Hypervigilance With PTSD and Other Anxiety Disorders

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Hypervigilance is about more than just being extra vigilant. It is a state of extreme alertness that undermines quality of life. If you are hypervigilant, you are always on the lookout for hidden dangers, both real and presumed. Because of this, hypervigilance can leave you exhausted while interfering with interpersonal relationships, work, and your ability to function on a day-to-day basis.

Hypervigilance is one of the central features of post-traumatic stress disorder (PTSD). It can also occur with other anxiety disorders, including panic disorder, substance/medication-induced anxiety disorder, and generalized anxiety disorder. Schizophrenia, dementia, and paranoia can also induce hypervigilance.

What Is Hypervigilance?

People who are hypervigilant are constantly on guard and prone to overreaction. They maintain an intense and sometimes obsessive awareness of their surroundings, frequently scanning for threats or routes of escape.

Causes

Hypervigilance is the body’s way of protecting you from threatening situations. It can occur in an environment where you perceive an extreme threat. An example may include walking home late at night through a strange neighborhood.

Chronic hypervigilance is a common consequence of PTSD, particularly in people who have been in dangerous environments for a long time (such as serving in battle during a war) or experienced extreme emotional trauma. Hypervigilance is common among children who have experienced the recent death of a parent, were witness to violence, or are victims of abuse. In some cases, the symptoms of PTSD may only appear later in life.

In people with schizophrenia, hypervigilance is associated with a threat that simply does not exist. It is an extension of the paranoia and delusions characteristic of the disorder. Genetic, psychological, and environmental factors are believed to contribute to the development of schizophrenia. Stress can play a central role in triggering a psychotic episode.

Within the context of paranoia, hypervigilance may be seen with any mood or personality disorder for which paranoia may be a feature, including bipolar disorder and borderline personality disorder. Hypervigilance can also occur as a result of dementia related to Alzheimer's disease and other neurodegenerative disorders, or during acute episodes of sleep deprivation or substance abuse (most commonly, methamphetamine or cocaine).

Symptoms

Hypervigilance can be characterized by four common features.

  • Overestimation of a threat: Hypervigilant people will be on the lookout for threats that are either unlikely or exaggerated. This may include shutting themselves in to avoid an attack, sitting near an exit so that they can escape quickly, or sitting with their back to the wall so that no one can sneak behind them.
  • Obsessive avoidance of perceived threats: This includes avoiding everyday situations where dangers may lurk, including public gatherings and unpopulated public spaces (like garages). In extreme cases, a person may develop agoraphobia (anxiety about being in places where escape might be difficult).
  • Increased startle reflex: This is an abnormal response in which a person jumps at any sudden noise, movement, or surprise, even in the middle of the night. Being in a new or uncomfortable environment might further exacerbate the response.
  • Epinephrine-induced physiological symptoms: Epinephrine (adrenaline) is one of two stress hormones associated with the fight-or-flight reflex (the other being cortisol). People with PTSD-associated hypervigilance will often have a sustained epinephrine response, manifesting with dilated pupils, an increased heart rate, and elevated blood pressure.

Hypervigilance can severely interfere with sleep, causing fatigue, a loss of concentration, and an inability to focus. Sleep deprivation can further intensify feelings of paranoia, fueling hypervigilant behaviors.

In extreme cases, people who are hypervigilant may feel the need to arm themselves with guns, knives, or pepper spray or to equip themselves with sophisticated alarm systems, extra door locks, and even panic rooms.

Treatment

The treatment of hypervigilance can vary based on the underlying cause as well as the severity of the behavior. It also depends on whether or not the affected person recognizes that the behavior is abnormal.

The first step is to remove the affected person from an environment in which there is an actual threat (such as in cases of domestic violence) or from high-stress jobs in which the potential of threat is real (like police work).

Treatment may involve psychotherapy, including mindfulness training and coping techniques, and pharmaceutical medications. Options include:

  • Cognitive behavioral therapy: The goal of cognitive behavioral therapy (CBT) is to teach you, through conversations with a therapist, that you cannot control every aspect of the world around you, but can control how you interpret and deal with your response to an environment.
  • Exposure therapy: The aim of exposure therapy is to expose you to the triggers that stimulate stress in order to help you recognize them and take steps to mitigate your response.
  • Eye movement desensitization and reprocessing: The goal of eye movement desensitization and reprocessing (EMDR) is to use eye movement as means to redirect you from traumatic memories of the past to current sensations of the present.
  • Mindfulness training: Mindfulness involves "living in the moment" and focusing thoughts on immediate sensations rather than following extraneous and often problematic thoughts. Other mind-body techniques include meditation, guided imagery, and biofeedback.
  • Medications: PTSD and other anxiety disorders may be treated with antidepressants, beta-blockers, or anxiolytic drugs. Schizophrenia, personality disorders, or bipolar disorder may be treated with antipsychotics or mood stabilizers.

Ultimately, as a symptom of an underlying disorder, hypervigilance cannot be treated in isolation. It relies upon the appropriate treatment of the condition (including substance abuse). In some cases, hospitalization may be needed to bring the symptoms under control.

Coping

If you are experiencing hypervigilance to the extent that it is interfering with your quality of life, seek help from a mental health professional. Overcoming hypervigilance can take time and be fraught with setbacks. To better deal with the challenges, even while undergoing treatment, get plenty of rest, improve your sleep hygiene, maintain a healthy diet, and find activities that relax you (such as yoga or tai chi).

Exercise can help by stimulating the production of endorphins, a hormone which can elevate moods while potentially tempering the epinephrine response.

Most importantly, communicate. Suffering in silence and refusing to share your thoughts will only promote your fears and isolate you from others. Find a friend or family member in whom you can confide, ideally someone who won't dismiss your fears.

You can also join a support group for PTSD or other disorders with people who understand what you are going through. The more you build a support network of individuals who recognize the goals and challenges of treatment, the more likely you will be to persist and reap the benefits of therapy.

If you or a loved one are struggling with PTSD, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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  1. Kimble M, Boxwala M, Bean W, et al. The impact of hypervigilance: Evidence for a forward feedback loop. J Anxiety Disord. 2014;28(2):241-245. doi:10.1016/j.janxdis.2013.12.006

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