Symptoms of increased arousal sometimes emerge as the most prominent and distressing clinical symptoms (e.g., hypervigilance, exaggerated startle response, chronic sleep disturbance, generalized fear/anxiety). Although upsetting and disruptive, such responses may sometimes be viewed as “peripheral manifestations” of a PTSD syndrome not yet fully activated that serve to “block out” intrusive traumatic recollections, flashbacks, and associated affect. While increased arousal symptoms may serve to keep specific trauma-related stimuli outside their conscious level of awareness, such individuals appear extremely tense, rigid, fearful and anxious, and are unable to relax as they constantly on the lookout for the next “bomb to drop.”

Mervin Smucker

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