Hypervigilance With PTSD and Other Anxiety Disorders

Causes of an Exaggerated Fear of Danger

Hypervigilance is about more than just being extra vigilant. It is a state of extreme alertness that undermines your quality of life. If you are hypervigilant, you are always on the lookout for hidden dangers, both real and presumed.

Not only is hypervigilance considered 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.

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

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 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 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).


Hypervigilance can be characterized by four common features:

  • The overestimation of a threat: Hypervigilant people will be on the lookout for threats that are either unlikely or exaggerated. This may include shutting yourself in to avoid an “attack,” sitting near an exit so that you can escape quickly, or sitting with your back to the wall so that no one can sneak behind you.
  • The 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 (the extreme fear of situations where you are helpless or vulnerable).
  • An increased startle reflex: This is an abnormal response in which you jump 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.

If left untreated, these “self-protective” behaviors can become obsessive, leading you to establish routines to mitigate every possible threat. As a result, it is not uncommon for people with long-term PTSD to be co-diagnosed with obsessive-compulsive disorder (OCD).

Hypervigilance can severely interfere with your sleep, causing fatigue, a loss concentration, and the 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.


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

In either case, the first step would be 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 of 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 mean to redirect you from traumatic memories of the past to current sensations of the present.
  • Mindfulness training: Mindfulnessinvolves “living in the moment” and focusing your thoughts on immediate sensations rather than following extraneous and often erratic thoughts. This may include self-help techniques like meditation, guided imagery, or 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 problems and neurodegenerative dementia). In some cases, hospitalization may be needed to bring the symptoms under control.


If you or someone you love is experiencing hypervigilance to the extent that it is interfering with your quality of life, you need to seek professional help, preferably with a certified psychotherapist.

Overcoming hypervigilance can take time and be fraught with setbacks. To better deal with the challenges, get plenty of rest, improve your sleep hygiene, maintain a healthy diet, and find activities that can relax you (such as yoga or tai chi).

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

Most importantly, perhaps, you need to communicate. Suffering in silence and refusing to share your thoughts will only serve to 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 or tell you that you are “being silly.”

You can also join a support group for with 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.

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