How To Recognize Hyperarousal Symptoms in Post-Traumatic Stress Disorder?

Hyperarousal symptoms represent one of the defining characteristics of PTSD. They can, the diagnostic and statistical manual of mental disorders (DSM-5) lays out, present as hypervigilance (often described as "always being on guard"), an amplified startle response, and dysfunctional sleep — but also irritable, angry episodes, trouble concentrating, and reckless and self-destructive behavior. To be diagnosed with PTSD in the first place, a person will suffer at least two of these symptoms, but some people will experience more or even all. 

Together, the hyperarousal symptoms PTSD causes can be seen as a result of brain changes that place someone's mind in a perpetual state of readiness for new danger. Many of these behaviors are even actively helpful in circumstances of acute threat — but in a "normal life" setting, they themselves severely limit a person's ability to connect with others socially or carry out work-related tasks. 

Recognizing PTSD-related hypervigilance

Hypervigilance is exactly what it sounds like — a state of always, consciously or subconsciouly, being on the lookout for danger or threats. Incredibly useful and even sometimes life-saving in immediately threatening situations, like on the battlefield or in a home filled with domestic violence, hypervigilance becomes a problem for people with PTSD who are now trying to adapt to a life in which danger doesn't lurk everywhere. 

It's hard for someone who is hypervigilant to notice this symptom in themselves, since the state of always being on guard has become normal for them. Other people may notice exceptional observational patterns, however, often to the point of what may be considered "paranoia". 

Recognizing an exaggerated startle response

An exaggerated startle response is closely related to hypervigilance. To give examples from my own life as someone who was diagnosed with PTSD, this can include intense panic reactions to the ring of a doorbell, to a wrong and triggering touch that causes your brain's "flight or fight" response to take over and suddenly makes you reach out to punch your partner or a passing neighbor who puts their hand on your shoulder as they say hi, or even to non-physical experiences like people bringing up difficult topics. 

Recognizing irritable and angry outbursts as a sign of PTSD

This symptom tops the DSM-5's list of hyperarousal symptoms, but I'm placing it third because it is so closely related to hypervigilance and an intense startle response. Many people with PTSD suffer from emotional numbing, or the persistent inability to experience positive emotions, but remain perfectly capable of experiencing fear and anger.

This symptom is hard to deal with for the loved ones of people with PTSD. Though it's not difficult to spot, it may be difficult to understand what causes someone with PTSD to react this way when they really don't mean you any harm.

People who suffer angry outbursts themselves will also absolutely know that they often feel angry and react instinctively before they can cognitively process what is actually going on, but will find it almost impossible to change their behavior. PTSD messes with the parts of the brain responsible for managing inhibition. Combined with a constant "danger readiness" and exagerrated startle response, it's not hard to see how anger and aggression can result. 

Recognizing dysfunctional sleep as a hyperarousal symptom

Hyperarousal symptoms often follow people with PTSD into the night. Small sounds and sights, of which you're highly aware, can make it tough to go to sleep and easy to wake up. Dysfunctional sleep is also, however, connected with the other PTSD symptoms — intrusive reexperiencing symptoms often show up in the form of nightmares, and knowing that those are likely waiting for you can make you reluctant to go to sleep. People with PTSD may also mull over their anxieties and fears for hours on end as they lie in bed attempting to get some shut-eye, and find that these early hours become prime time for feelings of self- blame and guilt. 

Recognizing self-destructive and reckless behavior

Research has identified reckless or risky and self-destructive behavior — like, for instance, dangerous driving, risky sexual relations, substance abuse, and getting into fights — as a result of the same disinhibitation and alterations in impulse control that play a part in causing angry outbursts. For me, it was how I sought an "out" from emotional numbing. In a dangerous situation, I could feel something. That thing was an adrenaline rush.

A final word

The hyperarousal symptoms seen in people with post-traumatic stress disorder appear to be the brain's way of making sure that the person is always prepared to handle threats — and research shows that these symptoms may, to some extent, persist even after a person has been in therapy for PTSD. They can fade and therapy can certainly teach healthier ways to cope, but in the meantime, it is important for both PTSD sufferers and their loved ones to understand how they can impact life.