Hyperarousal is represented by persistent symptoms of increased arousal not present before the trauma. For this cluster of symptoms to be positively endorsed, the patient must experience at least two of the five following symptoms:

• Difficulty falling or staying asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Hypervigilance
• Exaggerated startle response.

Individuals suffering from PTSD experience heightened physiological activation, which may occur in a general way, even while at rest. More typically, this activation is evident as excessive reaction to specific stressors that are directly or symbolically reminiscent of the trauma.

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