Acute stress disorder is an intense, unpleasant, and dysfunctional reaction beginning shortly after an overwhelming traumatic event and lasting less than a month.
People with acute stress disorder develop acute stress reactions that appear within a month of their exposure to a traumatic event. These stress reactions include having increased anxiety, mentally re-experiencing the traumatic event, avoiding reminders of the trauma, displaying negative mood, developing dissociative symptoms (including derealization and amnesia), and showing increased arousal. If symptoms persist longer than a month, people may be diagnosed with posttraumatic stress disorder (PTSD).
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 degree of distress following a traumatic event in people with acute stress disorder tends to be greater than that experienced in people with an adjustment disorder.
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. However, having acute stress disorder does not necessarily mean that someone will develop posttraumatic stress disorder.
Diagnosis of Acute Stress Disorder
A doctor's evaluation, based on standard psychiatric diagnostic 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 psychological or physical distress when reminded of the event (for example, by entering a similar location, or by hearing 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 of Acute Stress Disorder
Self-care
Psychotherapy
Sometimes medications
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 mental health care professionals are helpful.
Sometimes doctors temporarily give medications to relieve anxiety or help people sleep, but other medications (such as antidepressants) are usually not given unless they are prescribed to treat a co-occurring disorder.
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 and practical support
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 safety for themselves and their loved ones as much 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. Medications and substances that sedate (for example, antianxiety medications) and intoxicate (for example, alcohol) should be used sparingly, if at all. Practical support includes assistance with housing, legal support, insurance, and other issues that need to be addressed but can be overwhelming.
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 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. Interactions with family and friends and community involvement can be crucial, even if it is difficult to maintain human connection during a crisis. Stretching and exercise are beneficial, as are self-soothing techniques such as counting one's own breaths, meditating, or self-hypnosis can be equally helpful.
Under stress, people can become short-tempered, even with those they care about. Friends and family can be especially helpful in reaching out and providing expressions of concern and comfort. 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 shame that tend to be part of the experience of trauma.
Psychotherapy
Cognitive-behavioral therapies (CBT) can help by allowing the person to process traumatic memories in a safe setting, correct maladaptive thoughts about the trauma or responses to it, and discuss the trauma in one's own words once the person is able to do so. Trauma-focused cognitive-behavioral therapy (CBT) is a form of brief therapy that is the most effective treatment for acute stress disorder, and includes the following:
Education can help the person understand the stress response and the natural course of symptom improvement.
Cognitive restructuring helps correct maladaptive thoughts the person might have about the trauma or personal response to the trauma.
Exposure to traumatic memories or safe reminders of traumatic experiences is an important—if difficult—part of the psychotherapy. Through reexperiencing, the person is better able to emotionally process material that had previously been experienced as overwhelming.
Trauma-focused CBT is typically started at least 2 weeks following the trauma, although some forms are started sooner. Debriefing, in which a person is asked to describe the trauma in detail within 72 hours of the event, is not helpful and may in fact be harmful.
Medications
No medications are particularly helpful in reducing the symptoms of acute stress disorder or preventing it from developing into full-blown PTSD. Medications may be given to help with insomnia, anxiety, and agitation, but prolonged use appears to interfere with recovery.
