Differences between Hypervigilance and Hyperarousal

Q:Dear Frank, There is a lot of information on the Internet about hypervigilance and hyperarousal as part of the symptoms of PTSD. Could you please explain these two concepts and give examples?

A:¬†Dear reader, Thank you for asking for this clarification. These two “hyper” terms come up often in PTSI discussion and not everyone is familiar with them. First, “hyper” means over. It is the opposite of “hypo,” which means under. We think of a “hyper” person as one who is revved up–over emotional, too talkative, too active.

Among those who experience trauma, being hypervigilant means being overly alert for danger. I have a patient who describes himself as “the ball-turret gunner.” He lives his life as though he is in one of those old world war two planes where a gunner was placed in a rotating turret half-way between the pilot and the tail, continuously scanning the horizon for incoming enemy aircraft. But Joe (not his real name) was never in the military. He was traumatized as a boy and later as a physician and he could never let his guard down. His hypervigilance interfered with his job, his family life, his sleep, and his ability to enjoy life. I found myself quoting Hamlet to him, “The world is out of joint. O wretched spite that ever I was born to set it right.” Joe agreed. He was born to worry about the world. It isn’t easy to be hypervigilant. True, vigilance serves a purpose when you are in danger and you need to see the enemy before he sees you. But once in a safe place, haunted by ghosts from the past, hypervigilance is a symptom of PTSI and not an asset.

Hyperarousal means that a person has too much energy, not necessarily too much fear of harm. It does not mean aroused in a sexual way. It is the opposite of being relaxed and serene. It could include being vigilant. But there are situations in which a person is in a state of high energy, but not particularly perceptive. If you feel “wired” and others find you intense, too intense, it might be that you, due to being triggered, are “hyper-aroused.” But you might not be focused on danger, perceptive of others, aware of your surroundings.

To be vigilant is to be sensitive to threat. To be aroused is to be awake. Both states do overlap. PTSI creates a condition of having too much sensitivity to threat and too little ability to relax. Hypervigilance is too much sensitivity to threats that are not worth worrying about. Hyperarousal is the inability to relax when it time for relaxation, including time for sleep.

These states make perfect sense during danger. But our bodies and our minds need to move effectively from “hyper” to normal. Treatment for PTSI includes learning to relax – but not giving up the capacity to be effectively aroused and vigilant.