Rethinking Hypervigilance in Women

I was three years old the first time someone taught me not to trust what I perceived.

My mother’s boyfriend exposed himself to me and told me not to put my underwear back on. I don’t have a fully continuous memory of what happened. What I have are fragments, and the certainty that I registered immediately that something was deeply wrong.

Again, I was three.

By the time I started school, I’d already become fluent in reading rooms. I grew up in a home shaped by addiction, mental illness, domestic violence, and instability—chronic moves, chaos, and being caught between two parents in ways no child should ever be. My ACE score is 9 out of 10. I’m the poster child of developmental trauma. Tracking shifts in mood, tone, and behavior before they became overt wasn’t something I learned consciously. It was something I developed the way people develop any survival skill—intuitively and instinctually. You do it because you have to.

Later, as an adult, the results of that skill felt like dysfunction. I’d express a worry to a partner and he’d say, “You worry too much.” Then, the very thing I’d sensed about him turned out to be exactly right. A friend or family member would say, “You’re overthinking,” and now I realize I often triggered something in them they hadn’t yet examined themselves. But because at the time I wasn’t examining why they said things like that, all of it reinforced the same message: I was the broken one.

I know now that I wasn’t. I was often the one who saw and named what no one else wanted to acknowledge.

I’m now 51 years old, a licensed professional counselor with nearly a decade in private practice, and someone who has done serious trauma work of my own—years of EMDR and then Brainspotting, working through things I spent a long time not having words for. Somewhere in that process, both personal and professional, a question has stayed with me: What if what we call hypervigilance isn’t a single process, but several different processes we’ve been grouping under one label? And what if, in grouping them like this, we’ve been telling a particular population of survivors something they’ve already heard too many times?

Most of us were taught that trauma survivors are hypervigilant. Their threat-detection systems are oversensitive, activated beyond what the situation warrants. They read danger into neutral cues. They’re reading too much into it. The clinical task, then, is to help them turn the volume down—to recognize when the alarm is going off for no good reason and learn to override it.

I believed this for a long time.

But the more time I’ve spent sitting with myself, becoming more embodied in my own history, and sitting across from women with complex trauma histories, the more I’ve started to wonder whether we’ve ever properly tested that assumption. Because the framework we inherited, the assumptions baked into the methodology—much of it wasn’t primarily built to determine whether the survivor’s perception was accurate. Accuracy was rarely the central dependent variable. And that matters because attunement and hypervigilance can look identical from the outside, and feel identical from the inside, especially in someone whose nervous system was trained early.

The hypervigilance construct we inherited came largely from research on combat veterans—mostly men, processing singular traumatic events, where the threat was environmental rather than relational. Those frameworks were then applied broadly to a population that looks nothing like combat veterans: women with histories of childhood abuse, intimate partner violence, and coercive control. Women who develop PTSD at twice the rate of men, and whose trauma happened inside relationships with people who had names and faces and the authority to define their reality. Women whose survival depended not on scanning terrain, but on reading people.

When the Alarm Isn’t Wrong

The thing about relational trauma that doesn’t get said enough is that gaslighting is not incidental to the injury. It’s central to how the trauma functions. The way you control someone who might otherwise trust herself enough to leave you is to systematically dismantle that self-trust. You do that long enough, to a person young enough, and you don’t just change what she believes about the world. You change what she believes about her own ability to see it.

When we’ve studied individuals with relational trauma—putting them in research settings, measuring their perceptions—I believe there’s a question we haven’t asked carefully enough. Is what we’re measuring distorted perception, or accurate perception that’s been told it’s wrong? The distortion, when it’s there, is usually not in the perception itself. It’s in the meaning the person makes of it. Attunement tends to land on something specific and locatable—a shift in tone, a flicker of attention, a tightening in the room. It can be tested. When you slow down and stay with it, often, something real surfaces. What we have historically called hypervigilance—the part that warrants clinical attention—is usually not the perception. It’s the catastrophic story layered on top of it. He’s pulling away may be accurate. He’s pulling away because I’m unlovable is the trauma talking.

A client of mine once told me, mid-session, that she felt like she wasn’t saying anything important. She said it carefully, the way people do when they’re trying not to make it a big deal. My first instinct could have been to reassure her—no, no, of course it is, I’m listening. But something stopped me. I got curious instead. “Why do you think that?” I asked.

The truth was, she was picking up something real. I had been distracted. I was thinking about a piece of writing I wanted to get back to after our session, and my attention had drifted, probably my eyes too. She’d registered it in me before I’d fully registered it in myself. The signal was accurate. What wasn’t accurate—what was the residue of her history—was the meaning she’d made of my attention drifting: that she wasn’t saying anything important.

I told her what was true. I owned that my attention had drifted and that it had nothing to do with her. And then I came back into the room with her. She’d been right, as many clients are. The therapist’s distraction, fatigue, irritation, or unexamined skepticism is data our clients often pick up on in real time.

What I didn’t do was talk her out of what she’d sensed. Reassurance, in that moment, would’ve been a gentler form of the same gaslighting she’d received her whole life. It would’ve prioritized my comfort over her perception. Curiosity honored the signal. Honesty honored her.

The clinical move, then, isn’t to override the radar. It’s to help the client separate the signal from the story—to honor what’s real and gently examine what’s been added.

The Observer Isn’t Neutral

Not long ago, a client I’ll call Tara crystallized this pattern for me. She’d spent most of her life having her reality questioned by family, doctors, and partners. She was incredibly sharp and perceptive, but she’d been conditioned not to give herself credit for this.

We were in session and she was describing a difficult interaction with someone in her life. “How do you think they felt during that conversation?” I asked her, believing I was asking out of pure clinical curiosity.

She paused, looked at me, and said: “That feels like a trick question. I don’t know why.”

Almost immediately she walked it back.  “I’m sorry,” she said. “I know you’re not doing that. I know that’s not what you meant.”

But what I understood after she left is that Tara had picked up on something I hadn’t yet admitted to myself. It took me a few hours to realize what it was—and I’ve done a lot of work on knowing who I am! I was carrying a subtle layer of unexamined fatigue and skepticism that day. I wasn’t entirely neutral. Her initial perception was picking up on something I hadn’t yet been fully conscious of myself.

When I saw Tara a week later, I asked her what she’d taken away from our last session. I wanted to first know how my own lack of awareness in session had impacted her. And true to form, she was blaming herself. She said she struggled to know whether someone was asking a question out of curiosity or judgment. She trusted me. She knew I was safe.

And for the most part, I believe I had been nonjudgmental and truly curious with her.

But I’m also a flawed human being with my own shortcomings. It was more important to me to be honest and take ownership of my experience—because she was there to learn to trust herself, not me. I admitted where my head was at. I told her that her perception is very sharp, and that it sounds like she often gaslights herself to stay connected to those she trusts. We talked about how the story she tells herself about what she senses may not always be accurate—but the shift itself, the thing she’s picking up on, usually is. I told her that continuing to check her assumptions—watching not just words and actions, but patterns across time—would help her intuition become even sharper.

I let her know that what she had was a finely calibrated instrument. It wasn’t broken. It was sharp.

If a researcher had reviewed that session transcript, they’d have seen a textbook example of hypervigilance followed by insight: a client who perceived a threat in a neutral question and appropriately self-corrected. What the transcript could never show is what was happening on both sides of the room beneath conscious awareness.

When researchers—often in positions of institutional authority, often not from this population, often not carrying this history—sat across from women who’d spent their lives being told their perception was wrong, and measured those women’s perception and found it flawed: did anyone stop to wonder whether the women might be reading something real in the room? Did anyone consider that being assessed and classified by someone with power over your diagnosis might activate exactly the kind of interpersonal tracking this population developed to survive? And that this activation might then be scored as evidence of their deficiency?

That capacity these women developed for reading people didn’t arise because something went wrong with them. It developed because their survival required it. And it didn’t stop working when they walked into a research lab or a therapy office.

Within much of our field’s research—from Strange Situation studies categorizing children’s adaptations to inconsistent caregiving as insecurity to research on borderline personality disorder framing heightened interpersonal sensitivity through the language of dysregulation and dysfunction—what we measured became evidence of pathology.

Trusting the Signal

Here’s what I’ve learned from my own practice, and from my own life.

I didn’t trust my own perception until I became a therapist—as it turns out, providing therapy to others has healed me as much as being on the receiving end of therapy. Which is its own kind of irony.

What helped me develop self-trust was years of sitting with clients and noticing things—a micro-shift in affect, a tightening, something moving through the room before any words had come—and learning to name what I noticed instead of dismissing it. Not as interpretation. As observation. “I’m noticing something just shifted. It seems like there might be some shame here, or fear—I’m not sure. Does that land at all?”

Often clients said no. And I learned not to immediately retreat. Instead of gaslighting myself and backtracking, I would pause and get more curious. I wouldn’t recant, wouldn’t push. I would just let whatever was there be there. More often than not, if we slowed down and stayed with it, something did in fact surface—not because they’d been hiding it, but because they hadn’t been connected to it yet. They didn’t know what was happening inside them until someone named it and gave them a moment to feel for it.

I saw it before they could.

What I eventually understood is that my 9 out of 10 ACE score had built in me a sensitivity to interpersonal shifts at a threshold most people don’t register. What had been forged in survival, the thing the clinical literature might have called hypervigilance was, in a therapy room, something closer to a form of attunement. For therapists who carry this history, that’s worth sitting with. The body you may have spent years seeing as broken—the one that senses “too much” or won’t settle—may be your most precise clinical instrument. You’re not bringing a liability into the room. You just know this terrain from the inside.

I’ve learned to trust my body in this way. What looks like a dysregulated nervous system in this population is often a nervous system refusing to release a signal that hasn’t yet been named. When something shifts in me while a client is speaking—a lump in my throat, a tightening, a held breath—I receive it as information. Something is likely happening in the client’s body too. So I look. And often I find it. Her throat is tightening as she tells me something she’s framing as fine. Her shoulders have come up while she’s laughing about something painful. Her jaw is set while she’s telling me she has let it go.

The body doesn’t lie. The mind does—because the mind can be taught to. The mind learns to accommodate others, keep the peace, stay connected to authority figures, gaslight itself to survive. The body never learned any of that. It just keeps holding what is true and waits to be heard.

When I notice the mismatch, I name it specifically. “When you said that, I noticed your throat tightened. Can you check in with that? Is there a lump there?” That precision matters. I’m not asking her a general question about her body. I’m pointing to one specific place where something just happened and inviting her to look at it. And that’s usually when the truth starts to come up—not because she was hiding it, but because her words had been organized around the frame she was handed, and her body was holding what the frame didn’t allow.

So maybe what “hypervigilant” people have isn’t simply pathology. Maybe our job isn’t to override their hard-won intelligence but to help them restore trust in it. Maybe the therapeutic task is to help them tolerate the vulnerability that arises alongside what they sense long enough for them to be able to evaluate it without collapsing into fawning or recanting their own reality.

The clinician who works with this population needs to be willing to ask themselves: What am I bringing in today that she might read before I do? If she presents herself as the problem, am I going to take that frame at face value, or am I going to hold it lightly enough to notice if it was installed in her? If I’m about to reassure her, what am I reassuring her out of—her perception or my own discomfort with what she’s perceiving? If we’re going to assess the perceptual accuracy of trauma survivors, we owe them observers—clinicians and researchers alike—who’ve done the work of knowing what they themselves are bringing into the room. Anything less measures the wrong thing.

Maybe the women in these studies weren’t imagining things when they sensed the researcher’s skepticism, doubt, or impatience. Some of them were reading the room accurately in real time. We may not always have had a way to distinguish between distortion and clarity. And in going with our assumptions, we did what was always done to them. We made their wisdom feel like self-doubt.

I became a therapist in part because I wanted to be the person in the room who could finally say: what you sense deserves to be taken seriously. I’m still learning what it takes to do that, and the field isn’t done learning this, either.

This isn’t a call to abandon rigor. It’s a call to a different kind of rigor—to consider that the people we’re studying might be seeing something we haven’t yet looked for.