Combat PTSD Symptoms – Hyperarousal (Being Keyed Up)

September 24, 2014 Harry Croft, M.D.

An increase in arousal (hyperarousal), or feeling "keyed up" is part of combat PTSD. Learn about hyperarousal and its treatment.

For the past few posts I’ve been talking about the symptom clusters of combat posttraumatic stress disorder (PTSD). Today I will talk about the final category of PTSD symptoms: hyperarousal.

What is Hyperarousal?

Hyperarousal simply means “increased arousal” and can easily be thought of as feeling “keyed up.” People experiencing hyperarousal are often constantly jittery, overreact to small things and are always looking around them for danger.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (the manual responsible for creating the diagnostic criteria for disorders like PTSD), a person must experience two of the following as a response to a trauma as part of a PTSD diagnosis:

  • Irritable or aggressive behavior
  • Self-destructive or reckless behavior
  • Hypervigilance (an enhanced state of sensitivity and exaggerated behaviors designed to detect threats; may be accompanied with anxiety)
  • Exaggerated startle response
  • Problems in concentration
  • Sleep disturbance

The study: Predicting Symptom Clusters of Posttraumatic Stress Disorder (PTSD) in Croatian War Veterans: The Role of Socio-Demographics, War Experiences and Subjective Quality of Life, found that a higher total number of traumatic events and a lower quality of life contribute, significantly, to the symptoms of hyperarousal.

The Problems with Hyperarousal in Civilian Life

An increase in arousal (hyperarousal), or feeling "keyed up" is part of combat PTSD. Learn about hyperarousal and its treatment.When in a combat zone, it’s natural to feel hyperarousal and constantly be on the lookout for danger when danger could be all around you. Back in civilian life, though, always looking out for danger no longer makes sense.

For example, if you’re constantly hyperaware of everything going on around you, you may see a person walking behind you on the street. You may see a flash from an object in this person’s hand. If you’re experiencing hyperarousal, you may think that the person is an enemy with a knife and react accordingly when, in reality, it is just a person with his or her car keys.

Of course, not only can the symptoms of hyperarousal cause problems in behavior but they, themselves, can also be very unpleasant to live with. Not being able to sleep or concentrate and jumping out of one’s skin at the slightest startle is no fun at all.

Treating Hyperarousal

Hyperarousal in combat PTSD can be treated primarily with therapy or, in more extreme cases, medication. Therapy that focuses on exposure to small events that elicit the symptoms of hyperarousal (exposure therapy) may help the veteran learn, and train the body and brain, that such arousal isn’t necessary in civilian life.

It’s worth noting that hyperarousal and quality of life are closely linked; so an improvement in quality of life tends to reduce hyperarousal symptoms and a reduction in hyperarousal also increases quality of life. This means that social interventions aimed at improving general well-being can also improve the symptoms of hyperarousal.

What’s important to remember is that while hyperarousal symptoms may feel out of your control, with therapy, and sometimes medication, they start to become within your control and you can overcome them.

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APA Reference
Croft, H. (2014, September 24). Combat PTSD Symptoms – Hyperarousal (Being Keyed Up), HealthyPlace. Retrieved on 2024, July 20 from

Author: Harry Croft, M.D.

Dr. Harry Croft is a keynote speaker, consultant, and media guest and contributor specializing in the diagnosis and treatment of combat-related posttraumatic stress disorder (PTSD). He currently acts as a trainer and consultant to businesses with regard to veterans, PTSD, and employment-related issues.

Find Dr. Croft's book, I Always Sit with My Back to the Wall, here, and find out more about him on his website.

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