Acute Stress Disorder

What Is Acute Stress Disorder?

Acute stress disorder (ASD) is a mental health condition that can occur within 3 to 30 days after experiencing a traumatic event. People with acute stress disorder may experience symptoms so severely that it affects their everyday lives. Common symptoms of ASD include:

• Extreme anxiety
• Flashbacks
• Nightmares
• Detachment
• Avoidance

The American Psychological Association defines trauma as an emotional response to a life-threatening or terrible event. A traumatic event can be any distressing event, such as experiencing a natural disaster, a physical or sexual assault, a global pandemic such as COVID-19, or an automobile accident.

Other types of traumatic events include combat or war, refugee camps, a home invasion, prison, neglect, the death of a loved one, mass shootings, severe injury or illness, emotional abuse, or terrorism. When people think of trauma, they often think of combat veterans or victims of sexual assault. While this is true, other populations, like medical professionals, are also commonly exposed to trauma.

What’s the Difference Between Acute Stress Disorder and PTSD?

The primary difference between acute stress disorder and post-traumatic stress disorder (PTSD) is the timeline of symptoms.

Acute stress disorder is an “acute” mental health disorder because symptoms arise and subside within 30 days (one month) of the traumatic event. If symptoms persist for longer than 30 days after the traumatic event, then it is referred to as PTSD. ASD is both a risk and predictive factor of developing PTSD.

Acute stress reaction is a term used to describe an individual who is exposed to a traumatic event and develops symptoms immediately afterward, but these symptoms resolve within 48 hours; this is not considered an official diagnosis of ASD.

It’s also important to note that adjustment disorder is a differential diagnosis of both PTSD and acute stress disorder, as symptoms may be very similar. The main difference is that in adjustment disorder, the traumatic event is not life-threatening but is a significant life stressor, such as job loss, relationship issues, or financial problems. The distressing symptoms often exceed what may be considered a normal stress response to these life changes.

How Common is Acute Stress Disorder?

It is difficult for experts to determine how common ASD is because many individuals do not report symptoms or seek help until they have been diagnosed with PTSD.

Additionally, the prevalence of acute stress disorder often depends on the type and severity of trauma. For example, victims of sexual assault are more likely to develop ASD compared to victims of natural disasters; both are traumatic events but are different types of trauma. Overall, it is estimated that ASD occurs in 5-20% of individuals who experience a traumatic event.

Symptoms of Acute Stress Disorder

Common symptoms of ASD fall into the following five categories:

Intrusion

Intrusion symptoms involve remembering or re-living the event and include distressing nightmares, memories, or flashbacks.

Negative Mood

A person with ASD may seem depressed because they are unable to experience positive emotions such as laughter, joy, humor, etc., due to the trauma they experienced.

Dissociation

Having an out-of-body experience, an altered sense of reality, or the inability to remember important details about the traumatic event (dissociative amnesia) are dissociative symptoms of ASD.

Avoidance

Trying to avoid emotions, feelings, or thoughts associated with the traumatic event is a common symptom of ASD. People may keep themselves busy by becoming overly involved with their jobs, workout routines, or hobbies to avoid processing their feelings.

A concerted effort to avoid any physical reminder of the traumatic event, such as places, situations, people, or conversations that may cause distressing feelings or emotions associated with the traumatic event may also be seen.

Arousal

Arousal symptoms are a sign of heightened stress response, including sleep disturbances, problems concentrating, irritable or aggressive mood or behavior, increased startle response, and hypervigilance.

Causes of Acute Stress Disorder

You may wonder why some people recover after a traumatic event while others develop acute stress disorder. It’s hard to pinpoint what exactly causes acute stress disorder in individuals who experience traumatic events. Still, research has shown that it may have to do with “fear conditioning,” which occurs when a neutral stimulus becomes associated with the traumatic experience.

For example, if a woman is attacked while walking home at night, she may develop a fear of the dark by associating it (a previously neutral stimulus) with the traumatic event. People who experience trauma but do not develop ASD are often able to adapt through a process called fear extinction, where their fear response gradually decreases over time, such as becoming less afraid of walking alone at night. However, not everyone is able to adapt in this way. The exact reasons aren’t fully understood, but certain risk factors are believed to play a role.

Risk Factors for Acute Stress Disorder

Experts believe that the same risk factors for PTSD occur in ASD. These risk factors include the following:

• Female gender
• History of mental health disorders
• Previous exposure to trauma
• The severity of the traumatic event
• Poor socioeconomic status
• Limited support system
• Avoidant coping style

It’s important to remember that these factors do not guarantee ASD will develop after experiencing a traumatic event; they simply represent a heightened risk.

Does ASD Predict PTSD?

ASD is a predictive factor of PTSD, with studies showing between 40-80% of people with ASD go on to develop PTSD. However, some cases of ASD never develop into PTSD. Since they share the same symptoms, early detection and proper treatment can help stop the progression of ASD into PTSD.

How is Acute Stress Disorder Diagnosed?

Acute stress disorder can be diagnosed by any licensed health professional who is trained in mental health disorders, such as a psychiatrist, psychologist, or general practice physician.

To receive a diagnosis, the individual must have experienced a traumatic event and developed the above symptoms within the specific time frame of 3-30 days after the traumatic event. There are no tests, such as labs or imaging, to diagnose ASD; the diagnosis is based on history and symptoms. Therefore, a thorough interview process with appropriate assessments must be carried out by the licensed health professional. Three assessments can be used to help diagnose ASD, including:

• The Stanford Acute Stress Reaction Questionnaire (self-reported)
• The Acute Stress Disorder Interview (structured clinical interview)
• The Acute Stress Disorder Scale (self-report)

These assessments can also help measure the severity of ASD and guide the appropriate treatment and intervention approaches.

Treatment for Acute Stress Disorder

Treatment for acute stress disorder is primarily psychotherapy, with the first line of management being trauma-focused cognitive behavioral therapy (CBT). Trauma-focused CBT can reduce symptoms of ASD and prevent progression to PTSD. The goal of trauma-informed CBT is to focus on educating the person on trauma psychology, identifying and refocusing unhealthy thoughts, emotions, and behaviors, learning and adopting symptom management skills, and practicing exposure therapy.

Exposure therapy is a specific trauma CBT method that slowly, over time, exposes the person to the traumatic source in a controlled and safe setting. The goal is to reduce the emotional and mental distress linked to the traumatic event by repeatedly exposing the person to its source. Over time, this repeated exposure can cause the event to lose its emotional impact and become a neutral stimulus, a process known as fear extinction.

Initially, during this process, a temporary worsening of symptoms can appear. Therefore, de-briefing sessions occur between the professional and the client so the client can explain in detail their feelings and thoughts associated with the trauma and the exposure sessions.

Treatment medications such as antianxiety medications and antidepressants (selective serotonin reuptake inhibitors) have not shown any evidence to provide symptom relief for individuals with acute stress disorder.

Can Acute Stress Disorder Be Prevented?

It is difficult to determine whether ASD can be prevented, especially if the person has a predisposing risk factor. Even individuals without any risk factors can still develop ASD when exposed to a traumatic event.

The best form of prevention is to seek help from a professional right away to discuss the traumatic event and how to cope with emotions and thought patterns, lean into your support system, practice healthy self-care techniques, and avoid unhealthy coping mechanisms such as relying on alcohol or drugs to numb feelings.

However, even with these preventative approaches, there is no guarantee a person will not develop ASD after experiencing a traumatic event. Therefore, it is important not to engage in any form of self-blaming behaviors for the traumatic experience or developing ASD.

How Do I Take Care of Myself If I Have Acute Stress Disorder?

If you have acute stress disorder, there are many ways to take care of yourself, including:

• Practicing healthy coping mechanisms (prioritizing exercise, sleep, nutrition)
• Joining a trauma support group
• Leaning on your support systems (call friends and family, spend time with loved ones, talk about your feelings, etc.)
• Attending regular therapy as soon as possible
• Practicing self-care routines
• Avoiding unhealthy coping mechanisms such as alcohol, drugs, and self-blame
• Educate yourself on ASD and your symptoms

When Should I See My Healthcare Provider?

It is best practice to see your healthcare provider as soon as possible after the traumatic event. Even if you are not experiencing symptoms of ASD, they can help educate you on ASD and provide you with appropriate resources in the hope of preventing symptoms.

If you are experiencing symptoms of ASD, you should connect with a healthcare professional so you can work through a management and treatment plan for symptom relief in hopes of preventing PTSD. If you cannot afford to attend therapy or if you are uninsured, you can look into free trauma support groups and hotlines that can provide support.