Summary: Hyperarousal is a core feature across many mental health conditions — from insomnia and ADHD to depression, anxiety and PTSD — yet the term has often been used loosely. New research shows that hyperarousal is not a single uniform state but consists of seven distinct dimensions. Identifying these dimensions enables more precise assessment and could help clinicians deliver targeted, transdiagnostic treatments.
Researchers analyzed nearly 500 participants who completed a comprehensive set of questionnaires drawn from multiple disorder-specific surveys. The team found seven separable types of hyperarousal that commonly overlap across disorders, while each disorder and each individual display a unique profile or “signature” of these dimensions. From these results the authors created a concise, validated Transdiagnostic Hyperarousal Dimensions Questionnaire (THDQ) to measure the seven types efficiently.
Key Facts
- Seven distinct dimensions: The study identifies seven specific forms of hyperarousal — anxious, somatic, sensitive, sleep-related, irritable, vigilant and sudomotor — moving beyond the vague, one-size-fits-all notion of “tension.”
- Cross-disorder occurrence: Most hyperarousal dimensions appear in multiple conditions including insomnia, generalized anxiety, depression, panic disorder, PTSD and ADHD, but their relative prominence differs by disorder and by person.
- Practical assessment tool: The researchers distilled 221 questionnaire items into a reliable 27-item THDQ that maps the seven dimensions in a standardized way.
- Ongoing brain research: The lead author is investigating which brain circuits link to each hyperarousal dimension to better understand underlying mechanisms.
- Clinical implications: Using a transdiagnostic questionnaire can uncover underlying predispositions that span conventional diagnostic categories, helping clinicians target the specific forms of hyperarousal that sustain a patient’s symptoms.
Source: KNAW
Why this matters
Hyperarousal affects symptom severity across several psychiatric disorders but has been inconsistently defined and measured. By combining many disorder-specific scales into one comprehensive survey, the research team asked whether hyperarousal is a single transdiagnostic construct or a set of distinct dimensions. Better characterization of hyperarousal promises clearer diagnosis, improved treatment selection and a stronger link between clinical symptoms and neuroscience.
Study design and participants
The study pooled data from 467 adults recruited through media and the Netherlands Sleep Registry between December 2023 and June 2024. Participants (mean age 58.3 years; range 21–89; 77.6% female) completed 221 items drawn from 18 established questionnaires covering insomnia, anxiety, depression, PTSD and ADHD symptom severity. Exploratory factor analysis identified candidate hyperarousal dimensions, and multiple regression models related these dimensions to disorder severity. The team then selected 27 items to form the THDQ and validated it in a second sample of 592 adults recruited in 2025.
Seven hyperarousal dimensions
Exploratory analysis revealed seven reproducible dimensions that together explained about half of the variance in responses: anxious, somatic, sensitive, sleep-related, irritable, vigilant and sudomotor hyperarousal. Each dimension showed differential associations with symptom severity across disorders: some dimensions strongly predicted insomnia severity, while others correlated more with depression, anxiety, panic, PTSD or ADHD symptoms.
The Transdiagnostic Hyperarousal Dimensions Questionnaire (THDQ)
From the full item pool, researchers derived a concise 27-item THDQ that reliably measures each hyperarousal dimension (confirmatory fit indices reported strong model fit and internal consistency). The THDQ simplifies assessment by replacing a prior “patchwork” of disorder-specific scales with a single, validated instrument suitable for research and clinical screening.
Implications for neuroscience and treatment
Beyond assessment, the study opens new paths for neuroscience: mapping which brain regions and circuits underlie each hyperarousal dimension could reveal mechanistic targets for intervention. Clinically, the THDQ can help therapists identify co-occurring predispositions that conventional diagnoses may miss. Rather than treating a single labeled disorder, clinicians can use the THDQ to prioritize interventions that address the specific hyperarousal patterns maintaining a patient’s problems.
Frequently asked questions
A: Historically yes, but this study shows hyperarousal is multidimensional. Like different kinds of pain, hyperarousal can present in several distinct ways, each with different clinical implications.
A: Yes. Most people with mental health conditions show combinations of dimensions, and the mixture varies by disorder and individual.
A: The THDQ helps therapists see underlying tension types across diagnoses. This enables more targeted, integrated treatment instead of separate, siloed approaches.
Editorial notes
- This article was edited by a Neuroscience News editor.
- The original journal paper was reviewed in full.
- Additional context was added by staff for clarity.
About this research
Author: Eline Feenstra
Source: KNAW
Contact: Eline Feenstra – KNAW
Image credit: Neuroscience News
Original research: “Hyperarousal transdiagnostically dissected: different dimensions characterize mood, anxiety, insomnia, posttraumatic stress and attention deficit hyperactivity disorder” by Tom Bresser et al., published in EClinicalMedicine. DOI: 10.1016/j.eclinm.2026.103810 (open access).
Abstract
Background: Hyperarousal is a common construct linked to the severity of insomnia, depression, anxiety, PTSD and ADHD, but it has been measured inconsistently across disorders. This study tested whether hyperarousal represents a single transdiagnostic construct or multiple distinct dimensions.
Methods: In a cohort of 467 adults recruited via the Netherlands Sleep Registry and media outlets, participants completed 221 items from 18 established questionnaires. Exploratory factor analysis identified potential hyperarousal dimensions. Multiple regression examined how these dimensions related to symptom severity across several disorders. A 27-item THDQ was derived and validated in an independent sample (n = 592).
Findings: Seven dimensions emerged, accounting for 50.2% of variance: anxious, somatic, sensitive, sleep-related, irritable, vigilant and sudomotor hyperarousal. These dimensions showed differential associations with insomnia, depression, anxiety, panic, PTSD and ADHD symptom severity. The 27-item THDQ demonstrated strong psychometric properties. Selected population survey items could estimate some dimensions reliably.
Interpretation: Distinguishing hyperarousal into multiple dimensions and using the THDQ can advance research on underlying brain mechanisms and support more targeted clinical interventions.
Funding: European Research Council (ERC) and ZonMw.