Calming The Beast: Hyperarousal & PTSD

Many people living with the mental illness post-traumatic stress disorder (PTSD) may experience hyperarousal, which can be defined as a state of being constantly aware and alert to potential dangers. While this may serve people well in the short-term, persistent feelings of hyperarousal can lead to extended periods of elevated stress hormones and the eventual breakdown of bodily systems. It can be important to address PTSD and its symptoms through therapy, which can be completed in person or online.

Post-traumatic stress disorder (PTSD) defined

Post-traumatic stress disorder (PTSD) is generally an anxiety and stress disorder that can occur following a traumatic event or a series of traumatic events. While PTSD was once narrowly defined as a disorder unique to post-combat war veterans, it's currently growing in scope and can include people from various backgrounds. 

PTSD can affect anyone who has experienced trauma or an ongoing series of traumas. However, not everyone who undergoes trauma may go on to develop PTSD. Those at a higher risk for developing PTSD can include people with an anxiety or depressive disorder or a family history of anxiety or depression. Things like substance abuse can exacerbate PTSD symptoms. 

Environmental factors may also serve as potential risk factors for developing PTSD. For example, someone lacking a stable support system may be more at risk.

Receiving a PTSD diagnosis typically requires experiencing key symptoms for at least one month following a traumatic experience. Although it was once necessary to experience symptoms within a specific time frame to qualify for a diagnosis, PTSD is now typically recognized as a disorder that can develop from three months to several years after a traumatic event.

PTSD can be its own diagnosis, but complex PTSD may be another form of this disorder. Complex PTSD (CPTSD) can be defined as any form of PTSD in which the trauma experienced was not a single, isolated event but an ongoing cycle of trauma. 

The most common source of complex PTSD is usually physical or emotional abuse*. This can include sexual abuse, or well as physical violence of any kind. There may be other ways to develop complex PTSD as well. For example, witnessing repeated trauma as a healthcare provider or first responder may result in the development of CPTSD.

PTSD and hyperarousal

Post-traumatic stress disorder (PTSD) symptoms usually vary to some degree among different PTSD patients, depending on the person's background, trauma source, and support system. Overall, there are generally four core PTSD symptoms, with several sub-symptoms, such as difficulty sleeping, anger, and outbursts. 

The four core symptoms of PTSD can include memory disturbances, avoidant behavior, behavioral changes, and mood swings. Memories may come in flashbacks or manifest as nightmares or other sleep disturbances. The memory of a traumatic incident often arrives without notice or without the desire to remember it, frequently causing significant distress. Within these memories, there are often gaps or confusion regarding the event's details.

Avoidant behavior usually involves avoiding triggers by refusing to visit certain places, entertain certain thoughts, or see certain people. To qualify as a PTSD symptom, avoidant behavior may need to significantly impact your day-to-day life. For some, this may look like isolating yourself when you used to be outgoing or friendly; for others, it may look like increased anger or irritability. 

Mood swings can also be a typical symptom of PTSD, wherein people with the disorder may move from pain to joy to fear to anger and back again without feeling as though they can control or manage their emotions.

PTSD can come with other mental health disorders and self-destructive behavior, such as self-harm*. Coping mechanisms, wellness professionals, PTSD support groups, and other strong support systems may be available to manage symptoms.

Symptoms and signs to look for

Post-traumatic stress disorder symptoms may often force an individual into a state of chronic stress, which can mean constantly living in a fight-flight-freeze mode. In this mode, even everyday occurrences can take on heightened sensations and make daily living difficult.

Hyperarousal effects

In cases where adrenaline is necessary, for instance, moving quickly to escape a real danger, hyperarousal can be immensely useful. However, when your body is constantly hyper-aroused, many of your physical and mental systems can begin to break down. Experiencing post-traumatic stress disorder can lead to chronic stress. 

When experiencing hyperarousal over more extended periods, your brain can essentially prioritize its functions. This may mean that mood control and other non-essential functions can become secondary to accommodate the constant need to potentially fight, flee, or freeze.

Chronic stress can manifest in the body as sleeplessness or oversleeping, loss of appetite or excessive appetite, depression, and brain fog. Symptoms of hyperarousal may exacerbate the other symptoms of PTSD and can lead to a host of other mental and physical disorders.

Treatment and support options

After being formally diagnosed with PTSD, treatment to manage hyperarousal symptoms for people with post-traumatic stress disorder is typically incorporated into standard PTSD treatment. The first course of action in treating PTSD can be working through the trauma leading up to your diagnosis. PTSD treatment will likely begin with talk therapy, but other modes of therapy can be explored and have been found to be effective treatments, including cognitive behavioral therapy (CBT), exposure therapy, eye movement desensitization and reprocessing therapy (EMDR), acceptance and commitment therapy (ACT), and cognitive processing therapy (CPT). Therapy may also address any comorbid issues, such as substance abuse, depression, or anxiety.

What to expect in a session

Initially, your therapist may teach you some self-soothing techniques so that you can better manage your emotional responses when you begin to talk about the trauma. Then, you might walk your therapist through the event or events that could be responsible for your PTSD, while taking note of any details that may be prominent or conspicuously missing. Your therapist may then identify which portions of the trauma have potentially become "stuck" in your psyche.

Working through your experiences with a trusted therapist can help you gradually develop stronger, more effective coping methods. These methods might include meditation, mantras, deep breathing, and positive self-talk. 

Ultimately, the goal of any therapeutic approach is usually to rewire the brain's response to the traumatic event to process it and heal safely. When a traumatic event is stored away before it is processed (as can be the case in PTSD), it can result in reexperiencing symptoms and the event, and one may not fully recover until it has been reopened and evaluated to understand it better. 

Getting professional help with PTSD

Post-traumatic stress disorder can be treatable, and seeing an in-person or online therapist for treatment can help. Most PTSD treatments tend to last between 12 and 18 weeks, at which point the person with PTSD and their therapist can reevaluate and determine whether additional resources or therapy may be needed. 

Online therapy

Online therapy can be done in the comfort of your home, which can be helpful for those experiencing hyperarousal. Being in an unfamiliar environment can make it difficult to relax enough to fully engage in conversation with your therapist. However, completing therapy virtually can empower you to work with a licensed mental health professional from your bed, couch, or wherever you feel most safe and comfortable.

Online therapy can be as effective as face-to-face therapy. One study stated that online therapy “proved to be a viable treatment alternative for PTSD with large effect sizes and sustained treatment effects. A stable and positive online therapeutic relationship can be established through the Internet which improved during the treatment process.”

Online counselor review

“I am really lucky to have Justin as my therapist. I write to him so much about my everyday life in solitude, and dating problems, family problems and traumas, and he goes through all the messages and really helps me even with the replies. And after every video session, I feel quite relieved and see progress and how I am slowly becoming a stronger and wiser human being, who doesn’t need to repress as much family pain anymore. Because there is someone who knows what he’s doing to help me deal with the problems we all have sometimes. And Justin helps me to motivate me to work towards my life goals. Personal, and career-wise. After almost 5 years of swirling in nothingness, like a fly without a head, I finally feel like there is lots to achieve and with baby steps, will be achieved with less stress. Thank you, Justin!”