Hypervigilance: causes, symptoms and treatment.

We explain the psychological and neurological basis of this state of overactivation.

It is possible that we have seen at some point someone nervous, with a high level of energy, looking everywhere as if looking for 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 he is in constant tension, which can be tremendously harmful if it is prolonged over time. The subject in question is showing hypervigilance, which we will talk about throughout this article..

Hypervigilance: concept and symptoms

It is understood by hypervigilance to a state of tension and elevated energy consistent over time in which the sufferer presents an apparent enlargement of the level of consciousness, being hypersensitive and reacting quickly and energetically to sensory stimulation.

The sufferer usually manifests hyperprosexias, in which the level of attention is much higher than usual and frequently focuses on any stimulus and detail of the surrounding context. It usually occurs together with the sensation 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 in general it is detrimental to its correct analysis as the focus of attention moves from one element to another continuously, so that although it may seem contradictory, the excess of attentional capacity would cause a high level of distractibility.

The hyper-reactivity that is also manifested by those who present hypervigilance The result is that their reactions tend to be maladaptive and ill-considered.. They present a high level of anxiety, so that it is usually lived 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, a sullen attitude and even depression.

Causes and contexts of appearance

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

In the context of psychopathology, it frequently appears in the course of a chronic delusional disorder or during schizophrenia (especially of the paranoid type), in which the subject is in expectation of concrete 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 generalized, with the subject being prepared to respond in a generalized manner.The subject is ready to respond in an extremely reactive way to whatever reminds him of this situation. For example, a person who has suffered an aggression will tend to be over-prepared to any element that may indicate that he/she is going to be attacked again, considering the smile of a stranger or someone touching them as a possible threat.

Another moment when hypervigilance usually appears is in substance intoxication, generally those of an excitatory or psychoanaleptic nature such as cocaine or psychodysleptic 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 from it.. To begin with, the characteristic hyperprosexia will make it difficult to concentrate on a specific stimulation, which hinders the subject's own performance in his work or academic life. On a psychological level, it can lead to cognitive biases and distortions, as well as behavioral changes or avoidance of stimuli and situations.

At the social level it can also cause problems: the environment may feel underestimated and a large number of situations may be misinterpreted, which can lead to the subject losing social support or even becoming isolated.

In addition, the high level of energy sustained over time leads to exhaustion, and weakness, lowered immune system, or even organ problems such as Heart disease, may occur. or even organic problems such as cardiac, respiratory, endocrine or muscular problems.

Treatment

Hypervigilance is not considered a disorder in itself, but rather a symptom. The treatment to be used will depend to a great extent on what caused it..

However, it is common that in almost all cases there is anxiety and a high level of activation, so that techniques such as cognitive restructuring, exposure in vivo or in imagination, systematic desensitization and relaxation techniques are recommended. Externalizing what causes hypervigilance is also a good idea (both in pathological and non-pathological cases), and 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 to alleviate possible discomfort during therapy. In cases of psychotic symptoms, also neuroleptics.

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

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