The Connection Between Hypervigilance and PTSD

Witnessing or experiencing a traumatic event can cause PTSD. Most people who go through a trauma have a difficult time adjusting, but those who develop PTSD may continue to experience symptoms for months and years. Someone experiencing hypervigilance experiences drastic changes in physical and emotional reactions, which is one of the four main groups of symptoms for PTSD.

According to the DSM-V, a diagnosis of PTSD requires two or more of the following hyperarousal symptoms: sleep problems, irritability, concentration problems, hypervigilance, and an exaggerated startle response. Research over the years has required refining of these diagnostic criteria, but hypervigilance has remained a hallmark symptom since the DSM-III in 1987.

Someone experiencing hypervigilance is always on guard and assessing for threats. They experience a lack of objectivity paired with over-awareness of the situations around them, but they may not be aware of things that are obvious to other people. Some question whether the people around them are going to betray them and become preoccupied with each person's body language, tone, and actions.

Hypervigilance has a real impact on quality of life. Going out in public can be a harrowing experience for people experiencing hypervigilance. Because they are always looking for a threat, mundane activities like going out to dinner or shopping in the grocery store are very stressful and exhausting. Some people may forget why they have gone to the store because they are busy finding the nearest exits or wondering which customers are threats.

Hypervigilance does not stop at night. Small noises can elicit an immense stress response, releasing a surge of adrenaline that makes it very hard to go back to sleep. Waking frequently throughout the night is common. These sleep disturbances lead to exhaustion, which only amplifies the effects of hypervigilance.

Hypervigilance has the potential to affect relationships with close friends and family. Suspiciousness can cause people experiencing hypervigilance to feel like betrayal is inevitable, prompting them to cut ties and end supportive relationships. This reaction is not the same as paranoia, however. A person with hypervigilance is aware of their fears and symptoms and that they could be unfounded. Unfortunately, this may also lead them to assume they are experiencing paranoia.

One study shows that the causes of hypervigilance are not as predictable as initially thought. Researchers assumed that assessing multiple factors could predict hypervigilance; these factors include trauma without PTSD, military training, and depression. However, the data indicates that only military deployment and PTSD (with military deployment or civilian trauma) were predictive factors.

As hypervigilance is a long-recognized part of PTSD, it is not surprising that the latter is a predictive factor for the former. What is surprising is that the previous study suggests PTSD is the only syndrome of those studied connected to post-trauma hypervigilance. Trauma without associated PTSD is unlikely to lead to hypervigilance. This suggests that anyone who experiences PTSD is likely to develop hypervigilance, regardless of the presence or intensity of other symptoms.

This study also looked at hypervigilance in relation to military deployment. Results show that deployment alone is enough to cause hypervigilance unrelated to PTSD. Veterans without PTSD reported experiencing hypervigilance at the same frequency as study participants with PTSD from a non-deployment-related trauma and at a much higher level than civilians without PTSD. This strongly indicates that deployment to a war zone is enough to cause hypervigilance that continues after return to civilian life.

Hypervigilance can also predict post-traumatic functional impairment. Multiple studies show that early symptoms of hyperarousal, including hypervigilance, predict the least amount of improvement over time. It is unknown whether hypervigilance itself causes this impairment, but some researchers believe that hypervigilance, with or without PTSD, can lead to poor social, psychological, and occupational functioning, significantly increasing the chance of poor outcomes.