The Hidden Psychology Of Highly Sensitive People - Dr Sasha Hamdani

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Why did you get interested in researching emotionally sensitive people?

I got interested in researching emotionally sensitive people because I am one myself. And from my body of work seeing patients, you start to see patterns of people becoming, or falling into the pattern of being, emotionally sensitive.

What does that look like? What's the experience of life like for someone who's emotionally sensitive?

It's different for each person, but one of the bigger overarching things is that these are the people who feel things quickly, deeply, and for a long time.

What would their days look like? What are some of the habits and mental experiences they go through?

A lot of times, people with emotional sensitivity, because they're taking in so much emotional data, are overanalyzing every interaction and reading it for: am I doing something weird? Is this other person doing something weird? Are you mad at me? They're interpreting and re-evaluating every single interaction, which takes up a lot of brain power throughout the day.

The other thing they do is spend a tremendous amount of time predicting that something could be an issue. So they're changing their behavior, masking, overcompensating for certain things. There's work being done within interactions on a day-to-day basis, and there's also the work of anticipating these possible interactions.

That's interesting — so even silence and preparation, people are interpreting that with a particular lens as well.

What about criticism? What's the relationship like with criticism?

I don't think anybody in the universe likes criticism. But when you look at rejection sensitive dysphoria, which is a neurological phenomenon, it's this robust emotional — sometimes physical — response to rejection or criticism. It's not just "okay, that happened, it really hurt my feelings and that sucks." It's "I feel like the air has been pushed out of my lungs. I don't know if I can recover from this." Instead of something you're chewing on that's annoying, it becomes something that consumes them. And it can be as significant as looking like a major depressive episode.

A fear of disappointing other people feels quite central to this.

I think it stems from a fear of rejection or criticism. If you're going to disappoint someone, you don't want that person to be upset with you, to reject you, to think badly of you, or to criticize you. So you're dealing with this very complicated phenomenon coming at you — all of these emotions happening at once — and you're trying to process them in real time.

Rejection sensitive dysphoria vs. being a highly sensitive person

Is rejection sensitive dysphoria the same thing as being a highly sensitive person? Is there something necessary-but-not-sufficient going on here?

"Highly sensitive person" isn't a clinical term, but it came about years and years ago, and it refers to being highly sensitive to everything — not just emotions, but sounds, lights, everything.

When I talk about rejection sensitive dysphoria, I'm putting it on a spectrum of emotional sensitivity. Some people aren't tremendously impacted by emotions and emotional data on a day-to-day basis; they roll along through their day, and maybe they sit a bit off median — they could probably afford being a little more emotional. Some people have healthy ups and downs. And then there are others whom emotional data can just sink, with reactions that might be completely out of proportion to the stimulus.

So highly sensitive people might be sensitive to emotions but also to light, sound, busyness, chaos, and so on. Rejection sensitive dysphoria is specifically the emotional angle.

Why "rejection sensitive"?

Why the word "rejection sensitive" rather than "emotionally sensitive dysphoria"?

Good question. The term was coined by Dr. William Dodson, who was brilliant and brought this to attention. Looking at longitudinal data with his patients, many of them were responding to rejection and criticism that triggered this profound emotional response.

Those are two really big triggers, but I think we need to start expanding the conversation to emotional sensitivity in general, because then you can start talking about emotional dysregulation — which I think is one of the things we've been missing in discussions of ADHD and anxiety for years and years.

Why does social rejection hurt so much?

How much time do you have? There are many different reasons this is so painful.

Neurobiologically, there is inherently a dopamine imbalance. Your brain is already struggling to emotionally regulate, so when something happens, instead of thinking "okay, we can work with this," you're shot down. You get suspended in a low, highly anxious mood where you're spinning and chewing on it for hours and hours.

Another reason is that in people who are highly emotionally sensitive, two areas of the brain are really impacted. The first is the amygdala, your threat receptor, which in these cases is highly attuned to picking up emotional data. So your brain picks up this seemingly negative data, but the frontal lobe—which handles judgment, processing, and decision-making, and should be able to say "this isn't that big of a deal"—isn't as active. You end up with a highly active threat receptor and a poorly responsive frontal lobe, and that emotional train just runs away.

The interviewer asks for the underlying neuroscience of emotional sensitivity — what is happening inside the brain of an emotionally sensitive person.

The answer is that it depends on several factors. The first is the combination already described: a highly responsive amygdala paired with a poorly responsive frontal lobe, so you feel things before you think about them logically.

The second factor is dopamine dysregulation. Dopamine is multifaceted and helps with many different things, but when it's dysregulated, you're less able to regulate your emotions.

Asked whether these are people with a high or low dopamine baseline, or low catecholamine clearance, the speaker says he wants to say "low," but it's not that simple — the issue is that there isn't enough dopamine in the right place at the right time. With proper dopamine function, a person could better weather the ups and downs and regulate more effectively.

The interviewer offers himself as an example: he carries the COMT variant — two copies of it — along with several related polymorphisms. For him, when things are chaotic it's very hard to focus, but when things are predictable and unambiguous, it's hard to get him to stop. That makes environment design really important for him.

This connects to the dopamine question: some people can be what Stantin calls "airplanes," going up and down quickly but with less depth, while others are "submarines" — far more depth, but it takes time to come back up.

The third factor is norepinephrine, which fuels the very physical response. With rejection sensitivity, it's often not just "I feel bad because something bad happened." It's "I can't breathe, my ribs hurt, I have chest pain." People frequently think they're having an anxiety attack or a heart attack when it's truly just rejection sensitivity — a surge of norepinephrine spilling alarm chemicals that tell the body something bad is happening. At that point it's not just mentally psyching yourself up over, say, someone not texting back and assuming they're mad. Your body itself is telling you there's a problem: you're panicked, your heart rate is up, you're sweating and tremulous — so you believe something is wrong because your body is responding that way.

Summing up the factors so far: dopamine, norepinephrine, and the amygdala. The interviewer notes that the prefrontal cortex presumably exists to control the amygdala, so the relationship between the two must matter. The speaker agrees: it's not only a hyperactive amygdala and an underactive prefrontal cortex — the linkage between them is also frayed.

The shooter shot a couple of Secret Service people and then got taken down. What's even happening with that guy? Do we even know? Now I'm interested in whether it's another— you know what's crazy? There are multiple presidential assassins in the legal system at the moment. Has there ever been multiple presidential assassins in the legal system at the same time? The guy in Utah is currently on trial, and the guy who did the other one is also being prosecuted. It's like, get in the queue.

Inside, all of a sudden it just started getting noisy — tables getting flipped over, guys running in with guns, and they were screaming, "Get down." I didn't get down. It was awesome. I literally took every minute of it in.

So that's what happened: the assassin goes in, and that's Dana White's actual reaction when he sat down in the room. Everybody else is under the table, and all he wants is to watch. My point being, that amygdala–prefrontal cortex thing — obviously the triggering of his fear center hasn't kicked in, and he's able to think with full access: "Isn't this interesting? This is a memory worth encoding for a while. I'm having a good time."

Maybe an underactive amygdala for that guy. That's what I'd say too. Look at his face — an absolute kid in a candy store, just having the best time. Actively smiling. Forget the active shooter — active smiler. Isn't that an interesting response from somebody in that situation?

I get what you mean. When you look at neurophysiology, the brain is fascinating for so many reasons, but when you actually understand what areas of the brain do what and the connections between them, you can see it in human behaviors and patterns. It's wild.

What about the limbic system? The limbic system matters because it's really the emotional circuitry in general. When you're dealing with big emotional data that may or may not be justified—it might just be that you perceived rejection or criticism or emotional input—your limbic system goes wild. Areas light up, you're communicating as if a big emotional response is happening, and you're trying to navigate that in real time.

Is it right to say some people feel emotions more than others? Yes. When we talk about feeling emotions, there are several steps: perceiving them is the first thing that happens, then experiencing them in the moment, and then how long you spend on that emotion afterwards. Some people can walk into a room and already know something weird is happening. They'll say something feels off, or there's something in the air—and what they're doing is scanning the room. They're not only listening to the words in the immediate conversation, but reading body position, tone, volume of voice, picking up all these different cues and amalgamating them, sometimes for the negative.

So when it comes to emotional intensity, first you have to realize the emotions are happening. Then it's how big the feeling feels inside of you—that is, how many different cascades occur in your brain and body to make you feel it. And then how long is the falloff afterwards.

Someone walking into a room hypervigilant—noticing a person turned away a little bit, blinking a bit more, or just getting a sense that they don't feel too good—will often, like a smoke detector principle, perceive problems where there are none. That's when it becomes very maladaptive. It's already somewhat maladaptive to perceive things with a level of resolution higher than everyone else, because the world most people inhabit, at the center of the bell curve, and the world you inhabit, out toward the tail end—and the world Dana White is in, out on the other tail end—are different existences. There are things Dana would miss that it would be great for him to pay more attention to, but the highly sensitive person has a different type of error: they've pattern-matched something that wasn't actually there, like concluding an aunt across the room is in a mood with her sister when she isn't. So there are strengths and weaknesses on both sides.

When thinking about RSD, what other traits tend to be bundled in with it? Are there other things that come along for the ride?

Before answering that, there's a huge factor we forgot that happens in the brain: hormones. There's not much else in the brain that can change your entire system so globally, from top to bottom. Hormones are especially interesting for females, because for women you're changing every month, when you're pregnant, when you're perimenopausal, when you have a kid — you can have eight different versions of yourself. Men deal with hormonal changes too, such as dropping testosterone and other shifts happening in real time.

Hormones directly affect emotional regulation. For example, as your estrogen drops, your dopamine drops as well, making you less able to regulate your emotions. This is a hugely important factor in emotional sensitivity and rejection sensitivity: for two weeks out of the month, if your estrogen level is intrinsically lower, your dopamine level is lower and it's harder to regulate — so you'll be more rejection sensitive and emotionally sensitive during those times.

What relationship does testosterone have to emotional sensitivity?

Testosterone can actually be protective in that respect, to a degree — it helps you feel alert and awake and may help you emotionally regulate and balance a little better. The problem is that as testosterone drops, as happens for males in their 50s and 60s, that drop can produce a huge rise in emotional sensitivity, and a lot of men aren't equipped to deal with it.

Going back to why social...

Going back to why social rejection hurts so much—from an adaptive standpoint, presumably I'm being kicked out of the tribe. There are only 30 people in my pod out of the 150-person Dunbar tribe I'm part of. If I'm on my own, I'm dead. So why would evolution create a brain that can be so devastated by criticism?

I don't know. Here's the deal, though: I know that I myself am emotionally sensitive, and I wouldn't trade that for the world. It's really difficult at times to be highly emotionally sensitive, but I think it makes me a better person, a better physician, a better parent, and a better partner. Being highly attuned to emotional data and incoming information can be one of the greatest signs of emotional intelligence you have. So I wouldn't trade that emotional sensitivity.

Did evolution make a brain that can be devastated by rejection? Yes—but there are also some positives that come with it.

The conversation turned to hormones: does RSD look different in men? The psychiatrist offered what he called a weird answer, and his personal soap box.

As a psychiatrist watching mental health in general, and its progression as it's discussed more openly, you start to notice patterns. Looking at male mental health, he believes we have done men a huge disservice by not educating them or helping them cultivate knowledge about emotional sensitivity. As a result, many men only know how to target a couple of emotions, one of them being anger.

Many men have been told to "man up," that it's not a big deal, not to cry. They've been forced to suppress emotions, and the only socially acceptable emotion they're allowed to express is anger. Some of that anger is probably misdirected or confusing signals of emotional sensitivity.

What happens when emotionally sensitive boys are told to man up? You get really angry dudes. As a parent with a son—perhaps it's the mom-son thing making her so protective—she has started zooming in on how other people raise their six-year-old boys. Even in kindergarten, the way girls are treated versus boys—not by the teacher, but by the parents—is striking. At birthday parties, a girl who falls down is scooped up, coddled, told everything's okay. A boy who falls down hears, "Oh, that's not that big of a deal, let's move on." Boys are given no space to explore and navigate emotional sensitivity.

He agreed: emotionally sensitive women seem to have more latitude and forgiveness to explore that sensitivity than men do, especially into adulthood. Anger is such an antisocial emotion—it's dangerous, destructive, often unwanted even by the people experiencing it, who don't want its impact. Yet for many men, anger is more socially acceptable than sadness. Given how antisocial anger is, that really shows how unaccepted sadness can be.

We talk a lot online about getting men to open up. He had two conversations that week about male suicide, and in both came the refrain: "I just wish he'd reached out, I wish he'd talked." But in over 90% of cases where a man takes his own life in the UK, he has already received some form of mental health counseling. So it's not just about talking—it's about giving men room to actually feel their feelings.

A lot of the work here, he said, can be laid at other men's feet. Everyone says they want their friend to open up if he's having a bad time—"I really need you to talk to me." That's easy to say after the fact, especially if something devastating has happened. But how many guys are actually supportive of another man on the internet opening up about how much he's struggling? Not within the acceptable emotional Overton window—"things are hard, but I'm getting back in the gym and putting on muscle"—but really broken down: "I don't know what to do. I'm alone. I'm broken. I'm lost. I'm devastated."

A guy who's crying is aversive to a lot of men—and to women, too. His point: you don't get to say male suicide is a big problem, that society needs to care more, and then take the piss out of a guy opening up about his emotions online.

He floated an idea he calls "man points": guys feel they need to accumulate sufficient surplus masculinity in areas like muscularity, strength, success, money, notoriety, or women.

The idea behind "man points" is that guys need to accumulate a surplus of masculinity in areas like muscularity, strength, success, money, notoriety, or women. If they've got that bank account reserve, they can withdraw from it and then talk about emotions — like a special video game unlock that only happens once you've reached a particular level of being a man.

Basically, most of society has a big ick about men talking about deep emotions, especially difficult ones — but far fewer of them if it comes from a place of prestige rather than poverty. A guy who's already down on his luck and doesn't have much going for him, talking about how much things are hurting, doesn't get the same sympathy that Chris Bumstead gets. He's a six-time Olympia world champion, one of the most muscular guys on the planet. He can cry and talk about how he broke down in his girlfriend's arms six weeks before winning the world championship, because he has all these trappings of masculinity that make it seem like it's not coming from a place of weakness — it's coming from a place of strength.

But Chris doesn't need the same kind of support, because he already has a community around him — a supportive wife and all these successes continuing to move him down the track. The people who really need it are the guys who don't have anything going for them, and they're presumably the biggest risk as well. That's my soapbox: I really wish there were more latitude. Speaking as a guy that feels feelings — I did a full week retreat working exclusively on emotions, twelve hours a day for seven days in Northern California last year. Two weeks ago I did a jhana meditation retreat, a silent seven-day retreat working on the conductivity of emotions, sitting on the cushion six or eight hours a day. Both were attempts to get below the neck, to move away from the felt scrutiny and existing patterns of asking: how is this going to show up in the world? Can I operate this way inside my business? Is this publicly acceptable? You can go work on this thing in isolation and then come back, but those questions don't leave.

I know what it's like to be a really sensitive kid growing up with nowhere to put it, because you're in a working-class, blue-collar environment and the people around you don't notice or don't have the tools to help. It can drive you to do really amazing things, but it also creates a bunch of coping mechanisms. I had this weird gift — a depth of connection I could have had with the world, and I contorted it, alchemized it, you could say, because it went from being a challenge to something I turned into something good. But it is also a denial of a bit of yourself at the same time. That's one of the reasons I was excited to speak to you — it's a very personal, super interesting topic.

I think it's fascinating that a lot of emotionally sensitive people go through life hiding that part of themselves, because there's so much internalized shame around it: you're not supposed to be sensitive, you're supposed to be strong, you're supposed to be able to handle stuff. This applies to men and women alike — as a human condition, people are celebrated for getting on the other side of adversity: you did so well, you didn't complain. So from a young age you just learn to shut down that part of yourself or become really embarrassed. I remember being a kid — something would happen and it would hit my ear the wrong way, and I'd think, oh my god, I'm so embarrassed, and I'd go hide under a table or in a closet, because I was embarrassed and sad and everything happening all at once. Eventually, around age eight, I decided this was not conducive to moving forward and functioning well — I can't do that when I'm grown up. So then you just start hiding it. If you're emotional or having a hard day, you lie about it: "I'm fine, I'm fine, it's not a big deal, I don't want to talk about it." Sometimes I wouldn't want to talk about it with other people because I'd cry, and that would prove I'm emotionally sensitive. I hear that story a lot.

The insight that suppression isn't the same thing as strength.

Yeah.

It's kind of world-changing to realize that, if you're an emotionally sensitive person, swallowing your feelings down means you're performing the role of somebody who has composure — but that's not the same as having composure. You're performing the role of somebody who hasn't felt the thing, but that's not the same as not feeling the thing.

And you've got this line: "The real challenge lies not in feeling deeply, but in living in a world that doesn't always know how to support that sensitivity."

That's a good quote — it really is a great line. The world feels very spiky. Every time I come back from retreat, everything feels so tender.

And then what you get to see is that operating in a world that's incredibly intense, chaotic, and fast-moving, you have to create these strange patterns and coping mechanisms and wall yourself off just so you can move through the day. And that's fine — you don't want to be a whimpering blob on the floor.

I don't want to be a puddle of emotions. I want to be able to show up. But at the same time, there are bits of your experience you're denying yourself, and there are strengths that come along with this sensitivity.

What are the strengths of highly sensitive people, and of people with rejection sensitive dysphoria?

There's a direct pipeline between being highly emotionally sensitive and being highly emotionally intelligent—it's just a matter of how you deal with that sensitivity. Some of the strengths that come with it:

1. A deep understanding of other people's emotional insides. That's part of what led me into psychiatry and why I've continued to enjoy it. Sometimes a patient comes in and, when asked what has upset them in the past two months, answers "I don't know"—a stone wall you don't know how to get past. But as a highly emotionally sensitive person, you're picking up on body cues from earlier in the conversation—when they talked about their family, or how they answered certain questions. You notice the tension and start asking different questions. You're picking up things you might not even have clocked as they happened, but you've amalgamated them and know exactly which direction to go. That's an incredibly wonderful thing to have.

Outside of psychiatry, this also makes you a good friend, a good partner, and a good parent—I think it's especially helpful with parenting. It's that huge scope of understanding of the emotional condition.

Emotional sensitivity and self-esteem

Does emotional sensitivity affect self-esteem? Yes—but sometimes negatively. If you're highly emotionally sensitive and used to reading emotional data negatively, it can start to erode your self-esteem. Self-worth and self-confidence are different things, but you walk into a room and start feeling like maybe you're not wanted there—reading emotional information and attaching a narrative that doesn't actually exist. That can definitely impact your self-esteem.

But there are other times when it works in your favor. In my work as a psychiatrist, I'm celebrated for that sensitivity, and it's a really unique field for an emotionally sensitive person. It's where I get the most validation, because people feel like they've been understood for the first time.

What's the difference between confidence and self-esteem? Self-esteem is inherent — it's just you. Confidence is more about what you're capable of, your confidence in your skills and what you can do in that moment. Confidence fluctuates, while self-esteem — your self-worth — is your base.

Does that mean people with RSD are more likely to need constant reassurance? Yes. What's happening is that they're getting negative input — or potentially input that isn't actually negative at all. They may be reading neutral input as negative, or even positive input as negative, but either way they're reading it as negative. There are times when you get so stuck in these amygdala loops of fear, with stress hormones cascading through your body, that you just think: I need someone else to tell me this isn't actually the case. It's a form of reality testing.

Can you build self-esteem without external validation? Yeah, I think so — though success is kind of external validation in itself. One of the biggest things that helps is understanding your own brain. If you can destigmatize things for yourself — this isn't a personal failing, this is just neurobiologically how my brain works — that can bolster your self-esteem tremendously.

Are compliments hard for these people to believe? Sometimes. It depends on how they're receiving it in that moment and what the relationship is with the person. If it's a sibling who's always been a bit of a truth-teller giving a compliment, you might not trust it — that's weird. Or if someone is already self-conscious about something and a person they don't know well compliments them on it, it might hit their ear strangely. It really depends on where they are in that moment — but it's possible for compliments to land.

"How does emotional sensitivity show up in relationships?" — I laughed because it's such a broad question. I think emotional sensitivity plays a role in every relationship, whether you're highly emotionally sensitive or not. Relationships are a minefield for emotions anyway, because in a very real way you're putting yourself in a spot of vulnerability: you're exposing parts of yourself to another person, putting it out there, and possibly receiving rejection or criticism. For a highly emotionally sensitive person, that can get really tricky. I know a lot of people with rejection sensitive dysphoria who don't want to date anymore. They say, "This is too hard. I can't do it, because as soon as there's a delay in texting, I've convinced myself this person isn't interested and I've redownloaded an app."

Why does waiting for a text feel so unbearable? It's the lack of an immediate answer and knowledge. Your brain fills in a narrative in that empty space — for example, "If they were interested, they would respond right away." I've even had the thought, when someone hasn't texted back, that they must be with somebody else and not thinking about me. By the time they respond after their shift, I've already moved on — I'm angry with them — and it takes a while to recalibrate and realize that's just where my brain went.

Does this mean anxious people sometimes sabotage relationships before they've even had the chance to be rejected? Yes. How does that show up? That was my pattern through all of my twenties. As soon as people got close enough that I'd have to show actual parts of myself — that I'm really emotionally sensitive and overthink absolutely everything they say — I'd assume they were going to leave, so I'd just end it first. I've never been broken up with, ever, because I would just quit: "You can't find me. I'm out of here." And it was literally no fault of theirs; they would not have been the cause.

It's not even fear of abandonment, because I'd rather be alone. I just don't want you to say something negative about me, or point out something I already fear about myself. I don't want to hear the words that you don't want to be with me. I'm fine alone — I just don't want you to push me away.

There's also the vulnerability hangover after you've opened up. What is that? For me and so many of my patients, it's the period where you feel you've shared too much and let someone into your internal environment — you've cracked the door open so they can see that stuff. Then my brain just spins: now they know this, they probably think I'm a huge weenie who can't handle anything. It's a direct path from being very vulnerable to being very embarrassed and then pulling away.

It feels like the common thread here isn't really feeling the emotions deeply — it's the story you tell yourself about what those emotions mean and what other people might think of you for having them. There's a lot of shame wrapped up in this, at least that's how I'm interpreting it.

I think if you look at emotional sensitivity as a spectrum, there's a place where maybe you're not as emotionally sensitive as you might should be—

Dana White. [laughter]

Then there's a place where you're kind of regulated in the middle, a place where you're highly emotionally sensitive, and then when you move further down that path—

Pathologically sensitive.

Yeah, I think that's more rejection sensitive dysphoria.

Right, so we're talking about the most sensitive people.

That's what I say, yeah.

Okay. And you consider this to be you?

Yeah.

Right. But you managed to operate in the world—I mean, you've chosen a very specific industry to be in. [laughter] I think this is the

If we take you at one end of the spectrum and Dana White at the other, physiologically you're two very different humans. Dana White would probably make a horrendous psychiatrist, and I don't think you'd be fantastic as the CEO of the UFC. But there are dispositions, and there are situations you put yourself into. If you were in a relationship with somebody who was go-go-go, didn't really think about emotions, wasn't able to sit with you in the muck or hold space, that would be a bad type of partnership. I'm sure you could make it work, maybe even have a flourishing relationship, but it would be done by gritting your teeth and gripping the bar aggressively. The same for Dana White: if he were in a relationship or business where he constantly had to be soft, patient, sensitive, and move at a delicate pace, he might make it work—he's a flexible, competent human—but he wouldn't be fully utilizing that part of his capacity, just as the world loses a great psychiatrist if you became the CEO of the UFC.

To me, this is compatibility. The more I think about it and the older I get, compatibility is kind of everything in life. You have this disposition; you can work on it and smooth off the edges that feel a bit pathological or maladaptive—firing at the wrong times, wanting a bit more of this and less of that. But largely you have a suite of strengths that come with this particular disposition, and you can put yourself in a situation where those aren't things you need to curtail—they're things you can use as a platform and a springboard.

I pay a lot of attention to stuff, specifically words. Words were my first love as a kid; I read a lot. Now, when I build brands—like this podcast—that means wordplay, coming up with cool copy, and spending obsessive amounts of time on details. On the first run we ever did, there were three icons on the back of the can, and one was half a point off offset. We'd sold millions of cans and no one had noticed, until one day I picked one up and said, "Guys, there's something wrong with the back of the can." The only reason that was seen was that level of attention to detail. Is that going to be the difference between this being a billion-dollar brand or not? Probably not. But my point is that I work in industries where that attention to detail can be used properly. If I were an architect or an engineer building bridges, or a surgeon's assistant paying attention to how clean the surfaces are, it would be great. In a different industry, I'm not convinced that level of attention to detail would be so good.

So for people who think, "I feel stuff a lot, I pay a lot of attention, I focus on things, I tend to ruminate, I have intrusive thoughts that play out these pantomimes of what might have happened with this person and their motivations"—okay, that can and should be alchemized in some ways. We can work on it, but you can also find worlds and domains where that's a real superpower. The goal isn't to suppress it as a strength, but to see that the issue is not you being sensitive—the issue is being in a world that doesn't utilize your sensitivity properly. That's an interesting way to get tactical about this.

That's how I ended up in psychiatry. I went into medical school hoping to do pediatrics—my mom's a pediatrician, so I thought that's what I'd do. I got through pediatrics and thought, this is a little boring. I wish it wasn't, but I can't be in clinic all day, and I also can't be sick every winter.

From Pediatrics to Psychiatry

I couldn't do it. So I decided to pivot and go into the PICU. I really thought that was my calling, because after all that work in med school, this felt like the superhero job—I was saving children, and nothing could be better than that.

I went in for my letter of recommendation. I was standing at the door of her office when this woman stopped me and said, "I hope you're not coming in here for a letter." I said, "Okay, what?" And she said, "You cry all the time. You cannot do this. You will burn out in five seconds." I put this story in my book, because in my brain I was thinking, just say something, make a noise, respond—and I couldn't say anything, because she was correct. I knew in that moment that she was right.

Every day I went to work in the PICU, I was scared and upset. I would be reporting to my attending, telling them what happened overnight, crying as I told them at the bedside. So I left her office, sat in my car, and thought, okay, I guess what area of medicine can I cry in? I ended up in psychiatry.

Finding an environment that can hold all of that emotional sensitivity is really important. And the same thing goes for friendships and relationships.

Asked why waiting for a text feels so much harder than bad news, the guest says it's because uncertainty isn't definite. With bad news, at some point you can say, "Okay, that's really bad, but here are the steps I need to take to make it better," and you can make a game plan. With uncertainty, "I will tell you 10 times out of 10, I will convince myself that a way worse outcome is happening in real time." Once you actually learn that something bad is happening, it usually turns out not as bad as what you had imagined.

The other speaker adds that imagination can create scenarios that defy the laws of physics — your dead great-grandmother can come back from the grave to laugh at you about something that couldn't even happen. That's how much our brains abhor uncertainty: they would rather fantasize a nightmare than deal with ambiguity. The guest admits she has invented situations like this, later telling her mom all about them and being met with "What? How did that come into your brain?"

Ghosting and the lack of closure

The host connects this to why ghosting is so damaging: there's no closure. The guest agrees, adding bluntly that ghosting is just awful and people shouldn't do it — it's an awful way to communicate. For an emotionally sensitive person, ghosting isn't just the dissolution of the relationship; the brain automatically jumps to "there's something about me that forced this person away." As the host puts it: "They're an asshole" becomes "I'm insufficient." The guest confirms that the blame gets turned inward on yourself, which she calls incredibly cruel to do to somebody else.

Taking it back to how RSD and emotional sensitivity show up in men: are emotionally avoidant men sometimes just emotionally sensitive men in disguise who lack the courage to show it?

A lot of times, yes. Men don't have much space to explore how to be emotionally sensitive, because from a young age they're told they can't be, so they learn to suppress and change it. When they're put in situations where they might have to be emotionally open in a way that could get them hurt or rejected, or trigger sadness or some other emotional response, their reaction is simply, "Nope, I'm out — I'm pulling myself away from this." I've been avoidant in the past for exactly that reason.

The interviewer asks how to draw the line between emotional sensitivity and emotional fragility. Wherever you sit on the spectrum—from Dana White to the guest, whom he jokes are "technically different species"—when is this something you need to man up about, grit your teeth and work through, as opposed to simply not understanding how emotionally fluid and sensitive the other person is? Everyone likes the idea of being validated, but validation taken to the extreme results in no accountability: if every emotion you feel and every response you have is valid, then you conclude you don't have to work on anything and can behave however you want, rather than pushing yourself against some limits. Many listeners will recognize this in a sister or girlfriend who cries at things they wouldn't, and who takes a while to come back down after an emotional event. So how does somebody know when it's emotional fragility that should be worked on—when should they push, and when should they pivot?

The guest doesn't think it's for another person to make that decision; it belongs to the person experiencing the moment. For years she asked herself, "Am I too fragile? Am I too weak? What is wrong with me?" Her conclusion, after three years of research, is that emotionally sensitive people have been existing in an extremely difficult environment—right now the world is a hard place to be a human in.

The interviewer agrees it depends: if you don't want to feel feelings, it's actually quite a fun place to be, with endless novelty and an infinite velocity of stimuli to enjoy. But if you actually want to feel feelings, it's horrendous.

She places herself on that horrendous end—existing in the world right now can sometimes be very difficult. Beyond that, emotionally sensitive people have never been given tools. They've been told they're too sensitive, too fragile, too weak, and need to strengthen themselves—but no one has told them how.

What it boils down to is the step of receiving emotional data and catching it in the moment. You can't change the processing—you're still going to read it—but can you impact the intensity? Can you impact the duration? Can you get past it and make it a usable moment? There are skills and tools for that, and pulling from every area of psychology and psychiatry to find tools that work both in the moment and over time is what led to her book, because people don't have them. She never did.

Asked which emotional regulation tools are most powerful, the speaker described her "calm your mind toolkit" of twelve techniques. All of them are things people have probably heard before—challenge negative thoughts, move your body, delay your reaction—but for an emotionally sensitive person or someone going through big emotions in real time, the moment can become so overwhelming that nothing is happening in the brain: you can't think, process, or figure out which tool to use. That's why she wrote the book: in a regulated state, she could pick the tool she wanted and break down its steps, knowing that an emotionally sensitive brain will go blank in the moment. She wanted a step-by-step guide because she believes it would have made med school, dating, the early years of her marriage, and parenting easier.

Movement

One of her favorites is movement. This doesn't mean heavy weightlifting or a set amount of cardio—when you're incredibly emotionally overloaded, physical movement has tremendous value for two reasons. First, it disrupts the pattern. Second, it gets oxygenated glucose to the brain and, ideally, shunts it to the frontal lobe so you have the resources to think, process, and override the amygdala in real time.

Asked what this looks like in practice—does someone just start doing push-ups?—she said whatever works for you, and gave her own example: the last time she used it in real time, she was in a meeting telling her partners of nine years that she was leaving the practice to start her own. She felt overcome with guilt and fear about starting something new, recognized what she needed to do, and simply began tensing her calves and moving her legs under the table. She connects this to ADHD, where nearly 100% of people have some form of rejection sensitive dysphoria: fidgeting serves as emotional regulation and self-stimulation, a way to surge dopamine and norepinephrine.

Delay Your Reaction

Another favorite is delaying your reaction. Her initial impulse when pressed against the wall or facing big emotional stuff she doesn't know how to handle is to respond with urgency—if a text message goes unanswered, she's the person who texts four times asking where you are and what's happening. Delaying her response lets the amygdala stop spinning, brings the frontal lobe online, and makes the narrative she tells herself significantly less negative; usually by that time the other person has responded.

Asked whether this doesn't just create more time in uncertainty, she said the key is that it's a purposeful, mindful act. You're not stepping away thinking "maybe they'll respond in that time"—you're stepping away because you know your brain needs time to stop overheating, to let the amygdala stop spinning out of control and the frontal lobe come online. Giving it enough time means you'll think better, and knowing you're using a tool means you're not just sitting there.

Asked how being a mother has been with her sensitivity, she says it is chaotic—but she thinks all parenting is chaotic. "It's a wild ride." She considers herself lucky because her husband is very measured, calm, and patient, and acts as an emotional barometer for the whole family. In that context, where she feels safe and everyone is given free rein to explore their feelings and navigate life, being emotionally sensitive as a parent has been really helpful.

It has helped her understand that kids can be very annoying—that's just part of being a kid. The interviewer jokes that they reliably grow up to be annoying adults too. She agrees: there's the noise and the things they do, and they're not little adults. Their frontal lobes aren't developed; they don't know any better. But parents are so tired and fatigued from the nonstop marathon of parenting that it's sometimes hard to remember that.

Being emotionally sensitive means that when you see your kid having a big emotional moment, you recognize it: "I know what this feels like, and I know what can help you come out of it." And it's not going to be snapping, yelling, or trying to pull them out of that moment by force—it's giving them the safety and freedom to explore and figure out the solution for themselves.

The third favorite tool is mindfulness. What matters most about it, for me, is a correction to how I used to think about it. I always assumed mindfulness meant a factory reset — that during meditation nothing should be going on in your brain. The real difference is giving yourself the space to non-judgmentally observe what's happening in your mind, just watching what is going on. There was a study out of Yale looking at exactly this: the power of pure observation instead of judgmentally rushing to fix a feeling. Just looking at the feeling reduces activation in the brain.

That's something I learned on a meditation retreat, in an interesting style called Jhana, which is the one I was practicing. Mindfulness is a bit more brute-force, which is probably why it's become more popular: you have a thought, you notice it's there, and then you release it. It's not quite a pushing — more an opening of the hand. But in the school I was doing, you actually welcome the thought in. You pull it toward yourself.

So if you start thinking about work and then judge yourself for being distracted, you notice both thoughts and say, "Wow, there's that part of me that thinks about work — I'm really glad I care that much about my pursuits. Why don't you come here, let me show some gratitude to that." And then: "There's that part of me judging me for not being good at this. He just wants to work so hard, he really wants to do this right, and he's here to protect me — you can come here as well." Continuing to do that makes it a very different experience, especially after roughly 2,000 to 2,500 sessions in the other style across my life and then being thrust into this new school. I imagine it's like training in kickboxing your whole life and then starting Brazilian jiu-jitsu: you're still fighting somebody, but the domain is completely different.

What it comes down to is emotional conductivity — how can I see what I'm feeling completely non-judgmentally? I think that's the same thing you're pointing at. In one approach you let the thought go, in the other you bring it in, but both share a lack of judgment. And I think that shame spiral we were talking about is...

The question was raised: what is TikTok and social media doing to emotionally sensitive teenagers?

Social media is just a weird place in general — and that's coming from someone who is on it. I get triggered by social media all the time. I'm constantly comparing myself to others. For a long time, much of my day-to-day relationship with self-worth was driven by numbers: how many likes a post got, how much engagement I was getting. That external validation was what told me whether I was good at what I was doing.

I'm a physician who went to med school and studied the brain, and this is still happening to me. So for kids whose frontal lobes aren't fully developed, I think they probably are at higher risk.

That said, I don't think completely shielding kids from social media is realistic — the train is moving. You can't shelter your kids from absolutely everything; you have to teach them how to navigate these constantly evolving waters.

Asked whether early childhood upbringing can enhance sensitivity, the guest says a huge part is genetic, but growing up in an incredibly chaotic and tumultuous home also makes you hypervigilant — constantly searching for cues — and you can become more emotionally sensitive because of that. If both factors combine, the effect is stronger.

Rejection sensitivity can be seen in two- and three-year-olds.

Parenting and the "heel of bread" problem

On whether parenting behaviors accidentally create emotional fragility, she points to things many parents do hoping to raise a more resilient child: telling them "you don't need to cry about this, move on, this isn't a big deal." She thinks about this constantly raising her own kids. Her son recently had a tantrum because she wouldn't give him the heel of a loaf of bread — "that's objectively the worst part," she told him. But then she realized this kid hasn't dealt with disappointment yet; from his perspective this is probably one of the worst things that has happened to date, since he hasn't had a very hard life. So instead of saying "this isn't a big deal," she needed to teach him how to navigate disappointment. It probably is kind of a big deal to him — he really wants that heel of bread, and she doesn't have a good reason not to give it. They just had to navigate through that moment. It's easy in the moment to say "this is a dumb problem, move on."

The host calls the heel of bread a lovely meme for everything: working out the difference between validating feelings and encouraging victimhood, which applies in adulthood too. There can be situations where what you're after is your own "heel of bread," and everybody around you — and the better version of yourself — has every right to say, "No, dude, you don't want that. You're being silly." Finding the line between validating somebody's feelings ("Hey, I know that you feel this way") and not encouraging them to further weaken the emotional resilience they need — that's where the rubber really meets the road.

How they got through the moment: she took out the heel and another piece of bread and asked him to describe what he liked about the piece he didn't want, instead of the one he did. He concluded, "No, I wanted this one instead." He had been so stuck on the idea that he couldn't get past it, and rather than just saying "that's dumb," letting him actually see and reach the conclusion that he didn't really want the heel of bread was helpful for both of them.

Asked how RSD shows up in work and achievement, the guest notes that while you might expect overachievers and perfectionists, sometimes people never even get to the point of overcompensating because they aren't putting themselves out there at all. She has patients who describe getting spooked during a job interview and walking out — "I couldn't do it. I didn't feel like they liked me."

Even for those who make it into the workplace, the pattern is familiar among high-achieving people, especially high-achieving women. Society pressures women to do it all without complaining, so when another task comes along, the answer is always yes — yes, I can take that on. The result is that you override the signs of burnout and keep adding more to your plate, because you don't want to look less capable than your peers. You don't want people saying, "She could do that last week — why can't she do it this week?" So you keep adding more until you hit the tipping point where you can't.

The tension women face at work

The host cites an essay, "The Ambitious Mother Paradox: Good Mother or Wasted Potential," and reads a line from it:

The implicit logic of protecting your right to work in the workforce was clear: you can't argue for equal access and then immediately ask for accommodation that implies you are different.

Women have only recently been brought into the workplace, and they worry that what they've gained might be taken away. Yet aspects of many women's psychology can make the workplace feel spiky, unforgiving, sterile and cold — emotional sensitivity has little room in a fast-paced, capitalist, meritocratic environment.

At the same time, you know you fought for this career, as did every other woman who just arrived, and you don't want it taken away. So you feel bad asking for accommodation that implies you're different — especially when the men around you don't seem to feel the same thing, or perhaps just suppress it more effectively. The host says he'd never heard anyone articulate this tension before, like a bridge swaying in an earthquake: a pull on the system, especially for highly sensitive women at work. He describes the internal conflict: "I feel like I need to show up as the men that I think are running the company, but I want to be one of the women that's maybe running the company — but I'm denying part of the nurturing, empathetic people skills that are my competitive advantage." You want to protect progress for everyone else, not deny yourself, and you might need support — but you worry that support counts as accommodation in this brand-new world. Reading Taylor's long essay, his reaction was simply: that's a lot to navigate.

Motherhood and career logistics

Beyond that, there's a logistical layer: child-rearing falls right at the peak of your career. You have a kid, step away, then reintegrate — and everything you worked toward seems pulled away from you. Everyone assumes your priorities have completely changed, and opportunities are kept out of your reach. It can be very difficult to maneuver, simply because women are the ones bearing the children.

The host mentions conversations about "dad brain" and "mom brain": if you have a child as a mother, there's roughly a 2.5% gray matter loss — meaning almost anything requiring executive function that isn't your child gets pruned a little.

And that means if you were the EA to some high-powered CEO, basically running his entire life, or the chief of staff—before, you were this absolute military killer who knew exactly what was going on at all times, and now it feels like there's fluff in your brain.

This is another situation where I think compatibility matters. One suggestion—not my idea—but suggesting that mothers look at transitioning careers to things that utilize this new skill set. Not to see it as a weakness, not to say, "I want to be the person I was at 25, when I had literally a different brain, different priorities, and a different stage of life," but rather, "I've just unlocked this entire new world." Maybe becoming a therapist would be an incredible opportunity to focus this brand-new level of empathy.

The flip side: should those environments accommodate these changes? Understand that these changes are happening to women, that priorities shift, and instead of putting them in the same roles, pivot their roles so they can utilize the skills they have—same idea, but inside the same company. I think that's a great idea. But it's a culture and narrative change that would need to be made, and I get the sense that a lot of women would feel, if it were imposed on them, "You're saying I can't do what I used to do."

What you're trying to open up is: no, I'm saying you're better at other things you couldn't do previously. There are two ways to look at it—what have I lost, what have I gained? We're saying this is something you've gained; why don't we utilize this new skill? As opposed to, "This is something you've lost; why don't we get you away from that old skill?" It's just the framing. But the volitional component matters too—if the woman herself feels this is where she could spend more time and use these skill sets better, at the end of the day it should be her choice and her pushing that decision.

I agree. Creating the culture that makes it not feel like just chalking up an L—that's where external influence can shape internal desire. The way it's framed externally, what society says I should be doing, actually makes me feel more or less comfortable doing it.

And the ruthless part of this—for every woman running a career, let alone every man—the market doesn't give a damn. Businesses need to run businesses that are profitable and growing. That's where you find the line between validation and knowing when to push, when to pivot. The same thing is true for men: if your testosterone is dropping and you're not quite as mentally quick at 65, you're probably not going to be the same killer salesman you were at 28. The market doesn't care.

Here's how I've been thinking about this whole conversation and your book: sensitivity is the input and emotional intelligence is the output—that feels like the equation we're playing with. Is that a fair assessment? And that gives people certain advantages, and certain challenges as well.

I think emotional sensitivity as a whole can be difficult and it can be wonderful. As a person who's gone through this, and as a physician who went through medical school and psychiatry training—this was never taught. People aren't taught how to actually, in a very real and tangible way, deal with their emotions. A lot of my research was on ADHD, and with ADHD, executive function and all that—to some degree you can find a hack, or you can delegate. You can't do that with emotions.

They're just in you, and you can't show them to anybody else. You have to be able to process them and get through to the other side. If you're completely consumed by them, or having a hard time regulating them, you're not going to be able to think. You're not going to be able to move on from that moment—it takes so much brain space. That's one of the things I hope this book will help give people: a little bit more agency over their emotions.

Asked what she would want to tell someone who feels the world is too spiky for their emotions, she said they simply don't have the tools yet. Life is hard, and this world is hard. Being emotionally sensitive is, for many of us, a beautiful thing — it's just sometimes really difficult to keep your head above water when emotions are big. Having those tools and being able to grab hold of them and use them at the appropriate times is life-changing.

The host thanked Dr. Sasha Hamdani for exploring the world of people with "way too many emotions," and asked where listeners could follow her work.

She can be found on Instagram, TikTok, and YouTube under the handle Psych Doctor MD. Her new book, Too Sensitive, comes out August 25th.

The episode closed with the host's usual sign-off: congratulations on making it to the end of a podcast episode without dying — now here's another one.