Merck Manual

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Acute Stress Disorder

By

John W. Barnhill

, MD, Weill Cornell Medical College and New York Presbyterian Hospital

Last full review/revision Apr 2020| Content last modified Apr 2020
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NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
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Acute stress disorder is an intense, unpleasant, and dysfunctional reaction beginning shortly after an overwhelming traumatic event and lasting less than a month. If symptoms persist longer than a month, people are diagnosed as having posttraumatic stress disorder (PTSD).

People with acute stress disorder have been exposed to a terrifying event. They may experience it directly or indirectly. For example, direct exposure may involve experiencing serious injury, violence, or the threat of death. Indirect exposure may involve witnessing events happening to others or learning of events that occurred to close family members or friends. People mentally re-experience the traumatic event, avoid things that remind them of it, and have increased anxiety.

People with this disorder may have dissociative symptoms. For example, they may feel emotionally numb or disconnected from themselves. They may feel that they are not real.

The number of people with acute stress disorder is unknown. The likelihood of developing acute stress disorder is greater when traumatic events are severe or recurrent.

Diagnosis

  • A doctor's evaluation, based on specific criteria

Acute stress disorder is diagnosed when people have been

  • Exposed directly or indirectly to a traumatic event

In addition, they also must have had at least 9 of the following symptoms for 3 days up to 1 month:

  • Recurring, uncontrollable, and intrusive distressing memories of the event

  • Recurring distressing dreams of the event

  • Feelings that the traumatic event is recurring—for example, in flashbacks

  • Intense psychologic or physical distress when reminded of the event (for example, by entering a similar location, or by sounds similar to those heard during the event)

  • A persistent inability to experience positive emotions (such as happiness, satisfaction, or loving feelings)

  • An altered sense of reality (for example, feeling in a daze or as if time has slowed)

  • Memory loss for an important part of the traumatic event

  • Efforts to avoid distressing memories, thoughts, or feelings associated with the event

  • Efforts to avoid external reminders (people, places, conversations, activities, objects, and situations) associated with the event

  • Disturbed sleep

  • Irritability or angry outbursts

  • Excessive attention to the possibility of danger (hypervigilance)

  • Difficulty concentrating

  • An exaggerated response to loud noises, sudden movements, or other stimuli (startle response)

In addition, symptoms must cause significant distress or significantly impair functioning.

Doctors also check to see whether symptoms could result from use of a drug or another disorder.

Treatment

  • Self-care
  • Supportive measures

Many people recover from acute stress disorder once they are removed from the traumatic situation and given appropriate support in the form of understanding, empathy for their distress, and an opportunity to describe what happened and their reaction to it. Some people benefit from describing their experience several times. Friends and loved ones can often provide this support. Otherwise, doctors or other health care professionals are helpful.

Sometimes doctors temporarily give drugs to relieve anxiety or help people sleep, but other drugs (such as antidepressants) are usually not given.

Self-care

Self-care is crucial during and after a crisis or trauma. Self-care can be divided into 3 components:

  • Personal safety

  • Physical health

  • Mindfulness

Personal safety is fundamental. After a single traumatic episode, people are better able to process the experience when they know that they and their loved ones are safe. It can be difficult, however, to gain complete safety during ongoing crises such as domestic abuse, war, or an infectious pandemic. During such ongoing difficulties, people should seek the guidance of experts on how they and their loved ones can be as safe as possible.

Physical health can be put at risk during and after traumatic experiences. Everyone should try to maintain a healthy schedule of eating, sleeping, and exercise. Drugs that sedate and intoxicate (for example, alcohol) should be used sparingly, if at all.

A mindful approach to self-care aims to reduce the feelings of stress, boredom, anger, sadness, and isolation that traumatized people normally experience. If circumstances allow, at-risk individuals should make and follow a daily normal daily schedule, for example, get up, shower, get dressed, go outside and take a walk, and prepare and eat regular meals.

It is useful to practice familiar hobbies as well as activities that sound fun and distracting: draw a picture, watch a movie, or cook.

Community involvement can be crucial, even if it is difficult to maintain human connection during a crisis.

Stretching and exercise are terrific, but it can be equally helpful to sit still and count one's own breaths or listen carefully for surrounding sounds. People can become preoccupied with the trauma or crisis, and so it is useful to choose to think of other things: read a novel or get engaged with a puzzle. Unpleasant emotions may typically feel "frozen" during and after a trauma, and it can be a relief to find activities that shift the feeling state: laugh, watch a fun movie, do something silly, or draw with crayons. Under stress, people can become short-tempered, even with people they care about.

Spontaneous kindness can be a win/win solution for everyone: sending a nice note, making someone cookies, and offering up a smile may not only be a nice surprise for the recipient, but they can reduce the hopelessness and passivity that tends to be part of the sender's experience of trauma.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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