Hypervigilance: A Guide to Understanding

There are many different times in our life when we are in a state of “high alert.” Think about some of those times. Perhaps it was the first night in a new home or maybe you recently experienced trauma from a car accident or another unsettling event. During that time, something as simple as a sound that would otherwise go unnoticed or a shadow that is relatively innocuous would be incredibly unsettling.

This state of being on “high alert” is usually temporary. However, for some people, being in this state of “high alert” is not something that comes and goes, but rather it is a state of being that characterizes the lives of many different people—especially those suffering from Post-Traumatic Stress Disorder (PTSD).

What is Hypervigilance?

The psychological term for being in a state of high alert is “hypervigilance”. Taking a look at the words, “hyper” means an increase while vigilance speaks to the levels of sensory perceptions. Ultimately hypervigilance relates to how keen one reacts to different stimuli.

As one of the main symptoms of PTSD, hypervigilance is closely associated with this particular disorder. In fact, if a therapist diagnoses a patient with PTSD, then the first thing he or she will do is look for clinical signs of hypervigilance.


The good news is that these symptoms manifest themselves quite overtly in a physical fashion. However, the key to understanding hypervigilance is not pigeonholing it into just a physical disorder.

Hypervigilance has consequences for a person’s emotions along with their relationships. Simply put, for people who have a relationship with a hypervigilant person, these relationships can be exhausting and require boundaries.

Though PTSD is not a mental illness in the way bipolar disorder is, it can be quite debilitating.

PTSD Meaning

PTSD is a type of anxiety disorder manifesting as an acute response to specific stimuli or a traumatic event. People who suffer from PTSD have experienced serious trauma, and the psychological response is to create defense mechanisms. PTSD is also anxiety based. This means that post-traumatic stress isn’t congenital.

There are many different PTSD symptoms. Hypervigilance is one of them. Some of the more affected groups of people who are diagnosed with PTSD are people who have experienced intense situations.

For example, soldiers and police officers are two professions that often deal with PTSD. Others are those who are victims of violent crimes, such as rape, assault, and other types of violence often manifest with various behaviors characterizing this disorder. Another group of people who can suffer from PTSD are people who survive natural disasters or other types of calamitous events.

As you can see, PTSD is not something that is within a person’s genetic code like schizophrenia or other types of disorders; instead, it is a psychological response to stimuli that triggers a very serious cycle of anxiety.

Another type of PTSD that involves hypervigilance is complex PTSD. This particular variant affects children and is often the result of repeated childhood traumas.

For example, Ashley Judd is a famous actress and celebrity who experienced this particular brand of anxiety as a child. She sought treatment and today she has more control over her anxiety and feels less anxious. Treatment for people with PTSD often involves anti-anxiety medications prescribed by psychiatrists. In severe cases, intense cognitive-behavior therapy may be necessary.

Hypervigilance Symptoms

Hypervigilance, or hyperarousal, symptoms in a person with PTSD can be put into several different categories. Someone suffering from hypervigilance will be characterized by different physical, emotional, mental, and behavioral symptoms. Many times, these symptoms do not present with uniform consistency.

For example, it is not entirely unheard of for a person suffering from hypervigilance to present physically normal but have odd behavioral issues consistent with hypervigilance. If a person is highly trained, such as military or law enforcement, it’s entirely possible that the physical symptoms may not be apparent. However, no two cases of hypervigilance are alike. Therefore, it’s important for a therapist to be aware of all different types in order to make an accurate diagnosis.

There are a couple things to differentiate. For example, someone with hypervigilance is aware of their surrounding and events, unlike someone with dysphoric hyperarousal. However, the perceptual set of dysphoric hyperarousal is far different.

Although PTSD hypervigilance is the most common, hypervigilance can be a symptom of other types of mental health issues. However, a disorder like schizophrenia has different modalities of treatment than PTSD.

Physical symptoms of hypervigilance can include the following:

  • Excessive sweating
  • Rapid heartbeat and elevated blood pressure
  • Fast, shallow breathing and/or hyperventilation
  • Extreme fatigue or exhaustion

These physical symptoms, or interoceptive exposure revealing a hypervigilant personality, show how the body reacts to the mind. When the mind is on alert, the body responds to support the senses and react accordingly to stimuli. Being on alert is quite taxing, hence the fatigue and exhaustion—especially when respiration is abbreviated.

Emotional symptoms of hypervigilance can include the following:

  • An increase in fear or anxiety
  • Consistent feelings of panic
  • Persistent worrying

These emotional feelings are often a result of PTSD, and are the brain’s natural reaction to dealing with possible threats. Again, hypervigilance is a defense mechanism and these emotional responses to sensory sensitivity or environment are typical.

Behavioral symptoms of hypervigilance can include the following:

  • Fast-twitch reactions; being “jumpy” when confronted with a “threat”
  • Faulty interpretation of innocuous remarks
  • Reacting in a hostile manner consistent with self-defense

The more prominent the behaviors, the more likely there is a correlation with increased anxiety.

Finally, the mental symptoms of hypervigilance include:

  • Paranoia is a large part of hypervigilance
  • Lack of sleep
  • Extreme rationalizations of illogical action

Mental symptoms are the machinations the brain goes through to process the different stimuli associated with hypervigilance. In other words, this means that the brain’s processing protocol is “broken”. This is also where cognitive-behavioral therapy has proven to be helpful.

What is Paranoia?

Paranoia is one of the most common mental symptoms associated with hypervigilance. Thanks to the psychological trauma of PTSD, what would normally be innocuous events are amplified to an illogical level.

Paranoia is commonly described as a feeling that everyone and everything is out to get you. There are many different examples of paranoia. For example, a soldier who has experienced trauma in a tactical situation can be affected by certain stimuli. This can introduce feelings that create the paranoid state. An example of this is a former soldier who was attacked by an enemy force. As a result, the soldier may feel unsettled or unnerved by loud bangs.

Another example is a rape survivor. In many cases, rape survivors are unable to sleep without a light on in their homes. They will acknowledge that the practice is illogical, however, if the incident occurred in the dark, then the paranoia is that danger lurks in the darkness. This is not an uncommon practice or feeling. Many people who have been victims of violent crimes are often far more attuned to the different stimuli that could precede a dangerous situation. This is typically an overcompensation due to the inability to prevent the initial incident.

Regardless of why a person with hypervigilance is experiencing paranoia, the situation exists in his or her mind. Therefore, it’s important not to diminish these issues but instead help the person get the necessary help.

Coping with Hypervigilance

‘Regardless of whether you are the person suffering with hypervigilance or in a relationship with a hypervigilant partner, hypervigilance is very difficult to deal with.

The first thing anyone with hypervigilance should do is seek therapy. Good psychologists will provide several different modalities using cognitive-behavioral therapy (CBT). CBT is a successful treatment method because anxiety disorders are not typically rooted in genetics; rather, they are the result of faulty processing.

CBT attacks processing and attempts to “re-wire” the brain so that information is not processed through the hypervigilant perspective. CBT exercises include breathing exercises, counting exercises, and any methods that help calm the mind, such as meditation or journaling. These methods help unearth the metacognitive processes of information processing.

Empathy and patience are key for dealing with a hypervigilant person. Never dismiss the person’s feelings; instead be warm and attempt to talk out their reasoning in a calm, rational fashion. Be sure to also set boundaries. Hypervigilant people tend to unintentionally blow past boundaries, through no fault of their own. Boundaries can help you stay away from the intricacies of the hypervigilant person’s day-to-day life.

A healthy lifestyle can also help combat hypervigilance. Research indicates that a gluten-free diet can help individuals who suffer with processing anxiety disorders. A balanced diet and a healthy lifestyle always net benefits.

A Happy Life—Free from Fear and Worry

Hypervigilance is a very difficult part of dealing with PTSD. However, there are plenty of things one can do to help combat PTSD and hypervigilance. Firstly, understanding that hypervigilance is treatable is a great place to start. Ultimately, solving the problems associated with hypervigilance will go a long way towards getting out of a vicious cycle of anxiety.

After seeking treatment, a person can get back to living a normal life, free from irrational worry and fear.





author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings

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