What is Acute Stress Disorder?
Welcome to this video on acute stress disorder!
According to the American Psychiatric Association, acute stress disorder is characterized by the development of symptoms persisting from three days to one month after an exposure to or experience of a traumatic event.
Traumatic events may include:
- natural disasters
- actual or threatened death of a loved one
- physical assault
- sexual assault
- combat
- serious accidents
- mass casualty events
Acute Stress Disorder Symptoms
To meet the criteria for acute stress disorder, the individual must experience nine or more symptoms in the following five categories:
- Intrusion
- Negative mood
- Dissociation
- Avoidance AND
- Arousal
Let’s talk about these categories of symptoms, beginning with the first category, intrusion, which refers to recurrent intrusive memories of the traumatic event. These memories can be experienced as dreams, nightmares, flashbacks, prolonged emotional distress, or—in children—repetitive play or reenactment play.
With negative mood, the individual is unable to experience positive emotions or to feel happiness. Sometimes the individual begins to blame themselves for the event or their failure to recognize danger. They may appear chronically unhappy and depressed.
Dissociative symptoms may result in the individual experiencing an altered sense of reality or even amnesia associated with the event. They may experience flashbacks in which they relive the events and are unaware of their surroundings. They also may experience intense fear and perception of danger with these flashbacks.
Avoidance symptoms include conscious and unconscious efforts to avoid remembering the event and to avoid people or places that trigger memories. Additionally, people may avoid any situations that may seem dangerous or stress-producing, such as doctor’s appointments and work.
Arousal symptoms, the last category, may be experienced as sleep disturbance, a heightened startle response, labile emotions, aggressive behavior, angry outbursts, hypervigilance, and difficulty concentrating.
Symptoms may vary among individuals although most experience negative and catastrophic thoughts as well as severe levels of anxiety. Panic attacks are quite common and may be associated with chest pain, stomach ache, nausea, sweating, and palpitations.
Individuals typically experience impaired social, interpersonal, and occupational functioning that cannot be attributed to substance abuse or a different medical disorder. Some individuals with acute stress disorder may engage in impulsive behavior, such as drinking and reckless driving.
Older children and teenagers often exhibit symptoms similar to those of adults and develop destructive behaviors, but younger children may present differently.
Children may exhibit increased separation anxiety. They may regress, such as by wetting the bed; they may act out the event during playtime or draw pictures of the event; and they may become increasingly clingy and dependent on their parents or other caregivers.
Prevalence varies according to the type and intensity of trauma, with the highest rates in those experiencing some type of interpersonal trauma, such as a rape, assault, or a mass casualty event.
Overall, about 19% of those who experience a traumatic event develop acute stress syndrome.
Acute Stress Disorder vs. PTSP
Acute stress disorder progresses to post-traumatic stress disorder, commonly referred to as PTSD, if it persists more than one month or if symptoms first occur more than 30 days after an event. The symptoms of acute stress disorder and PTSD are essentially identical.
About half of those with PTSD first presented with acute stress disorder. Typically, if a person with acute stress disorder is going to progress to PTSD, the person shows increasing symptoms during the first month after a traumatic event rather than lessening symptoms.
Who is at risk for acute stress disorder?
It can be hard to predict which individuals will experience acute stress disorder, but some factors increase risk. For example, those with a history of mental disorder or neurotic personality and those with avoidant coping styles have increased risk, as well as those who have previously experienced a traumatic event.
Some may lack necessary support, and others may have a genetic disposition. Additionally, acute stress disorder is more common in females than males, although it occurs in both.
Acute Stress Disorder Treatment
Treatment usually falls under one of three categories: psychological “first aid”, psychotherapy, and pharmacological. Some people may benefit from sleeping aids as well as low doses of benzodiazepines for severe anxiety. However, benzodiazepines may increase the risk of developing PTSD. Medicines are not typically recommended.
Psychological “first aid” methods that aim to educate and provide support initially after a traumatic event are helpful and often occur before psychotherapy. They may be provided by police, first responders, and medical personnel. Psychological “first aid” includes:
- Attending to immediate needs and assuring confidentiality
- Providing for safety and comfort, including clothing, food, and water, and protecting from further harm
- Listening
- Stabilizing the person and instilling hope
- Gathering information about the traumatic event
- Providing practical assistance AND
- Connecting to needed services and support systems
Trauma-Focused Cognitive Behavioral Therapy
The type of psychotherapy most commonly used is trauma-focused cognitive behavioral therapy, which is usually initiated two weeks after a traumatic event and continued for six or more weekly sessions.
Studies show trauma-focused cognitive behavioral therapy, which helps people cope with the impact of trauma, may relieve symptoms and prevent progression to PTSD.
There are three different approaches to trauma-focused cognitive behavioral therapy that are commonly used:
- First, cognitive restructuring therapy is recommended, which helps individuals recognize and change unrealistic or negative thoughts about the traumatic event.
- Second is the common elements treatment approach (CETA), which focuses on alleviating the symptoms of acute stress disorder.
- Third is exposure therapy, which focuses on re-introducing memories of the traumatic event and the negative emotions associated with those memories. Sometimes this is done by returning to the scene of the trauma or asking the individual to discuss the details of the traumatic event in full. In some cases, exposure therapy may be delayed to minimize the risk of worsening the individual’s symptoms, such as those experiencing extreme dissociation, those indicating risk of suicide, those experiencing extreme anger or grief, and those with other psychiatric disorders.
Traumatic events are common in life and difficult to avoid, but different individuals may perceive the same event in very different ways.
Most individuals react with some degree of fear and anxiety, and this can trigger physical and psychological changes that can lead to acute stress disorder and, in some to PTSD, so it’s important to be aware of the symptoms and to provide the necessary support to those experiencing trauma.
That’s all for this review.
Thanks for watching and happy studying.
