ACUTE STRESS DISORDER and POSTTRAUMATIC STRESS DISORDER: Reactions to Severe Life Stressors

Acute Stress Disorder & Posttraumatic Stress Disorder (PTSD)

The stressor is unusually severe, involving intense fear, and is psychologically traumatic for example life threatening situation, the destruction of ones home, seeing another person mutilated or killed, or being the victim of physical violence.

 Acute stress disorder and PTSD often go hand-inhand. This is because a diagnosis of PTSD can only be given one month after the experience of a traumatic event. Yet, it is likely that people may be experiencing PTSD-like symptoms soon after a traumatic event.
The 4th edition of the Diagnostic and Statistical Manual for mental disorders describes these PTSD-like symptoms occurring within one month of a traumatic experience as Acute Stress Disorder or ASD.

Symptoms of Acute Stress Disorder

The symptoms of ASD are similar to those of PTSD except they occur soon after the experience of a traumatic event. ASD symptoms include the reexperiencing avoidance and hyperarousal symptom of PTSD. For example, a person with ASD may experience frequent thoughts, memories, or dreams about the traumatic event. They may also constantly feel "on-edge" or try to avoid reminders of the event.

 ASD also includes symptoms of dissociation. Dissociation is an experience where a person may feel disconnected from himself and/or his surroundings. Dissociation may range from temporarily losing touch with what is going on around you (such as what happens when you daydream) to having no memories for a prolonged period of time and/or feeling as though you are outside of your body.

Getting Diagnosed with Acute Stress Disorder

It is normal to experience certain stressrelated symptoms following the experience of a traumatic event. Therefore, to be diagnosed with ASD, a person must meet certain requirements (or criteria). These requirements are described by the DSM-IV and are provided on the next page:

 Criterion A
A person must have experienced a traumatic event where both of the following occurred: The person experienced, witnessed, or was confronted with an event where there was the threat of or actual death or serious injury. The event may also have involved a threat to the person's or another person's physical well-being. The person responded to the event with strong feelings of fear, helplessness, or horror.

 Criterion B
The person experiences at least three of the following dissociative symptoms during or after the traumatic event: Feeling numb or detached or having difficulties experiencing emotions. Feeling dazed or not entirely being aware of surroundings. Derealization, or feeling as though people, places, and things are not real. Depersonalization, or feeling separated and detached from oneself. Dissociative amnesia, or being unable to recall important parts of the traumatic event.

 Criterion C
The person has at least one re-experiencing symptom, such as having frequent thoughts, memories, or dreams about the event.

Criterion D
The person attempts to avoid people, places, or things that remind him or her about the event.

 Criterion E The person has hyperarousal symptoms, such as feeling constantly on guard or jumpy, having difficulties sleeping, problems with concentration, or irritability. Criterion F The symptoms described above have a great negative impact on the life of the person experiencing them, interfering with work or relationships. Criterion G The symptoms last for at least 2 days and at most 4 weeks. The symptoms also occur within 4 weeks of experiencing the traumatic event. Criterion H The symptoms are not due to an illness or other medical condition, medication being taken, or

 PTSD Symptoms
The persistent event is persistently reexperienced by the person. The person persistently avoids stimuli associated with the trauma. The person may experience persistent symptoms of increased arousal, such as chronic tension and irritability often accompanied by insomnia, the inability to tolerate noise and the complaint that I just cant seem to relax. The individual may experience impaired concentration and memory. The individual may experience feelings of depression

 Acute Disorder occurs within 4 weeks of the traumatic event and last for a minimum of 2 days and maximum of 4 weeks. If the symptoms last longer, the appropriate diagnosis is PTSD. If symptoms begin within 6 months after the traumatic situation, the reaction is considered to be acute. If the symptoms begin more than 6 months after the traumatic situation, the reaction is considered to be delayed.

 Acute Stress Disorder and PTSD

ASD is a serious condition. People with ASD have been found to be at greater risk for eventually developing PTSD. Because of the dissociation symptoms of ASD, a person may not be able to recall important parts of the event, as well as the emotions they experienced. This might interfere with a person's ability to fully process the impact of the event and their emotions about the event, hindering the recovery process.

Conclusion
If you think you may have ASD, it is important that you meet with a mental health professional trained in assessing and treating ASD. The earlier you recognize and address these symptoms, the greater the chance you have of preventing the development of PTSD.

We will now look at some general principles underlying reactions to catastrophic events. Then we will turn to some specific stressor that can cause posttraumatic stress.

The reactions of many victims to catastrophes is called Disaster Syndrome

 A persons initial responses following a disaster involve 3 stages: (a) the shock stage in which the victim is stunned, dazed and apathetic;
(b) the suggestible stage in which the victim tends to be passive, suggestible, and willing to take directions from rescue workers or others; and (c) the recovery stage in which the victim may be tense and apprehensive and show generalized anxiety, but gradually regains psychological equilibrium often showing a need to repeatedly tell about the catastrophic event. It is in this stage that PTSD may develop.