adaptive and functional behavior. Ultimately, a more integrated and solid sense of self emerges, more cohesive and coherent in time and space.

Under And Over-Responsive

Poor interoception has been related to mental health issues like panic disorder; depression and generalized anxiety disorder (GAD).

In the under-responsive, low muscle tone (discussed later) causes people to fail to notice changes in breathing, heart rate, muscle tension, pain and proceed blindly. This lack of awareness not only disconnects them from their bodies but can result in one failing to take the necessary actions to calm, balance, and reset when destabilized. This puts them at risk for depersonalization.

The over-responsive to sensations out in the world are also more sensitive to internal cues, like a pounding heart, churning stomach, tickle (tactile over-responsive find tickling highly aversive), and tense muscles. Not surprisingly, anxious individuals tend to show increased interoceptive sensitivity and this might distort their perception of their bodily experience and contribute to excessive anxiety and depression.

Tactile Sense

Emotional security starts with the sensations of warmth and deep pressure from the tactile sense. These sensations create a chemical buzz of hormones and neurotransmitters in the limbic area of the brain, the seat of emotions, and create pleasure. These neurotransmitters include serotonin, dopamine, and oxytocin, the “cuddle” hormone that makes us feel attached to someone and that is released by dopamine during touching.

If a person lacks sufficient loving touch, they might experience skin hunger that drives them to hunt for ways to get intense pressure into their bodies. Some will sleep around to get hugs, engage in abusive sex, and even slash themselves as cutting provides extreme skin pressure to confirm their existence.

Under And Over-Responsive

If a person is tactile over-responsive, also described as hypersensitive, or tactile defensive, they find ordinary touch aversive. Some will cringe when cuddled, kissed and lightly touched, especially from a stranger. Depending on degree of sensitivity, they respond to light touch with annoyance to panic.

If a person is tactile hypo-sensitive, they under-register sensation and miss out on tactile information. To get more sensation into the skin so they can better tune into the world, they might wear tight clothes with rough, fuzzy, or uneven texture and much jewelry. Many don’t get cold easily and have a high pain tolerance. In fact, some might enjoy pain for its intensity and adorn their body with tattoos and piercings. In the extreme, some will be self-abusive, banging their head, pulling out their hair, cutting their skin, and seeking and enjoying rough or abusive sex.

Oral/Motor Dysfunction

Tactile receptors in the mouth can also be under or over-responsive to sensation.

Over-Responsive

If a person is hypersensitive to oral/motor input, they are likely to be a picky eater with extreme food preferences and limited food choice. During adolescence some might appear anorexic. They might be extremely fearful of the dentist, and dislike toothpaste and brushing teeth. Kissing tickles and they might withdraw from their partner, creating relationship problems.

Under-Responsive

If someone is hyposensitive to oral/motor input, they are driven by the need for oral/motor input. Many overeat.

Vision

A common symptom of those who are sensory over-responsive is photophobia or light sensitivity, a hidden and undiagnosed mental health trigger that causes many mental health issues.

Anxiety: Harsh or overwhelming amounts of light can cause anxiety. This is especially common with fluorescent lights as they contain certain colors or color distortions, as well as pulsing vibrations that make older lights buzz and flicker, all of which stress the body’s nerve endings and confuse and overwhelm the nervous system. Fluorescent lights in the workplace, gym, classrooms, and supermarkets cause some people to feel quickly drained, spacey, agitated, and anxious.

Social Phobia: In social settings, bright lighting will render some sensitive people unable to make eye contact and they seem socially phobic.

Agoraphobia: In public places bright lights might be the fear finger that pushes the panic button.

Fear of Driving in the Dark: Driving at night for the photophobic is a nightmare as the bright street headlights of oncoming cars, especially on highways, scream at them. Under stress fear may escalate to panic.

Hyperactivity: Bright lighting and fluorescent lighting in classrooms causes or contributes to hyperactivity, something that has been documented for over thirty years.

In 1973, light therapy pioneer and photobiologist John Ott, and the Environmental Health Research Institute compared the performance of four first-grade, windowless classrooms in Sarasota, Florida, under full spectrum, radiation-shielded fluorescent light fixtures, that emit the full range of the sun’s colors, or the standard cool-white fluorescents. Under cool-white fluorescent lighting, some students demonstrated hyperactivity, fatigue, irritability, and poor attentions. Under exposure to full-spectrum lighting for one month, the student’s behavior, classroom performance and overall academic achievement improved markedly. Several learning-disabled children with extreme hyperactivity calmed down and seemed to overcome some of their learning and reading problems. Since then, other studies have found similar results.

How Anxiety Affects Vision

Vision is often affected by anxiety. The adrenaline released by anxiety dilates the pupils. When the pupils are dilated a person may experience any number of symptoms:

• Brighter lights and light flashes

• Blurry vision

• Tunnel vision

Sound

How one perceives and interprets sound can cause anxiety. One study found altered auditory information in youth with obsessive-compulsive disorder.

Auditory Over-Responsiveness

Many people in our noisy modern society feel irritated and easily bothered by loud or jarring noise. This does not mean they are auditory over-responsive. Those who are behave in an extreme fashion.

The problem exists widely in the SOR. They will pick up sounds that others don’t hear, like the whirring of fluorescent lighting, and become unnerved by noise most people tune out and tolerate, like air-conditioning running. Sudden noise, and ambient noise like people chattering or chewing, sniffling, or coughing bothers them acutely. High frequencies like voices, certain speech sounds, a ringing telephone, or low frequencies like a lawn mower, air conditioning, or vacuum cleaner will send them into overload.

Auditory Discrimination Problems

Some people with sensory processing disorder have a problem listening, perceiving, and processing language or sound. This happens because the vestibular system in the inner ear is malfunctioning and auditory input drifts or scrambles. The brain interprets the auditory input slowly or misinterprets it, though hearing may be normal.

This causes many problems including:

• Confusion and misunderstanding what is said, or hearing things that weren’t said.
• Blending foreground and background noises.
• Over-responsiveness or SUR to sounds.
• Trouble articulating thoughts verbally or in writing.
• Problem filtering out other sounds while conversing and attending to what the other is saying.
• Slow responding to questions. Failing to respond when called; in school, their mind goes blank when called upon even if they know the answer.

• Failing to understand or follow two sequential directions at a time and freeze when someone asks them to please pass the salt and pepper.
• Talking out of turn or "off topic", causing people to accuse them of not paying attention and getting misdiagnosed with attention deficit disorder (ADD).

Smell

Smell is our primordial sense, protecting us from imminent danger like smoke or rotten food.

Though everyone has smells they love and smells they hate, those with sensory processing disorder react intensely to smells others will easily ignore. They might be bothered or nauseated by cooking, bathroom and/or perfume smells, refuse to go places or be with people because of smells, and choose foods based on smell.

In her book Sensational Kids, Lucy Miller reports how in her laboratory she found that smells that are generally not offensive, such as wintergreen, citrus and mint can set off an alarm response in children with olfactory over-responsivity that she measures physiologically. Something as benign as milk can trigger sweating, an increase in heart rate, shallow breathing, and other physiological reactions that are normally seen in the presence of a real danger, such as a snarling dog.

SPD Subtypes

Sensory processing disorder gets played out in different ways:

• Sensory Modulation Disorder (SMD)

• Sensory Discrimination Disorder (SDD)

• Sensory-Based Motor Disorder (SBMD)

Some experience problems in only one area, typically sensory modulation, others experience problem in all areas.

Sensory Modulation Disorder-SMD

Sensory modulation is “the capacity to regulate and organize the degree, intensity and nature of responses to sensory input in a graded (ability to separate irrelevant stimuli from meaningful ones) and adaptive manner. This allows the individual to achieve and maintain an optimal range of performance and to adapt to challenges in daily life.”

Those who suffer sensory modulation disorder lack the ability to turn up or turn down the volume of sensory input and focus on and respond appropriately to relevant sensation.

Some people under- or over-react strongly to sensation and the response guides their behavior and interferes with normal functioning. These people are unable to easily stay alert and focus on a task or wind down. They have a sensory modulation disorder, or SMD.

Let’s break this down further.

• Sensory Over-responsive (SOR): Some people strongly avoid input from one or more of the senses and are called “over-responsive” or “sensory defensive.”
• Sensory Seekers/Cravers (SSC): Some people strongly seek input from one or more of the senses in a disorganized manner and never seem satisfied and continue seeking input. They are termed “cravers.”
• Sensory Under-responsive (SUR): Some people strongly ignore input from one or more of the senses and are termed “under-responsive.”

Constant misinterpretation of sensation gives rise to extreme behavior in order to get to the comfort zone, where the person feels neither anxious/threatened nor bored/oblivious. The result is a slew of psychopathological conditions, from anxiety and depression to mania and substance abuse that SMD mimics, exaggerates, or results in.

Sensory Over-Responsiveness/Avoiders

We take in sensory information through our eyes, ears, inner ears, muscles, joints, and skin. Once registered, we integrate, modulate, analyze and interpret those sensations for immediate and appropriate functioning.

In the typically functioning adult, this generally happen spontaneously and appropriately. Someone taps us on the shoulder, and we turn around to see who that person was. A siren whizzes by and we ignore it.

Those with sensory over-responsiveness (SOR) (also referred to as sensory defensiveness, hyperarousal, and sensory-processing sensitivity), a common symptom of SPD, feel irritated by sensations that most ignore. For instance, they may interpret a light stroke on the shoulder as an attack and become anxious, hostile, or aggressive and spontaneously flinch, withdraw, or lash out. After the irritation has passed, they fail to return to baseline quickly and remain at red alert. Itchy tags may be unbearable. Loud music maddening. Perfume sickening.

A caveat. Sensory over-responsiveness is not the same as sensory-processing sensitivity which is defined as a temperament trait underlying individual differences in personality development and involving a tendency to perceive internal and external stimuli at a lower threshold, and to be more easily affected by those stimuli.

Because the SOR feels constantly hyped, stressed, and agitated, life feels like a constant emergency; anxiety is omnipresent. In fact, anxiety is so strongly aligned with sensory over-responsiveness that some have proposed SPAD (Sensory Based Anxiety Disorder) as a secondary disorder as it so often comes about as a result of living with SPD. In those with severe sensory over-responsiveness, anxiety might lead to panic attacks.

Such constant sensory assault leads to a slew of mental health illness, especially anxiety and often depression, documented in many research studies. Over time, chronic, unrelenting, and uncontrollable stress keeps their bodies flooded with stress chemistry and locks them into a hyper-vigilant, self-protective stance.

By adolescence, the SOR will typically have been referred to as anxious, phobic, depressed, compulsive, hostile, aggressive or controlling. By adulthood many will probably have been in therapy for anxiety, fears or depression. Studies with samples of university students have consistently reported the positive correlation between SPS and depressive symptoms. Many report having taken tranquilizers and antidepressants, some have used betablockers for panic, and some report of engaging in alcohol and recreational drugs to self-calm.

Mild to Severe SOR

Determining the depth and scope of psychopathology involves determining the degree of hypersensitivity experienced by the individual, and ranges from mild to severe.

The mildly SOR feel irritated by many clothing textures and toss and turn at night to the sound of a dripping sink. Nevertheless, life seems manageable, though many will report suffering mild psychiatric symptoms like generalized anxiety.

The moderately SOR feel bombarded by discomforting sensations and live hyper-alert and frazzled. Anxiety and undue stress diminishes their ability to interact with the world. They suffer many mental health issues and are likely to be on or to have been on psychotropic medication.

The severely SOR suffer hair-raising sensitivity to barely noticeable stimuli like a gentle touch or sudden noise; minor sensations, like the phone ringing can quickly send them over the edge. Functioning is greatly compromised, and psychopathology is obvious, pronounced, and acute. They are extremely likely to be or to have been on psychotropic medications. Those on the autistic spectrum often experience severe SOR and severe anxiety that leads to panic.

Self-regulation is the processes that influences which emotions we have, when we have them, and how we experience and express them. In both the moderate and severe SOR, repeated sensory overload makes self-regulating emotions terrifically challenging. As a result, negativity defines their being.

Shy/Feisty

Avoiders fall into two categories, depending on energy level (high/low) and attempted control of sensory overstimulation (passive/active):

Shy: low energy/passive sensation avoidance. Some avoiders are shy/introverted and fearful. In order not to make waves and draw attention, they passively avoid sensation by fleeing or withdrawing, for instance by not making eye contact and leaving the noisy party early.

Feisty: high energy/active sensation avoidance. Other avoiders are feisty, possessing high energy. They tend to be edgy and look and act hyper and wired. They actively avoid sensation by fighting; in a restaurant they will complain the music is too loud and the lights too bright and demand to sit somewhere quiet and dim. Emotionally unregulated, many appear fussy, stubborn, negative, intense, and uncooperative and can be difficult and hard to be around.

See-Sawing

Some people see-saw, showing SOR to some sensations and sensory seeking to others. For instance, one might be touchy but love roller coasters. One might be shy with some people but feisty with others.

SOR Psychopathology

SOR creates a constant state of hyper-alertness, agitation, stress, and anxiety. These discomforting states intensify unpleasant emotions and lead to extreme and often uncontrollable behavior. As a result, sufferers manifest a broad range of psychopathology, the depth and scope of which is determined by the degree of hypersensitivity.

Adjustment Disorder

Constantly hyped and hyper-alert, the person with SOR often feels perpetually agitated, tense and stressed. Consequently, they cope poorly with stress and life transitions, such as marriage, divorce, childbirth, changing jobs and so on, and experience adjustment disorder.

Anxiety

Generalized Anxiety Disorder (GAD)

Easily overwhelmed, hyped, and stressed, the SOR experience constant muscle tension, fidgeting and restlessness, irritability, angry outbursts, sleep difficulties, concentration difficulties and fatigue — symptoms generally used to describe people with GAD. The more severe the SOR the more severe the person’s anxiety and the more quickly they go over the edge.

Several research studies conducted by occupational therapist Moya Kinnealey of Temple University support a strong relationship between SOR and anxiety in all age ranges.

Phobias & Panic Attack

Starting at the moderate level, SORs commonly experience phobias. Glaring light, over-stimulating eye contact, sudden touch and other people’s odors might overwhelm them to where they must disengage from social contact, and appear to be socially phobic. Feeling intense pain, some will freak out when getting an injection and suffer needle phobia.

Space related phobias occur in some from faulty vestibular integration. The person gets easily destabilized from movement experiences like elevators, escalators, roller coasters, going fast, or spinning, and might panic. If SOR becomes severe, touch, loud noises or bright lights alone will trigger panic.

Panic Disorder

Panic disorder (PD), is a type of anxiety disorder that is characterized by recurring unexpected panic attacks with symptoms such as heart palpitations, dyspnea, paresthesias, dizziness, and derealization. Hypervigilance to body symptoms is characteristic of PD. Some theorize that interoception is central to the disorder, with individuals with PD experiencing increased interoceptive sensitivity.

Social Anxiety

Social anxiety is a condition where social interactions cause irrational anxiety. The SOR experience social anxiety frequently for several reasons. For some, social interactions are overstimulating because of discomforting touches, smells, noises (loud laughter), and eye contact. Further, those suffering from SOR often feel different from others, and fear being rejected.

Post-Traumatic Stress Disorder

Severe SOR can overload a person and result in them going over the edge into shut-down, where they become numb and tune out the world. This might happen because many experiences are connected in memory with irritation, annoyance, distress and even pain. Consequently, many live essentially in a state of PTSD.

Conversely, PTSD is strongly associated with hypervigilance and SOR. Any trauma to the nervous system can create sensory over-responsiveness. Hyperarousal, having a lower sensory threshold is one of three criteria to define post-traumatic stress disorder. An APA article entitled Neurobiology of Posttraumatic Stress Disorder stated that “disturbances in sensory processing are believed to play a prominent role in the hyperarousal symptoms of PTSD such as the exaggerated startle response.”

Further as we know, people with PTSD often experience flashbacks of the traumatic event they experienced, and at times these flashbacks are triggered when their senses are overwhelmed.

In other words, sensory over-responsiveness may result from, cause, or contribute to post-traumatic stress disorder.

Agoraphobia

Easily overloaded in public places, the moderate to severe SORs can go over the edge from sensory overload and have a panic attack. To avoid another attack, some bury themselves in their home and appear agoraphobic. Agoraphobia is a serious disorder in which the person fears harm in open spaces, away from the security and safety of home and known people. The SOR can also become reclusive because home is the only place where they can reasonably control sensory input.

Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder is characterized by obsessions - recurrent and persistent thoughts, and compulsions - repetitive behaviors or mental acts performed to avoid anxiety, that cause distress, are time-consuming, and/or impair functioning.

SOR is prevalent in those with OCD. Tactile defensiveness can make certain sensations on one’s hands, like dirt or anything gooey or sticky acutely aversive and the person may wash hands constantly, wear gloves when preparing meals and obsess over getting dirty. These behaviors result in a misdiagnosis of OCD.

Likewise, some people might engage in rituals like repetitive rocking or counting as a distraction and to lower arousal levels. Repetition boosts serotonin in the brain to regulate mood and balance neurochemistry.

Ordering objects is a common compulsion for those on the autistic spectrum. Keeping things in order creates predictability that gives the SOR more control and influence over their immediate environment, clothes, food and activities enabling them to be more open to other issues.

In a study done by Eric Rieke and Diane Anderson, reported in the American Journal of Occupational Therapy in 2009, 51 adults with OCD were observed relative to a normative adult population. Adults with OCD scored higher than the average on sensory over-responsiveness and sensation avoiding as indexed by the Adolescent/Adult Sensory Profile (AASP).

Substance Abuse

To create a steady flow of pleasurable vibes and blunt feelings of tension, anxiety, and frustration, as well as to blunt the senses, the moderate to severe SOR might develop an addiction to controlled depressive substances, like alcohol or tranquilizers.

Mood Disorders

Depression

Lonely, anxious, stressed, fatigued, unable to sleep or find comfort in cuddling, those with SOR may become depressed.

The extreme stress associated with SOR also depletes serotonin, the mood regulating neurotransmitter. Add to this a profound lack of control in one’s life, a person's despair of getting what they want creates learned helplessness that one drags through life. The more severe the SOR, the more one feels out of control of their destiny and the deeper the depression.

The restrictions a person feels compelled to impose to avoid overstimulation also dampen mood. For instance, one might like cloudy days because they are light sensitive. They might stay home to avoid the overstimulation of crowds, noise, bright lights and people, resulting in alienation from others. Perhaps worst of all, if one is tactile over-responsive, intimate contact might be uncomfortable, interfering with close human connection.

Bipolar Disorder II

Bipolar II is characterized by hypomania (less severe than mania) and depression without psychosis.

SOR can mimic bipolar disorder. In some who are severe SOR, sensory overload can cause impulsive, frantic, aggressive, and even violent behavior and in turn the person appears manic. When they cannot escape the overload, they shut down and appear depressed. At the severe level especially, they vacillate from meltdown (mania) to shutdown (depression).

Some may suffer both Bipolar II and SPD; others may get their sensory issues misdiagnosed as depression and mania and benefit little if at all from psychiatric drugs or therapy.

Auditory processing problems are common in bipolar disorder. Writes Mitzi Waltz in Bipolar Disorders: A Guide to Helping Children and Adolescents, “…These patients will describe many normal sounds as affecting them like fingernails scraping a blackboard…” And not just auditory defensiveness. Waltz believes that under- or oversensitivity to smell, taste, texture, types of touch, and movement are more common than the literature discusses, and change depending on the current stage of the bipolar cycle. During a manic phase, heightened sensitivity may be experienced as pleasurable or in some cases painful.

Bipolar children are especially hypersensitive and in a depressed-irritable state, writes Waltz. In fact, the Juvenile Bipolar Research Foundation describes symptoms of SOR, or hypersensitivity as item five of the “Core Phenotype-Research Diagnostic Criteria” for juvenile bipolar disorder - depression accompanied with episodes of mania.

“Disturbance in the capacity to habituate to sensory stimuli often when exposed to novel, repetitive or monotonous sensory stimulation. A tendency to over-react to environmental stimuli and to become over-aroused, easily excited, irritated, angry, anxious or fearful when exposed to novel sensory experiences (e.g., vacuum cleaners, ticking clocks, thunder and lightning), and dissonant sensations (e.g., shirt tags, fit of clothes or shoes, perceived foul odors).”

Akathisia/Suicide

In some, anxiety and tension become unrelenting and maddening, making the person want to jump out of their skin. This is a psychiatric condition called akathisia and happens often in response to drug withdrawal from anti-depressants. Akathisia has long been linked to suicide as the only means of ending horrific bodily upheaval. Some severely SORs will attempt suicide to end the unbearable state.

Eating Disorders

Anorexia

Moderate to severe oral defensiveness can be confused with anorexia. Some teenagers refuse to eat, not because they want to be thin but because they find many food textures irritating to the mouth, and eating is an effort. Eating little can appear as anorexic-like starving and get misdiagnosed as such. The book Too Loud, too Bright, too Fast, too Tight by Sharon Heller presents one such case.

Further, limited food choices can lead to nutritional and vitamin deficiencies that impact the nervous system, intensifying sensory issues, stress and starvation and the likelihood of a misdiagnosis.

Researchers theorize that those with anorexia nervosa (AN) and bulimia nervosa (BN) have altered taste perception which may contribute to alterations in food consumption. Compared to healthy controls, those with AN and BN had lower perception of bitter taste, but there were no significant differences when sweet or acidic stimuli were tested.

Personality Disorders

Avoidant Personality

Sensory issues often cause a person with SOR to withdraw from social experiences and intimacy making them seem anti-social, and lead some to be labeled as avoidant personality.

Borderline Personality

Unstable relationships, poor or negative sense of self, inconsistent mood and significant impulsivity characterizes the borderline personality. An intense fear of abandonment interferes with many aspects of their lives and often acts as a self-fulfilling prophecy because they cling to others, are very needy, and feel helpless. Further, dependency needs cause them to become overly involved and immediately attached.

With moderate to severe SOR, the person might be misdiagnosed with borderline personality disorder (BPD) from marked shifts in mood, impulsive and unpredictable behavior, and great difficulty in personal relationships.

Some will show as well self-destructive addictive behavior, like substance abuse used for self-calming. In doing research into sensory over-responsiveness and borderline personality disorder in England, OT Kathryn Smyth and her team found a high incidence of sensory over-responsiveness in people hospitalized for BPD.

Obsessive-Compulsive Personality

Bombarded constantly by sensations that they cannot control, some SORs take extreme measures to self-calm. This can lead to compulsive activity like eating, shopping, sexual activity and so forth, predisposing them to obsessive and compulsive behavior. The more severe the over-responsiveness, the more severe are the rituals and compulsive behavior.

Dissociative Disorders

Depersonalization/Dissociation

When life inside their body becomes intolerable, some SORs will shut out the world and depersonalize, losing sense of self as real, and feeling out of their bodies. The experience is terrifying as the person loses touch not only with the world but with one's own self as an agent in it and they become a floating non-entity. For a case example, see Too Loud, too Bright, too Fast, too Tight.

Some disassociate and lose memory, as in amnesia or multiple personality disorder.

Attention Deficit Disorder (ADD)

If one feels overwhelmed by sensory input, they can’t attend to the task at hand, for instance, what someone is saying to them or anything else for that matter, and might appear as if they have ADD.

Sensation Seekers

Sensory Seekers require intense sensation to register “pay attention!” They fall into two categories based on: energy level (high/low); muscle tone (firm/floppy); and self-regulation (active/passive control of understimulation):

• Sensory Under-Responsive (SUR): low energy/low muscle tone/passive sensation seeking
• Sensory Seeking Cravers (SSC): high energy/firm muscle tone/active sensation seeking

Sensory Under-Responsive (SUR)

The under-responsive don’t process enough stimuli, and ignoring it, easily tune out the world, unbothered by sensations that most find disturbing, like a passing siren, the smell of rancid milk, or the pain of a cut or bruise.

Possessing low energy, they passively seek the intense sensation needed to become alert. They are likely to over-eat, gamble, and be addicted to sex. They depend on stimulants like coffee, coke, or nicotine to pump up enough to tune into the world. As they easily ignore sensation, they have poor interoception and many don’t know if they are hungry or full, need to go to sleep, to the bathroom, calm a pumping heart, or are in pain.

Low Muscle Tone

In most under-responsives, low responsivity goes hand in hand with low muscle tone, weak muscles, and lack of coordination (dyspraxia). As a result, it takes enormous effort and concentration to resist gravity and to get one’s body moving. In fact, it takes nine times the effort of those with normal muscle tone to get enough punch to use the information being taken in by muscles and joint receptors. Consequently, they slump and drag as they lack muscles needed to hold up their bodies against gravity and they fight gravity all day long. Fatiguing easily, they appear lethargic, “lazy,” disorganized, and depressed.

Sensory Under-Responsive Psychopathology

Under-responsiveness to sensation, low energy and high but passive sensation seeking, along with low muscle tone that makes engaging in the world effortful creates psychopathology.

Anxiety

Generalized Anxiety

Low responsiveness to sensation results in much missed information and the world often doesn’t make sense. For instance, the person might wonder why everyone is running to the kitchen because they have misinterpreted the resounding smoke alarm as a passing police car. Easily confused and scattered, they get quickly frustrated and anxious.

Low muscle tone, clumsiness, and poor fine motor coordination makes it difficult to get routine things done and they fatigue easily. This causes some to worry excessively about completing the day’s tasks like shopping, cooking, getting dressed in the morning, and getting kids dressed, washed, fed and out the door and so forth. Such worry and difficulty in making it through the day efficiently stresses them and makes them irritable. At the same time, poor body awareness and interoception leaves them unaware of body signals indicating irritability, like rapid breathing and tense muscles. Consequently, tension might escalate until they explode or collapse.

Phobias

Because of low muscle tone and vestibular dysfunction, those who are SUR tend to feel uneasy in space and might experience space related phobias like fear of heights or claustrophobia.

Mood Disorders

Depression

When one is under-responsive to sensation, getting engaged takes much effort, for instance getting out of bed in the morning. This difficulty puts them at risk for depression. Low muscle tone compounds this risk by making moving effortful and often not pleasurable and many exercise little if at all. As movement is the primary means for releasing stress chemicals and for releasing the feel-good hormones needed to modulate the nervous system, not moving destabilizes one's biochemistry and creates lethargy and depression.

Such frustration leaves many with a sense of failure because they lack control to change their state and fear being unable to succeed. Many will give up trying or not even attempt to try, seeming unmotivated to help themselves. This despondent state of mind is called learned helplessness and is the precursor of depression.

A study by Beth Pfeiffer and Moya Kinnealey that looked at children with Aspergers (mild autism) confirmed a relationship between SUR and depression. In concert with SUR’s tolerance of extreme weather, another study found individuals with major depressive disorder (MDD) experience a lower sensitivity to cold and hot stimuli as indicated by their ability to withstand more extreme temperatures.

Bipolar II

As mentioned, Bipolar II is characterized by hypomania (less severe than mania) and depression without psychosis. When depressed, the senses are dulled. To snap out of it, SURs need extreme sensation and may flip into sensation seeking mode which appears as hypomania. In fact, psychologist Marvin Zuckerman found that virtually all with bipolar disorder are sensation seekers.

In a study done in the UK that followed a group of dyspraxic children into adolescence and adulthood, the researchers confirmed that they were likely to have emotional and other behavioral difficulties, especially depression. If they were taking certain drugs, like steroids, MAO inhibitors, tricyclic antidepressants, or L-dopa, or if they had infections, metabolic disturbances, or tumors, all of which can create mania, they appeared bipolar and could get misdiagnosed and mistreated as such.

Addictions

Substance Abuse

Because their biochemistry is so off, some people with SUR will rely on stimulants to rev up enough to tune into the world. This leads easily to substance abuse, for instance with cocaine or amphetamines as both release dopamine in the brain which is low in sensation seekers. At the very least, many SURs drink strong coffee throughout the day, smoke cigarettes, and crave chocolate as it also provides a caffeine buzz.

Compulsive Over-Eating

Another common way to balance biochemistry is compulsive over-eating. As mentioned, low muscle tone makes it hard to get moving and many avoid exercise. Instead, they will passively seek sensation by overeating food with intense taste, and especially rich food, and they gain weight easily. Further, if they have low muscle tone and are relatively inactive, they will overeat because chewing offers needed proprioceptive input into the jaws to balance the nervous system.

Over-eating & Proprioception

The SURs also like to feel full as proprioception is strong along the GI tract. Interestingly, having this extra weight can be oddly comforting. The heavier one is, the more gravity has to work on, and the more firm is one’s grip to the earth, giving one better body awareness and ability to feel their edges. Unknowingly, the person overeats to feel more grounded and secure. This may be one of the reasons why most heavy people regain weight.

Eating Disorders

Bulimia

In some cases, over-eating leads to bulimia as one gorges and purges to control weight. Providing strong odors, loud noise, and violent movement of the body, purging also provides intense sensory input.

Sexual Disorders

Sexual Acting Out

Some SURs might engage in frequent sex. Intense odors, sounds, movement, and heavy pressure into the skin increases body awareness, which they lack, while sexual arousal provides intense sensory stimulation. Because their body is loose from low muscle tone, their hips tend to move easily, and females are likely to readily achieve orgasm while men can have more intense orgasms.

Personality Disorders

Dependent Personality

Lack of motivation and poor fine and gross motor skills leads some SURs to rely on others to force them out of lethargy and this creates dependency.

Disassociative Disorders

Depersonalization

Sensory under-responsiveness to touch and poor body awareness makes it hard to figure out one’s edges. Under severe stress a person might lose physical and personal boundaries and feel unreal and the world distant. Neuroscientist V.S. Ramachandran, M.D., Ph.D., director of the Center for the Brain and Cognition at the University of California, San Diego, proposes that a shift occurs in boundaries of self-perception when incoming sensory input defies what one perceives and requires as the norm.

Implicated as well in depersonalization is poor vestibular functioning because the person experiences a mismatch in their sensory experience of the world and reality. That makes some feel spacey and, when severe, detached from their surroundings.

A study published in 2006 and conducted by F. Yen Pik Sang and colleagues found a prevalence of depersonalisation/derealisation symptoms in patients with peripheral vestibular disease, evoked by presenting them with disorienting vestibular stimulation. The researchers concluded that in vestibular disease, frequent experiences of derealisation may occur because distorted vestibular signals mismatch with the other sensory input to create an incoherent frame of spatial reference. This experience makes the patient feel detached or separated from the world.

Impulse Control Disorder

Cutting/Hair Pulling/Skin Picking

Low muscle tone and poor body awareness go hand in hand and SURS feel out of touch with their bodies. Under severe emotional turmoil, they may feel emotionally frozen and cut off from their bodies. Cutting their skin or pulling out hair (trichotillomania) provides intense skin sensation and pressure that helps them re-connect with their bodies and know they are alive and okay. Further, cutting or pulling distracts from intense emotional pain as it is proposed to release endorphins, the body's natural painkillers, and explains why cutting and pulling rapidly reduces tension. Some people have described the feeling afterwards as a “calm, bad feeling.”

Cutting may also give one an increased sense of mastery and control. This mindset is often missing in those with SPD who often feel powerless to change their circumstances or experiences, especially those who have suffered the dysfunction their whole lives.

University of Washington psychologists have discovered that adolescent girls who engage in behaviors such as cutting themselves had lower levels of serotonin, along with reduced levels in the parasympathetic nervous system of respiratory sinus arrhythmia (RSA), a measure of the ebb and flow of heart rate along with breathing. RSA is related to vagal tone. As mentioned above, Lucy Miller and colleagues at the SPD Foundation found significantly lower vagal tone in SPD children than in a typically developing sample. This is another example of how biological vulnerability associated with SPD lends itself to mental illness.

Skin Picking

Skin picking, which falls under trichotillomania is also a common issue in those with SPD.

Learning Disorders

Attention Deficit Disorder (ADD)

Those who need much sensation to tune into the world might appear unfocused and out of it and have poor memory. Working memory relies on serotonin, and low serotonin causes depression. Many SURs are depressed and also have problems remembering five to seven things at the same time, which could be a reflection of low serotonin in the cortex.

Sensation Seekers/Cravers

Sensory Seekers/cravers (SSC) under-react to sensation and require intense sensation to register “pay attention!” and tune into the world. Easily bored, they need constant newness, intensity, uncertainty, challenge, or thrills to engage in life. Think of the “daredevils” who swallow fire or lie on nails. If strong sensation is unavailable, dopamine, the pleasure-seeking neurotransmitter drops too low and they zone out or run around frantically seeking something to perk their interest; some appear hyperactive.

As a child, they may have crashed into walls, people, beds, and the like to get weight, pressure and traction into their bodies.

Miller in Sensational Kids, writes about “Ben,” a typical sensory seeking child,

“… when children pulled their weight on the family farm or in the family business instead of going to school …. Ben would have been a superstar! In that context, his physical stamina, agility, and coordination would have been prized and he would have functioned better because his sensory needs would have been met naturally by the routine of his daily life.”

Sensation Seeking/Craving And Mental Illness

Here are the many ways sensation seeking can play out as mental illness:

Mood Disorder

Mania

Constant sensation seeking makes one appear manic, and they may be misdiagnosed as bipolar. As you might recall, psychologist Martin Zuckerman found that virtually all with bipolar disorder are sensation seekers.

Addictions

Substance Abuse

Cravers often use stimulants to rev up and tune in, and to escape. This leads easily to substance abuse, commonly with cocaine or amphetamines as both release dopamine which is low in sensation seekers.

Sexual Disorders

Sexual Acting Out

Seeking intense sensation, some cravers may engage in promiscuity, risky sexual behavior, and sexual experimentation.

Learning Disorders

Attention-deficit/Hyperactivity Disorder (ADHD)

If a SSC doesn’t get enough sensation to feed the nervous system, they become frenetic and appear hyperactive and distracted. This is because their cortex lacks sufficient dopamine to engage in the world and they seek activity to boost it.

Personality Disorder

Obsessive/Compulsive

SSCs might be compulsive shoppers or gamblers, the latter entails risk taking.

Sociopathology

Insensitive, poor at reading social cues, and hell-bent on sensation seeking regardless of the other’s needs, some appear and may be a sociopath.

Sensory Discrimination Disorder-SDD

Sensory discrimination refers to the ability to distinguish one sensation from another. It enables one to pluck out the salient characteristics of a sensation and correctly interpret its meaning—gritty, smooth, silky, gooey—and to place sensations correctly in time and space.

Those who suffer sensory discrimination disorder find it difficult to distinguish one sensation from another, like the taste of lemon from lime or the sound of a cat’s meow from a bird chirp. Such confusion makes it difficult to accurately assess information and causes frustration, and anxiety.

Mental Health Issues That Might Accompany Sensory Discrimination Disorder

Learned Helplessness/Depression: Easily confused, the person feels inept and finds it hard to meet daily wants and needs. This can create learned helplessness and depression.

Dependent Personality: Needing to rely on input from others to glean appropriate information from the environment and get organized, the person might appear helpless and dependent.

Fear of Dark: Easily disoriented in the dark, one can become fearful when robbed of orienting light.

Eating issues: Poor tactile discrimination creates problems with interoception, and the person lacks cues to know when they are hungry or satiated. This can result in eating too much or too little.

OCD: Because the person is confused and easily thrown, they need everything in its place and rigid routines and schedules.

Depersonalization: Out of touch with their bodies, some feel unreal and the world distant.

These feelings are greatly compounded by motor issues that commonly accompany discrimination problems.

Sensory-Based Motor Disorder-SBMD

Those who suffer sensory-based motor disorder have difficulty navigating through space and are dyspraxic (clumsy and uncoordinated), and often gravitationally insecure (over-responding to position changes) and fearful.

Mental Health Issues

Depression

When movement is uncoordinated and moving feels effortful, as does keeping one’s body upright to resist gravity, sufferers might seem lazy, unmotivated and often depressed.

In a study done in the UK that followed a group of dyspraxic children into adolescence and adulthood, the researchers confirmed that they were likely to have emotional and other behavioral difficulties, especially depression. If they were taking certain drugs, like steroids, MAO inhibitors, tricyclic antidepressants, or L-dopa, or if they had infections, metabolic disturbances, or tumors, all of which can create mania, they appeared bipolar and could get misdiagnosed and mistreated as such.

Fears and Phobias Tied to Low Muscle Tone

Space Phobias: As the person easily loses their place in space, they might fear flying, heights and wide, open spaces and may panic or develop space related phobias.

Elevators/Escalators: Some fear escalators, afraid of not being able to get on or off the escalator on time or without tripping, as well as elevators, worried they will be unable to get in or out before the door closes.

Tunnels: Some fear tunnels, nervous that they will be unable to keep their car within its lane in the dark.

Choking: Some fear swallowing pills, worried that they will choke as vestibular dysfunction may un-coordinate normal reflexes.

Agoraphobia: Floppy muscle control creates jelly legs, and the person fears falling, fainting, getting injured or losing control in public and they fear going out.

Childhood Disorders

In the Canadian Child and Adolescent Psychiatry Review of May, 2005, Michael Cheng, M.D. and Jennifer Boggett-Carsjens, OT describe a 9-year old boy who, by being impulsive and aggressive in school was diagnosed as Bipolar, ADHD, and ODD (oppositional defiant disorder). He was put on antidepressants and psycho-stimulants, and given psychotherapy, counseling and anger management programs.

Fortunately, he was also seen by a pediatric occupational therapist who diagnosed him as severely SOR. His aggression toward other children happened when other children got too close or touched him and his impulsivity and hyperactivity— “mania”—reflected extreme agitation from sensory overload. When too overloaded, his system would shut down and he would appear “depressed.” Within weeks of receiving appropriate occupational therapy interventions, he calmed down, became more alert, focused, and able to learn and handle school better.

Occupational therapists often find that children with sensory processing issues have disorders that the DSM IV lists as first recognized in childhood.

Separation Anxiety

Children with sensory over-responsiveness often feel unsafe when separated from parents who have learned how to help regulate their child, and the child will often show separation anxiety. The more severe the SOR the more extreme is the separation anxiety.

Social Anxiety

Children with sensory issues often feel isolated from other children who enjoy physical activity, playing in mud, getting their hands dirty, wearing school uniforms, and who don’t squirm when touched or clap their hands over their ears when the bell rings. Such behavior can make them seem like the odd one out and other children will reject and often bully them, creating social anxiety

Oppositional Defiant Disorder

Both the SSC and the SOR child might get misdiagnosed with oppositional defiant disorder. if forced to be in a boring, unstimulating situation, the SSC child might become aggressive and defiant, while children with moderate to severe SOR may demonstrate wild mood swings and unpredictable aggression when in sensory overload. For instance, a tactile over-responsive child might tear off clothes that itch and refuse to get dressed or unintentionally punch someone who bumps into her.

Learning Disorders

ADHD (craver; avoider)

Children with ADHD have trouble with focus, attention, impulsivity, hyperactivity, and show constant and fidgety movements. Inattention, impulsivity, fidgetiness, and constant movement are also symptoms of SPD. Though ADHD and SPD are two distinct syndromes, clinicians believe that many children with SPD are misdiagnosed with ADHD and are put on unnecessary medication.

As A. Jean Ayres first noted, a tactile defensive child in overload looks over-alert, distracted, and hyperactive, the symptoms of ADHD. Also, a bored craver might become overly active and impulsive in his quest for sensation and appear hyperactive and distracted. Carol Kranowitz writes in Beginnings from the National Alliance on Mental Health, “Sensory stimulation—too much, too little or the wrong kind—may cause poor motor coordination, incessant movement, attention problems and impulsive behavior as the child strives to get less—or more—sensory input.”

ADD (under-responsive)

Those with ADD have problems with focus, attention, and impulsivity but not hyperactivity. An under-responsive child can seem out of it and distracted and appear as if he is not paying attention. In a review of children with ADHD and sensory processing problems, researchers found that sensory processing problems in children with ADHD are more common than in typically developing children and that co-morbidity with oppositional defiant disorder and anxiety are predictors of more severe sensory processing problems in children with ADHD.

Treatment Of Metal Health Issues In Those With SPD

Treatment for mental health disorders in adults with SPD revolves largely around treating sensory modulation problems. Occupational therapist Tina Champagne, author of Sensory Modulation & Environment: Essential Elements of Occupation has outlined a program for treating sensory modulation problems.

The Sensory Modulation Program (SMP) includes the following:

• Therapeutic use of self
• Standardized assessment tools
• Sensory modulation checklists & self-rating tools
• Grounding activities
• Orienting/alerting activities
• Relaxation/calming activities
• Self-nurturing activities
• Self-soothing activities
• Distracting activities
• Mindfulness activities
• Strategies for identifying and coping with triggers
• Activities promoting increased connectedness (to others, nature, a higher power)
• Environmental modifications