PTSD Hyperarousal: Symptoms & Causes

What Is Post Traumatic Stress Disorder (PTSD)?

PTSD is a mental health condition within the trauma and stressor-related disorder section of the DSM-5-TR. It develops in the context of exposure to one or more traumatic events that are likely disturbing or distressing to an individual.¹ Certain clinical criteria must be present and associated with the event, including exposure to actual or threatened death, serious injury, or sexual violence, presence of intrusion symptoms, persistent avoidance of stimuli, negative alterations in cognitions and mood, and marked alterations in arousal and reactivity.¹

Trauma is best conceptualized as a full system disruption, impairing a person’s functioning and how they move through life. Their cognitive, social, and emotional experiences are altered. Most individuals will initially have symptoms of reexperiencing, avoidance, and hyperarousal following the trauma that will extinguish over time.² However, symptoms often persist, and a person will be diagnosed with PTSD.

Common symptoms of PTSD include:

• Hyperarousal
• Distressing memories of the trauma
• Flashbacks
• Avoidance
• Social withdrawal
• Concentration problems
• Negative emotional state
• Reckless or self-destructive behavior
• Sleep disturbances
• Negative thinking

Who Is Most at Risk for PTSD?

Trauma is a subjective umbrella term and simply being exposed to something that is considered traumatic by someone does not guarantee a person will be diagnosed with PTSD or develop its associated symptoms. Lifetime prevalence estimates range from 6.1% to 8.3%.¹ Historically, roughly 1/3 of individuals that are exposed to a traumatic event go on to develop post traumatic stress disorder. Some of the most at risk professions include first responders, military personnel, and healthcare workers given their continued exposure to traumatic events.

Some risk factors for PTSD include:

• Early exposure to trauma (abuse, serious illness)
• Lack of social support
• Severity of trauma
• Gender
• Inadequate coping strategies
• Age
• History of mental health issues

What Is Hyperarousal?

Hyperarousal is one of the key symptoms associated with PTSD, the other two being re-experiencing and avoidance.³ It is an abnormal state of activation that occurs in the wake of traumatic or highly stressful events.⁴ The individual feels they are on edge and can’t relax. Not only is the mind wired, but more importantly, so is the body. The stress response of a traumatic event floods the brain with stress hormones, such as norepinephrine and cortisol.

Chronic hyperarousal may alter certain brain structures, such as the hippocampus, with exposure to abnormal levels of stress hormones.⁴ Our body is in a constant fight-or-flight response and ready to react as it senses a threat is always imminent. In the aftermath of traumatic events, the brain becomes threat-sensitized.⁴ The body “remembers” the traumatic event and over-reacts when faced with a new stressor.⁴

Common symptoms of hyperarousal include:

• General irritability: Hyperarousal can lead to heightened sensitivity to perceived threats, making them more prone to interpret benign situations as provoking. This heightened vigilance can trigger outbursts and alter a person’s general demeanor making them sullen and negative.
• Impulsivity: Heightened emotional states are likely to make someone impulsive, and not think before acting. They may lash out and jump to conclusions as they are hijacked by emotions and their rational brain is shut down.
• Hypervigilance: Hypervigilance is a heightened state of alertness and constant scanning of the environment for potential threats when few to none are likely present. Individuals experiencing hypervigilance are excessively watchful and tend to perceive benign stimuli as potentially harmful.
• Attention issues: Constant scanning for threats makes it difficult to be present focused and attend to one issue at a time.
• Sleep disruption: Sleep is as much mental as it Is physical and a hyperarousal mind is not shut off. It becomes difficult for the person to mentally and physically relax and turn off the internal noise so they can rest.
• Excessive startle reflex: Given the individual is on high alert, they are more sensitive to stimuli in the environment. The reaction is likely well beyond what is considered a typical response.
• Anxiety disorders: Anxiety disorders are characterized by excessive and persistent worry, fear, or anxiety about everyday situations or specific triggers. Experiencing traumatic situations are likely to exacerbate feelings of worry and fear.
• Panic attacks: PTSD panic attacks are intense, sudden episodes of extreme anxiety triggered by reminders of the event. Panic attacks symptoms include rapid heartbeat, shortness of breath, sweating, and a sense of impending doom, often resembling the fight-or-flight response even when there is no immediate danger.

Physiological symptoms of hyperarousal may include:

• Heart palpitations
• Elevated blood pressure
• Nausea
• Dizziness
• Headaches
• Shallow/rapid breathing
• Muscle tension
• Sweating
• Digestive disturbances

Hyperarousal Vs. Hypervigilance

The core neurobiological alteration in PTSD is hyperarousal, a tendency for the brain and the body’s nervous system to react in a rapid, extreme, and prolonged manner to stressors.⁵ If hyperarousal persists, the adaptive attempt to anticipate and prepare may escalate into a maladaptive preoccupation with even mild or remote signs of threat or bodily distress, hypervigilance.⁵ You can experience both at the same time as hyperarousal is the body’s response to a threat and hypervigilance is the constant scanning behavior that one employs to keep safe.

Hyperarousal Causes

Hyperarousal can stem from diverse triggers such as heightened stress levels and vivid recollections of the traumatic incident. Elevated stress amplifies physiological responses, fostering a state of perpetual alertness. Memories of the trauma act as potent catalysts, causing intense anxiety, irritability, and an augmented startle response. These intertwined factors perpetuate a relentless cycle of hyperarousal, eroding daily functioning and overall well-being.

Some possible causes of hyperarousal symptoms in PTSD include:

• Hearing a song come on the radio that brings back vivid memories associated with a traumatic event
• Smelling a fragrance that was in the environment at the time
• Revisiting a location where the traumatic event happened
• Hearing loud bangs like from fireworks which can be reminiscent of munitions going off
• Conflicts and arguments may provoke hyperarousal with those of domestic violence histories

Treatment Options for PTSD Hyperarousal

Hyperarousal treatment usually requires a multi-pronged approach of psychotherapy, medication, lifestyle changes, and mindfulness. Hyperarousal alone is not just the target but the multitude of symptoms that accompany trauma and a diagnosis of PTSD. An individual can begin to relax, mentally and physically, when a sense of safety is provided. The goal is to quiet the body and calm down the central nervous system which has become too activated and sensitized to threats that are not present. The person needs to learn that they are living in the past and the present is not harming them.

Treatment options for hyperarousal include:

Therapy

Therapy is a wonderful way to address the trauma that was experienced and learn coping skills to move beyond it. Several different therapy options for trauma and hyperarousal exist and can be beneficial.

• Cognitive behavior therapy (CBT): CBT for PTSD is a structured therapeutic approach to help individuals reframe maladaptive thought patterns and behaviors associated with their trauma. It aims to reduce symptoms through techniques such as exposure therapy and cognitive restructuring which can empower individuals to regain control over their reactions to traumatic experiences.
• Prolonged Exposure Therapy (PE): PE helps individuals confront and process traumatic memories, reducing their emotional intensity and hyperarousal responses through controlled exposure to the traumatic event’s memories and triggers.
• Cognitive Processing Therapy (CPT): CPT for PTSD focuses on identifying and challenging maladaptive thought patterns related to the trauma, which can contribute to hyperarousal, and helps individuals develop healthier thought processes.
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR for PTSD uses bilateral stimulation, typically in the form of rapid eye movements, to help individuals process traumatic memories, reducing hyperarousal symptoms and emotional distress.
• Mindfulness-Based Stress Reduction (MBSR): MBSR incorporates mindfulness meditation and relaxation techniques to help individuals manage hyperarousal symptoms by increasing awareness of their thoughts and emotions, promoting relaxation, and reducing reactivity to triggers.

Lifestyle Changes

Therapy is not the only means of healing after trauma. Lifestyle changes can be valuable in alleviating hyperarousal symptoms and promoting internal growth.

• Diet modification: Diet alone won’t cure PTSD. However, a balanced diet can help regulate mood, reduce stress, and improve sleep, which are important factors in managing PTSD symptoms
• Mindfulness: Trauma pulls us from the here and now to the there and then. We can become fixated with the past and how we were hurt. Mindfulness is a present focused practice which teaches us how to stay in the moment.
• Meditation: Meditation allows the body to achieve a sense of calmness which is needed in quieting down an overactive nervous system. Through regular meditation for ptsd, individuals can cultivate greater awareness of their thoughts and emotions, reduce hyperarousal, and develop coping strategies to enhance their emotional resilience.
• Deep Breathing: Deep breathing, or diaphragmatic breathing, is at the heart of learning to relax. This type of breathing engages the parasympathetic nervous system which puts the body in a rest and digest state rather than in fight or flight.
• Yoga: Trauma can often sever the connections between the mind and body. Trauma-informed yoga can serve as a forum for a person to relearn how to listen to their body and relieve the stress and torment that is held within. The goal becomes for a person to let go of the held physical trauma.
• Sleep Hygiene: Proper sleep is crucial in mood regulation and you can improve your sleep quality by establishing a good sleep hygiene routine. Not getting enough restful sleep can cause a person to become irritated and quick to anger or sad and frustrated. A well-regulated mood is important when coming down from the emotional highs and lows of trauma.
• Avoid alcohol and drugs: Substances can act as an escape from the internal and external problems associated with trauma. The more someone runs away through substance, the less likely they are to work on their issues and they become reinforced that this is a viable means of coping.  

Medication

Medication can be a powerful adjunctive treatment option to therapy for individuals to help decrease a variety of PTSD symptoms. There are no standard PTSD medications and the most common used for treatment are Selective Serotonin Reuptake Inhibitors (SSRIs) or anti-anxiety drugs. These drugs can regulate mood, reduce anxiety, and mitigate the physiological responses associated with hyperarousal.

When to Seek Professional Help for Hyperarousal

Knowing when to seek help is not always a straightforward decision. Seeking outside support is crucial when its impact becomes significant and persistent. If you find that hyperarousal symptoms continue for an extended period, causing you distress or impaired functioning, it’s an indicator to reach out. Additionally, when the severity of hyperarousal symptoms escalates, leading to intense anxiety or panic attacks, or if you struggle to cope with them despite attempting various strategies, professional help becomes imperative. Seeking trauma-informed therapy and consulting an online therapist directory are important steps to recovery.

In My Experience

In my experience, hyperarousal and other PTSD symptoms are treatable mental health issues. They are acquired and learned after being involved in traumatic, disturbing and potentially life-threatening situations. As a result, anything that is learned can be unlearned and an individual’s central nervous system can be retrained and calmed down. There are effective treatments that come from several categories depending on your comfort and needs. One of the best strategies you can do for yourself is connecting with others and leaning on trusted individuals for social support.