PTSD Symptom Spotlight: Hypervigilance

Before I went to a psychiatrist or a therapist, I wholeheartedly believed that my behaviors and thoughts were normal. I always thought “I wonder how other people deal with this” or “Why doesn’t it seem like other people are focused on the same things as me?” I can assure you that the PTSD diagnosis did shock me but it was also very validating. I went in complaining of anxiety and come to find out, my severe trauma popped up on the test and revealed a long standing belief system and PTSD diagnosis.

“Hypervigilance is about being more than 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.

Hypervigilance is considered one of the central features of post-traumatic stress disorder (PTSD) but can also occur with other anxiety disorders, including panic disorder, substance-induced anxiety disorder, and generalized anxiety disorder. Schizophrenia, dementia, and paranoia induced by a mood or personality disorders 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.”



  • 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.

What does hypervigilance look like for me?

  • Picking up on changes in other peoples behavior or mood. Being in abusive relationship will have you walking on eggshells just waiting for another egg to hit the floor and crack. It is miserable to tip toe around someone else’s explosive tantrums and feel like you contribute to it. It is emotionally exhausting and physically exhausting to feel like you are to blame for their behaviors. With this, you learn to pick up on small changes in their mood. If they make a comment about your skirt being too short you know that they will likely flip out about how you dated someone else prior to them. If they mention someone commenting on your Facebook wall, you know its going to turn into you give men too much attention and then block you for 4 days.
  • During arguments, I automatically assume the worst. This is the end of the relationship. We will not be able to move past this. I assume that every fight is going to turn into a break up. Arguments with a significant other can send me into a full blown panic attack where I feel as if I am unable to breathe or focus on anything but the argument. I envy those that can go on through their day seemingly unbothered about an argument. That is not the case for me.
  • Increased heart rate. I’ve always said that the physical symptoms of PTSD are some of the worst. The increased heart rate is something that is seemingly impossible to get through. Sure, you can do some deep breathing but you know what works? Xanax. This is what it is for. Nothing else is going to curb a fast beating heart like a benzodiazopine. So no, don’t tell me to go outside or breathe, I have tried it all.


Hypervigalance symptoms are called “self protective behaviors”. These are damaging if left untreated. The treatment can vary from person to person and largely depends on the diagnosis that you have. I have found that a combination of CBT, regular therapy and medications have been my best bet. Without these, I would be stagnant. With these, I feel like an entirely different person. I feel like behavior makes sense for what I have been through and I have the opportunity to change the course of my own mental health.

There are so many ways to get involved in therapy but my advice would be to get hooked up with a therapist that specializes in trauma and PTSD. After you find the right therapist, ask your therapist to recommend you to a psychiatrist. There is absolutely no way I would have made the progress I have made without medication.

Full article on hypervigilance

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