The Disease To Please – Hypervigilance Around Others’ Needs


Hypervigilance is not a mental health condition on its own, although it can be symptomatic of one. Being hypervigilant often means that people are sensitive to their environment, but it can also mean being extremely sensitive to other people’s emotions.

Hypervigilance Defined

Hypervigilance is characterised by an extreme sensitivity to the environment. Hypervigilant people are often on high alert and constantly on the lookout for hidden dangers and potential escape routes. It can be exhausting to deal with and can interfere with work and personal relationships.

Hypervigilance is commonly a symptom of post-traumatic stress disorder (PTSD) and can also be a symptom of panic disorder and generalised anxiety disorder.[1] Other experiences that can cause hypervigilance include being a survivor of domestic or childhood abuse, a war veteran, or surviving sexual assault. Symptoms of hypervigilance include:

  • Quick, shallow breathing
  • Rapid heart rate
  • Severe anxiety
  • Avoiding social interactions
  • Increased fear
  • Overreacting to environmental and emotional stimuli

Additionally, hypervigilance can be defined by four features:

  1. Avoidance of perceived threats – depending on where an individual sees a threat, they may avoid those places or scenarios. People may also develop agoraphobia, an intense fear of places and situations in which they may be trapped.
  2. Startle reflex – everyone startles at loud noises occasionally, but in cases of hypervigilance, people can jump or flinch at sudden movement, noise, and surprise. This is also called hyperekplexia.
  3. Overestimating a threat – hypervigilance causes people to constantly be prepared for threats, to the point where they will take any precaution to prepare themselves. This can include sitting with their back to a wall or near an exit so that they can escape easily.
  4. Epinephrine-induced physiological symptoms – also known as adrenaline, epinephrine is a stress hormone that can impact our fight-or-flight response. Hypervigilance can release more epinephrine than needed to prepare for threats, which causes increased blood pressure, a rapid heart rate, and dilated pupils.

Hypervigilance may be mistaken for paranoia. Although there are similarities between the two, there are also marked differences:

  • Present and future – paranoia is characterised by a belief that someone is trying to hurt them in the present. In contrast, hypervigilance is marked by intense anxiety about bad things happening in the future.
  • Being on guard – hypervigilant people are consistently on guard, but those struggling with paranoia suffer from delusions that someone or something is out to get them.
  • Insight – paranoid people are often unaware that they are suffering from delusions. However, hypervigilant people know that they may be irrational but still find it difficult or impossible to relax.

Emotional Hypervigilance

Hypervigilance is often a response to trauma, childhood abuse, assault, or surviving an accident or natural disaster. For those hypervigilant due to abuse, they may be especially vigilant with the needs of others, constantly going out of their way and out of their comfort zone in an attempt to keep them happy.

This can also play into attachment theory. Those with an anxious-insecure attachment style are constantly sensitive to their partner’s moods and emotions. As they are terrified of abandonment, they can be increasingly hypervigilant to their partners’ needs and wants. However, this behaviour can lead to resentment on behalf of the hypervigilant person, as they strive to cater to their partner’s wants, but their partner may not do the same.

Hypervigilance can also affect relationships, both romantic and platonic, in many ways:

  • Identity issues – those constantly hypervigilant to their partner’s moods and needs may neglect their feelings and needs and lose their sense of identity.
  • Clinginess – those coping with trauma and an anxious-insecure attachment style can become incredibly clingy to their partners out of fear they will leave. They are hypervigilant to their partners’ needs to try and discourage them from leaving.
  • Emotional outbursts – hypervigilance can cause people to have trouble regulating their emotions, leading to intense emotional outbursts.
  • Trust issues – hypervigilance leads to people constantly scanning their surroundings for threats. These threats can include people, and even in relationships and friendships, people can struggle with trust issues.

In addition, those struggling with hypervigilance can overreact to their partner’s or friends’ tones or expressions and overanalyse every situation. This can damage their relationships as their partners may take offence to their reactions and not understand why they behave the way they do.

Coping With Hypervigilance

If you notice that hypervigilance affects your life, there are several ways to help. As being intensely hypervigilant is linked to anxiety disorders and PTSD, it is wise to contact a mental health professional to see if there is an underlying cause.

An effective treatment for hypervigilance is exposure therapy. This form of treatment focuses on exposing people to specific triggers and fears to help individuals recognise what causes them to react so they can take steps to limit their responses. Therapy can also provide many tools for coping with hypervigilance, including:

  • Relaxation techniques – your therapist may incorporate relaxation aids such as yoga and breathing exercises into your treatment.
  • Mindfulness – learning how to be mindful of behaviour can help those struggling with hypervigilance become more aware of what they think and feel in the moment and reduce their reactive behaviour.
  • Communication -therapists can incorporate communication techniques into treatment to help those struggling with hypervigilance communicate what they need and how they feel to the people around them.


Hypervigilance is a symptom of conditions such as PTSD and several anxiety disorders. It is characterised by the intense fear and avoidance of threats, with those struggling with hypervigilance taking extreme measures to avoid potential adverse outcomes.

Many people struggling with trauma or an avoidant-insecure attachment style can be incredibly hypervigilant to the needs of others. They worry that if they don’t cater to the needs of people around them, their friends and partners will reject them and leave, so they take extreme steps to meet every need of their loved ones; however, this can come with a range of negative consequences and can actively damage relationships. With the help of therapy and healthy coping mechanisms, hypervigilance and its causes can be treated effectively.

If you have a client or know of someone struggling with hypervigilance, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential programme and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).


[1] Kimble M, Boxwala M, Bean W, et al. The impact of hypervigilance: Evidence for a forward feedback loop. J Anxiety Disord. 2014;28(2):241-245. doi:10.1016/j.janxdis.2013.12.006