Has this ever happened to you? You’re walking around town, and all of sudden you become overwhelmed by the totality of all that’s happening all around you – cars whizzing by, pedestrians brushing past, loud music playing, the sun beating down on you, two people having an argument, cars honking, the smell of garbage, dogs barking, and on and on it goes. It’s all just normal everyday city life, but nevertheless you become tense and nervous, scanning around for what feels like impending danger. Your anxiety boils up to the point of paranoia, to the point where any little additional thing directed your way would be enough to set you off into a full-blown panic attack. It’s a terrible feeling, and yet it’s not at all uncommon for those with fibromyalgia to experience this all the time. Even under less stimulating environments than the example above, the sensation can be extremely intense. This is called hypervigilance, and it is an iconic symptom of fibromyalgia.
Characteristics of Hypervigilance
The term hypervigilance is pretty self-explanatory. A soldier in charge of defending a fortress from an enemy that might strike at any moment needs to be vigilant in order identify signs of an attack. But once the war is over, that same soldier hardly needs the same level of vigilance to function in everyday civilian life. In fact, in most cases it would be directly counter-productive to maintain that level of awareness. The human brain simply does not have the capacity to maintain such attention over long periods of time. It needs to rest and recharge so that it’s primed to go when important situations call for it.
There are a number of characteristics associated with hypervigilance. Perhaps the most obvious is a constant scanning of the environment for sights, sounds, people, behaviors, smells, or anything else that is reminiscent of activity, threat or trauma. On its face this doesn’t seem so bad. However, it can have plenty of negative side effects. For example, it could cause you to constantly be distracted and lose focus on the task at hand. It doesn’t take too long before you simply become exhausted, with little energy left for anything else. It can lead to a variety of obsessive patterns, which negatively affects relationships and social interactions. After a while irritability is unavoidable, and it takes an extreme amount of discipline not to have an outburst and snap at those around you.
Another byproduct of hypervigilance is insomnia. It’s not much of a leap to imagine why being hyper alert can make falling asleep difficult. Sleeping is the ultimate manifestation of letting your guard down, and yet it’s one of the most important things we need to do as humans to maintain health (and sanity).
Hypervigilance and hypersensitivity go hand in hand. When you know your body can’t handle extreme heat or cold, loud noises, or bright lights, you become hypervigilant about avoiding these sensations. Effectively, you enter a state of stress about future (potential) discomfort. Let’s say you’re still walking around town and the temperature is dropping. Just knowing that in a half hour you will be very uncomfortable due to the cold can, by itself, induce a state of panic even before the actual sensation occurs. This anxiety is a form of hypervigilance, and it can have you scrambling for shelter or warmer clothes even if a more rational option would just be to remain calm and continue towards your destination.
Why is this such a Problem with Fibromyalgia?
There is solid science that helps explain why fibro folks so often have the problem of hypervigilance. Fibromyalgia is, at its core, a chronic activation of the body’s sympathetic nervous system. This is also known as the “fight-or-flight” response, and it is what allows us to respond to an imminent threat. This is useful in very rare circumstances when we are in immediate danger, but wreaks havoc on our bodies when it never shuts off. It prevents the proper operation of its counterpart, the parasympathetic nervous system. This system is responsible for calming our brains, relaxing our muscles, maintaining a stable metabolism, and allowing us to fall asleep. This “rest-and-digest” nervous system is the baseline mode of operation for a healthy person because it regulates all the mundane but important functions in our bodies.
Prominent theories for the cause of fibromyalgia hold that it results from severe physical or emotional trauma. This trauma, in turn, causes the malfunctioning and over-activation of the sympathetic nervous system. To add insult to injury, hypervigilance can manifest particularly strongly surrounding situations that are similar to past traumas. For example, if you developed fibromyalgia after a terrible car accident, you might experience extreme hypervigilance any time you are driving or riding in a vehicle.
In addition to fibromyalgia, hypervigilance is a prominent symptom of post-traumatic stress disorder (PTSD). In fact, one might even consider fibro a form of PTSD depending on the nature of its onset. The link to PTSD is so strong that soldiers returning home from war or police officers grappling with a violent past event often have to struggle with hypervigilance on a daily basis. If a situation occurs that bears any resemblance to the traumatic event, they can become extremely agitated and overreact to loud and unexpected noises or any other triggering stimuli.
Tips and Treatments to Minimize Hypervigilance
Sadly, hypervigilance is extremely difficult to counteract effectively, since it is such a close byproduct of the core problem of fibromyalgia – the malfunctioning of the sympathetic nervous system. However, there are a few strategies available outside of prescription medications that can help mitigate the worst effects of this symptom.
The first is to simply try to avoid environments that you know tend to trigger your hypervigilance. If crowds are extremely stressful for you, try to run your errands during less busy hours and think twice about attending a sold-out concert or sports game. If you simply aren’t sure whether a situation will be problematic, try to research or ask as many questions about it ahead of time so you can increase your confidence level that everything will be OK.
Making efforts to calm your hyperactive mind and body will also help reduce the negative effects of hypervigilance. Try to cultivate a habit of meditation as often as possible. Clearing your mind before going out into the world is a great way to keep the excesses of your fight-or-flight stress response in check. Similarly, practicing yoga can help by strengthening your muscles and increasing your overall endurance.
Finally, engaging in mindfulness will pay dividends in minimizing hypervigilance. Take a step back and try to recognize when you’re stressed about something. Often the stressor is a function of the nearby environment and is completely unconscious. You feel this vague sense of anxiety and panic, but you’re not entirely sure why. Ask yourself, “What is causing this stress, and am I worrying more than I need to? Is this response a knee-jerk reaction, or do I have a legitimate reason to be freaking out right now?” Often you’ll find that, in fact, you are safe and there’s nothing pressing to worry about.
Hypervigilance is a tenacious devil that I continue to struggle with in my life. Which aspect of this symptom is the most difficult to tolerate for you? Do you have any additional tips to handle these types of situations when they arise? Please share your responses in the comments below so we can all help each other face fibromyalgia together.
- The Fibro Manual by Dr. Ginevra Liptan (2016) http://www.drliptan.com/book/