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.
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.
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.
Examples of Hypervigilance
Hypervigilance may present as distinct and severe events or as mild and inconspicuous.
Some examples of hypervigilance include:
- Being suspicious of people in a restaurant
- Thinking that other people are talking about you
- Believing that neighbors are acting strangely
- Worrying that a person has a gun
- Feeling that the current location is dangerous
- Checking a partner’s phone to look for information
Impacts of Being Hypervigilant
Physically and mentally, hypervigilance has a negative impact on you. You will constantly feel rundown and tired but maintaining a healthy sleep schedule will be challenging. You could lose your appetite and struggle to maintain a healthy weight. Mentally, you will be exhausted and will most likely experience poor concentration and focus. Your personal relationships will most likely suffer due to increased irritability and decreased attention.
People who use alcohol and drugs to self-medicate their hypervigilance will often experience worsening symptoms. Misusing substances to self-medicate is an example of a negative coping skill that as a result, can create more physical and mental concerns.
Can Hypervigilance Go Away On Its Own?
Hypervigilance can go away on its own. At some point, many people will experience a period of the symptoms, and if the underlying trigger associated with hypervigilance is mild, they can respond well over time and return to their regular functioning.
When hypervigilance is connected to significant trauma or an ongoing trigger, the symptoms may be more persistent. In these cases, you should not wait to seek professional treatment.
Treatment for Hypervigilance
The treatment of hypervigilance will depend on the sources of its symptoms. The process of treating PTSD-related hypervigilance will vary greatly compared to the treatment of hypervigilance sparked by stimulant abuse. In many cases, a combination of psychotherapy, modest lifestyle changes, and medication management could greatly improve your psychological state.
Therapy
Fortunately, the therapeutic approaches used to treat anxiety disorder, PTSD, and OCD tend to overlap and share similarities with styles of therapy used to treat hypervigilance.
Some of the frequently used therapy styles for hypervigilance include the following:6
- Cognitive behavioral therapy (CBT): A form of talk therapy that studies the way thoughts, feelings, and behaviors influence each other. CBT works to identify and challenge unhelpful thinking patterns fueled by hypervigilance while finding more beneficial thoughts and actions.
- Exposure therapy: A specific form of CBT that encourages the client to confront and experience the situations that trigger anxious responses. By putting yourself in the stressful environment, you learn that your fears are needlessly intense and restrictive.
- Eye movement desensitization and reprocessing (EMDR): A therapeutic orientation that combines aspects of imaginary exposure with a series of eye movements to reprocess the traumatic events and limit their unwanted impact.
With any therapy for hypervigilance, the therapist will spend some time talking about appropriate coping skills, self-monitoring behaviors, and relaxation techniques. These will help you start to decrease symptoms of hypervigilance and make other forms of therapy more effective.
Medication
Psychiatrists, nurse practitioners, and primary care physicians are all good candidates for prescribing medications focused on decreasing signs and symptoms of hypervigilance. The specific medications will vary based on the cause of the emotional state.
Frequently used medications for hypervigilance include the following:6, 8
- Antidepressants: This class of drugs can help with depression, anxiety, sleep, and a host of other mental health disorders and symptoms. One group of antidepressants called selective serotonin reuptake inhibitors (SSRIs) help by allowing more serotonin to be absorbed into brain cells. Prescribers offer SSRIs like sertraline (Zoloft) and paroxetine (Paxil) for people with hypervigilance linked to PTSD.
- Benzodiazepines: Although these drugs have not been proven effective for PTSD, they work quickly to reduce anxiety-related symptoms. The major drawback of this form of medication is that you can become physically dependent and psychologically addicted. Examples of benzodiazepines includelorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax), and diazepam (Valium).
- Other anti-anxiety medications: Drugs like buspirone (Buspar) and beta blockers may be considered by prescribers to reduce hypervigilance. Buspirone helps to regulate serotonin, while beta blockers reduce the levels of adrenaline in the body. The most commonly used beta blocker for reducing anxiety is propranolol (Inderal, InnoPran XL) and it is often used for bad cases of stage fright. Some prescribing clinicians will also use the blood pressure medication clonidine to lower feelings of hyperarousal and hypervigilance.
Managing Hypervigilance
There are steps you can take to cope with and limit your hypervigilant tendencies. Lifestyle changes almost never provide the instant gratification you desire, but with time and perseverance, symptoms will improve. Stay the course and trust that your positive lifestyle changes will result in positive outcomes.
Here are some tips for managing and overcoming hypervigilance:7
- Get out of the house: For people with hypervigilance, home can feel like the safest spot to be, but getting outside of your comfort zone is essential. Exposure to the outside world is necessary to keep pushing back against the restrictions of hypervigilance.
- Practice relaxation techniques: While hypervigilance can stem from several sources, anxiety, stress, and worry all play a central role. Because of this, deep breathing, autogenic training, progressive muscle relaxation, and guided imagery are all great habits to practice.
- Address exercise, sleep, and diet: Activity, rest, and diet play a vital role for many aspects of life. Making these changes can be challenging, so be sure to start with reasonable expectations and build new routines with patience and consistency.
- Skip shortcuts: Healthy coping skills take time, effort, and energy, while negative coping skills are quick and easy. The problem is unhealthy coping skills, like substance use, overspending money, engaging in chaotic relationships, and risky behaviors, often lead to bigger problems. Drinking alcohol may seem like an effective way to address hypervigilance, but it does not resolve anything. It only covers up the symptoms.
- Build and maintain strong supports: Friends, family members, co-workers, church congregation members, and others can provide unparalleled support and encouragement. Consider starting with a pet as a way to build new relationships.
Final Thoughts on Hypervigilance
Hypervigilance can be a frightening and frustrating emotional state that makes you feel stressed and fearful in many situations. Remember, it produces flawed and distorted thoughts, and although they are convincing, they are wrong. By believing in yourself and committing to professional mental health treatment, you can overcome hypervigilance and the associated psychological disorders.
For Further Reading
Hypervigilance Infographics
