What is Acute Stress Disorder?

Acute stress disorder is diagnosed when a person develops severe symptoms after exposure to actual or threatened death, serious injury or sexual violation through direct experience, as a witness, through learning that the event happened to a close family member or friend, or through repeated or extreme exposure to terrible details of the traumatic event (common in first responders). Signs of acute stress disorder are distinguished from post-traumatic stress disorder (PTSD) in that its symptom pattern is restricted to a duration of three days to one month following exposure to the traumatic event.

Signs and Symptoms

For a diagnosis of acute stress disorder, a person must have experienced at least nine of the following acute stress symptoms:

• Intrusion symptoms
  • Recurrent, involuntary and intrusive distressing memories of the traumatic event(s)
  • Recurrent distressing dreams in which the content and/or effect of the dream are related to the event(s)
  • Dissociative reactions (like flashbacks) in which a person feels or acts as if the traumatic event(s) were recurring (in extreme cases, people may lose awareness of present surroundings)
  • In children, trauma-specific reenactment occurring during play
  • Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
• Negative mood – a persistent inability to experience positive emotions like happiness or satisfaction

• Dissociative symptoms
  • An altered sense of reality, such as being in a daze or feeling as if time is slowing
  • Inability to remember an important aspect of the traumatic event(s), known as dissociative amnesia 
• Avoidance symptoms
  • Trying to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
  • Trying to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

Which Physical Effect is Associated with Acute Stress?

• Arousal symptoms
  • Sleep disturbance
  • Irritable behavior and angry outbursts with little or no provocation, typically expressed as verbal or physical aggression toward people or objects
  • Hypervigilance
  • Concentration problems
  • An exaggerated startle response

In acute stress disorder, these symptoms last three days to one month following the traumatic exposure. Symptoms cause significant distress or impairment in social, occupational and other important areas of functioning. They are not attributable to the effects of drugs, alcohol, medication or another medical condition and are not better explained by a brief psychotic disorder.

Diagnosis

Diagnosing acute stress disorder requires a thorough physical and psychological evaluation. Your behavioral health provider will use the criteria for acute stress disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to determine if your symptoms indicate the condition.

Diagnostic tests include:

Physical examination: Your provider will perform a physical exam and ask questions about your health to determine if your symptoms could be linked to an underlying physical health problem, medication side effects or unhealthy behaviors (like drug use).

Psychiatric evaluation: Your behavioral health provider will ask you questions about the traumatic event and your symptoms to confirm a diagnosis and rule out other psychiatric conditions.

Causes

Experiencing, witnessing or learning about an extremely traumatic event may cause acute stress disorder, which develops in up to a third of people who face these events.

What is Acute Stress?

The physiological aspect of this response, the fight-or-flight instinct, involves the production of adrenalin and other hormones, an accelerated heart rate, deeper breathing, and a surge in blood pressure. The threat may or may not be real, because it’s the perception of a threat that matters. Acute stress ranges in seriousness, from mild annoyance at answering a doorbell, to more serious concerns regarding job performance, personal relationships, or major life-events. 

Examples of Acute Stress?

Everyday life is filled with potential sources of acute stress:

• Test taking
• Job interviews
• First dates
• Weddings and funerals
• Legal and financial problems
• Relationship issues
• Illness
• Accidents
• Physical assault
• Crime victimization
• Crisis situations of all sorts.

Risk Factors

Risk factors that could contribute to acute stress disorder include:

Traumatic history: If you’ve experienced or witnessed an extremely traumatic event in the past, you could be at a higher risk of developing acute stress disorder with a new exposure.

Past stress disorders: If you’ve previously been diagnosed with acute stress disorder or PTSD, you may be at a higher risk.

Pre-existing psychiatric disorders or symptoms: Certain other psychiatric conditions or a history of dissociative symptoms during traumatic events may heighten your risk.

Gender: Women are at a slightly higher risk.

Prevention

Acute stress disorder cannot be prevented. Seeking treatment at the earliest sign can help prevent the condition from getting worse or interfering with your life.

If you’ve been diagnosed with acute stress disorder, these strategies may help in the future:

Get treated: Seek medical treatment within a few hours of experiencing a traumatic event.

Train for trauma: If you work in a job with a high risk for traumatic events, such as a military or police position, you may benefit from preparation training and counseling.

Prognosis

Many people with acute stress disorder are later diagnosed with PTSD, which means symptoms persist for more than a month and cause significant distress and difficulty functioning. Timely treatment may reduce your chances of developing PTSD.

Treatment

Most people with acute stress disorder benefit from a combination of medication and psychotherapy delivered by a psychiatrist, psychologist or other behavioral health professional. Sometimes, acute stress disorder treatment requires brief hospitalization if a person is at risk of harming himself or herself or others.

Medication

You may need to try a few different medications, or medication combinations, before you find the one that’s right for you. Some medications take a few weeks before their full effect is obvious. Some cause side effects for certain patients. If you experience any side effects, it’s important to talk to your physician immediately but not to abruptly stop taking the medication, which could cause a worsening of symptoms.

Common medications prescribed for acute stress disorder include:

• Antidepressants: These medications may be prescribed to help manage negative mood symptoms associated with acute stress disorder.

• Anti-anxiety medication: These drugs may reduce abnormal electrical activity in the brain or help balance brain chemicals associated with mood regulation.

Psychotherapy

Also known as talk therapy or psychological therapy, this involves talking about your condition, symptoms, mental health history and life with a mental or behavioral health professional. Your behavioral health provider may also recommend exposure therapy – confrontation with a feared object or context without any danger – or hypnotherapy – used to create subconscious change in a patient in the form of new responses, thoughts, attitudes, behaviors or feelings.

Complications

The most common complication of acute stress disorder is the development of PTSD.

Other complications may include:

• Problems functioning at work or school or when trying to perform regular daily activities
• Alcohol or drug abuse in an effort to numb psychological responses