4. Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following:
   1. difficulty falling or staying asleep
   2. irritability or outbursts of anger
   3. difficulty concentrating
   4. hypervigilance
   5. exaggerated startle response
   6. physiologic reactivity at exposure to events that symbolize or resemble an aspect of the traumatic event (e.g., a woman who was raped in an elevator breaks out in a sweat when entering any elevator)
5. Duration of the disturbance (symptoms in B, C, and D) of at least one month.

Specify delayed onset if the onset of symptoms was at least six month after the trauma.

• American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders, (3rd ed.-rev.) Washington, DC: Author. pp. 250-251