Hyperarousal keeps the body and mind constantly “on guard,” which makes it hard to go about daily life. Chronically heightened states of arousal are perpetuated by the fight-or-flight branch of the autonomic nervous system.
This article discusses the causes, symptoms, and treatment for hyperarousal that occurs with PTSD.
Causes
As someone with PTSD goes through life, anything could remind them of the traumatic event(s) and cause symptoms.
Some possible examples that might cause your stress levels to spike include:
Catching the scent of diesel fuel can trigger flashbacks to a life-threatening event, possibly an accident, if that smell is linked to the time and place the trauma occurred. Seeing a freezing rain icon in the weather forecast before leaving for your morning commute if a PTSD-inducing automobile accident happened on black ice. Hearing an old song in the checkout line at a store that brings back a wave of vivid memories associated with a traumatic event.
Triggering events like these can instantaneously create an inner state of hyperarousal.
Physiological symptoms of autonomic hyperarousal include:
Accelerated heart rateElevated blood pressureSweaty palmsShortness of breath
Psychologically, hyperarousal is distressing and often makes people feel panicky or filled with anxiety. Even when there’s no real danger or threat, hyperarousal keeps the body and mind on high alert.
People with hyperarousal tend to be anxious and have trouble relaxing. Constantly being “on guard” and in a state of hypervigilance is draining. Hyperarousal’s ripple effects disrupt people’s ability to cope with day-to-day life.
Over time, PTSD-related triggering events can lead to dysregulation (dysfunctional management) of the autonomic nervous system’s stress response. Chronic hyperarousal develops as a result of the body’s built-in stress responses staying in hyperdrive and never quieting down.
Surges of epinephrine (adrenaline) and norepinephrine, both chemical messengers in the brain, kickstart the body’s fight-or-flight response quickly, which often protects us from danger. However, chronically high levels can lead to hyperarousal in PTSD.
Symptoms
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association’s handbook for diagnosing mental health conditions, highlights six symptom subcategories, or “clusters,” associated with hyperarousal.
Anger or angry outbursts: Engaging in aggressive verbal or physical behavior with little or no provocation is a form of incivility that chronic hyperarousal makes difficult to control. Impulsivity: One of hyperarousal’s biggest risks is engaging in reckless or self-destructive behavior such as dangerous driving, excessive alcohol or drug use, or self-injurious behavior. Hypervigilance: Heightened sensitivity to imaginary threats and constantly feeling on “high alert” depletes energy reserves. Excessive startle reflex: Heightened startle responses cause jumpiness in response to loud noises or unexpected movements (e. g. , jumping in response to a telephone ring). Attention issues: Difficulties with concentration, focus, or remembering scheduled events can cause problems at work and in daily life. Sleep disruption and insomnia: Perpetually elevated states of arousal and nightmares interfere with getting adequate sleep. (e. g. , sleep hygiene).
In addition to these six subcategories, anxiety disorders, irritability, and panic attacks are commonly associated with hyperarousal in PTSD.
Treatment
Hyperarousal treatment often requires a multi-pronged approach that might include a combination of psychotherapy, medication, device-based neurotherapy, and lifestyle interventions, such as diet modification, mindfulness training, meditation, or daily physical activity.
Specific examples include:
Cognitive behavioral therapy (CBT) Diaphragmatic breathing exercises Exposure therapy Eye movement desensitization and reprocessing (EMDR) Medications (e. g. , antidepressants or anti-anxiety drugs) Mindfulness-based stress reduction Progressive muscle relaxation Non-invasive vagus nerve stimulation
Summary
Hyperarousal is caused by overactive fight-or-flight stress responses that keep the body and mind on high alert, even when there’s no cause for alarm. It is a commonly experienced symptom of PTSD.
Being in a constant state of arousal can disrupt daily life in several ways and make it difficult to sleep. This vicious cycle can snowball out of control if left untreated. Fortunately, there are numerous treatment options, including therapy, medication, and mind-body exercises.
A Word From Verywell
If you’re experiencing hyperarousal symptoms that occur with PTSD, a healthcare provider or mental health professional can help you on the road to recovery. Further, there are many strategies that can make it easier to cope. Try making healthy lifestyle changes and and fortifying your support network by staying connected with friends and family.
