Acute stress disorder is a brief period of intrusive recollections occurring within 4 wk of witnessing or experiencing an overwhelming traumatic event.
In acute stress disorder, people have been through a traumatic event, experiencing it directly (eg, as a serious injury or the threat of death) or indirectly (eg, witnessing events happening to others, learning of events that occurred to close family members or friends). People have recurring recollections of the trauma, avoid stimuli that remind them of the trauma, and have increased arousal. Symptoms begin within 4 wk of the traumatic event and last a minimum of 3 days but, unlike posttraumatic stress disorder (see Posttraumatic Stress Disorder), last no more than 1 mo. People with this disorder may experience dissociative symptoms.
Diagnosis is based on criteria recommended by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5); these criteria include intrusion symptoms, negative mood, and dissociative, avoidance, and arousal symptoms.
To meet the criteria for diagnosis, patients must have been exposed directly or indirectly to a traumatic event, and ≥ 9 of the following must be present for a period of 3 days up to 1 mo:
In addition, manifestations must cause significant distress or significantly impair social or occupational functioning and not be attributable to the physiologic effects of a substance or another medical disorder.
Many people recover once they are removed from the traumatic situation, shown understanding and empathy, and given an opportunity to describe the event and their reaction to it.
To prevent or minimize this disorder, some experts recommend systematic debriefing to assist people who were involved in or witnessed a traumatic event as they process what has happened and reflect on its effect. In one approach to debriefing, the event is referred to as the critical incident, and the debriefing is referred to as critical incident stress debriefing (CISD). Other experts have expressed concern and some studies show that CISD may not be as helpful as supportive, empathic interviewing, may be quite distressful for some patients, and may even impede natural recovery.
Drugs to assist sleep may help, but other drugs are generally not indicated.
Last full review/revision May 2014 by John H. Greist, MD
Content last modified May 2014