Hypervigilanz

Hypervigilance is an enhanced state of sensory alertness in which a person maintains an exaggerated readiness to respond to perceived threats. It involves heightened attention to the environment, rapid scanning for danger, and a persistent expectation that harm may occur. Hypervigilance is a symptom rather than a standalone disorder and is commonly observed in trauma-related conditions as well as anxiety disorders, sleep deprivation, and certain medical or substance-related states.

In clinical contexts, hypervigilance is most closely associated with post-traumatic stress disorder, acute stress disorder, and, to a lesser extent, generalized anxiety disorder. It can persist long after a threat has resolved. It may also occur during stimulant use or withdrawal, manic or hypomanic states, delirium, or thyroid disturbances.

Symptoms commonly include a frequent startle response, irritability, difficulty concentrating, intrusive memories, avoidance behaviors, and trouble relaxing. Individuals may continually monitor surroundings for potential threats, misinterpret ambiguous cues as dangerous, and experience sleep disturbances due to heightened arousal.

Assessment relies on clinical interview and, where appropriate, validated scales for PTSD and anxiety. Differential diagnosis includes sleep disorders, substance intoxication or withdrawal, mood disorders, psychosis, and neurocognitive impairment.

Management focuses on treating the underlying condition and reducing arousal. Trauma-focused psychotherapies (such as EMDR and trauma-focused cognitive behavioral therapy), broader cognitive-behavioral approaches for anxiety, and pharmacotherapy (e.g., SSRIs or SNRIs) can be effective when indicated. Non-pharmacological strategies like sleep hygiene, mindfulness, grounding techniques, and stress-reduction practices can also help. In cases of safety concerns or severe distress, professional evaluation and support are advised.