Acute Stress Disorder

Acute stress disorder occurs in some people who have experienced trauma or significant stress. It may cause flashbacks and nightmares, difficulty sleeping, avoidance, withdrawal, and other symptoms that cause impairment. Many people with acute stress disorder can benefit from professional treatment, although some will see a resolution of symptoms without help. Treatment can minimize symptoms and prevent the condition from persisting and even transitioning to post-traumatic stress disorder, a longer-term and more serious mental illness.

What Is Acute Stress Disorder?


Acute stress disorder, or ASD, is a mental health condition related to stress and trauma. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is used by professionals to make diagnoses, it is categorized with similar conditions, like posttraumatic stress disorder and adjustment disorders. These are all conditions that are triggered by traumatic experiences.

The trauma that causes ASD may be something that occurred directly to an individual, but it can also be something the person witnessed or heard about happening to a loved one. Examples include being a victim of violence, being in a bad car accident, or losing a loved one in a sudden and unexpected way. Not everyone who goes through trauma will experience ASD.

The symptoms of ASD begin within a month of the traumatic experience and persist for no longer than a few weeks. They may include intrusive memories of the trauma, flashbacks, or nightmares, avoidance of reminders of trauma, depression, and difficulty functioning in normal activities. It is possible to recover from ASD without support, but some people need professional treatment. It is possible for ASD to develop into post-traumatic stress disorder (PTSD) if not treated.

Types of Acute Stress Disorder


The DSM-5 only lists one type of acute stress disorder, and there is not much variation in the criteria. However, ASD can be classified by the kind of trauma that triggers the condition. For instance, someone diagnosed with ASD may have experienced trauma personally, such as being assaulted. Or, the patient could have witnessed something traumatic happening to someone else, like a murder.

It is also possible to develop ASD after hearing about trauma or being exposed to events over and over again. Someone with ASD may have heard about something bad that happened to a loved one, for example. Or, as is most common in first responders, a person may have been exposed to details of trauma on a daily basis, even if they did not experience the trauma personally.

Facts and Statistics


Not everyone who experiences trauma or witnesses a traumatic event will develop a mental health condition. Among those who do have these experiences, ASD is not uncommon.

  • ASD can develop into PTSD if symptoms persist for more than about a month.
  • About half of all people diagnosed with PTSD initially presented with ASD.
  • Between 20 and 50 percent of people who were victims of assault or witnesses of assault were later diagnosed with ASD.
  • Other types of trauma are less likely to cause ASD. Only about 20 percent of people experiencing these other types will be diagnosed.
  • Thirteen to 21 percent of people involved in accidents are diagnosed with ASD.
  • Fourteen percent of people suffering from a traumatic brain injury will develop ASD.
  • Ten percent of people who have been severely burned develop ASD.

Symptoms and Diagnosis of Acute Stress Disorder


The first criterion for being diagnosed with ASD is to have experienced some type of trauma, either directly or indirectly. The symptoms of ASD then must last for at least three days and occur within a month of the trauma. To be diagnosed, a person must experience at least nine of the following 14 symptoms:

  • Intrusive, unwanted, and recurring memories of the trauma
  • Distressing and recurring dreams or nightmares that force the individual to relive the trauma
  • Flashbacks, which are very realistic and frightening memories of the trauma that can make a person feel as if they are reliving the experience
  • Distress in the face of any reminders of the experience
  • Difficulty feeling positive emotions
  • Dissociation, a sense of being separate from oneself, others, or objects
  • Selective amnesia, specifically forgetting aspects of the trauma, that is not caused by a physical injury, such as a brain injury
  • Avoidance of anything that reminds the person of the traumatic event
  • Avoidance of memories of or talking about the event
  • Sleeping more than normal or having insomnia
  • Trouble concentrating and focusing on tasks
  • Angry or irritable outbursts that seem irrational
  • A startle response that has become exaggerated
  • Extreme, irrational vigilance

For a diagnosis, these symptoms have to cause significant impairment in a person’s life, such as preventing them from going to school or work. The symptoms also cannot be caused by substance use, a medication, or a medical condition.

Causes and Risk Factors

Unlike many other mental illnesses, there is a known cause of ASD. Without a traumatic experience this condition would not exist. Trauma is the triggering cause, but there is still an imperfect understanding of why some people can go through trauma and not develop symptoms while others struggle and are diagnosed with ASD.

There are some known risk factors that have been recorded that indicate a person may be at an increased risk for developing ASD if they go through a traumatic experience, including:

  • Already having experienced trauma in the past
  • Experiencing a trauma that is particularly severe or extreme
  • Being assaulted or otherwise a victim of intentional violence
  • Having another mental illness, especially if it is not being managed or treated
  • Using coping strategies that involve avoiding the trauma or talking about it
  • Being female
  • Having a personality type that tends toward neurotic

ASD itself is a risk factor for PTSD. About half of people diagnosed with PTSD, which is a longer-lasting type of trauma disorder, had ASD first. The risk of developing PTSD after ASD can be minimized with good treatment and support. The sooner treatment is given the lower the risk will be.

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Co-Occurring Disorders


Co-Occurring disorders are not uncommon with any mental illness and may be another mental health condition or a substance use disorder. While PTSD and ASD are closely related, they are not considered co-occurring. PTSD can occur after ASD but not at the same time.

Having a mental illness is considered a risk factor for ASD, so it is not uncommon for someone diagnosed with ASD to also get a diagnosis of one or more other conditions. Additionally, the experience of trauma and the stress it causes can trigger, worsen, or initiate the onset of a set of symptoms that are diagnosed as a mental illness. Some of the more common mental illnesses that co-occur with ASD are anxiety disorders, major depression, and persistent depressive disorder.

Also common with ASD and other trauma disorders is substance abuse, which may or may not develop into a substance use disorder. It is typical for someone who is not coping well with a traumatic experience to use drugs or alcohol as a way to self-medicate. Misusing substances is not just a poor coping mechanism; it can also have negative consequences, such as addiction, legal and financial problems, and damaged relationships.

Treatment and Prognosis of Acute Stress Disorder


Not everyone needs treatment to resolve the symptoms of ASD, but there are many benefits of professional support. With care from experienced professionals, a patient will likely get relief from symptoms sooner and will learn coping mechanisms and stress management strategies that will help them deal better with trauma and stress in the future. Also, treatment can lower the risk that ASD will develop into PTSD, which is more difficult to treat.

Treatment for ASD does not need to go on for months. Short-term therapy can make a big difference. Behavioral therapies with a focus on trauma can help a patient with ASD face the traumatic experience and memories, reframe the event, process emotions associated with it, and learn to change negative feelings, thoughts, and behavior patterns. This kind of therapy can also teach a person better coping skills to manage stress and trauma.

Also important in the treatment of ASD is the diagnosis and management of any other mental illnesses or substance use disorder. The best and most effective treatments address all of a patient’s mental health needs, so managing depression or treating addiction is crucial to overall wellness and recovery from ASD.

Most people who develop ASD will get a good prognosis. This is a short-term condition, not a chronic one, so within a month a patient getting treatment should be feeling and functioning better. The exception to this is someone who transitions to PTSD or who experiences additional trauma. Treatment is the best defense against PTSD and can help someone react better to any future trauma.