Understanding the cultural concept of “highly sensitive person” among bipolar patients

Introduction The concept of “highly sensitive person” is a cultural concept, which has become popular in western societies including Sweden. A highly sensitive person (HSP) is usually described as having hypersensitivity to external stimuli, different cognitive processing and high emotional reactivity. Although the concept lacks diagnostic validity, psychiatric patients may refer to this concept. Aims To examine the feasibility of the Cultural Formulation Interview (CFI) and the clinical relevance of cultural concepts of distress among patients with bipolar disorder that report being a HSP. Methods A case series of three patients with a diagnosis of bipolar disorder that report HSP. The CFI was conducted with all patients and the applicability of the DSM-5 cultural concepts of distress tested. Results In all three cases, the CFI facilitated the clinical consultation as reported from the patients and in one of the cases also increased the treatment engagement. The HSP-concept could be conceptualized as a cultural syndrome, idiom of distress and as an explanatory model. Conclusion The CFI and the cultural concepts of distress proved to be useful for understanding the concept of HSP as also they increased the cultural validity of the diagnostic interview. The three cases illustrate the challenges when encountering patients with other cultural references than clinicians. This highlights the necessity to integrate anthropological thinking in our current diagnostic work in order to reduce the “category fallacy” and promote a more person-centered approach in psychiatry.