In PTSD, which symptom can reflect persistent autonomic arousal?

• A. Sleep disturbance
• B. Hypervigilance
• C. Exaggerated startle response
• D. All of the above

Answer: (D)

Persistent autonomic arousal in PTSD refers to ongoing activation of the body’s stress response, mainly the sympathetic nervous system. This heightened arousal shows up in multiple ways, including sleep disturbance, which happens because the body remains on alert and has trouble settling down for sleep; hypervigilance, where a person is constantly scanning the environment for potential threats; and an exaggerated startle response, where sudden stimuli trigger an outsized, automatic arousal reaction. Since all three are different expressions of the same underlying hyperarousal, the best answer is that all of these reflect persistent autonomic arousal in PTSD.