Seven different types of tension help characterize mental disorders

Hyperarousal plays an important role in mental disorders. It influences the severity of insomnia, depression, anxiety, post-traumatic stress disorder (PTSD), and ADHD. Yet it is striking that researchers do not always mean exactly the same thing when they use the term “hyperarousal.” Researchers at the Netherlands Institute for Neuroscience therefore investigated whether different forms of hyperarousal exist.

“Within sleep research, we already know a great deal about the role of hyperarousal in insomnia,” says first author Tom Bresser. “But hyperarousal also plays a major role in many other mental disorders.”

Bresser and his colleagues therefore wondered whether all these forms of hyperarousal are actually the same, or whether different types of hyperarousal exist. “If we better understand what hyperarousal really is, we can also better understand insomnia, anxiety, and depression,” he explains.

To gain more insight into this question, the researchers combined a large number of questionnaires for different mental disorders into one comprehensive survey. Nearly 500 participants from sleepregister.nl completed all the questions.

The questionnaire is freely accessible in the appendix of the publication in eClinicalMedicine.

Seven types of hyperarousal

The study revealed seven different types of hyperarousal. Almost every type of hyperarousal occurred across multiple disorders. However, the relative severity of each type of hyperarousal differed among people with insomnia, depression, anxiety, panic disorder, post-traumatic stress, and ADHD.

Tool for future research

Based on these findings, the researchers developed a new, concise questionnaire to measure the different types of hyperarousal. “Instead of having to search for the right combination of questionnaires, researchers can now use this tool to map hyperarousal much more easily and comprehensively,” says Bresser. The sleep lab is already using the questionnaire in several of its own studies on insomnia and anxiety.

In addition, Bresser is investigating which brain mechanisms are involved in the different types of hyperarousal. “We hope to better understand which brain regions are involved in which type of hyperarousal.” In this way, the researchers aim to more precisely map how hyperarousal works in the brain.

Better treatment

Bresser hopes that the questionnaire will also be used in clinical practice in the future. “Often someone comes to a psychologist with disorder A, but it turns out they also have a predisposition for disorder B or C,” he explains. “By using the combined questionnaire, the underlying forms of hyperarousal can hopefully become clearer.”

This could help psychologists provide more targeted treatment. Instead of addressing only one problem, a treatment plan could focus simultaneously on the types of hyperarousal that are most important for the individual patient. “We therefore hope that health care professionals will be willing to try out the questionnaire in practice,” Bresser concludes.