It is possible that we have seen at some point someone nervous, with a high level of energy, who looks everywhere as if searching or waiting for something to happen, trying to observe everything without missing the slightest detail.

Although in some cases it may seem that this could be adaptive, the truth is that it is easy to observe that it is under continuous stress, which can be tremendously harmful if prolonged over time. The subject in question is showing hypervigilance, which we will discuss throughout this article .

Hypervigilance: concept and symptoms

Hypervigilance is understood as a state of tension and high energy consistent over time in which the subject who suffers from it presents an apparent enlargement of the level of consciousness, being hypersensitive and reacting quickly and energetically to sensory stimulation.

The subject who suffers it usually manifests hyperprosexia, in which the level of attention is much higher than usual and often focuses on any stimulus and detail of the surrounding context. It usually occurs along with the feeling of having great mental lucidity. Although this may seem positive in such a way that it would make it easier to detect and analyze the environment, the truth is that it usually implies a detriment in its correct analysis by continuously shifting the focus of attention from one element to another, so that although it may seem contradictory, the excess of attention capacity would cause a high level of distractibility.

The hyperreactivity that is also manifested by those who present hypervigilance generates that their reactions tend to be little adaptive and little reflected . They present a high level of anxiety, so that it is usually experienced in an unpleasant way by those who suffer from it. This, together with the high level of energy, can lead to the person becoming irritable or even hostile.

But since our energy reserves are limited, prolonged hypervigilance can lead to fatigue and eventually to passivity, sullenness and even depression.

Causes and contexts of appearance

Although it may appear at specific times without being pathological, hypervigilance may be a symptom (not a disorder per se) indicative of some mental or even physical disorder.

In the context of psychopathology, it often appears in the course of a chronic delusional disorder or during schizophrenia (especially the paranoid type), in which the subject is in expectation of specific phenomena that correspond to his or her interpretation of the world. It also often appears in anxiety disorders and obsessive disorders, as well as during manic episodes. It is also common for hypervigilance to appear after a traumatic experience such as war or rape (being in fact a possible symptom of post-traumatic stress disorder or acute stress disorder).

In the case of a traumatic experience, the threatening situation itself can become generalised , with the subject being prepared to respond in an extremely reactive manner to that which reminds him of the situation. For example, a person who has suffered an aggression will tend to be overprepared for any element that may indicate that he or she is going to be attacked again, considering the smile of a stranger or someone touching them to be a possible threat.

Another time when hypervigilance tends to appear is in the case of intoxication by substances, generally those of an excitatory or psychoanalytic nature such as cocaine or psychodisleptics such as some hallucinogens or the sativa variant of cannabis.

Effects and symptoms in daily life

Hypervigilance can cause serious damage to the person who suffers it . To begin with, the characteristic hyperprosexia will make it difficult for him/her to concentrate on a specific stimulation, which makes it difficult for the subject to perform his/her own work or academic life. On a psychological level, it can generate biases and cognitive distortions, as well as behavioural changes or avoidance of stimuli and situations.

On a social level it can also cause problems: the environment can feel undervalued and a lot of situations can be misinterpreted, which can lead to the subject losing social support or even becoming isolated.

In addition, the high level of energy maintained over time produces exhaustion and it is possible that weakness, a decrease in the immune system or even organic problems such as cardiac, respiratory, endocrine or muscular problems may arise.

Treatment

Hypervigilance is not considered a disorder per se, but rather a symptom. The treatment to be used will depend largely on what caused it .

Despite this, it is common that in almost all cases there is anxiety and a high level of activation, so that techniques such as cognitive restructuring, live or imaginative exposure, systematic desensitization and relaxation techniques are recommended. Externalising what causes hypervigilance is also a good idea (both in pathological and non-pathological cases), so techniques such as psychodrama, role-playing or expressive therapies may be useful. Benzodiazepines and other anxiolytics, as well as some antidepressants such as SSRIs, may be useful in alleviating possible discomfort while therapy is being performed. In cases of psychotic symptoms, also neuroleptics.

In organic aetiology tables it may be useful to apply different medical procedures and/or drugs, such as the use of antagonists like naloxone in case of drug consumption.

Bibliographic references:

  • Barlow, D. H. and Durand, V. M. (2003): Psychopathology .Madrid: Thomson.
  • Goodman, H. H. (Ed.).(1987). General psychiatry . Mexico: El Manual Moderno. (Orig. 1984).

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  • Lemos, S. (2000): General Psychopathology. Madrid: Síntesis.
  • Vallejo-Ruiloba, J. (1991): Clinical cases. Psychiatry . Barcelona: Salvat.