Hypervigilance in PTSD and Other Disorders

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.

Hypervigilance is about more than just being extra vigilant. It is a state of extreme alertness that undermines the quality of life.

If you are hypervigilant, you are always looking 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.

Symptoms of Hypervigilance

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.

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.

Causes of Hypervigilance

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.

Threats

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.

Trauma

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 have experienced extreme emotional trauma.

Hypervigilance is common among children who have experienced the recent death of a parent, were witnesses to violence, or are victims of abuse. In some cases, the symptoms of PTSD may only appear later in life.

Mental Health Conditions

In addition to PTSD and anxiety disorders, several mental health conditions can contribute to hypervigilance. This includes:

• Schizophrenia: In people with schizophrenia, hypervigilance is associated with a threat that 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.
• Paranoia: Because paranoia is associated with hypervigilance, this symptom may be seen with any mood or personality disorder for which paranoia may be a feature. Such conditions can include bipolar disorder and borderline personality disorder.
• Dementia: Hypervigilance can also occur due to dementia related to Alzheimer's disease and other neurodegenerative disorders.

Medical Conditions

Some medical conditions can also contribute to hypervigilance. Fibromyalgia is a condition that can cause people to experience heightened sensitivity to light and noise, which can make people feel overwhelmed and hypervigilant at times. Endocrine tumors, hyperthyroidism, and adrenal disease can also play a part.

Hypervigilance Triggers

Certain factors can act as triggers for hypervigilance. Some common triggers include:

• Feeling of abandonment
• Sudden, loud noises
• Physical pain
• Emotional distress
• Stress
• Chaotic environments
• Reminders of past traumas
• Criticism and embarrassment
• Feeling trapped

Treatment for Hypervigilance

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.

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 With Hypervigilance

If you are experiencing hypervigilance to the extent of interfering with your quality of life, seek help from a mental health professional. Overcoming hypervigilance can take time and be fraught with setbacks.

Practice Self-Care

To better deal with the challenges, even while undergoing treatment:

• Get plenty of rest
• Improve your sleep hygiene
• Maintain a healthy diet
• Find relaxing activities (such as yoga or tai chi)

Lean on Friends and Family

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

Joint a Support Group

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 persist and reap therapy's benefits.