We’ve discussed the first two symptom clusters, intrusive symptoms and avoidant symptoms, and now we get to the third: changes in mood and thinking. This can include depressive symptoms—sadness, loss of pleasure from anything, a sense of guilt, an overfocus on negative things, and basically a feeling of emotional and physical exhaustion. Finally, the fourth symptom cluster is an alteration in arousal and reactivity. These are symptoms related to the sensitized stress-response networks being overactive and overly reactive. They include anxiety, hypervigilance, increased startle response, high
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