Acute Stress Disorder

Acute stress disorder, or ASD, is a mental health condition that follows immediately after experiencing something traumatic. The trauma may be something personally experienced, such as being in a car accident or being assaulted. It can also be indirect, something that the individual witnesses or hears about happening to someone else, often someone they care about.

ASD can cause a variety of symptoms, such as recurring and intrusive memories of the trauma, nightmares, flashbacks, difficulty feeling positive emotions, avoidance of triggers that remind the person of the trauma, and others. These symptoms begin within four weeks of the traumatic event and last for at least three days. The symptoms last no more than a month, and if they persist longer than this an individual may be diagnosed with post-traumatic stress disorder (PTSD).

Experiencing shock, intrusive memories, and feeling depressed or scared are normal reactions to trauma, but when they persist for a few days or more it may be ASD. Some people who go through ASD will recover on their own, while others need professional support and some continue to struggle and develop PTSD, a longer-term mental illness related to trauma.

Types of Acute Stress Disorder

There is really only one type of acute stress disorder, but this mental illness can be broken down by the kind of trauma that triggered it, including:

• Trauma directly experienced by the patient
• Trauma that is witnessed happening to someone else
• Hearing about something traumatic that happened to a loved one or close friend
• Repeated exposure to details of trauma, such as what first responders hear and see on the job

While these are different ways in which trauma may be experienced, all of them have the potential to cause ASD. The diagnostic criteria and treatment approaches are the same regardless of the type of trauma experienced or witnessed.

Acute stress disorder is caused by exposure to trauma, either directly or indirectly, but not everyone who has been through a traumatic experience will develop this condition.

• ASD is categorized in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders as a trauma- and stressor-related disorder.
• The rate of ASD in people who were victims or witnesses of a physical assault is between 20 and 50 percent.
• The rate is lower, less than 20 percent, when the trauma is not interpersonal assault. Examples of other types of trauma include accidents and severe injuries.
• Approximately half of people diagnosed with post-traumatic stress disorder experienced ASD first.
• Between 13 and 21 percent of people involved in car accidents will develop ASD. About 14 percent of people with traumatic brain injuries and 10 percent of people with severe burns will have ASD.

To be diagnosed with ASD a person must have experienced trauma in one of the four ways described previously, either directly, as a witness, by hearing about a loved one’s trauma, or being exposed repeatedly to traumatic details. This is the first criterion for a diagnosis, but there are also specific symptoms. A person must meet nine or more of 14 symptoms, and they have to cause serious distress, impairment, or both:

• Recurring, intrusive memories of the trauma that cause significant distress
• Recurring and distressing dreams or nightmares related to the traumatic experience
• Flashbacks that feel as if the trauma is actually happening
• Extreme distress caused by anything that reminds a person of the trauma
• Inability to feel positive emotions, like happiness or contentedness
• A feeling of dissociation, being separate from oneself or the surroundings
• Forgetting certain parts of the trauma, a type of amnesia not caused by a substance or a physical injury
• Avoiding memories associated with the traumatic event
• Avoiding any places, people, objects, or situations that are reminders of the trauma
• Difficulty sleeping or sleeping too much
• Outbursts of anger or irritability, typically unprovoked
• Difficulty concentrating
• Startling easily
• Being overly vigilant and wary

Finally, in order to be diagnosed with ASD these symptoms must have begun sometime within the month after the trauma and may not persist for more than a month. The symptoms must occur for three days or longer.

Causes and Risk Factors

Trauma- and stressor-related mental health conditions are unique from many other mental illnesses in that there is a known cause. A traumatic experience that triggers the symptoms of ASD is not only the cause but a required criterion for diagnosis. Of course, not everyone who goes through a traumatic event will develop ASD. Why some do and others do not is not known, but there are documented risk factors that make ASD following trauma more likely for some people:

• Having experienced trauma in the past
• Having a mental illness before the trauma
• Going through a trauma that is severe
• Experiencing physical assault
• Using avoidant coping strategies
• Having a neurotic personality
• Being female

ASD is also a risk factor for PTSD. Not everyone who develops ASD will go on to be diagnosed with PTSD, but it is fairly common. Treating ASD immediately may help mitigate the risk of developing PTSD.

PTSD is sometimes considered a co-occurring disorder with ASD, but in reality the definition of the two conditions makes this impossible. The symptoms of both are very similar, and the difference is the duration. When ASD symptoms persist for longer than a month it is no longer considered ASD. At that point a person may be diagnosed with PTSD.

Similarly to PTSD, there are several other mental health conditions that may co-occur with ASD. Having an existing mental illness can increase the risk that a person develops ASD, but the stress and trauma may also trigger symptoms and contribute to the onset of a mental illness. Common co-occurring conditions with ASD include major depression, persistent depressive disorder, and all types of anxiety disorders.

As with many other mental illnesses, and particularly trauma-related disorders, other mental health disorders commonly co-occur with ASD. A person struggling to cope with a traumatic experience may turn to other ways to escape or self-soothe. This is an unhealthy strategy that can lead to a variety of health problems.

The goals of treatment for ASD are to resolve symptoms, improve everyday functioning, and to prevent the onset of PTSD. If possible, immediate intervention can make a big difference. Known as psychological first aid, helping someone right after a trauma can help prevent ASD and PTSD. This involves a focus on psychoeducation rather than therapy, providing needed support and resources, and helping the individual feel safe and secure.

If immediate care cannot be given or does not help, ongoing treatment for ASD includes trauma-focused behavioral therapies. These are behavioral therapies that help patients reframe the traumatic experience, process negative emotions, learn and practice healthier responses to stress, and face and relive the trauma in a safe setting.

Treatment should also address any other mental health needs, which may include screening and diagnosis of mental illnesses. Medications may be used to manage symptoms of other mental illnesses, such as antidepressants for depression or anxiety. Some patients may also benefit from certain medications to treat intrusive thoughts, dissociative symptoms, and hyperarousal.

The prognosis for someone with ASD is largely positive. Many people will see symptoms resolve within a month, and those who still struggle benefit greatly from therapy and treatment. This is a short-term condition that most people recover from, and even those who go on to develop PTSD can recover within several months or a year with dedication to treatment. If you or someone you know has been through a traumatic experience and is struggling to cope, it is important to get professional support.