What Is Hyperarousal in PTSD?

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Hyperarousal is a psychophysiological state experienced by many people with post-traumatic stress disorder (PTSD). As its name suggests, hyperarousal is marked by excessive psychological and physical arousal that can interfere with day-to-day life and sleep. Traumatic events that cause someone to develop PTSD hyperarousal include accidents, combat, natural disasters, and sexual violence.

Hyperarousal keeps the body and mind constantly "on guard," which makes it hard to go about daily life. Chronically heightened states of arousal are perpetuated by the fight-or-flight branch of the autonomic nervous system.

This article discusses the causes, symptoms, and treatment for hyperarousal that occurs with PTSD.

Symptoms of Hyperarousal in PTSD: Person with an angry outburst, being startled, a hand with the word snap (impulsivity), a person attention issues, someone staying up in bed (sleep disruption and insomnia), eyes with bright colors and symbols around (hypervigilance)

Verywell / Ellen Lindner


As someone with PTSD goes through life, anything could remind them of the traumatic event(s) and cause symptoms.

Some possible examples that might cause your stress levels to spike include:

  • Catching the scent of diesel fuel can trigger flashbacks to a life-threatening event, possibly an accident, if that smell is linked to the time and place the trauma occurred.
  • Seeing a freezing rain icon in the weather forecast before leaving for your morning commute if a PTSD-inducing automobile accident happened on black ice.
  • Hearing an old song in the checkout line at a store that brings back a wave of vivid memories associated with a traumatic event.

Triggering events like these can instantaneously create an inner state of hyperarousal.

Physiological symptoms of autonomic hyperarousal include:

  • Accelerated heart rate
  • Elevated blood pressure
  • Sweaty palms
  • Shortness of breath

Psychologically, hyperarousal is distressing and often makes people feel panicky or filled with anxiety. Even when there's no real danger or threat, hyperarousal keeps the body and mind on high alert.

People with hyperarousal tend to be anxious and have trouble relaxing. Constantly being "on guard" and in a state of hypervigilance is draining. Hyperarousal's ripple effects disrupt people's ability to cope with day-to-day life.

Over time, PTSD-related triggering events can lead to dysregulation (dysfunctional management) of the autonomic nervous system's stress response. Chronic hyperarousal develops as a result of the body's built-in stress responses staying in hyperdrive and never quieting down.

Surges of epinephrine (adrenaline) and norepinephrine, both chemical messengers in the brain, kickstart the body's fight-or-flight response quickly, which often protects us from danger. However, chronically high levels can lead to hyperarousal in PTSD.


The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association's handbook for diagnosing mental health conditions, highlights six symptom subcategories, or "clusters," associated with hyperarousal.

  1. Anger or angry outbursts: Engaging in aggressive verbal or physical behavior with little or no provocation is a form of incivility that chronic hyperarousal makes difficult to control.
  2. Impulsivity: One of hyperarousal's biggest risks is engaging in reckless or self-destructive behavior such as dangerous driving, excessive alcohol or drug use, or self-injurious behavior.
  3. Hypervigilance: Heightened sensitivity to imaginary threats and constantly feeling on "high alert" depletes energy reserves.
  4. Excessive startle reflex: Heightened startle responses cause jumpiness in response to loud noises or unexpected movements (e.g., jumping in response to a telephone ring).
  5. Attention issues: Difficulties with concentration, focus, or remembering scheduled events can cause problems at work and in daily life.
  6. Sleep disruption and insomnia: Perpetually elevated states of arousal and nightmares interfere with getting adequate sleep. (e.g., sleep hygiene).

In addition to these six subcategories, anxiety disorders, irritability, and panic attacks are commonly associated with hyperarousal in PTSD.

Help Is Available

In extreme cases, PTSD symptoms may lead to suicidal ideation or thoughts of self-harm. If you or someone you know is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for help and support from a trained counselor. In emergencies, call 911.


Hyperarousal treatment often requires a multi-pronged approach that might include a combination of psychotherapy, medication, device-based neurotherapy, and lifestyle interventions, such as diet modification, mindfulness training, meditation, or daily physical activity.

Specific examples include:

How Does "Belly Breathing" Calm Hyperarousal Symptoms?

Diaphragmatic "belly breathing" techniques, such as taking a deep inhalation followed by a long, slow exhale, are an effective way to shift your autonomic nervous system out of hyperarousal. The exhalation phase of the breathing cycle stimulates the vagus nerve, which activates a calming response.


Hyperarousal is caused by overactive fight-or-flight stress responses that keep the body and mind on high alert, even when there's no cause for alarm. It is a commonly experienced symptom of PTSD.

Being in a constant state of arousal can disrupt daily life in several ways and make it difficult to sleep. This vicious cycle can snowball out of control if left untreated. Fortunately, there are numerous treatment options, including therapy, medication, and mind-body exercises.

A Word From Verywell

If you're experiencing hyperarousal symptoms that occur with PTSD, a healthcare provider or mental health professional can help you on the road to recovery. Further, there are many strategies that can make it easier to cope. Try making healthy lifestyle changes and and fortifying your support network by staying connected with friends and family.

If you'd like to find a local PTSD support group in your area, reach out to the National Alliance on Mental Illness (NAMI) hotline at 1-800-950-6264 or contact your local NAMI chapter.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Psychiatric Association. What is post-traumatic stress disorder?.

  2. Pan X, Kaminga AC, Wen SW, Liu A. Catecholamines in post-traumatic stress disorder: a systematic review and meta-analysis. Front Mol Neurosci. 2018;11:450. doi:10.3389/fnmol.2018.00450

  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association; 2013. doi:10.1176/appi.books.9780890425596

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

  5. Bremner JD, Wittbrodt MT, Gurel NZ, et al. Transcutaneous cervical vagal nerve stimulation in patients with posttraumatic stress disorder (PTSD): a pilot study of effects on PTSD symptoms and interleukin-6 response to stressJournal of Affective Disorders Reports. 2021;6:100190. doi:10.1016/j.jadr.2021.100190

By Christopher Bergland
Christopher Bergland is a retired ultra-endurance athlete turned medical writer and science reporter.