What's PTSD-Related Hypervigilance And How Does It Impact People With Post-Traumatic Stress Disorder?

People with PTSD are often hypervigilant. This means they are constantly on high alert for new threats and dangers — only logical, really, since their previous trauma has primed them to be on the lookout for risks, but also potentially debilitating. What do you need to know about hypervigilance as a symptom of post-traumatic stress disorder?

What is post-traumatic stress disorder?

Post-traumatic stress disorder is an anxiety-based condition that develops in a portion of people who have experienced a trauma — which may mean a one-time event like a robbery or natural disaster, or an ongoing threat like a war or domestic violence situation.

Almost everyone who suffered a trauma will suffer in the aftermath, but many develop resilience and find a way to recover from the distress they went through. A minority of people will develop PTSD in the aftermath of a trauma. The disorder causes a wide variety of symptoms, including:

• Reexperiencing the trauma (through flashbacks, nightmares, and intrusive memories).
• Avoidance of reminders of the trauma, which can have a disabling impact on daily functioning.
• Mood changes and changes in world view. 
• Physical symptoms of stress, like a pounding heart. 
• Changes in the way a person reacts to stimuli — like an exaggerated startle reflex, because sudden movements or touches can feel like a serious threat. 

Hypervigilance is another common PTSD symptom.

What is hypervigilance?

Hypervigilance isn't necessarily maladaptive (a "bad thing"). You'd expect a soldier on the battlefield or a bodyguard at work to be hypervigilant, for instance, and people in protective occupations will have specifically been trained to always be aware of their surroundings. Other, less threatening, contexts, may also call for hypervigilance. A sub-editor might be extremely focused on finding grammatical constructs that need to be improved, and a teacher overseeing a test super watchful for cheating students. These people, too, are hypervigilant. 

What does hypervigilance mean in the context of PTSD?

The fifth edition of the diagnostic and statistical manual of mental disorders, which is used to diagnose post-traumatic stress disorder in the United States, simply lists "hypervigilance" as a potential PTSD symptom, as part of the portion of symptoms that covers changes in "arousal and reactivity". 

In its section about the diagnostic features of the disorder, it goes into a little more detail when it says:

"PTSD is often characterized by a heightened sensitivity to potential threats, including those that are related to the traumatic experience (eg, following a motor vehicle accident, being especially sensitive to the threat caused by cars or trucks) and those not related to the traumatic event (eg, being fearful of suffering a heart attack)."

These behaviors learned after a trauma can, again, be useful (something that increases a person's safety) or the opposite. Because hypervigilance can actually keep people alive in threatening circumstances and therefore makes perfect evolutionary sense in some contexts, some research warns against automatically pathologizing this state of mind.

In a now safe situation, hypervigilance — or "always being on guard" or "on the alert" as people with PTSD often say — can, on the other hand:

• Cause a person to see danger even where there is none, or lead to the overestimation of risks. In layperson's terms, hypervigilance can make a person paranoid. Hypervigilance can then have a serious negative impact on social and professional relationships.
• Make a person anxious, worried, or fearful. 
• In more extreme settings, cause a person to inappropriately lash out, verbally or even physically, when a threat is perceived. Hypervigilance coupled with an exaggerated startle response can be dangerous. A classic example might be a former soldier who completely freaks out when a glass shatters, acting as though they were in combat again.
• Put someone in a constant "flight or fight response" situation. This affects physical health by leading to changes in heart rate, blood pressure, and stress hormones. 
• Cause a PTSD sufferer to be extremely preoccupied with safety, either limiting life or distressing others. Examples may include stocking up on weapons, planning escape routes wherever you go, avoiding romantic relationships or social situations, and not going out at all at night. 

PTSD-related hypervigilance is a double-edged sword that has advantages as well as disadvantages. Perhaps hypervigilance does promote physical safety. Perhaps it can even keep you alive. It also, however, has the very real risk of preventing you from living. In that sense, it impedes recovery.

Furthermore, though hypervigilance certainly exists in contexts besides post-traumatic stress disorder, including for instance anxiety disorders and situations that simply call for it, in this case, it's part of a wider symptomatic picture of PTSD. There's still debate in scientific circles about whether aspects of post-traumatic stress disorder (like hypervigilance itself) constitute a disordered behavior or are rather a "normal reaction to abnormal circumstances".

PTSD is often debilitating, though, and the way of life its symptoms create not the best strategy for a "normal life". That's what makes post-traumatic stress disorder a disorder. 

What can you do to cope with PTSD-related hypervigilance?

If you personally struggle with PTSD and the hypervigilance it often results in, we can only advise you to seek treatment. PTSD treatment can come in the form of talk therapy — frequently cognitive behavioral therapy that can include exposure therapy and cognitive restructuring, essentially a way of helping you process your trauma-related memories and adapting better to a now safer situation. It can also come in the form of medication, including antidepressants and medications to help you sleep better. 

Your hypervigilance may be tamed significantly once your overall PTSD symptoms improve. It may also stick around to a significant extent, but in a way that you can control and cope with. Whether or not you are currently in treatment, don't expect your symptoms to improve immediately, but give yourself time. Talk to people you trust if you can. Journal if that appeals to you. Try to look after your physical body. Be compassionate towards yourself. 

If someone you care about has PTSD, and their hypervigilance and startle response scare you at times, you're also in a difficult position. You can try to encourage your loved-one to seek help, but be aware that they may not be ready yet. Try to support their needs without neglecting your own. Join a support group for friends and relatives of people with PTSD, in person or on the internet, if you think it might help. Seek talk therapy yourself if you need to, and learn more about post-traumatic stress disorder to understand the PTSD sufferer in your life better.