People on the autistic spectrum, or with characteristics of 'highly sensitive person', may have an exceptionally highly powered brain, with greater than normal neuronal connections, and the potential capacity to register and process much more information than those who are 'neurotypical'. A relevant neurobiological model to account for this is the Markham's 'intense world theory'. According to this perspective, such a person can easily become overwhelmed by their own brain processing - the experience of too much going on - too much stimulation - and too intense. All this can give rise to chronic high anxiety. As a result, the person may engage in many activities and strategies functioning to reduce this intensity. Interactions with others may be strictly limited and regulated. Sensory stimulation and aesthetic qualities of the environment may be carefully curated. Emotional experience may similarly be titrated to avoid being overwhelmed. Routine and predictability of work and lifestyle may be valued over spontaneity. 

One variant of these constellations is the 'porous personality'. Here is an extract from my book on ADHD and Autistic Spectrum: 

 

The Porous Personality (and the ‘apparently normal’ persona)

[An extract from chapter 7 of my book The Disintegrating Self: Psychotherapy with Adult ADHD and Autistic Spectrum (Karnac/Routledge: London: 2015)]

The Porous Personality (and the ‘apparently normal’ persona)

 

From time to time, in a clinical practice of seeing several thousand patients over a period of over 40 years, I have encountered people with what I eventually recognised to be a particular constellation of characteristics that I have come to think of a ‘Porous Personality’, because of the combination of inadequate boundaries between self and other and between conscious and unconscious mind. It has taken a very long time for me to grasp the nature of this constellation – but eventually I realised that many of the more puzzling and apparently obscure personality presentations seem to correspond in certain ways to this description.

 

The patients I have in mind often present with a pattern of regular or occasional self-harm, but this is not always the case. Such episodes of self-harm may seem to occur without any obvious precipitating event. The person may seem very disturbed in ways that are not easy to understand. States of extreme self-loathing, associated with self-harm or vomiting, might suggest the possibility of repeated adverse experiences during childhood, such as sexual abuse – but none is found in the patient’s narrative. Whilst aspects of the person’s childhood experience might seem less than ideal, these do not seem sufficient to account for the severity of disturbance. The person may seem in some ways quite communicative, but in other ways rather private. Gradually, she or he may reveal some odd states of mind, with unusual imagery, fantasies or thought processes. These may appear to follow the Freudian ‘primary process’, the language and thought patterns of dreams and the unconscious.

 

The emerging impression (perhaps developing over a considerable period of psychotherapeutic time) is that the person’s boundaries – between self and other, and between conscious and unconscious mind – are porous. Primary process material, that in other people is screened off from the conscious awake mind, tends to leak into awareness, giving rise to cognitive experience that does not easily find a place in social discourse and is thus essentially autistic. For example, a patient reported a fantasy (accompanied by much reticence and shame) of slicing her arms in multiple places and walking down the street dripping with blood – and, on another occasion, of cutting out her eye ball. Another described an aversive fantasy that the plate of food she was eating had turned into a plate of faeces. Yet another reported an urge to swallow a handful of sewing pins. The person’s humour may appear quirky. At times, his or her perceptions, and interpretations of perceptions, may be eccentric, bordering on the psychotic and paranoid – but never enough to attract a diagnosis of schizophrenia. In some cases, however, the concept of schizotypal personality may be of relevance. Sometimes hallucinatory voices may be experienced, during childhood as well as when adult – but, again, not in way that would typically lead to a diagnosis of schizophrenia (although occasionally such an illness may develop). When highly stressed, brief periods of more florid psychosis or hallucinosis may occur, but these are rarely sustained. The person may present outwardly, and superficially, as ‘normal’, yet hidden autistic and psychotic characteristics can gradually be discerned. In these ways, the boundary between conscious and unconscious mind, secondary and primary processes, is more porous than in other people.

 

The second area of ‘porosity’ is in relation to other people. Boundaries between self and other seem flimsy, and a quality of appearing ‘thin skinned’ is apparent (Rosenfeld, 1987). The person with a ‘Porous Personality’ may correspond, in part, to the concept of ‘highly sensitive person’ (Aron, 1999), and Eigen’s (2004) account of the ‘sensitive self’, as well as Kohut’s (1971) description of narcissistically vulnerable people who are easily upset and wounded by seemingly small slights, criticisms, or rejections by others. These wounding events may be so subtle that their impact may seem puzzling. Examples might include: an absence of a sufficiently warm smile, or lack of sufficient enthusiasm in responding to the person or mild criticism or teasing. These may trigger strong internal reactions of shame, withdrawal, and rage. The person’s narcissistic vulnerability and sensitivity seems raw, with little of the normal buffering that allows others to weather the emotional rough and tumble of social interactions.

 

A crucial period for the development of disturbance in response to this vulnerability seems to be primary school, from age 7. At this time, children are becoming more concerned with the peer group, and rejections and other narcissistic wounds experienced within peer social life take on greater significance. The child may come home each day full of intolerable and toxic feelings of shame and rage, as a result of repeated painful interactions – but will not be able to explain to parents or teachers what is wrong.

 

The adults who develop the porous self constellation described here seem always to have felt (but not always perceived by others as) somehow odd – as different – not fitting it. The idea of feeling like ‘an alien in a human body’ is often apt – but this can also, paradoxically, coexist with a capacity for unusual empathy. As a result, the person can experience understanding of others, but not by others. The ‘oddness’ is essentially part of the autistic spectrum – which in females can be less apparent overtly than in males, since it is covered by a greater social skill and relational seeking (Attwood, et al., 2006). Social interactions are stressful for these people, at the same time as some contact with others is needed. The claustro-agoraphobic conflict is dominant, of experiencing too much contact as oppressive and ‘claustrophobic’, whilst finding too little contact results in loneliness. Disrupted expectations and changes of routine are also a source of stress and anxiety. All of this means that the child, and later the adult, with these problems exist in a chronic state of high anxiety. This may not be apparent to others because it is so constant, albeit with periodic intensification. It is therefore a ‘normal’ part of that person’s experience. In an attempt to cope, the child learns to override the anxiety – creating a split between the outward, socially performing persona, and the inner state of chronic intense anxiety combined with shame. The outward, ‘apparently normal’ persona will lack grace and ease, appearing at times slightly brittle or awkward. Sometimes, tell-tale signs of the underlying autistic spectrum qualities may be glimpsed – such as repetitive bodily movements, including hair stroking or pulling, and compulsive smoking, particularly when stressed.

 

Although traumatic experiences may have occurred during childhood, in the case of these patients the adverse events seem not to have been the primary cause of the disturbance, but function more to emphasise and entrench the sense of being different – or of being inadequate because of not coping – and to intensify the shame.

 

A third area of porous sensitivity is in relation to sensory stimulation. In keeping with their characteristics as ‘highly sensitive person’, these people feel easily impinged upon by noises, smells, unaesthetic sights, commotion, and ‘too much going on’. When overwhelmed with sensory and emotional stimulation in this way, the ‘porous’ person feels a need to withdraw and be alone. Too much contact with others is experienced as over-stimulating and emotionally and energetically draining. Change or disruption of routines or expectations may be highly aversive and disturbing.

 

Yet another area of porosity that is sometimes present is a tendency towards ‘clairvoyant’, ‘telepathic’, or other ‘psychic’ abilities (Brottman, 2011; Williams, 1998). An unusual awareness of other people’s thoughts, feelings, and intentions, or of future events, can be confusing to both self and others. Autistic writer, Donna Williams, comments:

One can respond to the body-mapped pattern of energy sensed and that response may demonstrate a ‘knowing’ that is seen as ‘psychic’. So, for example, I seemed constantly to surprise people who were closely involved with me when I would phone them up out of the blue – very often this would coincide with their just having mentioned me or been writing to me or thinking of me. By contrast with their other friends or acquaintances, the number of such occurrences was very high, leading people to believe there was some kind of psychic occurrence happening. Someone summed this up by saying, ‘you don’t have to call Donna, you just have to think loudly about her.’ I would have said it was not about thinking loudly but feeling strongly. In those days my ‘doors’ were wide open, too open, and too often. I’ve fortunately learned how to shut those doors and to use them at least more by choice than purely by resonance. [Williams, 1998, pp. 121-122]

 

The ego of the ‘Porous Personality’ feels threatened by both internal and external stimuli.  This vulnerability evokes shame and rage, usually directed against the self.

 

The ‘Porous Personality’ has struggled with this sensitivity and vulnerability from the beginning. Some develop what is recognised relatively easily as overt autistic spectrum qualities, such as extreme shyness, social avoidance, preference for routine and predictability, and aversion to strong emotions. Of these, a smaller proportion may attempt to create a mode of being that is based entirely on rational considerations and an avoidance of emotions and attachment. One such person remarked that she did not want anything to do with people or emotions because these cause pain – and she did not want to be attached to anyone because people “either hurt you or they die”. Not surprisingly, she struggled with a constant sense that life held no meaning, purpose, or pleasure.

 

However, the patients I am focusing on in this account are those who develop an extensive concealment of their sensitive autistic core. Outwardly, they present as ‘normal’. Teachers may not identify any abnormality, and may perceive the child as happy and outgoing. Family too may not recognise the problem, until some degree of disturbance becomes overt during adolescence. What appears to develop is a split between an ‘apparently normal’ outer persona and the inner realm of shame and rage.

 

The inner realm is indeed a cauldron of toxic shame. By ‘toxic’, I mean shame of a quality and intensity that cannot be psychologically metabolised. This is hidden. It is in the nature of shame that the wish to hide is evoked – and also that shame is itself shameful (Mollon, 2002). The person’s sensitivity is concealed, covered by a social façade. However, the sensitivities, vulnerabilities, and narcissistic wounds experienced in the course of ordinary social and relational interaction, evoke not only intense shame but also rage. The target of rage is the self (although there are some who express this outwardly at others, such as toward the mother or a partner). A tirade of self-directed abuse may in this way be continually stimulated, resulting in hostile inner self-talk and attacks on the body (which may also be hidden, such as cuts on parts covered by clothing, self-inflicted blows, or overdoses that do not require hospital treatment). The attacks on both body and mind cause further shame, although the assaults on the body may be experienced as soothing. This spiralling and intensifying ‘shame about shame’, with its associated self-directed rage, may reach panic proportions – but all of a nature that the person finds near impossible to explain to others, or indeed to gain any clarity or distance for internal understanding. All the person feels is panic, shame, and compulsions to self-harm.

 

Introspection into these states of mind may be alarming for the person experiencing them – creating panic about panic, and shame about shame. It is a self-fuelling system of disturbance, whereby each increment in shame distress evokes a further increment, somewhat akin to a nuclear explosion and with similar, but psychological, devastation.

 

Giving up the torrents of shame-fuelled rage against the self is not a simple matter. This self-directed aggression may have formed a crucial structuring function within the personality – providing a kind of ‘strength’ and keeping the person’s behaviour in line. Thus the messages of internal abuse may be along the lines of “you are pathetic – they will think you are stupid – you must not show how you feel – stop being such a wimp” (albeit with more colourful and vicious language). The person believes such voices are correct and that he or she needs them. One patient described her voices as like an exoskeleton – without them she would be formless and would have no direction. In extreme cases, the streams of self-abuse take on stable forms as quasi (or even actual) hallucinatory voices that appear to assume effective control over the personality. Such voices never take kindly to being discussed. They are like a military junta that has taken control of an otherwise weak or disintegrating country, maintaining order and power through aggression, cruelty, and intimidation.

 

Self-harm and the Prey-Predator dynamic

 

Self-harm, such as cutting the body, is often driven by shame, rage, and anxiety, and apparently can provide immediate relief for some. This relief appears to result from a sudden shift from the position of ‘prey’ to that of ‘predator’. Some hints concerning this dynamic are provided in a remarkable book Blood Rites, by Barbara Ehrenreich (1997). She traces the history of humankind, exploring the roots of fears of the predator, deriving from primordial terrors of being eaten by carnivores:

The transformation from prey to predator, in which the weak rise up against the strong, is the central ‘story’ in the early human narrative. [p. 83]

According to her thesis, the hard-wired terror of predators of other species gradually shifted to a fear of human predators – fuelling the human compulsion to engage in continual warfare and in other ways playing out the prey-predator dynamic.

 

An awareness of this came to me during a particular session with a young woman who fitted the Porous Personality pattern. She was speaking of her anger and scorn regarding her own feelings of vulnerability and sensitivity, remarking that the only time she felt safe was when she was in bed at night, curled around her large husband – adding, with self-contempt, “how pathetic is that?!” I tried to speak to her, in what I misguidedly intended to be an empathic way, about her general sensitivity. She became increasingly agitated, and told me that her urge to self-harm was feeling stronger and stronger as we spoke. As I continued to try to talk to her of her sensitivity, her agitation escalated, until she stated that at that very moment her urge to run away and self-harm was stronger than she had ever known it. At that moment, I realised my stupidity and what she was trying to convey. Her feelings of sensitivity and vulnerability were completely intolerable for her because in that state she felt herself to be in the position of ‘prey’. Self-harm has its relieving effect because it instantly shifts the person’s identity from that of ‘prey’ to that of ‘predator’. By harming the body, the person steps into the position of predator, even though it is her or his own body that is the prey. Once I had articulated this to her, she began to calm down.

 

What makes psychotherapeutic work with this kind of Porous Personality organisation very difficult is that the whole structure of inner disturbance, with its core of vulnerability around which is organised a ‘mafia-like’ patrol, engaging in self-directed aggression, is hidden – split off from the ‘apparently normal personality’ presented to the world, including the therapist. It is possible to work with a patient for a long time without getting much glimpse of this hidden structure.

 

Moreover, the ‘voices’ will emphasise to the person the foolhardiness of trusting anyone other than them – particularly the therapist. This message is easily received internally, since the person with a Porous Personality will have spent years in childhood of feeling inwardly very alone, not understood, and subject to rejections or bullying from peers (or even teachers). Even a kindly and loving mother may be experienced as failing to understand or protect the child.

 

Sometimes the impression is that the person’s emotional connections with others have been so severed, through pervasive distrust, that hallucinatory voices have become their only real companion. Their link with earlier precursors, such as imaginary friends, may become apparent.

 

 

Summary of characteristics

 

The people I am describing may or may not potentially attract a diagnosis of Aspergers or High Functioning Autism. In general, I am wary of categorical diagnosis, since mental and behavioural states exist along continuums. Moreover, the developmental and compensatory overlay and adaptations complicate the clinical picture enormously. However, it is possible tentatively to state the characteristics of the hidden autistic-hypersensitive core as follows:

• Chronic high levels of anxiety – often unfocused, but exacerbated in social situations, particularly in response to demands for social performance
• A preference for order, routine, and predictability
• A life-long unease and inherent awkwardness in social interactions and relationships – strongly concealed in some who have learned social skills through observation, mimicry, and practice
• A life-long sense of being ‘different’ – like an alien in a human body
• Puzzlement at the motives, emotions, and thought processes of others – although, paradoxically, this can co-exist in some with a marked capacity for empathy
• Hypersensitivity – to both social and sensory stimuli
• Hypersensitivity to emotional injury, rejections, slights, humiliations (narcissistic injuries) – ‘thin skinned’
• A tendency to ‘decompensate’ – severe (but usually temporary) deteriorations in mental state, with psychotic, paranoid, or suicidal reactions – in response to rejections or narcissistic injuries
• A tendency to avoid relationships because of this sensitivity
• Porous boundaries – easily affected by other people’s moods and emotions – sometimes resulting in high levels of empathy and interpersonal sensitivity
• Intrusions of ‘primary process’ thinking – images, fantasies, and ‘thoughts’ that are difficult to translate into social discourse
• A great propensity for shame
• Some propensity for rage (often hidden and directed toward the self)
• Clairvoyant and other ‘psychic’ or ‘paranormal’ abilities

 

Some people show these characteristics overtly – and thus can more easily be recognised as falling within the autistic or ‘highly sensitive’ spectrum. It is possible to achieve a healthy adaptation and self-acceptance in relation to these core traits. However, the people I am particularly describing have overlain this core with an ‘apparently normal’ personality which makes recognition of the hidden problem much more difficult. This apparently normal personality shows the following characteristics:

• Outwardly sociable – may be pleasant and charming
• Functions to conceal and protect the hidden autistic-hypersensitive core
• Can be sensitive to others, displaying empathy and tact (but not always)
• At times may display behaviour or reactions that strike others as ‘odd’

 

The ‘outwardly normal’ personality functions as a cover for the autistic-hypersensitive core. It is what most people, including, for a long time, the therapist, will encounter. Hidden behind it is not only the autistic-hypersensitive core itself, but also the shame, rage, and sense of inadequacy associated with this core. These are only gradually, if at all, revealed to the therapist. Family members, who have had most exposure to the patient from the beginning, may have some partial awareness of the more hidden aspects of the personality – but much may also be concealed from them.

 

Whilst this formulation may appear superficially similar to Winnicott’s (1960b) theory of the ‘false self’, the difference is that this is a response not to an intrusive or insufficiently adaptive mother but to the inherent vulnerability of the autistic-hypersensitive core and its difficulties in the sensory and social world.