Under conditions of chronic stress, something goes wrong as the body attempts to cope with this massive overload of responses. The effectiveness of the response diminishes, and the body becomes desensitized to some of the effects of the neurohormones and hypersensitive to others. The entire system can become dysregulated in many different ways. This results in a set of highly dysfunctional and maladaptive brain activities. The person experiences this as a state of chronic hyperarousal. Essentially, the baseline level of arousal for the person has changed and they cannot control their own responses to stimuli.
We all have a "volume control" over our level of arousal. If we are in a lecture hall and hear a noise at the back, we cease paying attention to the speaker and swivel our heads to appraise the source of the noise. Once we are assured that the noise was just a latecomer and that there is nothing to fear, our level of arousal rapidly returns to normal and we are able once again to attend to the lecturer. Our reaction is quite different if we hear a sound, turn our heads and see a man with a gun heading toward the front of the room. In this case we become hyperaroused. This is a clear and present danger, and the fight-flight-freeze response is triggered within each of us.
People who have been severely or repeatedly traumatized may lose this capacity to modulate their level of arousal. Their reaction to the benign latecomer is quite similar to their reaction to the threatening stranger. They stay hyperaroused and guarded; they are unable to calm themselves down even when they see that there is no danger. They feel embarrassed by their response, while at the same time, they are irritable, angry, and frightened for no apparent reason. They are prepared to fight or flee, even though there is no danger. They may also become flooded with memories, images, and sensations that are overwhelming. As a result, they are likely to feel they are "going crazy."This reaction can be triggered by almost anything. Once we have experienced a stimulus that evokes fear we become "fear-conditioned;' a state that is incredibly powerful and difficult for the logical centers of the brain to override. Because of the vast associational network of our brains, we can pair fear with virtually anything. This happens at the time of the frightening event, beyond conscious control, and very quickly. Later the person is usually not consciously aware of the connection between the fear- provoking stimulus and the fear-response has become completely automatic.
Each episode of danger connects to every other episode of danger in our minds, so that the more danger we are exposed to, the more sensitive we become to danger. With each fight-or- flight experience, our mind forms a network of connections that is triggered by every subsequent threatening experience or stimulus. Because we are so intelligent, these connections can be very widely linked to any stimulus that is paired with the dangerous experience.
An example can help us to understand this phenomenon. A man is in a car crash in which his wife is severely injured. We would not be surprised if he subsequently developed hyperarousal when driving or as a passenger in a car. But why would he become hyperaroused whenever he sees a woman's wristwatch? Only with great difficulty does he become aware of the fact that he is being triggered by wristwatches, and only with help and careful questioning, or even more specific therapy, does he finally recall that the last thing he laid eyes on before the crash was the watch on his wife's wrist. His brain has made the connection without his conscious knowledge. Not only will he unconsciously and self-protectively resist identifying the stimulus of the watch, but he will even more strongly resist remembering the actual event because the memory is so horrifying. Instead, the triggering may continue with a widening network of associations. Wristwatches may associate to clocks, or women's bracelets, or arms. The man may reach the point where even leaving his house becomes impossibility because he is too easily triggered by stimuli he can neither identify nor control. Meanwhile, every experience of hyperarousal further compromises and resets his central nervous system.
Now if this same man discovers something that helps calm down this uncontrollable sense of hyperarousal-even temporarily-would we fault him for utilizing it? Would it be so very hard for us to understand his dilemma? Alcohol, drugs, sexual activity, violent acting out, risk- taking behavior, eating excessively, inducing vomiting, purposely hurting the body, exercising, over-involvement in work-all of these behaviors can temporarily produce some relief from the hyperarousal. The problem, of course, is that the relief is only temporary. After withdrawal from alcohol or other drugs, or other behaviors, the agitation rebounds with even greater ferocity. All of these behaviors can become habitual, even addictive, in such a situation. In this way, coping skills that were initially highly adaptive become maladaptive habits.
If this man seeks treatment, he will likely get treated for the complicating and exacerbating symptom-perhaps anxiety, a substance abuse problem, depression, or physical symptoms-and the underlying cause is missed. Even if a clinician or friend does make the connection, it is just as likely that the man will remain totally unaware of the connection, and in fact, that he will protect himself from knowing, and experiencing the initial trauma all over again.
From Bloom, S. L. (2013). Creating sanctuary: Toward the evolution of sane societies. New York, Routledge.