What is hyperarousal?

Hyperarousal is a core symptom of PTSD, with at least two avoidance symptoms being required for a diagnosis. Hyperarousal symptoms include irritability or aggression, risky or destructive behavior, hypervigilance, heightened startle reaction, difficulty concentrating, and difficulty sleeping.

What is the evidence for hyperarousal in people with PTSD?

Moderate to low quality evidence finds five clusters of hyperarousal symptoms; irritability/anger, difficulty concentrating, hypervigilance, startle, and sleep difficulty. Items relating to irritability/anger include; I lost my cool and exploded over minor everyday things, I lost my temper, little things made me angry, I felt irritable, I had angry outbursts, and I felt that if someone pushed me too far, I would become angry. Items relating to difficulty concentrating include; I had difficulty paying attention, I was unusually forgetful, I had difficulty concentrating, I had trouble concentrating, I had trouble keeping my mind on what I was doing, and I had more trouble than usual remembering things. Items relating to hypervigilance include; I watched out for danger since the trauma, I was overly alert (for example, checking to see who was around me), I was very aware of my surroundings and nervous about what’s going on around me, and I felt on guard. Items relating to startle include; unexpected noises made me jump, I was jumpy or easily startled by ordinary noises or movements, I was watchful or on guard, I got startled when there was a sudden noise or movement, unexpected noises startled me more than usual, I was jumpy or startled at something unexpected, and I felt jumpy or easily startled. Items relating to sleep difficulty include; my sleep was restless, I had trouble falling asleep, I had sleep problems, and I had trouble staying asleep.

Moderate to high quality evidence finds small effects of less sleep efficiency, less total sleep time, less slow wave sleep, and more wake time after sleep onset in people with PTSD. Authors report that after adjusting for possible publication bias, the effect sizes for total sleep time, slow wave sleep, and more wake time after sleep onset did not reach statistical significance.

Moderate to low quality evidence finds a medium-sized effect that people with PTSD and sleep disturbances were significantly more likely to report suicidal behaviours.

August 2021

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Last updated at: 1:56 am, 29th August 2021
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