A state of heightened physical and psychological alertness that persists after a traumatic experience, even when there is no immediate danger. Hyperarousal is one of the three core symptom clusters of PTSD (alongside re-experiencing and avoidance). It can manifest as an exaggerated startle response — jumping at sounds that others barely notice — difficulty relaxing, irritability, angry outbursts, difficulty falling or staying asleep, and an inability to switch off. For co-survivors, hyperarousal may be particularly activated by the sight of the survivor looking unwell, monitoring equipment alarming, or any reminder of the cardiac arrest. For ICD patients, it may be heightened around the possibility of a shock. Hyperarousal is exhausting to live with and responds well to trauma-focused psychological therapies.
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