Acute Stress Disorder

Definition

Acute stress disorder involves symptoms that last from three days to one month following exposure to one or more traumatic events. Symptoms develop after an individual experiences or sees an event involving a threat or actual death, serious injury, or physical violation to the individual or others. Symptoms fall into the five general categories of intrusion, negative mood, dissociation, avoidance, and arousal, and begin or worsen after the trauma occurred.

The diagnosis was established to identify those individuals who would eventually develop post-traumatic stress disorder. This condition was referred to as "shell shock" as far back as World War I, based on similarities between the reactions of soldiers who suffered concussions caused by exploding bombs or shells and those who suffered blows to their central nervous systems. More recently, acute stress disorder came to light as it became clear that people might exhibit PTSD-like symptoms for a short period immediately after a trauma.

Trauma has both a medical and a psychiatric definition. Medically, trauma refers to a serious or critical bodily injury, wound, or shock. This definition is often associated with trauma medicine practiced in emergency rooms and represents a popular view of the term. In psychiatry, trauma has assumed a different meaning and refers to an experience that is emotionally painful, distressful, or shocking, and which often results in lasting mental and physical effects.

In general, it is believed that the more direct the exposure to the traumatic event, the higher the risk for mental harm. Thus in a school shooting, for example, the student who is injured will likely be the most severely psychologically affected, and the student who sees a classmate shot or killed is likely to be more affected than the student who was in another part of the school when the violence occurred. Even secondhand exposure to violence can be traumatic. For this reason, all children and adolescents exposed to violence or a disaster, even if only through graphic media reports, should be watched for signs of emotional distress.

Symptoms

For a diagnosis of acute stress disorder, symptoms must persist for a minimum of three days and last no more than one month after the trauma.

A person may be described as having acute stress disorder if other mental disorders or medical conditions do not provide a better explanation for the person's symptoms. If symptoms persist after a month, the diagnosis becomes post-traumatic stress disorder.

Symptoms fall into the following five categories:

  • Intrusion symptoms (involuntary and intrusive distressing memories of the trauma or recurrent distressing dreams)
  • Negative mood (persistent inability to experience positive emotions such as happiness or love)
  • Dissociative symptoms (time slowing, seeing oneself from an outsider's perspective, being in a daze)
  • Avoidance symptoms (avoidance of memories, thoughts, feelings, people, or places associated with the trauma)
  • Arousal symptoms (difficulty falling or staying asleep, irritable behavior, problems with concentration)

People with acute stress disorder may also experience a great deal of guilt about not being able to prevent the trauma, or for not being able to move on from the trauma more quickly. Panic attacks are common in the month following a trauma. Children with acute stress disorder may also experience anxiety related to their separation from caregivers.

Causes

A person must be exposed to a traumatic event to be at risk for acute stress disorder. Individuals may be at greater risk for developing acute stress disorder if they have previously been diagnosed with a mental disorder, perceive the traumatic event to be very severe, have an avoidant coping style when experiencing distress, or have a history of previous trauma. Women are more likely to develop acute stress disorder than men.

The physiological response behind acute stress disorder is called the acute stress response. When a fearful or threatening event is perceived, humans experience an automatic response geared toward either confronting or fleeing the threat (hence the term "fight-or-flight response"). The hallmarks of the acute stress response are an almost instantaneous surge in heart rate, blood pressure, sweating, breathing, and metabolism, and a tensing of muscles. Enhanced cardiac output and accelerated metabolism are essential to mobilizing for action. When people experience a trauma, they may perceive constant threats in their environment based on perceived danger (due to intrusive memories or dreams, for example), and therefore experience the acute stress response more frequently than at their baseline.

Treatments

Cognitive behavioral therapy is the treatment that has met with the most success in combating acute stress disorder. CBT has two main components. First, it aims to change cognitions, or patterns of thought surrounding the traumatic incident. Second, it tries to alter behaviors in anxiety-provoking situations. Cognitive behavioral therapy not only ameliorates the symptoms of acute stress disorder but also attempts to prevent the development of post-traumatic stress disorder.

Psychological debriefing and anxiety management groups are two other types of therapy that have been examined for the treatment of acute stress disorder. Psychological debriefing involves an intense therapeutic intervention immediately after the trauma so that traumatized individuals can "talk it all out." While some people have found this to be helpful, others have been re-traumatized by speaking about the situation that originally caused them distress. 

Psychotropic medications can assist with symptoms of anxiety and high arousal. Additionally, stress-reduction strategies such as mindfulness and relaxation strategies can help people cope with and ultimately reduce symptoms of acute stress disorder.

References

  • Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
  • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford press.
  • Jones, F. D., Sparacino, L. R., Wilcox, V. L., Rothberg, J. M., & Stokes, J. W. (1995). War psychiatry, textbook of military medicine. Zajtchuk, Bellamy & Jenkins (Eds.), Office of the Surgeon General.
  • National Institute of Mental Health
  • National Center for PTSD
  • Department of Health & Human Services
  • Center for the Study of Traumatic Stress

Last reviewed 03/05/2018