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)]

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 spoke of her feelings of vulnerability and shame about these. As I tried, with misguided empathy, to give further elaboration of what she seemed to be conveying, she became increasingly agitated and said she was experiencing escalating urges to self-harm at that very moment. Guided by her urgent feedback, I began to appreciate that 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.