Hypervigilance and PTSD

Hypervigilance and PTSD

One of the many hyper-arousal symptoms of PTSD (Post Traumatic Stress Disorder) is hypervigilance and this refers to the experience of being in a state of high alert, constantly tense and ‘on guard’ and always on the lookout for hidden dangers, both real and presumed – it’s stressful and exhausting to maintain.

This state of increased awareness, anxiety, and sensitivity to the environmental around you often manifests as a need to always scan your surroundings for potential threats. With the brains resources on constant alert, the results can be inappropriate or even aggressive reactions in everyday situations.

This constant scanning and rescanning of their environment can make people with hypervigilance ignore their family and friends around them. Often, they will overreact to loud sounds and bangs, unexpected noises, smells, etc. They can get really agitated and irritated, (especially when in a crowded or noisy area as there is too much to ‘analyse’).

Hypervigilance can make safe situations, people and places feel threatening, and even familiar surroundings and people can be an issue as hypervigilance can make people acutely aware of subtle details normally ignored – body language, a person’s voice and tone, their mood, their expressions – all things which are continually assessed.

Some other common behaviours of hypervigilance are:

  • Lack of objectivity – reading too much into situations
  • An over awareness of what people see or think about us
  • Perpetually scanning your environment to find threats (this can cause ‘Darting eyes’)
  • Looking for others to betray constantly
  • Not being aware of what is obvious to others
  • Appearing jumpy, jittery, and unable to sit still
  • A reluctance to try new things or meet new people
  • Unable to have conversations sometimes because you are distracted and unable to focus
  • The creation of obsessive patterns or obsessive avoidance of perceived threats (in extreme cases, a person may develop agoraphobia)
  • Constantly concerned about others
  • The mind tell us partial truths that we latch onto
  • Adrenaline-induced physiological symptoms: (dilated pupils, an increased heart rate, and elevated blood pressure)
  • Over scrutiny/analysing behaviour of situations

Many people with hypervigilance don’t see their reactions as intense, or unwarranted – infact, they may feel their actions are necessary to maintain safety and security in the aftermath of a trauma – but when hypervigilance is getting in the way of them being able to do day-to-day activities, and live their life as they want to, it’s something that needs to be addressed as part of their PTSD.

Sleep and Hypervigilance

Often, hypervigilance affects sleep: someone may be too afraid to fall asleep, and when you do, the smallest noise can fully wake you up, and the surge of adrenaline can make it very difficult to get back to sleep.

The founder of PTSD UK, Jacqui, remembers how hypervigilance affected her sleep, ‘When I could eventually get to sleep, I would wake up at least once an hour during the night – the smallest noise would wake me up with such a panic, I would be sweating, terrified and became so fearful of the dark. Frozen with fear, I’d need to get my husband to get up and check the house – several times a night. I’d be so tired the next day, but too scared to nap in the house on my own – it was such a difficult time, even with just the lack of sleep alone!’

This change in sleep can also exacerbate other PTSD symptoms and can further intensify feelings of paranoia, fuelling more hypervigilant behaviours.

Suspiciousness

Hypervigilance from PTSD can result in being suspicious of people and their motives. This can result in feelings of paranoia around others: ‘What are they really thinking about us?’ ‘What are they planning to do to us?’, ‘Why are they with me?’.

It can feel like you’re waiting for the betrayal, watching the other person looking for clues in order to prepare for it.  However, some people are not prepared to ‘wait’ for the betrayal and may end an otherwise healthy relationship.

Paranoia

‘When someone is paranoid, they have high levels of fear and anxiety. They are suspicious of other people and may believe that others are out to “get them”. They may believe in conspiracies or feel that others are threatening them. When left untreated, paranoia can progress into delusions.’ Hypervigilance from PTSD can often be mistaken for paranoia as it tends to over-estimate the potential for danger at any given moment. However, unlike someone suffering with paranoia, a hypervigilant person is usually aware of their symptoms. It can be a vicious cycle however, as a they may be so aware of their fears and hypersensitivity that they then think of themselves as paranoid – but it’s important to make the distinction. ‘Hypervigilance causes someone to be on guard and high alert. When someone is paranoid, they tend to have delusional beliefs that aren’t based on anything real. When someone has hypervigilance, they aren’t delusional.’

Catastrophizing

PTSD panic can often cause our minds to take a current situation and give it an extremely negative spin – allowing it to take us down all sorts of roads of worry and ‘what ifs’. ‘It can often produce a self-fulfilling prophecy of failure – we believe something will fail so we unconsciously create a situation that ensures failure.’

Of course, this can create many more negative situations, which can lead to a spiral of doubt, failure and so worsening PTSD symptoms.

How to cope with hypervigilance

The first thing to establish is that it’s very important to get treatment for PTSD. If you have PTSD symptoms after experiencing a traumatic event, whether it was a few days ago or years ago, it’s important to get the help that you need. 

There are some things however, that can help reduce hypervigilance in the meantime, but be mindful that reducing your symptoms of hypervigilance requires a lot of self-control and a conscious effort to identify things or incidences that provoke anxiety, and shift your focus away from such anxiety cues. 

  • Try to ‘catch yourself out’ when you sense yourself spiralling down your own personal hypervigilant thought patterns.
  • It can also help to be “in the moment” for a few minutes – perhaps focusing on your breathing in and out slowly, focus on your connection to the earth (your feet on the floor, your bottom on the chair) – this will give your mind time to calm itself.
  • Writing down your negative thoughts can also help to see patterns on when your hypervigilance and help control your mind a little more. To see why writing can help PTSD in general, you can read our blog post here.
  • Another helpful tactic comes from ‘Into the Light’: ‘instead of thinking “My partner is late again…it’s the third time this week…..perhaps he is losing interest me or doesn’t care about me anymore… I wonder if he’s having an affair … why was he checking his phone last night? This relationship is almost certainly over.”, perhaps try something along the lines of “My partner is late again … it’s the third time this week and I’m finding this difficult. We need to sit down together and work out a good communication plan when he’s going to be late so I can still relax and enjoy my evening.”’
  • ‘For people with hypervigilance, home can feel like the safest spot to be, but getting outside of your comfort zone is essential. Exposure to the outside world is necessary to keep pushing back against the restrictions of hypervigilance.’ 
  • ‘While hypervigilance can stem from several sources, anxiety, stress, and worry all play a central role. Because of this, deep breathing, autogenic training, progressive muscle relaxation, and guided imagery are all great habits to practice.’

‘Hypervigilance can be a frightening and frustrating emotional state that makes you feel stressed and fearful in many situations. Remember, it produces flawed and distorted thoughts, and although they are convincing, they are wrong. By believing in yourself and committing to professional mental health treatment, you can overcome hypervigilance and the associated psychological disorders.’

It’s important to note, that while choosing your PTSD recovery path you need to address both the symptoms and the underlying condition. NICE guidance updated in 2018 recommends the use of trauma focused psychological treatments for Post Traumatic Stress Disorder in adults, specifically the use of Eye Movement Desensitisation Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (CBT).

Please remember, these aren’t meant to be medical recommendations, but they’re tactics that have worked for others and might work for you, too. Be sure to work with a professional to find the best methods for you.

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