Journal of Behavioral Medicine

, Volume 39, Issue 3, pp 537–550 | Cite as

Development of the Sensory Hypersensitivity Scale (SHS): a self-report tool for assessing sensitivity to sensory stimuli

  • Eric A. DixonEmail author
  • Grant Benham
  • John A. Sturgeon
  • Sean Mackey
  • Kevin A. Johnson
  • Jarred Younger


Sensory hypersensitivity is one manifestation of the central sensitization that may underlie conditions such as fibromyalgia and chronic fatigue syndrome. We conducted five studies designed to develop and validate the Sensory Hypersensitive Scale (SHS); a 25-item self-report measure of sensory hypersensitivity. The SHS assesses both general sensitivity and modality-specific sensitivity (e.g. touch, taste, and hearing). 1202 participants (157 individuals with chronic pain) completed the SHS, which demonstrated an adequate overall internal reliability (Cronbach’s alpha) of 0.81, suggesting the tool can be used as a cross-modality assessment of sensitivity. SHS scores demonstrated only modest correlations (Pearson’s r) with depressive symptoms (0.19) and anxiety (0.28), suggesting a low level of overlap with psychiatric complaints. Overall SHS scores showed significant but relatively modest correlations (Pearson’s r) with three measures of sensory testing: cold pain tolerance (−0.34); heat pain tolerance (−0.285); heat pain threshold (−0.271). Women reported significantly higher scores on the SHS than did men, although gender-based differences were small. In a chronic pain sample, individuals with fibromyalgia syndrome demonstrated significantly higher SHS scores than did individuals with osteoarthritis or back pain. The SHS appears suitable as a screening measure for sensory hypersensitivity, though additional research is warranted to determine its suitability as a proxy for central sensitization.


Sensory hypersensitivity Scale development Central sensitivity Validity Reliability Quantitative sensory testing 



Sensory Hypersensitivity Scale


Highly Sensitive Person


Central nervous system


Sensory perception quotient


Adult/Adolescent Sensory Profile



The authors would like to acknowledge Maureen Donohue for her valued insight and guidance while editing this manuscript. Study 5 was funded by a Grant from the NIDA (K23 DA031808).

Compliance with ethical standards

Conflict of interest

Eric A. Dixon, Grant Benham, John A. Sturgeon, Sean Mackey, Kevin A. Johnson, and Jarred Younger declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of the 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Supplementary material

10865_2016_9720_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 17 kb)


  1. Aaron, L. A., Burke, M. M., & Buchwald, D. (2000). Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Archives of Internal Medicine, 160, 221–227.CrossRefPubMedGoogle Scholar
  2. Alabas, O. A., Tashani, O. A., Tabasam, G., & Johnson, M. I. (2012). Gender role affects experimental pain responses: a systematic review with meta-analysis. European Journal of Pain, 16, 1211–1223. doi: 10.1002/j.1532-2149.2012.00121.x CrossRefPubMedGoogle Scholar
  3. Al-Harthy, M., Ohrbach, R., Michelotti, A., & List, T. (2015). The effect of culture on pain sensitivity. Journal of Oral Rehabilitation,. doi: 10.1111/joor.12346 PubMedGoogle Scholar
  4. Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103, 411.CrossRefGoogle Scholar
  5. Aron, E. N., & Aron, A. (1997a). Sensory-processing sensitivity and its relation to introversion and emotionality. Journal of Personality and Social Psychology, 73, 345–368.CrossRefPubMedGoogle Scholar
  6. Aron, E. N., & Aron, A. (1997b). Sensory-processing sensitivity and its relation to introversion and emotionality. Journal of Personality and Social Psychology, 73, 345–368.CrossRefPubMedGoogle Scholar
  7. Aron, E. N., Aron, A., & Jagiellowicz, J. (2012). Sensory processing sensitivity a review in the light of the evolution of biological responsivity. Personality and Social Psychology Review, 16(3), 262–282.CrossRefPubMedGoogle Scholar
  8. Bartley, E. J., & Fillingim, R. B. (2013). Sex differences in pain: a brief review of clinical and experimental findings. British Journal of Anaesthesia, 111, 52–58. doi: 10.1093/bja/aet127 CrossRefPubMedPubMedCentralGoogle Scholar
  9. Batheja, S., Nields, J. A., Landa, A., & Fallon, B. A. (2013). Post-treatment lyme syndrome and central sensitization. Journal of Neuropsychiatry and Clinical Neurosciences, 25, 176–186.PubMedGoogle Scholar
  10. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the BDI-II. San Antonio: Psychological Corporation.Google Scholar
  11. Benham, G. (2006). The highly sensitive person: Stress and physical symptom reports. Personality and Individual Differences, 40(7), 1433–1440.CrossRefGoogle Scholar
  12. Blumenstiel, K., Gerhardt, A., Rolke, R., Bieber, C., Tesarz, J., Friederich, H. C., et al. (2011). Quantitative sensory testing profiles in chronic back pain are distinct from those in fibromyalgia. Clinical Journal of Pain, 27, 682–690. doi: 10.1097/AJP.0b013e3182177654 CrossRefPubMedGoogle Scholar
  13. Brown, C., & Dunn, W. (2002). Adolescent-adult sensory profile: User’s manual. Therapy Skill Builders.Google Scholar
  14. Clark, L., & Watson, D. (1995). Constructing validity: Basic issues in objective scale development. Psychological Assessment, 7, 309–319. doi: 10.1037/1040-3590.7.3.309 CrossRefGoogle Scholar
  15. Corrêa, J. B., Costa, L. O. P., de Oliveira, N. T. B., Sluka, K. A., & Liebano, R. E. (2015). Central sensitization and changes in conditioned pain modulation in people with chronic nonspecific low back pain: A case–control study. Experimental Brain Research, 233(8), 2391–2399.CrossRefPubMedGoogle Scholar
  16. Cruz-Almeida, Y., Sibille, K. T., Goodin, B. R., Petrov, M. E., Bartley, E. J., Riley, J. L., et al. (2014). Racial and ethnic differences in older adults with knee osteoarthritis. Arthritis & Rheumatology, 66, 1800–1810. doi: 10.1002/art.38620 CrossRefGoogle Scholar
  17. Dozois, D. J., Dobson, K. S., & Ahnberg, J. L. (1998). A psychometric evaluation of the Beck Depression Inventory–II. Psychological Assessment, 10(2), 83.CrossRefGoogle Scholar
  18. Dunn, W. (1999). The sensory profile. San Antonio, TX: Psychological Corporation.Google Scholar
  19. Farage, M. A., Osborn, T. W., & MacLean, A. B. (2008). Cognitive, sensory, and emotional changes associated with the menstrual cycle: A review. Archives of Gynecology and Obstetrics, 278, 299–307.CrossRefPubMedGoogle Scholar
  20. Fernández-de-las-Peñas, C., Galán-del-Río, F., Ortega-Santiago, R., Jiménez-García, R., Arendt-Nielsen, L., & Svensson, P. (2010). Bilateral thermal hyperalgesia in trigeminal and extra-trigeminal regions in patients with myofascial temporomandibular disorders. Experimental Brain Research, 202, 171–179. doi: 10.1007/s00221-009-2121-x CrossRefPubMedGoogle Scholar
  21. Finnerup, N. B., Johannesen, I. L., Fuglsang-Frederiksen, A., Bach, F. W., & Jensen, T. S. (2003). Sensory function in spinal cord injury patients with and without central pain. Brain, 126, 57–70.CrossRefPubMedGoogle Scholar
  22. Gazerani, P., & Arendt-Nielsen, L. (2005). The impact of ethnic differences in response to capsaicin-induced trigeminal sensitization. Pain, 117, 223–229. doi: 10.1016/j.pain.2005.06.010 CrossRefPubMedGoogle Scholar
  23. Geisser, M. E., Strader Donnell, C., Petzke, F., Gracely, R. H., Clauw, D. J., & Williams, D. A. (2008). Comorbid somatic symptoms and functional status in patients with fibromyalgia and chronic fatigue syndrome: sensory amplification as a common mechanism. Psychosomatics, 49, 235–242. doi: 10.1176/appi.psy.49.3.235 CrossRefPubMedGoogle Scholar
  24. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1–55.CrossRefGoogle Scholar
  25. Kaya, S., Hermans, L., Willems, T., Roussel, N., & Meeus, M. (2013). Central sensitization in urogynecological chronic pelvic pain: A systematic literature review. Pain Physician, 16, 291–308.PubMedGoogle Scholar
  26. Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2010). The patient health questionnaire somatic, anxiety, and depressive symptom scales: A systematic review. General Hospital Psychiatry, 32, 345–359. doi: 10.1016/j.genhosppsych.2010.03.006 CrossRefPubMedGoogle Scholar
  27. Latremoliere, A., & Woolf, C. J. (2009). Central sensitization: a generator of pain hypersensitivity by central neural plasticity. The Journal of Pain, 10, 895–926. doi: 10.1016/j.jpain.2009.06.012 CrossRefPubMedPubMedCentralGoogle Scholar
  28. Lluch, E., Torres, R., Nijs, J., & Van Oosterwijck, J. (2014). Evidence for central sensitization in patients with osteoarthritis pain: A systematic literature review. European Journal of Pain,. doi: 10.1002/j.1532-2149.2014.499.x PubMedGoogle Scholar
  29. Marsh, H. W., Hau, K. T., Balla, J. R., & Grayson, D. (1998). Is more ever too much? The number of indicators per factor in confirmatory factor analysis. Multivariate Behavioral Research, 33, 181–220.CrossRefPubMedGoogle Scholar
  30. Muthén, L. K., & Muthén, B. O. (2007). Mplus: Statistical analysis with latent variables; User’s guide; [Version 5]. Los Angeles: Muthén & Muthén.Google Scholar
  31. Nicolson, N. A., Davis, M. C., Kruszewski, D., & Zautra, A. J. (2010). Childhood maltreatment and diurnal cortisol patterns in women with chronic pain. Psychosomatic Medicine, 72(5), 471–480.CrossRefPubMedGoogle Scholar
  32. Ohla, K., & Lundström, J. N. (2013). Sex differences in chemosensation: Sensory or emotional? Frontiers in Human Neuroscience, 7, 607. doi: 10.3389/fnhum.2013.00607 CrossRefPubMedPubMedCentralGoogle Scholar
  33. Okun, A., Stein, R. E., Bauman, L. J., & Silver, E. J. (1996). Content validity of the psychiatric symptom index CES-depression scale, and state-trait anxiety inventory from the perspective of DSM-IV. Psychological Reports, 79(3), 1059–1069.CrossRefPubMedGoogle Scholar
  34. Piché, M., Arsenault, M., Poitras, P., Rainville, P., & Bouin, M. (2010). Widespread hypersensitivity is related to altered pain inhibition processes in irritable bowel syndrome. Pain, 148, 49–58. doi: 10.1016/j.pain.2009.10.005 CrossRefPubMedGoogle Scholar
  35. Racine, M., Tousignant-Laflamme, Y., Kloda, L. A., Dion, D., Dupuis, G., & Choinière, M. (2012). A systematic literature review of 10 years of research on sex/gender and pain perception–Part 2: Do biopsychosocial factors alter pain sensitivity differently in women and men? Pain, 153, 619–635. doi: 10.1016/j.pain.2011.11.026 CrossRefPubMedGoogle Scholar
  36. Rhudy, J. L., Bartley, E. J., Palit, S., Kerr, K. L., Kuhn, B. L., Martin, S. L., et al. (2013). Do sex hormones influence emotional modulation of pain and nociception in healthy women? Biological Psychology, 94, 534–544. doi: 10.1016/j.biopsycho.2013.10.003 CrossRefPubMedGoogle Scholar
  37. Robertson, A. E., & Simmons, D. R. (2013). The relationship between sensory sensitivity and autistic traits in the general population. Journal of Autism and Developmental Disorders, 43, 775–784. doi: 10.1007/s10803-012-1608-7 CrossRefPubMedGoogle Scholar
  38. Rodrigues, A. C., Nicholas Verne, G., Schmidt, S., & Mauderli, A. P. (2005). Hypersensitivity to cutaneous thermal nociceptive stimuli in irritable bowel syndrome. Pain, 115, 5–11. doi: 10.1016/j.pain.2005.01.023 CrossRefPubMedGoogle Scholar
  39. Ruscheweyh, R., Marziniak, M., Stumpenhorst, F., Reinholz, J., & Knecht, S. (2009). Pain sensitivity can be assessed by self-rating: Development and validation of the Pain Sensitivity Questionnaire. Pain, 146, 65–74. doi: 10.1016/j.pain.2009.06.020 CrossRefPubMedGoogle Scholar
  40. Ruscheweyh, R., Verneuer, B., Dany, K., Marziniak, M., Wolowski, A., Colak-Ekici, R., et al. (2012). Validation of the pain sensitivity questionnaire in chronic pain patients. Pain, 153, 1210–1218. doi: 10.1016/j.pain.2012.02.025 CrossRefPubMedGoogle Scholar
  41. Schoen, S. A., Miller, L. J., & Green, K. E. (2008). Pilot study of the sensory over-responsivity scales: assessment and inventory. American Journal of Occupational Therapy, 62, 393–406.CrossRefPubMedGoogle Scholar
  42. Shenker, N. G., Haigh, R. C., Mapp, P. I., Harris, N., & Blake, D. R. (2008). Contralateral hyperalgesia and allodynia following intradermal capsaicin injection in man. Rheumatology (Oxford), 47, 1417–1421. doi: 10.1093/rheumatology/ken251 CrossRefGoogle Scholar
  43. Simms, L. J., Prisciandaro, J. J., Krueger, R. F., & Goldberg, D. P. (2012). The structure of depression, anxiety and somatic symptoms in primary care. Psychological Medicine, 42, 15–28. doi: 10.1017/S0033291711000985 CrossRefPubMedPubMedCentralGoogle Scholar
  44. Smith, B. W., Tooley, E. M., Montague, E. Q., Robinson, A. E., Cosper, C. J., & Mullins, P. G. (2008). Habituation and sensitization to heat and cold pain in women with fibromyalgia and healthy controls. Pain, 140, 420–428. doi: 10.1016/j.pain.2008.09.018 CrossRefPubMedGoogle Scholar
  45. Smolewska, K. A., McCabe, S. B., & Woody, E. Z. (2006). A psychometric evaluation of the Highly Sensitive Person Scale: The components of sensory-processing sensitivity and their relation to the BIS/BAS and “Big Five”. Personality and Individual Differences, 40(6), 1269–1279.CrossRefGoogle Scholar
  46. Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory STAI (form Y) ("self-evaluation questionnaire").Google Scholar
  47. Spielberger, C. D., & Sydeman, S. J. (1994). State-trait anxiety inventory and state-trait anger expression inventory. In The use of psychological tests for treatment planning and outcome assessment, pp. 292–321.Google Scholar
  48. Stone, A. M., Vicenzino, B., Lim, E. C., & Sterling, M. (2013). Measures of central hyperexcitability in chronic whiplash associated disorder—a systematic review and meta-analysis. Manual Therapy, 18, 111–117. doi: 10.1016/j.math.2012.07.009 CrossRefPubMedGoogle Scholar
  49. Tavassoli, T., Hoekstra, R. A., & Baron-Cohen, S. (2014). The Sensory Perception Quotient (SPQ): development and validation of a new sensory questionnaire for adults with and without autism. Molecular Autism, 5, 29. doi: 10.1186/2040-2392-5-29 CrossRefPubMedPubMedCentralGoogle Scholar
  50. Taylor, K. S., Anastakis, D. J., & Davis, K. D. (2010). Chronic pain and sensorimotor deficits following peripheral nerve injury. Pain, 151, 582–591. doi: 10.1016/j.pain.2010.06.032 CrossRefPubMedGoogle Scholar
  51. Wang, D., Couture, R., & Hong, Y. (2014). Activated microglia in the spinal cord underlies diabetic neuropathic pain. European Journal of Pharmacology, 728, 59–66. doi: 10.1016/j.ejphar.2014.01.057 CrossRefPubMedGoogle Scholar
  52. Woolf, C. J. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152, S2–S15. doi: 10.1016/j.pain.2010.09.030 CrossRefPubMedPubMedCentralGoogle Scholar
  53. Yunus, M. B. (2007). Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Seminars in Arthritis and Rheumatism, 36, 339–356. doi: 10.1016/j.semarthrit.2006.12.009 CrossRefPubMedGoogle Scholar
  54. Yunus, M. B. (2008). Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Seminars in Arthritis and Rheumatism, 37, 339–352. doi: 10.1016/j.semarthrit.2007.09.003 CrossRefPubMedGoogle Scholar
  55. Zautra, A. J., Fasman, R., Reich, J. W., Harakas, P., Johnson, L. M., Olmsted, M. E., & Davis, M. C. (2005). Fibromyalgia: evidence for deficits in positive affect regulation. Psychosomatic Medicine, 67, 147–155. doi: 10.1097/01.psy.0000146328.52009.23 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Eric A. Dixon
    • 1
    Email author
  • Grant Benham
    • 2
  • John A. Sturgeon
    • 1
  • Sean Mackey
    • 1
  • Kevin A. Johnson
    • 1
  • Jarred Younger
    • 1
    • 3
  1. 1.Department of Anesthesia, Division of Pain ManagementStanford University School of MedicinePalo AltoUSA
  2. 2.Department of Psychological ScienceUniversity of Texas Rio Grande ValleyEdinburgUSA
  3. 3.Department of Psychology, Department of Anesthesiology and RheumatologyUniversity of Alabama at BirminghamBirminghamUSA

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