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Acute Stress Disorder

Acute Stress Disorder

Acute stress disorder is a mental illness that may develop after an intense traumatic experience. It can lead to serious psychological & emotional symptoms and may result in PTSD, if left untreated.


What Is Acute Stress Disorder?

Acute stress disorder (ASD) is a psychological reaction to an unexpected, traumatic, terrifying or life-threatening experience. The term ‘acute’ refers to the fact that the symptoms develop almost immediately after the stressful event, but usually do not last long. The response to the traumatic event is usually dysfunctional and persists for at least three days or up to a month. However, if the symptoms last for over one month, then it may be diagnosed as posttraumatic stress disorder (PTSD).

According to a report from Harvard Medical School, this mental health condition occurs “when symptoms develop within the first month after a traumatic event. When symptoms appear six months or more after a stressful event, the term PTSD with delayed onset (or delayed expression) is used.”

The American Psychiatric Association explains that around 13-21% of car accidents survivors develop ASD; while 20-50% of mass shootings, rape and assault survivors experience it. Moreover, about 50% of people suffering from acute stress disorder develop posttraumatic stress disorder (PTSD), when left untreated. However, the United States Department of Veterans Affairs claims that about 19% of people surviving a traumatic event will develop ASD. It may result in major distress in the daily life of the sufferer. Moreover, it can also lead to poor performance at school or work and other crucial tasks.

Read More About Post-traumatic stress disorder (PTSD) Here

Understanding ASD

First introduced into DSM-IV 1 as a diagnostic category in 1994, ASD is also known as acute stress reaction or psychological shock. It is a type of anxiety disorder that is characterized by severe stress symptoms in the first month after the traumatic event. It may cause a wide range of symptoms in the sufferer, like –

  • Severe anxiety
  • Numbness
  • Feeling dazed
  • Dissociation
  • Detachment from self
  • Insomnia
  • Recurrent nightmares, flashbacks & recollections
  • Distress when exposed to reminders

Each of us responds and reacts to trauma and adverse experiences in our unique way. But it is crucial that we understand how such events can emotionally and psychologically affect us afterward. According to The Merck Manual, “People mentally re-experience the traumatic event, avoid things that remind them of it, and have increased anxiety.” Acute stress disorder may also lead to the development of severe behavioral disturbances and extreme generalized anxiety. This can make the sufferer experience recurrent thoughts, dreams, visual images and flashbacks igniting the memories of the trauma. As a trauma response, the sufferer may experience dissociative symptoms along with reduced emotional responsiveness.

This can prevent them from feeling joy or pleasure from enjoyable activities or feeling shame and guilt for performing daily tasks. It can also affect their concentration and have difficulty remembering specific details about the negative & traumatic experiences. This is known as dissociative amnesia. The sufferers may feel like they are in a dreamlike or unreal state and feel detached from their own emotions and body. However, they may have a poor memory of the event. They may also experience hyperarousal and hypervigilance leading to restlessness, insomnia and irritability.

Read More About Anxiety Here


Most of the ASD symptoms are similar to PTSD as both these conditions are closely linked. However, ASD is a separate condition and the time frame of the symptoms is a major difference between ASD & PTSD. ASD symptoms must be present in the sufferer for 3-30 days to be diagnosed properly. But the diagnosis can transform to posttraumatic stress disorder (PTSD), if the symptoms are present for over a period of 30 days after the traumatic event. However, according to a 2018 study 2, it can be often difficult to effectively distinguish between ASD and PTSD. The study explains that research highlights “the complexity of accurately differentiating between symptoms of PTSD and ASD, particularly in young children who are unable to articulate their experiences.”

Although not all patients suffering from ASD may develop PTSD, it has been observed that acute stress disorder can increase the risk of developing posttraumatic stress disorder. One 2005 study 3 reveals “The research to date on the utility of the ASD diagnosis has found it to be highly predictive of PTSD status 3 to 6 months after the trauma in cases where either full ASD criteria are met or when at least two ASD criteria are not met.”

Effective and immediate diagnosis and treatment of ASD can help sufferers control the symptoms and enable them to substantially reduce the risk of developing PTSD.

Symptoms Of Acute Stress Disorder

Symptoms Of Acute Stress Disorder
Acute Stress Disorder

According to the research paper ‘Stress: Physiology, Biochemistry, and Pathology’, ASD is “characterized by the presence of nine (or more) of symptoms from any of the five categories of Intrusion, depressed mood, dissociation, avoidance, and arousal, which began or worsened after the traumatic event(s) and lasted for the first month after the trauma.”

The symptoms of acute stress disorder are similar to that of PTSD. Here are some psychological and physical symptoms of ASD:

A. Psychological Symptoms

People with acute stress disorder may experience the following 5 categories of symptoms:

1. Intrusion Symptoms

The sufferer may recollect memories of the traumatic event to mentally re-experience the trauma through flashbacks or dreams. This is mostly involuntary and uncontrollable which makes it difficult for the person to stop. The experience may involve:

  • Having recurring thoughts, flashback, nightmares, visualizations, images or illusions of the traumatic event
  • An intense feeling that they are revisiting and reliving the negative event
  • Experiencing distress when reminded of the traumatic experience

More About Nightmares And Nightmare Disorder Here

2. Negative Mood

A person with ASD may feel a range of negative emotions, like low mood, distress, sadness, helplessness and difficulty feeling positive emotions. These can affect their daily functioning leading to poor performance in work or school. It may also affect their relationships and social life as well.

3. Dissociative Symptoms

People with ASD may experience dissociation. This can lead to a lack of awareness about themselves and their surroundings, unable to remember specific details about the traumatic event and an altered sense of reality. Here are some other common dissociative symptoms:

  • Decreased awareness of their environment
  • Feeling emotionally unresponsive, dazed, numb or detached
  • Experience depersonalization. Feeling that their thoughts or emotions are unreal or don’t belong to them
  • Feelings of physical displacement or having an out of body experience
  • Experience derealization. Feeling that their environment is not real or strange
  • Sensing an altered perception of time
  • Experience dissociative amnesia, making them unable to recall particular important details about the traumatic experience

4. Avoidance Symptoms

People with this mental condition often purposefully avoid stimuli that may trigger feelings or thoughts related with the traumatic event. Hence, they may avoid people, places, objects, activities or conversations which may remind them of the negative experience.

5. Arousal Symptoms

Hypervigilance and hyperarousal are common symptoms of ASD. These can also lead to associated symptoms, like:

  • Sleep disturbances or insomnia
  • Angry outbursts or irritable mood
  • Inability to focus
  • High levels of anxiety
  • Difficulty concentrating
  • Easily startled
  • High alertness
  • Difficulty being still
  • Constantly on guard or tensed

Read More About Insomnia Here

B. Physical Symptoms

Apart from these, there may be some physical symptoms of acute stress disorder that are usually a result of overactivity in the nervous system or caused due to stress hormones like adrenaline. Some of these symptoms are:

  • Heart palpitations
  • Chest pain
  • Difficulty breathing
  • Nausea
  • Fatigue
  • Stomach pain
  • Headache
  • Sweating

The psychological, behavioral and physical symptoms of acute stress disorder can lead to feelings of intense fear or terror, depression, gastrointestinal & rheumatic symptoms as well. However, these usually tend to go away within a couple of weeks.

Causes Of Acute Stress Disorder

Causes Of Acute Stress Disorder
Acute Stress Disorder

Witnessing or experiencing one or more deeply traumatic events may lead to the development of acute stress disorder. However, the likelihood of being affected by this mental condition may depend on the severity of the traumatic event. ASD can occur from possible traumatic events, like –

  • Natural disasters, like earthquakes, fires or floods
  • Car accidents or other types of accidents
  • Domestic violence, physical or sexual assault or rape
  • Receiving diagnosis of a life-threatening injury or terminal illness
  • Sudden death of a loved one
  • Mass shooting or witnessing a murder
  • Terrorist attacks or a combat
  • An unexpected life crisis
  • Surviving a brain injury
  • Facing serious and extremely difficult life challenges

Apart from these, military personnel are also at higher risk of developing this mental disorder due to adverse and severe experiences during conflicts. However, viewing negative events on the news, television, social media or other online media is generally not believed to trigger this psychiatric disorder.

Moreover, psycho-biological, biological and cognitive factors are also theoretically considered as causes for ASD. Although such theories are based on PTSD, these can be helpful in understanding the causes of ASD as the symptoms are largely similar for both disorders. According to a 2017 study 4, cognitive function can be affected in the long run even by a single stressful experience or event.

Who Is At Risk For Developing ASD?

Although many studies have been conducted on people at risk for experiencing PTSD, few studies focused on the risk factors for developing acute stress disorder. The United States Department of Veterans Affairs explains “Trauma as a result of an assault is associated with a higher risk for developing ASD than other types of trauma.”

Research reveals that anyone may develop this condition after witnessing or experiencing a traumatic event. However, the risk for experiencing ASD may increase, if you have:

  • A history of ASD or PTSD
  • A history of dissociative symptoms due to traumatic events
  • A history of trauma
  • A history of psychiatric disorders
  • A greater trauma severity
  • Neurotic personality traits
  • Avoidant coping tendencies
  • Witnessed or experienced a traumatic event previously

Moreover, the United States Department of Veterans Affairs also suggests that you have a higher risk of developing ASD if you are a female or if you’re younger than 40 years of age.

Diagnosis Of Acute Stress Disorder

To diagnose acute stress disorder, the symptoms must result in medically significant distress. Moreover, it must cause impairment in the sufferer’s ability to perform necessary tasks in occupational, social or other vital areas of functioning. The problems related to ASD must persist for at least 3 days and for a maximum period of 30 days. The symptoms must also be experienced within 4 weeks of experiencing or witnessing the traumatic event. Moreover, the symptoms should not be caused by substance abuse, medications or a pre-existing medical condition. It should also not be a result of another psychotic disorder.

Exposure to serious injury, threatened or actual death, sexual violation or other traumatic events is one the basic requirements for diagnosis. According to the DSM 5 diagnostic criteria for ASD, a person must experience at least 9 of The following symptoms for 3 days up to one month:

  • Recurrent and involuntary distressing traumatic event memories
  • Persistent distressing dreams of the event
  • Dissociative reactions like flashbacks
  • When reminded, there is intense psychological or physiological distress
  • Inability to feel positive emotions
  • An altered sense of reality
  • Inability to remember details of the event
  • Avoid distressing memories associated with the event
  • Avoid external reminders associated with the event
  • Hypervigilance
  • Difficulty concentrating
  • Sleep disturbance
  • Increased startle response
  • Irritability or anger outbursts

A doctor or mental healthcare professional may ask questions about the symptoms and the traumatic event to diagnose ASD. They may also review the patient’s medical history.

Read More About DSM 5 Here

Treatment Of Acute Stress Disorder

Most people suffering from this condition may not require any treatment at all as the symptoms may go away naturally once the person learns to deal with or overcome the traumatic event. However, treatment 5 may be necessary for ASD when the symptoms are persistent and severe. ASD treatment usually includes psychotherapy, medication or a combination of both. Effective treatment can help in relieving the symptoms, improving coping mechanisms and reducing the likelihood of developing PTSD. But if ASD symptoms do not improve after treatment, then the patient may be diagnosed for PTSD.

Here are some of the available treatment options for acute stress disorder:

1. Therapy

According to the American Psychiatric Association, “Psychotherapy, including cognitive behavior therapy can help control symptoms and help prevent them from getting worse and developing into PTSD.” Trauma-focused cognitive-behavioral therapy (CBT) 6 can prove to be effective for the successful treatment of ASD. It is a form of talk therapy that can help us alter our thought and behavior patterns. Trauma-focused CBT may involve exposure, cognitive restructuring and patient education.

CBT can help the sufferer to identify negative thoughts that lead to anxiety and stress. Moreover, it can also help patients to develop coping strategies and enhance recovery speed. CBT can also help in preventing the disorder from becoming PTSD. One study 7 revealed that “ PTSD can be effectively prevented with an early provision of cognitive behavior therapy and that prolonged exposure may be the most critical component in the treatment of acute stress disorder.”

Apart from trauma-focused cognitive-behavioral therapy, some other therapy options may also be used in the effective treatment for acute stress disorder, such as:

  • Exposure-based therapies
  • Hypnotherapy
  • Cognitive therapy
  • Psychological debriefing

Read More About Cognitive Behavioral Therapy (CBT) Here

2. Medications

Medications like anticonvulsants or antidepressants may be prescribed by a doctor to treat the symptoms of ASD. “Medication, such as SSRI antidepressants can help ease the symptoms,” adds the American Psychiatric Association. However, medication is not considered as the first-line treatment for this condition.

The World Health Organization (WHO) has advised against prescribing sleeping pills or anti-anxiety drugs like benzodiazepines for the treatment of ASD in adults. Moreover, the British National Formulary claims that benzodiazepines, if prescribed at all, should be used for “short-term relief of severe anxiety only.” These types of medications must be used in the lowest possible dose for a brief period of time. These should generally be avoided due to high risk of dependence and tolerance. A type of non-addictive medication, known as beta-blockers, may also be prescribed for reducing the physical symptoms associated with this mental health condition.

3. Relaxation Techniques

Practicing mindfulness can be an excellent way to cope with ASD. Mindfulness practices can help the sufferer to reduce the feelings of anger, anxiety, stress, isolation and sadness.

Mindfulness-based interventions can help the sufferer to learn anxiety and stress management strategies, such as breathing exercises, yoga, mindfulness meditation and other relaxation techniques. A 2016 study 8 found that relaxation techniques like mindfulness, deep breathing, yoga, and meditation “are shown to help address the physiological manifestations of prolonged stress.” It adds “By utilizing these techniques traditional therapies can be complemented.” However, most studies 9 “emphasizes on long and regular practice” for effective and faster recovery from ASD.

Self-Care Of Acute Stress Disorder

Apart from treatment, self-care is also a crucial aspect of the recovery process. This is especially important during the treatment process. Practicing self-care routines like following a nutritious diet and regular exercise can greatly help in reducing stress, anxiety and depression. One 2012 study 10 reveals “Regular exercise is thought to be associated with stress reduction and better mood, which may partly mediate associations between depression, stress, and health outcomes.”

Moreover, getting good quality sleep and following a healthy sleep schedule is also highly recommended. The patient should also refrain from consuming alcohol or drugs for complete recovery from ASD.

How You Can Help A Loved One

If a family member or a friend is suffering from acute stress disorder, then you can take a few steps to help them cope with their condition. Apart from encouraging them to seek professional help and continue treatment, you can ask them to talk about what they are feeling.

Here are a few ways to help a loved one with ASD:

1. Listen To Them

Be willing to listen to them without forcing them to talk. By being an active listener without trying to judge them to “fix” their problem, you can give them the necessary support. However, make sure to be patient and give them enough space so that they can talk when they are comfortable. Simply inform them that you are available to help them.

2. Talk To Them

When your loved one is willing to talk, then make sure you truly listen to them without any interruptions or distractions. Ask them questions if you have any doubt but refrain from reminding them of the traumatic event as it might trigger an inappropriate reaction. You also need to ensure that you refrain from making assumptions and avoid giving advice, unless asked.

3. Seek Help

If the person affected by acute stress disorder starts exhibiting suicidal behavior or talks about suicide, then make sure to seek professional help immediately. However, it is crucial that you remain calm and discreetly remove any objects that can lead to self-harm, like sleeping pills, sharp objects or any weapons. Based on the severity of the condition, a healthcare professional may recommend hospitalization.

Recovery Is An Ongoing Process

Acute stress disorder is a common mental illness that can be overcome successfully. Unfortunately, there is no effective prevention for ASD as we can never accurately predict what traumatic event we may experience in life. Therapy, counseling, medication, relaxation techniques and self-care is the best way to cope with sudden traumatic experiences and reduce the risk of developing PTSD.

Learning about ASD and PTSD can not only help the sufferer, but also enable their friends and family to provide better support leading to complete recovery. Moreover, staying connected with social support groups can also help.

👇 References:
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  2. Stavropoulos, K. K., Bolourian, Y., & Blacher, J. (2018). Differential Diagnosis of Autism Spectrum Disorder and Post Traumatic Stress Disorder: Two Clinical Cases. Journal of clinical medicine, 7(4), 71. []
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  6. Bryant, R. A., Harvey, A. G., Dang, S. T., Sackville, T., & Basten, C. (1998). Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling. Journal of consulting and clinical psychology, 66(5), 862–866. []
  7. Bryant, R. A., Sackville, T., Dang, S. T., Moulds, M., & Guthrie, R. (1999). Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counseling techniques. The American journal of psychiatry, 156(11), 1780–1786. []
  8. Scotland-Coogan, D., & Davis, E. (2016). Relaxation Techniques for Trauma. Journal of evidence-informed social work, 13(5), 434–441. []
  9. Heidari Gorji, M. A., Davanloo, A. A., & Heidarigorji, A. M. (2014). The efficacy of relaxation training on stress, anxiety, and pain perception in hemodialysis patients. Indian journal of nephrology, 24(6), 356–361. []
  10. Hamer, M., Endrighi, R., & Poole, L. (2012). Physical activity, stress reduction, and mood: insight into immunological mechanisms. Methods in molecular biology (Clifton, N.J.), 934, 89–102. []