Hypervigilance: Signs, Symptoms, & Treatments

Hypervigilance is a state of constant anxiety and high-alert that often affects trauma survivors. A person will continuously scan their environment for potential threats in order to maintain safety and avoid harm. While there are many factors that can cause hypervigilance, including other mental health conditions, effective treatments are available to help a person overcome it. 

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What Is Hypervigilance?

Hypervigilance is a mental health state that influences a person’s thoughts, emotions, and actions. According to the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM), hypervigilance is considered a sensitive sensory state marked by exaggerated behavior to detect a threat.¹

Hypervigilance also has the following traits:

• Linked to anxiety, which can result in fatigue and mental exhaustion
• Abnormally increases your responses and reactions to stimulation
• Leads to perpetually scanning your environment to find threats
• Results in your being on high alert, even when it is not warranted
• Produces numerous obsessive patterns
• Negatively affects social skills and relationships

To appreciate hypervigilance as a skewed psychological state, it is essential to understand that vigilance is a desirable characteristic that helps you avoid dangerous people, places, things, and situations. If vigilance is the baseline, hypervigilance is one extreme while hypovigilance is the other. Hypovigilance can present as indifference, carelessness, apathy, or an overly lackadaisical attitude.

Is Being Hypervigilant Bad?

Hypervigilance can make safe situations feel threatening. If you’re constantly scanning and rescanning your environment with elevated sensory perception, you are likely to misjudge a person or item, assigning some level of danger to it, even when it isn’t dangerous. Hypervigilance is part of the “fight or flight” response, an evolutionary trait passed down from our ancestors to create a physiological response to threats.³ The problem is when it extends beyond the occurrence of danger and presents frequently, with high intensity, or for a long duration.

Hypervigilance vs Paranoia

Separating hypervigilance from paranoia is challenging at times because they can look very similar and create overlapping symptoms.

Hypervigilance

• Reacting to real stimulation
• Responding in an exaggerated way
• More easily recognizes their overreaction

Paranoia

• Reacting to imagined stimulation
• Responding in an exaggerated way
• Less easily convinced that they were overreacting

Symptoms of Hypervigilance

Hypervigilance, if sparked by anxiety or some misperception of events, can cause an array of different symptoms including restlessness, poor sleep, and irritability.

Physical Symptoms

Physical symptoms of hypervigilance can include:¹

• Sweating
• Shakiness
• Trouble breathing comfortably
• Feeling dizzy, unsteady, or light-headed
• Feeling chills or very hot
• Nausea or gastrointestinal distress
• Powerful muscle tension
• Poor sleep

Emotional Symptoms

Emotional hypervigilance symptoms can include:

• Increased irritability
• Worry
• Fear
• Panic
• Nervousness
• Anger

Behavioral Symptoms

Behavioral symptoms associated with hypervigilance can include:

• Restlessness or being on edge
• Being overly tired and fatigued
• Poor sleep
• Agitation and moving quickly
• Using alcohol and other drugs to manage symptoms
• Physical or verbal aggression

Causes of Hypervigilance

The causes of hypervigilance may not always be clear, but a combination of situational experiences, mental health disorders, and genetic predisposition can all trigger the psychological state. Depending on the cause, a hypervigilant state of mind may emerge as a frequent but time-limited state or a long-lasting characteristic that seems woven into your personality. Of course, each person’s experience with hypervigilance is unique.

Hypervigilance & Anxiety

Types of anxiety disorders like generalized anxiety disorder, social anxiety disorder, and specific phobias can create hypervigilance in many cases. Social anxiety disorder and specific phobias, in particular, are good examples of the forward feedback loop described earlier. While some may see hypervigilance as a tool to decrease anxiety, in actuality, it worsens anxiety over time.

For example, if you experience an intense fear of snakes, the hypervigilance will emerge as an apparent coping skill or safety precaution. Instead, being hypervigilant will likely cause you to become easily startled and needlessly fearful. Even a twig can seem like a snake.

Hypervigilance & PTSD

Traumatic events commonly place people in a state of altered arousal and reactivity. This means you may be more alert, sensitive, and over-reactive to the situations around you.

During periods of hyperarousal and hyperreactivity, an individual can experience:¹

• Increased irritability and anger
• Behavior aimed at self-destruction or recklessness
• A startle response that is needlessness sensitive
• Poor concentration
• Poor sleep
• Being hypervigilant

Not only is hypervigilance connected to PTSD, but it is likewise linked to acute stress disorder. Acute stress disorder is much like PTSD except that its symptoms usually begin immediately after the traumatic event. With PTSD, the symptoms must last for at least one month after the threatening situation.¹

Hypervigilance & OCD

Although the American Psychiatric Association does not specifically state that hypervigilance is linked to OCD, it does say that hypervigilance can result in a variety of “obsessive behaviors.”¹ These obsessions may focus on staying safe, avoiding certain stimuli, and managing dangerous situations, while compulsive behaviors could involve checking, scanning, and constantly observing the environment. Like other mental health conditions, the supposed control gained from the compulsions only serve to make the obsessions more intense.

Hypervigilance & Substance Abuse

Stimulants are a broad category of prescription and illicit drugs that serve to activate the central nervous system. These drugs make people feel happy, energized, alert, focused, and social.¹ They can also result in cardiovascular changes, nausea, vomiting, agitation, weight loss, confusion, and seizures.

Hypervigilance is directly linked to stimulants like cocaine, methamphetamine, and medications for attention-deficit/hyperactivity disorder (ADHD). As the effects of the stimulant diminish, the hypervigilance diminishes too.

Hypervigilance & Schizophrenia

Some people believe that the disorganized thinking and odd beliefs associated with schizophrenia are driven by hypervigilance. In reality, hypervigilance’s connection with schizophrenia is uncertain. The connection between them is affected by a third factor: paranoia.

Paranoia is a delusional state of stress and anxiety where you may believe you are being harassed, followed, or treated poorly. It may appear to be hypervigilance, but these two states share several differences.¹ Hypervigilance is an extremely sensitive and reactive state, but the observations are always based in reality. With paranoia attached to schizophrenia, the delusional thinking may be disconnected from reality.