/ DBT-C, English, Supersensers / By Francheska Perepletchikova

This discussion was prompted by a question that I have received from one of the participants on my Superparenting 101 course. This is quite a frequent question from concerned parents.

She wrote:

“Hello, I took this course a couple of years ago. It changed my life in a very impactful ways. I continue to practice all of the techniques. It’s the best program I’ve ever taken.

I’m writing because I have a burning question for Francheska. She knew exactly what kind of child my son was. She asked me if it seemed like he just wanted to rip off his skin due to all the internal hyperactivity and she asked if the only time he’s not defiant is when he’s sick. Without even seeing him she knew who he was.

I wanted to ask her if that kind of kid will often end up being diagnosed with psychopathy? I’m just struggling to come to terms with things I see and was curious to know what this type of child often ends up diagnosed with.”

So, to sum up, this concerned mother was asking whether her emotionally dysregulated supersenser can develop psychopathy. Psychopathy is characterized by extreme lack of empathy, overly high self-regard, mistrust of others, predatory exploitativeness, cruelty, impulsivity, difficulty with self-regulation, and risk-taking behaviors. Psychopaths can be charming and adventurous but lack conscience and guilt and frequently refuse to accept responsibility for their actions. 

If a child is a supersenser, s/he has a zero chance of developing psychopathy. Supersensers are emotionally sensitive, while psychopaths (or children with conduct disorder) are callous/unemotional. Both groups are born this way. They have different brains. On a level of physiology, Supersensers have a limbic system (a structure of the brain that generates emotions) bigger than average, while psychopaths have a small limbic system that cannot generate strong emotions. 

Ironically, both groups can look very similar behaviorally – verbal/physical aggression and even emotional/physical abuse of other people. However, functions of these behaviors are different for each group! Supersensers mostly have temper tantrums as a coping mechanism, as they are overwhelmed by their emotional tsunamis and screaming/yelling/punching can indeed help in a moment to decrease the painfully intense emotional arousal. Psychopaths (or children with conduct disorder) have temper tantrums primarily with an instrumental function – to force other people to give them what they want. Their outbursts do not stem from being emotionally overwhelmed.

Supersensers can also have tantrums with instrumental function, as all behaviors are multifunctional. The key here is which function is most frequent and starts the fire. Supersensers indeed frequently use force to get what they want, however, this primarily stems from their tremendous difficulty withstanding the emotional pressure of the delay in gratification. Further, they have learned that using force works as others frequently accommodate to stop or prevent outbursts. 

Supersensers are frequently misdiagnosed due to the overlap in symptoms in different disorders. I would like to highlight here just the most common clinical diagnoses for supersensers with emotional and behavioral dysregulation, as well as the most common misdiagnoses. 

Supersensitivity can range in severity and intensity. The intensity of supersensitivity ranges from 1) a child being mostly happy-go-lucky between outbursts to 2) a child who appears electrified (tense) most of the time. Interestingly, clinical observations indicate a pattern – the first type becomes much more irritable when they get sick, while the second type finally mellows down when ill. Further, severity of supersensitivity can range from the least resilient “snowflake”  to a more resilient “butterfly”. 

“Happy-go-luck” Supersensers with emotional dysregulation are mostly diagnosed with Depressive Disorders, while “Electrified wire” Supersensers are mostly diagnosed with Disruptive Mood Dysregulation Disorder or Intermittent Explosive Disorder. Both types equally may receive co-morbid diagnoses of Anxiety Disorder, ADHD, Bipolar Disorder, may have severe social problems and can develop Borderline Personality Disorder in adulthood. 

All types of Supersensors are frequently misdiagnosed with Oppositional Defiant Disorder (ODD) and Autism Spectrum Disorder (ASD). Symptoms of ODD represent just a list of behavioral problems that can be equally observed with emotionally sensitive children as well as with callous/unemotional children, even though their problems have different origins (as discussed above). Emotional sensitivity also frequently comes in a package with rigidity, sensory processing problems, inappropriate social interactions, learning differences, impulsivity, attention difficulties, and hyperactivity. These problems overlap with symptoms of ASD, hence, frequent misdiagnosis. Further, Supersensers with a profile “Electrified wire” + “Butterfly” can be misdiagnosed with Conduct Disorder in childhood and Antisocial Personality Disorder in adulthood, due to their intensity and severe behavioral dysregulation. In the moments of emotional intoxication Supersensers can indeed become cruel, and even violent, and disregard other’s feelings, mimicking callous/unemotional characteristics. 

Accurate diagnosis is very important, as it determines treatment. Supersensers need emotion regulation training to learn to adaptively deal with their emotional tsunamis. Emotion regulation training, however, will not work for psychopaths to address their issues. Psychopaths (or conduct disorder children) need problem solving training with a specific motivator to change maladaptive behaviors – mostly money (not much else works for them). Both groups, however, require parent training to help caregivers learn effective techniques and withstand the impact of their children’s severe dysregulated behaviors, without resorting to using force to regain control or accommodation to avoid escalations.