Have you also had the impression that lately there seem to be a lot of ADHD, autism, OCD, and so on diagnoses popping up in the kink sphere? Certainly, the greater attention paid to mental health recently is also a cause, but when the frequency of cases reaches such high levels, it’s time to learn more. To do this, I turned to the most sought-after name in this field: here is our conversation.

Hello! When I started researching the topic of neurodivergences in the kinky environment, I often came across your name, and here I am. But… who are you?

Hello! My name is Rodolfo Pessina, I am a queer, polyamorous and kinky person and I am a physician. I use male/neutral pronouns; I work as a psychiatrist and clinical sexologist, with a particular focus on people belonging to minority groups (queer people, BIPOCs, with disabilities and neurodivergences). I am an activist for minorities and I do outreach on inclusive mental and sexual health issues on Instagram. My goal is also to show the human side of the figure of the doctor and the psychiatrist, as an active part of the caring community, with a life beyond the white coat – or even without a white coat, just with a harness on. I promote the concept of a professional who is above all attentive to inclusivity, or rather to the coexistence of diversity and the intersection of the multiple identities of the individual in clinical practice.

So you are just the right person to address an issue that I am under the impression to being treated often, but with great superficiality. Let’s start from the beginning: in recent years, attention to neurodivergences has increased a lot both in the old media and, especially, on social networks – and I suppose this is a good thing. However, I have also noticed a dizzying increase in the number of people diagnosed as autistic, ADHD and so on. I’m wondering whether those who claim that it’s just a fad, or a conspiracy of doctors hunting for clients, might actually be right?

Perhaps it would be best to start by explaining what neurodivergences are.

‘Neurodivergence’ is an umbrella term originated not in the medical field but in social activism, which encompasses all deviations from the statistical norm of various brain and neurological functions – such as movement, memory or attention. Very often this term is used, in a limited way, to indicate congenital or early acquired conditions such as the autism spectrum, attention deficit hyperactivity disorder, specific learning disorders or Tourette’s syndrome.

In medicine, these conditions are called ‘neurodevelopmental disorders’ which, I remind you, are not synonymous with neurodivergence, because the latter technically refers to any deviation in brain functioning from the statistical norm. In this broad definition, people who have suffered a head injury, have some form of epilepsy, a brain tumor or even people with more widespread mental health conditions such as anxiety disorders, depression or personality disorders can be included.

In recent years, there has undoubtedly been a strong increase in media attention on neurodivergences – not only in the developmental age, but also on the weight that these conditions, if not addressed, can have on adult life. As a result, we have also been able to observe more diagnoses and dedicated diagnostic centers. Accomplices of this phenomenon have undoubtedly been the 2020 lockdown and the spread of content on the topic through social networks such as Instagram and TikTok.

We do not yet know precisely the impact of COVID-19 isolation on everyone’s lives, but it has certainly been dealt with in very different ways. While for most people the lockdown represented a dark period and strong psychological distress due to social isolation, many others realized that they felt comfortable in a context of reduced social demands. This highlighted how in terms of “social energies” not all people function the same way and could potentially fall into what is a neurodivergence. Furthermore, the current ability to access health content not only by professionals, but also by people living with different conditions, has allowed a previously submerged population – such as those living daily with ADHD and the autism spectrum – to make themselves known and communicate their way of living with the difficulties related to interfacing with a neurotypical society.

Undoubtedly, it is also true that many professionals have taken advantage of the period to expand their client base, often offering “quick and affordable” diagnostic paths that, however, do not meet quality standards or in-depth assessments of the real needs of those who come for a consultation. Furthermore, various “ready-to-wear” diagnostic paths do not provide the person with follow-up psychoeducation and coaching regarding neurodivergence, or do not direct the patient to the subsequent possibilities of therapeutic (even pharmacological) and assistance support.

This phenomenon has also been accompanied by an extremely rough and “catchy” popularization on social networks, which, however, has launched a series of superficial and misinterpretable messages without allowing these issues to be explored in depth. For example: how many people have wondered that «we are all a bit autistic/ADHD after all» and that therefore the problem is best left unaddressed? On the one hand, this wide media coverage has favored the self-identification of many people in a condition of divergence – an aspect that I consider positive, especially if followed by a diagnostic path with trained professionals – on the other hand, it has not always been accompanied by the dissemination of content in line with scientific evidence and the principles of professional ethics.

I do want to emphasize the importance of being able to finally talk about neurodivergence on social media, because many colleagues and patients have finally found answers to various long-standing issues in their lives and have begun to request training and diagnostic paths in this regard in our country.

The other observation I would like to start with is the really hard-to-ignore incidence of neurodivergent presences in the kinky world. At a polyamory munch, a queer party or a bondage workshop, you definitely encounter more cases than in other contexts. To what would you attribute this phenomenon?

Rodolfo Pessina

Rather than simply the “kinky world”, I would speak in general of the greater affective, relational and sexual exploration and openness of neurodivergent people, which in some cases extends to identity in terms of orientation, gender and expression/role. Just think of the strong correlation that is observed between neurodivergence and non-conforming gender identities – such as trans and non-binary – or unusual sexual orientations such as the asexuality spectrum. This relationship can be explained through the very definition of neurodivergence: if my mind tends to function in an “unconventional” way, how much can the standards imposed by society fit me when it comes to having sex or choosing my affective network?

Many conventions at the affective-relational and sexual level turn out to be not only difficult for the adaptation of a neurodivergent person, but, in some cases, also “devoid of logical sense”.

Furthermore, we know that it is not necessary to be a neurodivergent person to deconstruct imposed standards such as sexism, binarism in all its forms, or hetero-mono-amatonormativity. For a neurodivergent person, however, this work of deconstruction begins much earlier than for a neurotypical person because – to use the words of many patients – from the early years of life, many have felt «strange, different, without a place in the world» even just for their own way of interacting and relating to others. In summary, neurodivergent people can perceive social and interaction norms differently, and be more attracted to sexual practices that may seem less conventional. These alternative sexualities often prioritize consent and safety, and can make these subjects feel more comfortable expressing their desires and limits.

Moreover, in many cases, neurodivergence is accompanied by pathologies that hinder “traditional sex”, such as endometriosis, vulvodynia, fibromyalgia, or even just a different sensory perception. Here, kinks going beyond the simple concept of sex as a penetrative act, allow neurodivergent people to experience a playful and ludic dimension, perhaps also detached from a concept of sexual attraction – which is an important aspect also for those who identify with orientations such as asexuality and graysexuality.

And finally, many individuals who identify as neurodivergent may find a sense of belonging and acceptance within kinky or non-monogamous communities, because these environments can offer opportunities to explore their sexuality in ways that feel more authentic and liberating, or even through well-defined rules that convey a sense of security, such as the SSC principle, in a context that values open communication, free from stereotypes or prejudices about “what sex and relationship should be”.

Before going any further, I would like to prevent a possible criticism by asking you if these observations are supported by scientific data.

Of course! The literature is still limited, but in recent years there have been several publications in the academic psycho-sexological field and in the field of community-based research, i.e. carried out within the same neurodivergent, queer, poly and/or kinky community.

Here is a selection to start with:

• “Comforting, reassuring, and…hot: a qualitative exploration of engaging in BDSM and Kink from the perspective of autistic adults” (2024) by Amy Pearson and Sophie Hodgetts, published in Autism Adulthood.
• “Sexuality in autism: hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder” (2017) by Daniel Schöttle et al., published in Dialogues in Clinical Neuroscience.
• “Let’s Talk about Sex… and ADHD: Findings from an Anonymous Online Survey” (2023), by Susan Young et al., published in International Journal of Environmental Research and Public Health.
• “Sexuality in Adults With ADHD: Results of an Online Survey” (2022), by Priscilla Gregório Hertz et al., published in Frontiers in Psychiatry.
• “Exploring Autistic Sexualities, Relationality, and Genders: Living Under a Double Rainbow” (2024), by H.B. Rosqvist, A Day, M Krazinski.
• “Asexuality: A possible background and how it relates to autism and neurodiversity” (2018), by L Ekblad.
• “Gender identity in autism and neurodiversity” (2018), by L Ekblad.
• “A Systematic Review of the Relationship Between Neurodiversity and Psychosexual Functioning in Individuals with Autism Spectrum Disorder (ASD) or Attention-Deficit/Hyperactivity Disorder (ADHD)“, by Susan Young & Kelly Cocallis, published in Neuropsychiatric Disease and Treatment.
• “Autism, Sexuality, and BDSM” (2022), by Ariel E. Pliskin, published in The Journal of Autistic Culture.

Thank you. Let’s then address an unpleasant issue that had also emerged in a conversation with the autistic kink coach John Pendal. Essentially, it was said that the clear patterns and acceptance of diversity in the kinky world tended to attract neurodivergent people… but also that sometimes the latter take advantage of it, transforming a well-meant inclusivity into their excuse for imposing judgemental behaviours precisely towards those who have internalized the absence of judgment.

I think it can be seen this way: nobody says that being part of an invisible or ostracized minority makes one immune from judging or discriminating, and even neurodivergent people can fall into mechanisms of categorization, stereotyping or judgment/prejudice towards others. Speaking of people with disabilities, Marina Cuollo observes that «one can be both disabled and an asshole». In my opinion, this simply makes us human, subject to the automatic mechanisms of social psychology that can only be countered to a certain extent by the conscious effort towards mutual respect for differences.

We need to learn not to generalize and to see the particular individual: even if they have deconstructed a series of principles, not all people – whether neurodivergent or neurotypical – will behave in the same way. This is why I believe it is important that the various communities focused on alternative sexualities welcome neurodivergent people and their experiences, trying to enter into dialogue, respect and coexistence of differences, rather than just aiming for simple inclusion. Given how much inclusivity is talked about on social media, it seems paradoxical, but as linguist Vera Gheno says, ‘inclusivity’ means that a majority group from its position of privilege “accepts” the presence of a minority group and assimilates it. But this same process can then be implemented in the opposite direction, by the minority group, without however observing an abandonment of power dynamics and forces at play. This is why today one should more properly speak of ‘coexistence of differences’, valuing the point of view of all members of the community, whether they are kinky, vanilla, poly, monogamous, queer, cishet, neurotypical or neurodivergent.

And how do you think this path towards neurodiversity will evolve? What is needed to achieve an ideal coexistence for everyone?

I really love the term ‘neurodiversity’ because it encompasses everyone, neurotypical and divergent people, showing how there is a fluid and serene continuum in the neuropsychological functioning of the general population, and not a simple split between “normal/abnormal; healthy/sick”. I believe the media should push it even more than ‘neurodivergence’, because it highlights the true goal for which so much is being said about these conditions – that is, to realize, make room for and exalt the diversity that permeates human society as a driving force for change and progress. And, above all, it shows that a coexistence of diversities is possible because no one includes anyone, but everyone lives together in full respect.

In the modern fluid society, as Bauman would say, we have witnessed a modest but progressive coexistence of different ways of living relationships, sexuality, bodily and mental functioning, ethnicities and cultures. We openly discuss consensual non-monogamies, affective and sexual orientations, unconventional practices and disabilities, for example. I see no reason why this path cannot further expand to the neuropsychological functioning of the person, paying attention to the needs and requirements of different groups, not just the majority.

I believe that the first step towards real coexistence is education, and that is why I do outreach and agreed to this interview. In addition to explaining, it is then also important to show, so I believe that greater representation of neurodivergence in everyday life – such as social media and TV series – is fundamental to help those who live in the “majority” understand what it means, and that it is not as frightening/abnormal/strange as it appears only because «I’m not used to seeing it every day».

If, unlike just half a century ago, despite various recent reactionary trends, it no longer seems absurd to see a BIPOC person or a woman leading a great state, it is because we have opened our horizons through knowledge and direct experience. Two goals that I believe are achievable and mandatory in a society constantly in close contact thanks to new technologies.

Let me play the devil’s advocate and tell me: beyond all these beautiful concepts – which I fully agree with – what would you say to those who point to a kind of “competition to be the weirdest” in the various communities? Their observation is that starting from the proud (Italian) definition of ‘different’ of the 1960s to indicate homosexuality, there has been a race to attach specialized labels to one’s preferences, practices, relationships, identities… and now also neurodivergences.
In fact, even at the media level, there are no shortage of characters who seem to be trying to self-ghettoize as much as possible in order to obtain attention or gain moral leverage in discussions… or not?

Ah, the infamous ‘competition to be the strangest’…

I believe that this interpretation, which tends to reduce all diversities – even non-neurological ones – to a competition of originality or a mere desire for attention through alternativeness, can be based on the unfamiliarity with certain life experiences. In reality, what some see as an “appropriation” of neurodivergence by some minority communities, including the queer one, is nothing more than a deep need for recognition and belonging.

For example, neurodivergence and queer identity often share common experiences: both represent ways of being that deviate from the “norm” and are often marginalized and misunderstood. It is not a struggle for the title of who is “more peculiar”, but a path to affirm one’s existence beyond the labels imposed from the outside. The possibility of recognizing oneself in multiple identities – queer, neurodivergent, or other – is an act of self-affirmation, not of spectacularization.

Anyone who has ever experienced the feeling of being out of place knows well how fundamental it is to give a name to one’s own experience. It is not a matter of inventing labels just for the sake of it, but of finding ways to describe one’s own reality and feel seen. It is easy to talk about “competition” when one has never been forced to fight for a sense of identity and belonging. I believe that such statements typically come from those who are part of a majority that holds a privilege of which they are not fully aware.

I believe that each of us must learn to recognize the forms of privilege and discrimination connected to our own identities in an intersectional perspective. We are all composed of multiple identities that are “different” for someone else and involve secondary advantages and disadvantages, but usually it makes little sense to instrumentalize them in comparisons in search of attention or “moral” advantages.

Let me suggest two scenarios. In the first, there is a neurotypical kinky person who meets a neurodivergent person open to exploring alternative sexualities. What recommendations would you give to both? And how is the responsibility of the partners impacted?

When it comes to alternative sexuality, both for neurotypical and neurodivergent people, there are some important considerations and attentions to keep in mind that apply to both populations. In a brief list, I believe the following elements are fundamental:

• Clear and informed consent: it is essential that all involved members have a clear understanding of the relational dynamics and expectations. Consent should be continuous and can be revoked at any time.
• Open communication: Communication is essential, especially for people who have difficulty understanding social dynamics or rhetorical language, such as some people on the autism spectrum. Openly discussing desires, limits and concerns is crucial. Using clear and unambiguous language and explaining in detail what is expected and what might happen helps prevent misunderstandings.
• Respect for boundaries: respecting personal boundaries and the needs of others is crucial. Each person has the right to set their own rules and limits in an alternative relationship or sexuality.
• Emotional management: for all those involved, it is important to be prepared to manage strong emotions – such as jealousy or anger – with strategies to cope with triggering events and feelings themselves, also through open discussion with the other people. This is especially important for those with significant emotional dysregulation, as is the case for example for ADHD or autistic people in the midst of an explosive (meltdown) or implosive (shutdown) emotional crisis. Some people may therefore need safe spaces to express and discuss their feelings and to self-regulate, such as separate, low-sensory impact (“chill”) rooms.
• Structure and routine: establishing a structured routine can be particularly helpful for people on the autism spectrum, who can benefit from knowing what to expect in different relational situations. The opposite is often true for ADHD people, who may prefer more spontaneity in the relationship and sexual activity.
• Sensory sensitivity: considering sensory preferences is important, not just for neurodivergent people. This could include elements like touch, smells/fragrances, lighting, and sounds.
• Customization of practices: when dealing with neurodivergent people, one must be open and willing to customize relational and sexual practices to respond to the specific needs of the individual.
• Recognize and validate diverse experiences: it is crucial to recognize that each person’s experiences – of any kind – are unique. Validating their experiences and listening to their concerns is essential, especially when something seems to go wrong in sexual practice. In particular, in practices that may involve the use of substances (such as chemsex), one must also bear in mind that the neurobiology of neurodivergent people may be different and lead to unexpected paradoxical or side effects.
• Education on diversity: everyone should be open to learning from each other’s experiences and to recognizing differences in preferences and needs.
• Space for negotiation: creating safe spaces to negotiate relational rules and address any concerns in a respectful and non-judgmental context is important to allow for the coexistence of diversity in the context of alternative sexuality.
• Self-care: both groups (neurodivergent and neurotypical) should pay attention to their own mental and physical health, ensuring they have access to the resources needed to support their personal well-being.

In summary, the key to open alternative sexuality, both for neurotypical and neurodivergent people, is clear communication, mutual respect, and attention to individual needs, with a focus on consent, emotional support, and continuous education.

It’s interesting how you have just described the same kind of approach that I proposed in the Sexual Explorers Manifesto. But let’s move on to the second scenario: one morning I wake up and, being surrounded by neurodivergent kinky people, I start to wonder if I’m a bit odd too. How should I behave?

I can think of asking for an opinion from a mental health professional expert in neurodivergence. Nowadays it is not easy to find one or to check their training and curriculum: for some professionals you can check whether they have acquired a specific specialization title – as in the case of psychologists, for whom there is a school of specialization in ‘neuropsychology’. For other professionals such as neurologists and psychiatrists, there are no specific studies within Italian medical schools, and they are often trained after the specialization period. Moreover, in Italy there are no Guidelines on PDTA (diagnostic-therapeutic-care pathways) for neurodivergent people, and having training on one neurodivergence – for example ADHD – does not mean being prepared on the others. For example, few are aware of and know how to treat Tourette’s syndrome! All this makes it difficult to understand how to choose the right mental health professionals for us and our particular situation. To this end, non-profit scientific societies of associated professionals are emerging, such as the Italian ADHD Network, to guide patients towards diagnostic, care and habilitation paths that are as much as possible shared among multiple experts, also taking into account international Guidelines such as those present in the United Kingdom.

Let’s take the case of a person who wants to explore their doubts about having ADHD. Although it is easy to administer the diagnostic interview for ADHD in adults (which is called DIVA), few know that this tool is not enough to arrive at a clarifying and functional diagnosis for the person’s future path. Often, several neuropsychological and psychometric tests are necessary to make a correct differential diagnosis with other mental health conditions – for example anxiety and depression, or personality disorders – but also to assess a person’s strengths and weaknesses with respect to their mental functions, all fundamental information to support them in the subsequent path.

Thank you very much for your availability. Before saying goodbye, would you like to tell us where we can find you?

Thank you for giving me the space and opportunity to talk about this topic, Ayzad!
You can find me on Instagram as @sexotan_gocce, where there are a series of educational content on various topics related to mental and sexual health.
My scientific publications can finally be found on PubMed.