What Is Hypervigilance and What Does It Feel Like?

A woman looking over her shoulder at night

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Hypervigilance is a state of heightened awareness and watchfulness. You may be hypervigilant if you are constantly on guard and on the lookout for danger, even when there is little to no risk of something bad happening.

Hypervigilance can be a symptom of psychological conditions such as post-traumatic stress disorder (PTSD) and anxiety. Sometimes hypervigilance is a sign of physical health conditions, such as hyperthyroidism or Alzheimer’s disease. Recreational drugs and substance use disorders can also lead to hypervigilance. 

Excessive hypervigilance can have a significantly negative impact on your quality of life, leading to memory impairment, difficulty regulating emotions, trouble maintaining relationships, and struggles carrying out day-to-day tasks. 

What Does Hypervigilance Feel Like? 

It’s normal to experience brief periods of hypervigilance. For example, if you watch a scary movie, you may be on high-alert and get scared by sounds that would otherwise not bother you, such as a creaky floor or wind rustling in the trees outside. 

Some people are hypervigilant about specific things, such as tags on a shirt rubbing against their skin or the sound of someone’s alarm clock going off repeatedly in the apartment next door. You may notice these sensations or sounds and become agitated and distracted by them, but eventually you move on. 

Chronic hypervigilance, on the other hand, goes beyond temporary awareness and annoyance. People with hypervigilance may constantly scan their environment to find threats and have abnormal responses and reactions to everyday sounds, sights, and situations. Hypervigilance can cause physical, behavioral, and emotional symptoms. 

Physical Symptoms of Hypervigilance

Physical symptoms of hypervigilance may include: 

  • Sweating 
  • Rapid heart rate 
  • Fast, shallow breathing
  • Restlessness
  • Tense muscles
  • Dilated pupils 

Being in a constant state of “fight or flight” awareness can lead to exhaustion and fatigue over time. 

Behavioral Symptoms of Hypervigilance

Behavioral symptoms of hypervigilance can include: 

  • Agitation and quick movements of the head (quickly looking back and forth) 
  • Overreactions to sounds
  • Distraction from engaging with others, carrying out important tasks, and recreational activities 
  • Trouble sleeping
  • Argumentative or combativeness with others 
  • Using alcohol or drugs to numb symptoms 

These symptoms can have a negative impact on a person’s relationships with others and their work/school life.

Emotional Symptoms of Hypervigilance

Emotional symptoms of hypervigilance can include: 

  • Anxiety
  • Nervousness 
  • Irritability 
  • Paranoia 
  • Fear
  • Worry 
  • Anger
  • Isolation

Some people with hypervigilance may experience intense mood swings or have intense reactions to situations, especially if the person perceives they’ve been judged or harshly spoken to by another person, such as a family member or coworker. 

What Causes Hypervigilance? 

There are several different factors that can lead to hypervigilance. Mental health disorders, traumatic life experiences, and physical health conditions can all trigger a hypervigilant state of mind. For some people, hypervigilance may come and go and for others it can be a long-lasting, every day experience. 

Post-Traumatic Stress Disorder (PTSD) 

One of the key features of PTSD is hypervigilance. This is especially true for people with PTSD who have lived through traumatic experiences for long periods of time, such as those who served in a war or experienced ongoing physical, emotional, or sexual abuse. 

Research shows that exposure to trauma can cause some people to have ongoing increased activity in their amygdala — the part of the brain that processes fearful and threatening stimuli. This suggests that the brain is on constant alert, even when a person is in a safe environment. 

Anxiety Disorders 

Anxiety disorders, like social anxiety disorder and generalized anxiety disorder, are common causes of hypervigilance. If you have social anxiety disorder, you might be hypervigilant with other people, especially people you don’t know or you don’t trust. Generalized anxiety disorder may cause you to be hypervigilant in new environments, or even environments that are familiar to you but cause sensory overload of bright lights, loud noises, or crowds of people.

Misuse of Stimulant Drugs

Misuse of recreational drugs and stimulant prescription medications is linked to hypervigilance. Short-acting stimulant drugs, like cocaine or methamphetamine, activate the central nervous system and can make people feel energized, alert, and focused. Over time, people may take higher doses to feel the effects of the drugs and may experience less desirable effects, such as anxiety, irritability, restlessness, suspiciousness, and hypervigilance.

Medical Conditions

A number of medical conditions can make you more alert and on guard, almost as if you are anticipating negative experiences or sensations. For example, fibromyalgia, adrenal disease, and hyperthyroidism, can lead to hypervigilance. Some people with chronic illnesses experience body hypervigilance and may be extra sensitive to every sensation and feeling in the body in anticipation of pain or new or worsened symptoms.

Hypervigilance Treatment Options

Treatment for hypervigilance varies, depending on the cause. Treatment for PTSD-related hypervigilance, for example, will be different from treating hypervigilance caused by the misuse of stimulant drugs. Treating the underlying condition combined with counseling and coping mechanisms can help people overcome hypervigilance. 

Therapy Options

Some of the different styles of therapy used to treat hypervigilance include:

  • Cognitive behavioral therapy (CBT): A form of talk therapy that focuses on how thoughts, feelings, and behaviors are connected. It teaches you how to change hypervigilant thought patterns, feelings, and behaviors to more positive thoughts and actions. 
  • Exposure therapy: A specific type of CBT that encourages people to gradually approach traumatic memories that trigger anxious, hypervigilant responses. The goal is to show that traumatic memories and triggers are no longer a threat and should not restrict you from living a full life. 
  • Eye movement desensitization and reprocessing (EMDR): This therapeutic approach encourages a person to briefly focus on a traumatic memory combined with eye movements. This helps reduce the intensity of emotional responses related to memories and situations associated with the traumatic memories. 

Medication Options

Severe anxiety and PTSD-related hypervigilance may be treated using medications, such as:

  • Antidepressants
  • Anti-anxiety medications, such as beta blockers and buspirone 
  • Benzodiazepines (depressant drugs)

Self-Care Options

Learning how to cope and limit hypervigilance takes time and perseverance. Self-care can strategies can help you cope as you work through your anxieties and fears: 

  • Breathing exercises: Take slow, deep breaths when you feel triggered and pause before reacting.
  • Relaxation techniques: Breathwork, meditation, yoga, and guided imagery can help calm the mind and body.
  • Journaling: Writing down your thoughts can help you identify patterns and begin to make slow changes to the way you respond to these thoughts, situations, and feelings. 
  • Regular exercise: Moving your body regularly helps boost feel-good hormones 
  • Support: lean on family and friends for support or find a join group with other people who have similar lived experiences to receive and give support 

A Quick Review

Hypervigilance is a chronic state of heightened alertness and awareness. When you’re hypervigilant, it can feel overwhelming and exhausting and affect nearly every part of your life. Hypervigilance is often a symptom of mental health disorders, like anxiety and PTSD. While you may feel defeated at times, therapy and medications can help treat hypervigilance, and self-care goes a long way in helping you feel better over time. If you’re constantly feeling on edge or are avoiding things and people you once enjoyed, talk to your healthcare provider. 

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