• PTSD & Alterations in Arousal

    3/22 tip PTSD and alterations in arousal and reactivity

    As I posted earlier, according to the DSM 5, PTSD can develop if you go through a traumatic event, if you witness a traumatic event happening, learning of the traumatic event happening to a close family member or friend, or repeated exposure to traumatic events (for example first responders).

    One category of PTSD symptoms are alterations in arousal and reactivity associated with the traumatic event(s). This includes:

    Irritable behavior and angry outbursts – these reactions are typically out of proportion to the situation and can include yelling, throwing things, or physical lashing out. The person may or may not know why they are so angry and irritable all the time.

    Reckless or self-destructive behavior – this often includes the use and abuse of substances that often start as an attempt to help regulate their mood. Sometimes this use is because they struggle to feel unless the experience is extreme and/or dangerous.

    Hypervigilance – this is when the person is always on alert for danger. They may not feel comfortable with having people behind them, they may not want to sit with their back exposed, and their head might be on a constant swivel looking for danger and assessing their current environment. Interpersonally they may be on high alert for signs of being betrayed, abandoned, disrespected, not listened to, etc.

    Exaggerated startle response – this is due to their nervous system and their brain being on high alert for danger.

    Difficulty falling/staying asleep or restless sleep – this is again due to the heightened level of anxiety and alertness. The system is set on overdrive, making it difficult for the brain to rest and fall asleep, and the threshold for being startled awake is much lower for the same reason. In addition, nightmare and bad dreams that often accompany PTSD can make sleep less restful and leads some people to actively try not to sleep.

    Problems with concentration – in part this occurs due to the heightened state of alertness. The brain is attending to potential signs of danger, and this may interfere with focus and concentration on the task at hand. This heightened level of arousal is also likely to drain energy more quickly, leaving little energy for other things. In addition, the sleep difficulties make thinking clearly and concentration more difficult.