Table of ContentsView AllTable of ContentsPhysiological Causes of HyperarousalSymptomsMental Health Complications After TraumaEffective Treatments For Hyperarousal SymptomsCoping with Symptoms of Hyperarousal

Table of ContentsView All

View All

Table of Contents

Physiological Causes of Hyperarousal

Symptoms

Mental Health Complications After Trauma

Effective Treatments For Hyperarousal Symptoms

Coping with Symptoms of Hyperarousal

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Hyperarousal is a specific cluster of symptoms associatedwith post-traumatic stress disorder (PTSD). As the name implies, hyperarousal is the abnormally heightened state of anxiety that occurs whenever you think about a traumatic event. Even though the threat may no longer be present, your body will respond as if it were.

PTSD can develop after a recent or past trauma, such as warfare, acts of violence, a life-threatening illness, or abuse. Hyperarousal can persist long after the trauma has passed, leaving you hyper-responsive to anything that reminds you of the event (including sights, smells, sounds, or even specific words of passages of music).

Myths and Misconceptions About PTSD

PTSD does not occur in isolation but rather in response to trauma, either sustained over a long period of time or as a single traumatic event.PTSD symptoms like hyperarousal ultimately develop as a result of the overreaction of the body’s stress response. More specifically, due to alterations in the neuroendocrine system, dysregulated neurotransmitters and hormones, and structural and functional changes in the brain.

Neuroendocrine Changes Impact Hyperarousal

Essentially, the neurological pathways to the hypothalamus-pituitary-adrenal (HPA) axis—which regulates the stress response—become overly sensitized to internal and external stimuli. When confronted with perceived danger, the amygdala will overreact, signaling the HPA axis to release stress hormones including excessive amounts of epinephrine and cortisol.

Epinephrine(adrenaline) is one of two stress hormones that play a role in the body’s flight-or-fight response. Epinephrine works in the short term and produces acute stress symptoms, including pupil dilation, increased blood pressure, and a rapid heart rate. The other hormone,cortisol, works over the long term to regulate the body’s response to stress.

Unlikechronic stressin which cortisol levels will invariably rise, cortisol levels in people with PTSD tend to be low. Because cortisol is meant to restore balance to the body after a stressful event, if it remains low, the lack of cortisol can potentially prolong and worsen PTSD. Even during a panic attack, epinephrine levels will shoot up in people with PTSD; cortisol levels will not.

Neurochemical Changes that Impact Hyperarousal

There are long-term changes in circulating neurotransmitters in people who have PTSD, including increases in dopamine, norepinephrine, glutamate, and endorphins, and lower levels of serotonin and GABA. Each of these neurochemicals contributes to the symptoms of PTSD in its own way, including emotional dysregulation, heightened arousal levels, impaired fear processing, increased startle response, and acute response to memories.

Catecholamines in the Stress Response

Structural and Functional Changes in the Brain that Impact Hyperarousal

There are three main brain structures involved in the stress response including the amygdala, hippocampus, and pre-frontal cortex. Changes in the functioning of the areas of the brain following trauma contribute to symptoms of hyperarousal.

How Does Trauma Impact The Brain?

An overactive amygdala impairs our ability to discriminate threats from non-threats. This is known as theamygdala hijack. When we perceive danger, the amygdala, the fear center of the brain, sends the alarm and triggers the HPA axis to initiate the stress response.

The low cortisol levels in people with PTSD lead to shrinkage of thehippocampus. The reduced volume and activity in the hippocampus alters the normal stress response and impedes the extinction of the heightened fear response despite being in a safe place.

Low levels of serotonin also disrupt the normal communication between the neighboring limbic system structures, the amygdala and hippocampus, and this new dynamic is linked with the experience of intrusive memories.

The pre-frontal cortex is also found to have decreased volume in people with PTSD. This means executive functions such as attention, focus, perception, and judgment will be impaired.

Common Triggering Events

Among some of the more common events that trigger PTSD:

People who lack a strong support system, endure long-term emotional trauma, or have an alcohol or substance use problem are more vulnerable to PTSD.

Hyperarousal in PTSD can affect children and adults equally. Symptoms include:

What Is Unresolved Trauma?

Many people with PTSD will internalize feelings of shame and guilt and bear an inappropriate sense of responsibility for the trauma they incurred. This can lead to severebouts of depression. All too often, people with PTSD may turn to unhealthy methods of coping to calm their nerves, numb themselves, and escape their memories.

There is an increased risk of self-destructive behaviors like excessive drinking and substance abuse, risky sex, or reckless driving. There is a higher incidence of alcohol and substance use in people with PTSD. All of these high-risk behaviors exacerbate the challenges of PTSD in the long run.

Eating disordersare not uncommon in people with untreated PTSD.

Understanding the Link Between Trauma and Substance Abuse

In extreme cases, PTSD may lead to suicidal thoughts and behaviors. A 2010 study from Denmark, which examined 9,612 suicide cases from 1994 to 2006, reported a 9.8-fold increase in the risk of completed suicide in people diagnosed with PTSD compared to the general population.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

As with all symptoms of PTSD, hyperarousal can be difficult to manage. It not only involves managing the underlying anxiety but effectivelydealing with sleep problems, panic attacks, impulsive behaviors, self-harm, anger, and substance abuse issues.

Treatment is typically multidisciplinary and may includepsychotherapy, medication, and stress management training. Examples include:

Some doctors will also prescribemedical marijuana, where legal, to help alleviate anxiety and aid in sleep (although there is no clear clinical evidence of its benefit in improving PTSD over the long term).

Benzodiazepinestend not to be used in PTSD, as their risks (such as dependency) tend to outweigh their potential short-term benefits.

What Is Trauma-Informed Therapy?

Hyperarousal symptoms are part and parcel of the PTSD experience.There is rarely a straight road to recovery, and there may be setbacks and complications along the route. But, even when faced with these challenges, it is important to remember thatyouare as much a factor in your recovery as are your doctors and medications.

To this end, there are things you can do to better cope as you take the steps to recognize and overcome PTSD. Among them:

To find a PTSD support group in your area, call the National Alliance on Mental Illness (NAMI) hotline at 800-950-NAMI (6264) from Monday through Friday, 10:00 a.m. to 6:00 p.m. ET, or contact yourlocal NAMI chapter.

Coping With a Slip in Your PTSD Recovery

12 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Center for Substance Abuse Treatment.Understanding the Impact of Trauma. Substance Abuse and Mental Health Services Administration; 2014.Sherin JE, Nemeroff CB.Post-traumatic stress disorder: The neurobiological impact of psychological trauma.Dialogues in Clinical Neuroscience. 2011;13(3):263-278. doi:10.31887%2FDCNS.2011.13.2%2FjsherinNational Institutes of Health.Post-traumatic stress disorder.KidsHealth from Nemours.Posttraumatic Stress Disorder.El-Solh AA.Management of nightmares in patients with posttraumatic stress disorder: Current perspectives.Nat Sci Sleep. 2018;(10):409-420. doi:10.2147/NSS.S166089Kimble MO, Fleming K, Bennion KA.Contributors to hypervigilance in a military and civilian sample.J Interpers Violence. 2013;(28)8:1672-1692. doi:10.1177/0886260512468319Gradus JL, Qin P, Lincoln AK, et al.Posttraumatic stress disorder and completed suicide.Am J Epidemiol.2010;(171)6:721-727. doi:10.1093/aje/kwp456Zoellner LA, Feeny NC, Bittinger JN, et al.Teaching trauma-focused exposure therapy for PTSD: Critical clinical lessons for novice exposure therapists.Psychol Trauma. 2011;(3)3:300-308. doi:10.1037/a0024642American Psychological Association.Medications for PTSD.Weston CS.Posttraumatic stress disorder: A theoretical model of the hyperarousal subtype.Front Psychiatry. 2014;(5):37. doi:10.3389/fpsyt.2014.00037National Sleep Foundation.Caffeine and sleep.Tagay S, Schlottbohm E, Reyes-Rodriguez ML, Repic N, Senf W.Eating disorders, trauma, PTSD, and psychosocial resources.Eat Disord. 2014;(22)1:33-49. doi:10.1080/10640266.2014.857517Additional ReadingLancaster CL, Teeters JB, Gros DF, Back SE.Posttraumatic stress disorder: Overview of evidence-based assessment and treatment.J Clin Med. 2016;5(11). doi:10.3390/jcm5110105

12 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Center for Substance Abuse Treatment.Understanding the Impact of Trauma. Substance Abuse and Mental Health Services Administration; 2014.Sherin JE, Nemeroff CB.Post-traumatic stress disorder: The neurobiological impact of psychological trauma.Dialogues in Clinical Neuroscience. 2011;13(3):263-278. doi:10.31887%2FDCNS.2011.13.2%2FjsherinNational Institutes of Health.Post-traumatic stress disorder.KidsHealth from Nemours.Posttraumatic Stress Disorder.El-Solh AA.Management of nightmares in patients with posttraumatic stress disorder: Current perspectives.Nat Sci Sleep. 2018;(10):409-420. doi:10.2147/NSS.S166089Kimble MO, Fleming K, Bennion KA.Contributors to hypervigilance in a military and civilian sample.J Interpers Violence. 2013;(28)8:1672-1692. doi:10.1177/0886260512468319Gradus JL, Qin P, Lincoln AK, et al.Posttraumatic stress disorder and completed suicide.Am J Epidemiol.2010;(171)6:721-727. doi:10.1093/aje/kwp456Zoellner LA, Feeny NC, Bittinger JN, et al.Teaching trauma-focused exposure therapy for PTSD: Critical clinical lessons for novice exposure therapists.Psychol Trauma. 2011;(3)3:300-308. doi:10.1037/a0024642American Psychological Association.Medications for PTSD.Weston CS.Posttraumatic stress disorder: A theoretical model of the hyperarousal subtype.Front Psychiatry. 2014;(5):37. doi:10.3389/fpsyt.2014.00037National Sleep Foundation.Caffeine and sleep.Tagay S, Schlottbohm E, Reyes-Rodriguez ML, Repic N, Senf W.Eating disorders, trauma, PTSD, and psychosocial resources.Eat Disord. 2014;(22)1:33-49. doi:10.1080/10640266.2014.857517Additional ReadingLancaster CL, Teeters JB, Gros DF, Back SE.Posttraumatic stress disorder: Overview of evidence-based assessment and treatment.J Clin Med. 2016;5(11). doi:10.3390/jcm5110105

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Center for Substance Abuse Treatment.Understanding the Impact of Trauma. Substance Abuse and Mental Health Services Administration; 2014.Sherin JE, Nemeroff CB.Post-traumatic stress disorder: The neurobiological impact of psychological trauma.Dialogues in Clinical Neuroscience. 2011;13(3):263-278. doi:10.31887%2FDCNS.2011.13.2%2FjsherinNational Institutes of Health.Post-traumatic stress disorder.KidsHealth from Nemours.Posttraumatic Stress Disorder.El-Solh AA.Management of nightmares in patients with posttraumatic stress disorder: Current perspectives.Nat Sci Sleep. 2018;(10):409-420. doi:10.2147/NSS.S166089Kimble MO, Fleming K, Bennion KA.Contributors to hypervigilance in a military and civilian sample.J Interpers Violence. 2013;(28)8:1672-1692. doi:10.1177/0886260512468319Gradus JL, Qin P, Lincoln AK, et al.Posttraumatic stress disorder and completed suicide.Am J Epidemiol.2010;(171)6:721-727. doi:10.1093/aje/kwp456Zoellner LA, Feeny NC, Bittinger JN, et al.Teaching trauma-focused exposure therapy for PTSD: Critical clinical lessons for novice exposure therapists.Psychol Trauma. 2011;(3)3:300-308. doi:10.1037/a0024642American Psychological Association.Medications for PTSD.Weston CS.Posttraumatic stress disorder: A theoretical model of the hyperarousal subtype.Front Psychiatry. 2014;(5):37. doi:10.3389/fpsyt.2014.00037National Sleep Foundation.Caffeine and sleep.Tagay S, Schlottbohm E, Reyes-Rodriguez ML, Repic N, Senf W.Eating disorders, trauma, PTSD, and psychosocial resources.Eat Disord. 2014;(22)1:33-49. doi:10.1080/10640266.2014.857517

Center for Substance Abuse Treatment.Understanding the Impact of Trauma. Substance Abuse and Mental Health Services Administration; 2014.

Sherin JE, Nemeroff CB.Post-traumatic stress disorder: The neurobiological impact of psychological trauma.Dialogues in Clinical Neuroscience. 2011;13(3):263-278. doi:10.31887%2FDCNS.2011.13.2%2Fjsherin

National Institutes of Health.Post-traumatic stress disorder.

KidsHealth from Nemours.Posttraumatic Stress Disorder.

El-Solh AA.Management of nightmares in patients with posttraumatic stress disorder: Current perspectives.Nat Sci Sleep. 2018;(10):409-420. doi:10.2147/NSS.S166089

Kimble MO, Fleming K, Bennion KA.Contributors to hypervigilance in a military and civilian sample.J Interpers Violence. 2013;(28)8:1672-1692. doi:10.1177/0886260512468319

Gradus JL, Qin P, Lincoln AK, et al.Posttraumatic stress disorder and completed suicide.Am J Epidemiol.2010;(171)6:721-727. doi:10.1093/aje/kwp456

Zoellner LA, Feeny NC, Bittinger JN, et al.Teaching trauma-focused exposure therapy for PTSD: Critical clinical lessons for novice exposure therapists.Psychol Trauma. 2011;(3)3:300-308. doi:10.1037/a0024642

American Psychological Association.Medications for PTSD.

Weston CS.Posttraumatic stress disorder: A theoretical model of the hyperarousal subtype.Front Psychiatry. 2014;(5):37. doi:10.3389/fpsyt.2014.00037

National Sleep Foundation.Caffeine and sleep.

Tagay S, Schlottbohm E, Reyes-Rodriguez ML, Repic N, Senf W.Eating disorders, trauma, PTSD, and psychosocial resources.Eat Disord. 2014;(22)1:33-49. doi:10.1080/10640266.2014.857517

Lancaster CL, Teeters JB, Gros DF, Back SE.Posttraumatic stress disorder: Overview of evidence-based assessment and treatment.J Clin Med. 2016;5(11). doi:10.3390/jcm5110105

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