Acute Stress Disorder

Acute Stress Disorder is a relatively new diagnostic category that was introduced in 1994 to differentiate time-limited reactions to trauma from post-traumatic stress disorder (PTSD). It is an anxiety disorder that develops within one month after a person has experienced a severe traumatic event or experience.

Acute stress disorder is caused by exposure to trauma, which is defined as a stressor that causes intense fear and, usually, involves threats to life or serious injury to oneself or others. Examples include combat, natural disasters, accidents, rape, mugging, combat, etc.

Distressing dissociative symptoms are common in the person with Acute Stress Disorder. Dissociative symptoms are reactions to trauma in which the mind splits off certain aspects of the trauma from conscious awareness. These can affect the patient's memory, sense of reality, and sense of identity, and include the following:

A subjective sense of numbing, detachment, or absence of emotional responsiveness

A reduction in awareness of the person’s surroundings (a sense of being in a “daze.”)

De-realization: A sense that world is unreal, strange, unfamiliar

De-personalization: Feelings of being an outside observer of one's self

Dissociative amnesia: Such as the inability to recall an important aspect of the trauma

Anxiety, irritability, and depression are also common in people who have Acute Stress Disorder. People with Acute Stress Disorder have a diminished ability to experience pleasure. There may also be problems falling or staying asleep. A person with Acute Stress Disorder will avoid any reminders of the trauma but re-experiences the event in dreams, nightmares, flashbacks, or painful memories.

The symptoms of Acute Stress Disorder can effect any sex or age group, and occur after a variety of traumatic events, even those that seem relatively harmless at first glance. One study revealed that automobile accidents generate a significant amount of acute stress disorder illnesses. In 90 percent of families with children injured in a traffic crash, the child or a parent will suffer at least one significant acute stress symptom, according to a study at The Children's Hospital of Philadelphia. And 25 percent of children and parents experience more pervasive symptoms that warrant clinical attention. Nancy Kassam-Adams, Ph.D. and Flaura K. Winston, M.D., Ph.D., co-authors of the study in the June 2002 issue of Pediatrics, offer guidelines for assessing acute stress symptoms in children and parents.

"The study investigated the range of acute stress symptoms in children and their parents to enable pediatricians to better identify and address the psychological impact of injury," said Dr. Kassam-Adams, associate director of behavioral research, TraumaLink at Children's Hospital. "Evidence about the prevalence of these symptoms in injured children can help physicians distinguish between normal reactions to trauma and reactions that require further care and follow-up."

Since traumatic events – including car accidents – can’t be foreseen, they are difficult to prevent beyond using the commonly known safety precautions. However, professional intervention soon after a major trauma might reduce the likelihood or severity of Acute Stress Disorder.

Treatment for Acute Stress Disorder usually includes a combination of antidepressant medications and short-term psychotherapy. Prognosis for recovery is impacted by the severity and duration of the trauma, the person’s closeness to it, and the person’s level of functioning prior to the traumatic event. Favorable signs include a short time period between the trauma and onset of symptoms, immediate treatment, and the appropriate level of social support.
If the person’s symptoms are severe enough to interfere with normal life and have lasted longer than one month, the diagnosis may be changed to Post Traumatic Stress Disorder (PTSD). If the symptoms have lasted longer than one month but are not severe enough to meet the definition of PTSD, the diagnosis may be changed to adjustment disorder.
The need to get a professional assessment after traumatic events is clear: Those who don’t get treatment for Acute Stress Disorder are at increased risk for substance abuse or major depressive disorders.