November 15, 2023/Mental Health

Always on Alert: Causes and Examples of Hypervigilance

Causes range from psychological conditions like PTSD to physical conditions like fibromyalgia

person running from a scary figure

You’re walking to your car late at night when you hear a noise. It could just be the wind rustling the trees, but it could also be something else. Your body tenses. Your breathing becomes shallow. All your senses get a little sharper. When you make it safely to your car, you notice you’re trembling, your palms are sweaty and the hair on your arms is standing on end. Your flight-or-flight instinct kicked in, just like it’s supposed to.


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Now imagine those same physical changes happening when you aren’t in a potentially dangerous situation. Imagine it happening every time you leave the house. Every time you introduce yourself at a work function. Every time your partner is 15 minutes late coming home. Your brain and body race far ahead of the facts, so you feel as if there’s danger around every corner.

If that sounds like you, you may be experiencing hypervigilance.

We talked to psychologist Susan Albers, PsyD, about hypervigilance: What it is, what causes it and what to do if it’s negatively impacting your life.

What is hypervigilance?

Dr. Albers describes hypervigilance as a heightened state of awareness. “It’s your brain’s way of protecting you by scanning the environment for signs of danger and being extremely aware of your surroundings” she says.

To be clear, hypervigilance isn’t a diagnosis. It’s a symptom that occurs with a wide range of different conditions — both mental and physical. It’s perhaps easiest to think about hypervigilance as a natural instinct gone awry.

“Hypervigilance is a basic human survival mechanism,” Dr. Albers explains. “It allows us to sense predators and threats to our safety. But with hypervigilance, you’re feel like you’re constantly under threat.” Put differently, the amygdala — the part of your brain that’s responsible for managing emotions — is on overdrive.

Perpetual fight-or-flight

You’ve probably heard of the fight-or-flight instinct. It’s a mental and physical response to perceived danger. In an attempt to survive, our bodies undergo big physiological changes when we’re threatened. Certain processes — like digestion — slow down. Meanwhile, Dr. Albers says, our bodies get flooded by adrenaline.

“You have higher blood pressure, your heart rate increases, your pupils dilate and your body prepares itself to respond to the threat,” she explains.

All of these changes — and others — serve an evolutionary purpose. You may become pale or flushed, for example, because your body is diverting blood to your brain and limbs. Your muscles may tense up or tremble, primed to react quickly if needed.

When our frontal cortex — the part of our brain that makes decisions — gets flooded with hormones, Dr. Albers says it produces emotions that “are so intense that they knock out any logic or reason.”

These automatic responses are beneficial when we find ourselves in genuine danger. But for people who are hypervigilant, fight-or-flight is the default mode. The result is physical, mental and emotional discomfort.

Hypervigilance causes

There’s a long list of medical and mental health conditions that can trigger hypervigilance. That list includes:


Dr. Albers says that hypervigilance is sometimes just a personality trait. “Sometimes, a person is just more aware and mindful of their environment or other people’s feelings, but if hypervigilance is chronic or severe, it’s usually a symptom of a mental health disorder.”

Hypervigilance is also strongly linked to childhood trauma. According to Dr. Albers, that has a lot to do with the fact that, as we grow up, our brain develops in a way that’s responsive to our environment.

She gives the example of a child growing up in an abusive home. “The child is immersed in an unpredictable environment,” she illustrates. “Maybe their parent is sometimes in a good mood and then — out of the blue — becomes enraged or violent. That child will learn how to pick up on very subtle clues because knowing what state their parent is in helps keep them safe.”

When it comes to person with a history of trauma, hypervigilance is about self-protection, about preventing a traumatic situation from happening again.

Examples of hypervigilance

Hypervigilant behavior looks different depending on who you are and its underlying cause. All of the following are potential examples of hypervigilant behavior:

Hyper-fixation on your surroundings

This kind of hypervigilance is especially common for people who’ve experienced violence — especially if they’re living with post-traumatic stress disorder (PTSD).

Perhaps they have to sit with their backs against the wall to ensure nobody can sneak up behind them. Maybe they have to sleep with the lights on. Perhaps they feel it necessary to have a weapon on hand at all times. They may also have a particularly strong startle reflex, jumping at the slightest noise or motion.


Hyper-fixation on the thoughts and feelings of the people around you

Dr. Albers says it’s common for a person who’s hypervigilant to watch the people around them diligently for slight changes in behavior, tone, cadence, body language, written communication or even sentence structure.

“These individuals tend to do a lot of overanalyzing of people’s moods and their expression — even things like text messages,” she explains. These traits are especially common in people who’ve endured abuse or been exposed to violence.

Hyper-fixation on your own body or mind

It doesn’t get as much attention as some other forms of trauma, but medical trauma is very real. Dr. Albers sees it frequently: People who’ve experienced severe illness (their own or a family member’s), major medical procedures, mental health crises or an extended hospitalization or disability can become aware of their own bodies to a degree that’s detrimental. It can cause hypervigilance-related health anxiety.

A minor ache or pain may get them concerned that their cancer is out of remission. A bad day could be misinterpreted as a sign that their depression’s returned. The result can be a vicious cycle: All that worrying causes physical symptoms that are, well, worrying.


“When a person catastrophizes,” Dr. Albers says, “they’re creating a narrative in their head in an attempt to understand a situation. But that narrative gets spun in a negative way.”

A hypervigilant mind tends to be preoccupied by worst-case scenarios. Not getting a call back within a couple of hours may get read as a sign that a loved one has died and a slow response to a message signals the end of a years-long friendship.

The tendency to catastrophize may make it hard to let one’s guard down and enjoy happy moments. When life is going really well, a person living with hypervigilance may find themselves anxious, waiting for the next shoe to drop.

Avoidant behavior

It’s normal to change your behavior in response to a traumatic experience, but a person who’s hypervigilant takes that natural response too far.

If, for example, a person’s in a bad car accident, it’s understandable that they’d want to buy a car with a top safety rating. Never driving again — even if it means losing out on job opportunities, missing family vacations and relying on others for transportation — is an overreaction. In extreme cases, a hypervigilant individual may go on to develop full-fledged agoraphobia — a fear of places, people or situations that they see as threatening.

Hypervigilance can also impact your education, career and other areas of your life. “Some people have difficulty trying new activities or even learning new things because they’re afraid of not being good at it,” Dr. Albers notes. “They might worry that other people will judge or not like them if they aren’t perfect.”


Hypervigilance is all about identifying, responding to or preventing threats as soon as possible — whether those threats are real or perceived. For people with a history of trauma that can happen in many different ways.

Hypervigilant people may struggle with clinginess, people-pleasing, emotional regulation problems and trust issues. They often neglect their own needs (or even suppress elements of their identity) to avoid conflict. The concepts of relationship OCD and good girl syndrome tend to fit neatly under this umbrella.

“Hypervigilance makes it hard for people to relax at all. They always feel awkward or worried that they’re doing or saying something wrong,” Dr. Albers says.


How hypervigilance can impact your life

One of the things that makes hypervigilance difficult to deal with is the fact that it’s a legitimately helpful instinct. We should all be hypervigilant in certain situations. But when we’re in nonstop fight-or-flight mode, it can wreak havoc on our bodies, our minds and our relationships.

The physical, mental and behavioral impact of hypervigilance

The impact of one’s body being constantly flooded with adrenaline and cortisol is no small thing.

“Over time, you become exhausted,” Dr. Albers says. “You may experience frequent physical illness, you may have difficulty sleeping, you might find yourself eating too much or not enough. You can even experience gastrointestinal problems from your body being in constant fight-or-flight mode.”

The result of all that pressure? Your mental state — and even your behavior — may change. You could find you struggle to pay attention when that’s not been an issue in the past. You might be more irritable, more inclined to fight with others or more likely to have emotional outbursts. You could isolate yourself from others or experience mood issues like depression.

All too often, people struggling to sleep, regulate their emotions or endure chronic stress turn to substances to cope. While it may seem to help in the moment, self-medicating ultimately makes things worse — especially if there’s an underlying mental health issue involved.

Hypervigilance’s impact on relationships

When it comes to relationships of all kinds, hypervigilance is a double-edged sword.

Dr. Albers concedes that an individual with hypervigilant tendencies may notice negative behavior, lying or red flags more quickly than the average person. “Hypervigilance can prevent a lot of conflict,” she says. “An individual who’s hypervigilant might hear a slight shift in someone’s tone and know not to go there.” It may also help you to spot someone whose behavior doesn’t add up, preventing you from getting into a relationship that could be dangerous or hurtful.

While hypervigilance can protect you from conflict or danger, it can also hurt your relationships. In some cases, Dr. Albers adds that hypervigilance prevents people from getting close to or trusting others. It can also have the opposite effect: It can promote an anxious attachment style. “Needing constant reassurance can drive other people away because they know everything’s fine, but the other person keeps reading into the situation and making assumptions.”

To make things more complicated, hypervigilance may cause somebody person to be overly sensitive to feedback, or to be emotionally volatile. Needing to provide constant reassurance can be frustrating, exhausting and — in some cases, for some people — insulting.

Hypervigilance can be self-perpetuating

Another thing that makes hypervigilance difficult to deal with is the fact that those gut feelings sometimes end up being valid.

“People with extreme hypervigilance can be so tuned in to what is happening that their feelings end up being spot on,” Dr. Albers recognizes. That kind of positive reinforcement can be damaging because it can lead a person who’s hypervigilant to accept their understanding of the world around them.

“If a person who’s hypervigilant has enough experiences where they’re spot on, it can almost start to feel like that they can predict the future,” she continues. “That becomes problematic because it leads to over-analyzing, making assumptions and anticipating the worst. Nobody’s gut instinct is always 100% right and we can’t know or control the future.”

Coping with hypervigilance

If hypervigilance is negatively impacting your life, there are lots of ways to address it. Dr. Albers suggests the following:

  • Therapy. If you think you’re experiencing hypervigilance, Dr. Albers recommends working with a mental health professional to address it. “Working with a counselor can help you identify your triggers and better understand how and why those triggers create a sense of panic and hyper awareness,” she says. Therapy is also a great place to work on distinguishing between feelings and facts, as well as unravelling any past trauma that might be influencing you in the present.
  • Self-soothing and grounding exercises. If you’re struggling with hypervigilance at a specific moment, Dr. Albers suggests calming yourself with deep breathing, counting, self-talk or whatever self-soothing or grounding activities you find helpful. “Calming down the fight-or-flight response’s going to help you stop catastrophizing, think more rationally and be present in the moment,” she explains.
  • Mindfulness. Self-soothing and grounding are great coping mechanisms for the times when you find yourself on high alert, but it’s just as important to reduce your overall stress and anxiety level. Mindfulness is a great way to do just that. “When engaged in mindfulness,” Dr. Albers says, “you focus on what’s happening on the inside instead of on the outside.” Instead of closely watching someone’s else behavior to decode what they’re thinking or feeling, mindfulness redirects you to your own thoughts and emotions. When practicing mindfulness, you try to look at situations neutrally without judgment. There are many different ways to be do that, so choose an activity that resonates for you.
  • Medication. Some people need extra help calming down their nervous system — especially people experiencing hypervigilance as a side effect of a physical condition like thyroiditis.
  • Limiting alcohol and caffeine consumption. Have you ever noticed a jittery feeling after overdoing it on the coffee-front? Dr. Albers says caffeine can increase anxiety which, in turn, can feed hypervigilance. Alcohol doesn’t mix with most mental health issues, including anxiety, so it’s best to steer clear of it when you’re struggling with hypervigilance.


The bottom line

Hypervigilance is what happens when our natural flight-or-flight instinct goes into overdrive. People who are hypervigilant are in a constant state of anxiety. It isn’t a diagnosable mental health condition, but it’s a common feature of a wide range of physical, psychological and thought disorders. Causes range from childhood trauma and personality disorders to physical conditions like hypothyroidism. Hypervigilance can be physically, mentally and emotionally exhausting. It can make daily life and relationships difficult.

If you’re experiencing hypervigilance, consider reaching out to your primary care provider or a mental health professional for help. You may also benefit from limiting your caffeine and alcohol intake, starting a mindfulness practice and learning self-soothing techniques you can use to ground yourself in the present moment.

Learn more about our editorial process.

Related Articles

Sad person holding smaller version of themselves in their hands
May 22, 2024/Mental Health
How To Be More Confident and Improve Your Self-Esteem

Ignore the negative self-talk, practice positive affirmations and remember, you’re not perfect — and that’s OK!

Person at podium in front of crowd, nervous, sweating
May 20, 2024/Mental Health
Anxiety Has Its Benefits — But Only in Healthy Doses

A healthy amount of anxiety can keep you safe from harm and motivate you to take action

Person sitting with multiple arms trying to juggle multiple tasks, with same person with hand on head
May 17, 2024/Mental Health
What Is High-Functioning Depression? Signs and Symptoms

People with high-functioning depression may not seem depressed on the outside, but the condition can cause turmoil on the inside

Person observing a loving couple
May 15, 2024/Mental Health
Resentment: How It Can Creep In and Take Hold

The key to letting go of resentment is unpacking complex emotions and learning how to express them

Person reflecting on food and exercise
May 9, 2024/Mental Health
The Importance of Understanding Your Eating Habits

Learning about your relationship with food can help improve your eating behaviors and patterns

person looking at phone surrounded by whirlwind of bad news and negativity
May 6, 2024/Mental Health
How to Finally Stop Doomscrolling

Embrace mindfulness and practice checking your phone consciously, not compulsively

Teen sitting in window well staring out the window
May 3, 2024/Mental Health
Signs Your Teen Is Self-Harming

Unexplained injuries, mood changes and sudden isolation may be signs your child needs help

A person's emotional storm raining down on someone else
April 22, 2024/Mental Health
Vicarious Trauma: What To Do When Others’ Distress Impacts Your Well-Being

Absorbing others’ trauma can take a big toll on your own mental health

Trending Topics

Person in yellow tshirt and blue jeans relaxing on green couch in living room reading texts on their phone.
Here’s How Many Calories You Naturally Burn in a Day

Your metabolism may torch 1,300 to 2,000 calories daily with no activity

woman snacking on raisins and nuts
52 Foods High In Iron

Pump up your iron intake with foods like tuna, tofu and turkey