Hypervigilance: Definition, Examples, & Symptoms

However, if you’re always in a state of heightened alertness, always on the lookout for threats, always expecting a mugger around every corner, always expecting contamination in your food, always expecting a snake underfoot, even when there is no true threat, you may find yourself unable to live a normal life. This state of constant high alert is known as hypervigilance. In this article, we’ll talk about what hypervigilance is and what conditions hypervigilance can appear in. We’ll end by going over some ways that you may be able to overcome hypervigilance.
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Vigilance is the state of being carefully aware and watchful for possible dangers or difficulties. A security guard needs to be vigilant for signs of crime. A health inspector needs to be vigilant for signs of poor hygiene. A medical doctor needs to be vigilant for early symptoms of diseases. In all of these examples, vigilance is appropriate and is a requirement of the job. When the alertness becomes excessive, when it becomes constant and high, or when it causes distress, it transcends from vigilance into hypervigilance (Bernstein et al., 2015).

Hypervigilance can include both increased searching for signs of potential danger and increased attention to signs of potential danger. A person hypervigilant to food contamination may carefully examine each bite of food before eating it and may also fixate on just how pink the chicken is.

Hypervigilance is often present in people who have lived through trauma or violence (Smith et al., 2019). In dangerous settings, vigilance to signs of potential threat or harm may save a person’s life. However, when this vigilance persists outside of these dangerous settings, in environments with a low risk of harm, the vigilance itself may become problematic.

Hypervigilance is often seen in military personnel and veterans, especially among those who have experienced battlefield violence (Kimble et al., 2013). This may be in part due to military training emphasizing alertness and vigilance, and in part due to exposure to threatening and dangerous environments.

Hypervigilance & Violence
High levels of hypervigilance have also been reported in people who have experienced neighborhood violence (Smith et al., 2019). Although experiencing violence at the hands of members of the community and the hands of the police both led to hypervigilance symptoms, the effect was bigger when the violence was perpetrated by police. The reasons for this are unclear. However, police violence may be more traumatizing than community violence because it represents a larger betrayal of trust, and also because victims may feel a greater sense of vulnerability after police violence.

Hypervigilance Duration
Symptoms of hypervigilance may persist for years after experiencing a traumatic event (Lindstrom et al 2011). Experiencing trauma second-hand may also lead to hypervigilance symptoms. Caregivers for military veterans who reported no first-hand experience with trauma exhibited hypervigilance symptoms (Sander et al., 2020).

The opposite of hypervigilance might be an appropriate level of vigilance – a level of attention to potential danger that doesn’t cause distress or lead to negative effects on emotional, physical, or mental health.

Alternatively, the opposite of hypervigilance might be problematically ignoring or refusing to acknowledge stressful experiences. These symptoms may represent a type of dissociation, which is an absence, lack, or reduction in the integration of thoughts, emotions, and experiences (Bernstein et al., 2015). While hypervigilance reflects chronic attention to traumatic information, dissociation reflects full or partial unawareness of traumatic information. Hypervigilance and dissociation may be compatible and may sometimes even be part of the same condition. For example, many people with PTSD often experience both hypervigilance and dissociation symptoms, alternating between extreme alertness and reactivity to signs of potential danger and an extreme tendency to avoid discussing or thinking about their trauma.

Hypervigilance & Avoidance
In some cases, hypervigilance may emerge when a person avoids talking or thinking about an extremely traumatic event. Such dissociation from the traumatic event may prevent the trauma from being fully processed and integrated into the person’s life story. The trauma may, in this way, continue to influence the person through hypervigilance. 

Anxiety covers a wide range of conditions including generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, social anxiety disorder, and specific phobias or fears. People with anxiety disorders tend to be very careful in how they move through the world. They tend to be very aware of things that may trigger feelings of discomfort and anxiety. People with anxiety tend to be especially cautious and wary in new settings or in situations where there may be some uncertainty or ambiguity (Armstrong & Olatunji, 2012).

Each anxiety disorder may lead to hypervigilance to a specific stimulus that may be perceived by the person suffering from that disorder as a potential threat. For example, people with social anxiety disorder fear being judged, embarrassed, or ridiculed by other people. They may be hypervigilant to signs of threatening social situations or potential embarrassment (Wermes et al., 2018). This hypervigilance doesn’t extend to other threatening stimuli. People with social anxiety may show no hypervigilance toward spiders or evidence of spiders. In contrast, people with arachnophobia, who fear spiders, may show hypervigilance to spiders and evidence of spiders, while not showing any abnormally high awareness of social threats.

Post Traumatic Stress Disorder (PTSD) is a collection of symptoms that may result after experiencing traumatic, terrifying, scary, or dangerous events. The symptoms of PTSD fall into four categories (Newport & Nemeroff, 2000).

• Re-experiencing symptoms: including flashbacks, nightmares, and intrusive thoughts
• Avoidance symptoms: including amnesia for the trauma, avoiding places or objects associated with the trauma, and a reluctance to talk or think about the trauma.
• Hyperarousal symptoms: including feeling tense, on-edge, or hypervigilant.
• Cognition and mood symptoms: including memory difficulties, feelings of guilt or shame, and a loss of interest in enjoyable activities.

Hypervigilance vs Hyperarousal
Hypervigilance falls within the broader category of hyperarousal. Hypervigilance may be the most common symptom of PTSD. Surveys of people who have lived through major terrorist attacks (De Stefano et al., 2018; Hafstad et al., 2014) and natural disasters (McNally et al., 2015) report hypervigilance as the most common symptom among survivors.

Hypervigilance & Trauma
Many traumatic events can lead to symptoms of PTSD and there can be considerable variation in how the symptoms of PTSD manifest across individuals. Some psychologists have proposed that traumatic events that lead to PTSD are characterized by two factors: social betrayal and terror or fear. Traumas that are high in social betrayal may be more likely to produce PTSD characterized by avoidance symptoms like dissociation, emotional numbing, amnesia, or shame. 

In contrast, traumas that are extremely frightening or terrifying may be more likely to produce PTSD characterized by hyperarousal symptoms including hypervigilance and anxiety (Bernstein et al., 2015). These responses may be adaptive – if you are betrayed, your survival may be better ensured by withdrawing. This may be especially true if the betrayal trauma was experienced in childhood. If you are terrorized or put into an extremely frightening situation, your survival may be better ensured if you remain aware and attuned to potential signs of danger in the future.

Traumatic events may cause hypervigilance in some people without any of the other symptoms of PTSD. To receive a diagnosis of PTSD at least one symptom from each category (re-experiencing, avoidance, hyperarousal, and mood or cognition symptoms) must be present. This means that a person may live through a traumatic event, develop distressing and debilitating hypervigilance as a result, but not be diagnosed with PTSD if they don’t also show re-experiencing, experiential avoidance, and cognition/mood symptoms. This doesn’t mean that the hypervigilance is not itself worthy of treatment.

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder characterized by two major components – obsessions and compulsions (Muller and Roberts, 2005). Obsessions are persistent thoughts, impulses, or ideas that are experienced as invasive or inappropriate and that cause distress or discomfort. Compulsions are repetitive behaviors or mental rituals that are typically performed in an attempt to relieve the distress caused by the obsessions.

Common categories of compulsion are checking compulsions like checking if doors are locked or if the oven is turned off and cleaning compulsions like hand-washing or housework. None of these actions are themselves problematic. However, if they are done in excess, and if they are done in an attempt to relieve uncomfortable thoughts, they may be a part of OCD.

Hypervigilance & Attention in OCD
Laboratory studies have found hypervigilance and a heightened attentional bias toward words associated with the obsession in people with OCD (Foa & McNally, 1986). For example, a person with a cleanliness obsession and a hand-washing compulsion may be hypervigilant to words associated with germs, dirt, or contamination.

​People tend to show specific hypervigilance to stimuli associated with their specific obsessions. The person with a cleanliness obsession may show hypervigilance to stimuli associated with contamination but may show no hypervigilance to stimuli associated with security such as unlocked doors (Foa et al., 1993). In contrast, a person with obsessions related to security may be hypervigilant to stimuli associated with breaches of safety and not to stimuli associated with cleanliness.

One way to treat OCD is through a structured program of exposure to the fear-inducing stimuli, along with blocking the compulsive response. After completion of such a program, hypervigilance toward the source of the fear decreased in some patients (Foa & McNally, 1986). It should be noted that this therapy was conducted under the direction of trained mental health professionals. Attempting such treatment yourself may be frightening and traumatic and is not recommended.

The attachment that a person feels toward someone that they are in a relationship with can be described as secure or insecure. Secure attachments are characterized by an inner sense of confidence and surety about the relationship. People with secure attachments feel that the relationship is strong enough to withstand some conflict and ambiguity.

In contrast, people with insecure attachments may feel that the relationship, or their role in the relationship, is vulnerable. Such people may not be able to tolerate any suggestions of conflict or disagreement. People with insecure attachments may need constant reassurance and might be hypervigilant to potential relationship threats (Mikulincer & Shaver, 2005).
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People with insecure attachments may be hypervigilant and hypersensitive to signs of possible abandonment or rejection. Ironically, such hypervigilance to relationship threats may itself become the biggest threat to the relationship. Hypervigilance may lead to jealousy, suspicion, mistrust, and a breakdown in interpersonal communication that may become intolerable, leading to relationship breakdown.

Hypervigilance may be present on its own, not connected to any other symptoms or condition, or as part of a larger syndrome or condition, as in OCD or PTSD. The most effective way to manage or overcome hypervigilance symptoms may differ according to the specific circumstances in which it is present. For example, if a person’s hypervigilance is a part of their OCD, managing the hypervigilance may be best accomplished by treating the OCD (Foa & McNally, 1986). 

In contrast, if the hypervigilance is due to PTSD, addressing the PTSD may improve symptoms of hypervigilance. In the short video below, a military veteran discusses how his time serving in warzones led to PTSD and extremely distressing hypervigilance. He was able to treat his PTSD and decrease his hypervigilance symptoms through meditation practice.

Want to learn more? Here are some related articles that might be helpful.​​

• Armstrong, T., & Olatunji, B. O. (2012). Eye tracking of attention in the affective disorders: A meta-analytic review and synthesis. Clinical psychology review, 32(8), 704-723.
• Bernstein, R. E., Delker, B. C., Knight, J. A., & Freyd, J. J. (2015). Hypervigilance in college students: associations with betrayal and dissociation and psychometric properties in a Brief Hypervigilance Scale. Psychological trauma: theory, research, practice, and policy, 7(5), 448.
• De Stefano, C., Orri, M., Agostinucci, J. M., Zouaghi, H., Lapostolle, F., Baubet, T., & Adnet, F. (2018). Early psychological impact of Paris terrorist attacks on healthcare emergency staff: A cross‐sectional study. Depression and anxiety, 35(3), 275-282.
• Foa, E. B., & McNally, R. J. (1986). Sensitivity to feared stimuli in obsessive-compulsives: A dichotic listening analysis. Cognitive therapy and research, 10(4), 477-485.
• Foa, E. B., Ilai, D., McCarthy, P. R., Shoyer, B., & Murdock, T. (1993). Information processing in obsessive—compulsive disorder. Cognitive Therapy and Research, 17(2), 173-189.
• Hafstad, G. S., Dyb, G., Jensen, T. K., Steinberg, A. M., & Pynoos, R. S. (2014). PTSD prevalence and symptom structure of DSM-5 criteria in adolescents and young adults surviving the 2011 shooting in Norway. Journal of affective disorders, 169, 40-46.
• Kimble, M. O., Fleming, K., Bandy, C., Kim, J., & Zambetti, A. (2010). Eye tracking and visual attention to threating stimuli in veterans of the Iraq war. Journal of anxiety disorders, 24(3), 293-299.
• Kimble, M. O., Fleming, K., & Bennion, K. A. (2013). Contributors to hypervigilance in a military and civilian sample. Journal of interpersonal violence, 28(8), 1672-1692.
• Lindstrom, K. M., Mandell, D. J., Musa, G. J., Britton, J. C., Sankin, L. S., Mogg, K., … & Hoven, C. W. (2011). Attention orientation in parents exposed to the 9/11 terrorist attacks and their children. Psychiatry research, 187(1-2), 261-266.
• McNally, R. J., Robinaugh, D. J., Wu, G. W., Wang, L., Deserno, M. K., & Borsboom, D. (2015). Mental disorders as causal systems: A network approach to posttraumatic stress disorder. Clinical Psychological Science, 3(6), 836-849.
• Mikulincer, M., & Shaver, P. R. (2005). Attachment security, compassion, and altruism. Current directions in psychological science, 14(1), 34-38.
• Muller, J., & Roberts, J. E. (2005). Memory and attention in obsessive–compulsive disorder: a review. Journal of anxiety disorders, 19(1), 1-28.
• Newport, D. J., & Nemeroff, C. B. (2000). Neurobiology of posttraumatic stress disorder. Current opinion in neurobiology, 10(2), 211-218.
• Sander, A. M., Boileau, N. R., Hanks, R. A., Tulsky, D. S., & Carlozzi, N. E. (2020). Emotional suppression and hypervigilance in military caregivers: Relationship to negative and positive affect. The Journal of head trauma rehabilitation, 35(1), E10.
• Smith, N. A., Voisin, D. R., Yang, J. P., & Tung, E. L. (2019). Keeping your guard up: Hypervigilance among urban residents affected by community and police violence. Health Affairs, 38(10), 1662-1669.
• Wermes, R., Lincoln, T. M., & Helbig-Lang, S. (2018). Anxious and alert? Hypervigilance in social anxiety disorder. Psychiatry Research, 269, 740-745.​

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