What are hyperarousal symptoms in PTSD?

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

What is the evidence regarding hyperarousal in people with PTSD?

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

Moderate to low quality evidence finds five clusters of hyperarousal symptoms. These are irritability and anger, difficulty concentrating, hypervigilance, startle, and sleep difficulty.

Items relating to irritability/anger

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. I felt that if someone pushed me too far, I would become angry.

Items relating to difficulty concentrating

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. I had more trouble than usual remembering things.

Items relating to hypervigilance

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. I felt on guard.

Items relating to startle

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. I felt jumpy or easily startled.

Items relating to sleep difficulty

My sleep was restless. I had trouble falling asleep. I had sleep problems. I had trouble staying asleep.

August 2021

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Last updated at: 9:31 pm, 7th October 2021
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