Getting to the root of hypervigilance in ADHD

Hypervigilance is when you’re overly aware of your surroundings and constantly scanning for danger. Experiencing this response can feel tiring and overwhelming. It’s also recognized as a key symptom of post-traumatic stress disorder (PTSD). Even though hypervigilance isn’t a feature of attention-deficit hyperactivity disorder (ADHD), many people still experience it. This could be because people with ADHD are between 28% and 36% more likely to have also experienced trauma.

With the right support, you can learn to manage both ADHD and hypervigilance. A therapist can help you understand what’s triggering your hypervigilance and address other PTSD symptoms you may be experiencing. 

Could your hypervigilance be a sign of something besides ADHD?

Hypervigilance is one of the core symptoms of PTSD. It’s a response in which you frequently scan your environment for potential threats. You feel like you need to always be prepared for when something might go wrong.

People with PTSD often experience hypervigilance because of the frightening and often life-threatening traumatic experiences they went through. They may feel unsafe and have a hard time relaxing even after the event has passed. Their nervous system stays activated, which can lead to hypervigilance.

Hypervigilance isn’t a symptom of ADHD, but it can look similar to ADHD symptoms like: 

• Inattention

• Distractibility

• Difficulty winding down

• Difficulties with sleep

• Restlessness

This can sometimes cause ADHD and PTSD to be misdiagnosed.

For example, someone could find themselves having difficulty at work. They seem to always be thinking of something else, and they may make careless mistakes. On the surface, it can be difficult to determine what's creating this lack of focus.

Someone with ADHD could be distracted because of the way this neurodevelopmental condition affects their brain. They might inherently have a hard time with focus and concentration.

For someone with PTSD and hypervigilance, they might be unfocused because they’re feeling like they constantly need to scan their surroundings for threats. They might be focusing on where the exits are in a room or trying to make a plan for how to escape a potentially dangerous situation. They could even have dissociative symptoms, which can mimic or worsen ADHD symptoms.

In addition, PTSD and ADHD often show up together. Research shows that people with ADHD are more likely to have experienced trauma — especially in childhood.

This is why it’s essential to work with a qualified mental health provider to get to the root of your symptoms. They can help identify whether you’re experiencing hypervigilance symptoms due to PTSD, ADHD, or both. ADHD and PTSD are addressed in different ways, so getting the right diagnosis is key.

How hypervigilance affects people with ADHD

Hypervigilance and ADHD can be challenging to live with. It can lead to burnout, missing out on moments that would otherwise bring you joy, and impact important areas in your life. 

If you live with ADHD and are experiencing hypervigilance, you might:

• Feel like you’re never safe

• Start planning for potential dangers from the moment you wake up 

• Be more distracted than usual because you're constantly scanning your environment

• Experience heightened sensitivity to noise, people, or situations that might seem neutral to others

• Feel emotionally drained or dysregulated because you feel unsafe

• Have difficulty relaxing or letting your guard down, including at night, which can interrupt your sleep

Ways to calm hypervigilance if you have ADHD

Hypervigilance itself isn’t a bad thing, and it can protect you from potential dangers. For example, if you’re hiking in an area where bears are present, hypervigilance can keep you alert and focused on your surroundings. 

But the hypervigilance that comes with trauma keeps you scanning for dangers even when there are none present. Even though your body is trying to protect you, this can make it difficult to relax or feel safe. 

You can reduce hypervigilance by learning how to calm your nervous system. Addressing the body’s response can be a powerful tool in long-term support. Once your body learns it’s safe, you can get back to the present moment and be engaged in your day. 

Try relaxation strategies like:

• Deep or diaphragmatic breathing

• Progressive muscle relaxation

• Grounding techniques

Hypervigilance after a traumatic event is natural. For some people, it can go away with time. But if your hypervigilance doesn’t go away (or gets worse) over time, or if you also have other symptoms of PTSD, it’s essential to see a mental health provider. Chronic hypervigilance can feel exhausting, but it’s manageable. With treatment, it’s possible to start feeling safe in the world again.

A therapist can explain whether what you’re experiencing is hypervigilance or a symptom of your ADHD (like distractibility). They can also assess your symptoms to determine if you meet the criteria for an additional diagnosis of PTSD. If you live with both conditions, like many people, it’s important to address both. 

Sometimes, one mental health provider might be able to treat both conditions, and other times you might benefit more from seeing different specialists for each set of symptoms.

• PTSD (and hypervigilance) is typically treated with therapy, including cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR). Medication can also help reduce the symptoms of PTSD.

• ADHD is treated with medication, therapy, and/or coaching. You can learn strategies to best support how your brain works and even how to use accommodations at work or school. Medication can only be prescribed by certain mental health providers, like psychiatrists or psychiatric mental health nurse practitioners (PMHNPs).

Clinican's take

A common challenge people face when managing both ADHD and hypervigilance is feeling constantly overstimulated and mentally exhausted. ADHD makes it hard to filter distractions, while hypervigilance keeps the nervous system on high alert. These experiences make it difficult to relax, focus, or feel safe even in calm environments.

Ashley Ayala, LMFT

Clinical reviewer

Find care with Rula

Hypervigilance can feel overwhelming — especially if you’re already trying to manage symptoms of ADHD. But support is available. A therapist can help you manage ADHD and PTSD symptoms. They can teach you ways to respond more calmly and feel safe in the world again. 

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we're here to help you make progress — wherever you are on your mental health journey.