Among the criteria for the diagnosis of Acute Stress Disorder specified in the Diagnostic and Statistical Manual – IV (DSM-IV) the person, either while or after experiencing the distressing event, has three or more of the symptoms listed above. The problems must cause clinically significant distress or impairment in social or other important areas of functioning. The symptoms must last for a minimum of 2 days and a maximum of 4 weeks and must occur within 4 weeks of the traumatic event, and not be the result of a preexisting medical condition.

Overview

Unlike most psychiatric disorders both Acute Stress Disorder and Post-Traumatic Stress Disorder are triggered by a specific event. Acute Stress Disorder refers to a reaction occurring within 4 weeks and lasting from 2 days to 4 weeks after an individual was exposed to a trauma. The person responded with intense fear, helplessness or horror to an event or events that involved actual or threatened death or serious injury, or a threat to the one’s physical integrity. Examples are rape, mugging, combat, natural disasters, etc. Acute stress disorder is a diagnostic category introduced in 1994 to differentiate time-limited reactions to trauma from post-traumatic stress disorder (PTSD). Not all individuals exposed to trauma will experience a disorder. The impact of a traumatic event on a child, depends on the severity of the event and the child’s previous level of functioning.

Diagnosis

Among the criteria for the diagnosis of Acute Stress Disorder specified in the Diagnostic and Statistical Manual – IV (DSM-IV) the person, either while or after experiencing the distressing event, has three or more of the symptoms listed above. The problems must cause clinically significant distress or impairment in social or other important areas of functioning. The symptoms must last for a minimum of 2 days and a maximum of 4 weeks and must occur within 4 weeks of the traumatic event, and not be the result of a preexisting medical condition.

Signs and Symptoms

  • A subjective sense of numbing, detachment, or absence of emotional responsiveness
  • A reduction in awareness of his or her surroundings (e.g., “being in a daze”)
  • Depersonalization – feeling that one’s body is unreal, is changing, or dissolving
  • De-realization – perception that the external environment is unreal
  • Dissociative amnesia – the mind splits off certain aspects of the trauma from conscious awareness; can affect the person’s memory, sense of reality and sense of identity.

The traumatic event is persistently re-experienced in least one of the following ways:

  • Recurrent images, thoughts, dreams, illusions, flashback episodes or a sense of reliving the experience, or distress on exposure to reminders of the event.
  • Significant avoidance of stimuli that arouse recollections of the trauma, such as avoiding thoughts, feelings, conversations, activities, places, people.
  • Significant symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).

Treatment

Treatment usually includes a combination of antidepressant medications and short-term cognitively based psychotherapy. The prognosis for recovery is influenced by the severity and duration of the trauma, the patient’s closeness to it, and the patient’s previous level of functioning. Favorable signs include a short time period between the trauma and onset of symptoms, immediate treatment, and appropriate social support.