Acute Stress Disorder

By Dr. Cheryl Lane, PhD

While most people are at least somewhat familiar with PTSD (posttraumatic stress disorder), few have heard of a very similar anxiety disorder called Acute Stress Disorder (ASD).

In fact, it often precedes the development of PTSD. Like PTSD, ASD is triggered by exposure to a traumatic event that evoked significant fear or horror and/or a sense of helplessness.

Traumatic events that lead to ASD (and PTSD) in many people may include witnessing a violent assault, injury, or death; being in combat or experiencing a natural disaster (e.g. a hurricane or tornado); being seriously injured or nearly dying in an accident or assault; or being raped, mugged, or abducted. Acute stress disorder may also develop after finding out that a loved one has died unexpectedly or violently, was seriously harmed, or that the loved one’s life was threatened.

The primary difference between PTSD and ASD involves the timeframe within which the symptoms develop and how long they last. In ASD, the symptoms appear within 4 weeks following the event. They last at least 2 days and no longer than 4 weeks. In PTSD, however, the symptoms must last for at least a month. They may start weeks or months after the event and can last for months or even years.

Symptoms

The symptoms of ASD must include:

• Dissociation
• Reliving the trauma
• Avoidance
• Anxiety or increased arousal

Symptoms details

Dissociation – One of the primary symptoms of ASD, dissociation involves a disturbance in your memory, identity, awareness, and orientation. With ASD, the dissociation may take place while you’re actually experiencing the traumatic event or at some point after it’s over. At least three of the following dissociative symptoms must occur:

• A lack of emotional response, or feeling numbed or detached
• The feeling that your surroundings are strange or not real
• The feeling that you’re outside of your body or in a dream
• A decrease in your awareness of your surroundings (e.g. feeling like you’re in a daze)
• Inability to remember key aspects of the event

Reliving the Trauma - Another major symptom of ASD involves reliving the traumatic event over and over in some way or several different ways, such as:

• Dreams or nightmares
• Flashbacks
• Recurring mental images
• Thoughts

You may also become very anxious or distressed if you are faced with anything that reminds you of the event.

Avoidance - With ASD, you will go out of your way to avoid anything that triggers memories of the trauma, such as people or places that you associate with it, talking about it, or thinking about it. You may also avoid any type of related activity, such as swimming or boating (for example) if you had almost drowned. Feelings about the event are also often suppressed or numbed (e.g. with alcohol, food, or drugs) as they can be far too painful or scary.

Anxiety / Hyperarousal - Acute distress disorder is categorized as an anxiety disorder because anxiety (or hyperarousal) is a key symptom. Hyperarousal may manifest in a variety of ways, such as having problems sleeping, being easily startled, feeling restless or irritable, or having a hard time concentrating. Sometimes people with ASD become hypervigilant.

The symptoms of ASD are serious enough to cause significant distress and interfere with your ability to function in various aspects of your daily life. They can even interfere with your ability to seek much-needed help or let your loved ones know about the trauma you’ve endured.

Risk Factors

While anyone is vulnerable to developing ASD following a traumatic experience, some people have a greater risk than others. Factors that increase the risk include:

• A history mental health disorders
• A history of PTSD
• Lack of support following the trauma
• Lack of a good support system in general
• Past history of trauma
• A history of child abuse or neglect
• Research has shown that ASD is much more likely to develop if the trauma involved violence. Also, the more directly exposed you are to the trauma, the more likely you are to develop ASD or PTSD (e.g. if your life was directly threatened as opposed to witnessing someone else’s life being threatened).

Diagnosing ASD

As with most psychiatric disorders, there are no blood tests or other specific tests used to diagnose ASD. It’s diagnosed by a mental health or medical professional based primarily upon the symptoms that appear following a traumatic event. It’s not unusual for a spouse, family members, or close friends to notice the symptoms first and encourage or insist upon an evaluation.

Treatment

Appropriate treatment can help significantly reduce and alleviate symptoms of ASD in most cases. The best time to seek treatment is as soon as the symptoms begin to appear. If the symptoms are ignored or treatment is delayed, it increases your risk of developing posttraumatic stress disorder.

Treatment for ASD may include psychotherapy, medication, or a combination of the two. While medication can help reduce some symptoms, such as anxiety, nightmares, and poor sleep, therapy often provides more lasting results and can decrease the risk of developing PTSD.

Medication

Medications that may be prescribed to help with symptoms may include benzodiazepines, antidepressants, and antipsychotic drugs. One particular hypertensive medication – prazosin – is sometimes prescribed to help with insomnia and recurrent nightmares.

Psychotherapy

Cognitive behavioral therapy and exposure therapy are often used to treat ASD. Other therapies may also be very beneficial, such as EMDR (eye movement desensitization and reprocessing) or other types of talk therapy.