A person who has experienced or witnessed a life-threatening, terrifying or otherwise deeply traumatic event may, in some cases, develop acute stress disorder (ASD), sometimes also called acute stress reaction. Examples of such events include:
Natural disasters, such as floods, fires or earthquakes
Physical or sexual assault
Car accidents
Sudden death of a loved one
Receiving a life-threatening diagnosis
People with acute stress disorder have been exposed to a terrifying event. They may experience it directly or indirectly. For example, direct exposure may involve experiencing serious injury, violence, or the threat of death. Indirect exposure may involve witnessing events happening to others or learning of events that occurred to close family members or friends. People mentally re-experience the traumatic event, avoid things that remind them of it, and have increased anxiety.
People with this disorder may have dissociative symptoms. For example, they may feel emotionally numb or disconnected from themselves. They may feel that they are not real.
The number of people with acute stress disorder is unknown. The likelihood of developing acute stress disorder is greater when traumatic events are severe or recurrent.
Acute stress disorder can develop following a person’s exposure to one or more traumatic events. Symptoms may develop after an individual either experiences firsthand or witnesses a disturbing event involving a threat of or actual death, serious injury, or physical or sexual violation. Symptoms begin or worsen after the trauma occurs and can last from three days to one month.
It is estimated that between 5 and 20 percent of people exposed to a trauma such as a car accident, assault, or witnessing a mass shooting develop acute stress disorder. And approximately half of those go on to develop post-traumatic stress disorder.
The diagnosis of acute stress disorder was established to identify those individuals who would eventually develop post-traumatic stress disorder. The condition was referred to as “shell shock” as far back as World War I, based on similarities between the reactions of soldiers who suffered concussions caused by exploding bombs or shells and those who suffered blows to their central nervous systems. More recently, acute stress disorder came to recognize that people might exhibit PTSD-like symptoms for a short period immediately after a trauma.
Trauma has both a medical and a psychiatric definition. Medically, trauma refers to a serious or critical bodily injury, wound, or shock, and trauma medicine is practiced in emergency rooms. In psychiatry, trauma refers to an experience that is emotionally painful, distressful, or shocking, often resulting in lasting mental and physical effects.
In general, it is believed that the more direct the exposure to a traumatic event, the higher the risk for mental harm. Thus in a school shooting, for example, the student who is injured will likely be the most severely psychologically affected, and the student who sees a classmate shot or killed is likely to be more affected than the student who was in another part of the school when the violence occurred. Even secondhand exposure to violence can be traumatic. For this reason, all children and adolescents exposed to violence or a disaster, even if only through graphic media reports, should be watched for signs of emotional distress.
Signs and Symptoms
Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.
A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD.
To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:
At least one re-experiencing symptom
At least one avoidance symptom
At least two arousal and reactivity symptoms
At least two cognition and mood symptoms
Re-experiencing symptoms include:
Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
Bad dreams
Frightening thoughts
Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.
Avoidance symptoms include:
Staying away from places, events, or objects that are reminders of the traumatic experience
Avoiding thoughts or feelings related to the traumatic event
Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.
Arousal and reactivity symptoms include:
Being easily startled
Feeling tense or “on edge”
Having difficulty sleeping
Having angry outbursts
Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.
Cognition and mood symptoms include:
Trouble remembering key features of the traumatic event
Negative thoughts about oneself or the world
Distorted feelings like guilt or blame
Loss of interest in enjoyable activities
Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.
It is natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.
Symptoms of acute stress disorder typically manifest immediately after a traumatic event. For a diagnosis of ASD to be made, they need to be present for between three and 30 days.
People who are affected by ASD tend to experience extreme feelings of terror and helplessness in reaction to the trauma and may develop psychological and physical symptoms.
The physical symptoms are typically caused by stress hormones such as adrenaline (epinephrine) and an overactivity of the nervous system. They may include:
Palpitations, i.e. a pounding heart
Difficulty breathing
Chest pain
Headache
Stomach pain
Nausea
Sweating
These symptoms usually develop within minutes or hours of the traumatic event and may clear within a few hours or days. However, in some cases the symptoms persist for weeks.
Psychological symptoms of acute stress disorder include:
Arousal: Hypervigilance, an inability to focus, sleep disturbances, irritable mood and angry outbursts
Avoidance: Determination to avoid memories, people, feelings or places associated with the trauma
Dissociation: A sense of physical displacement, e.g. seeing oneself from outside one’s body, feeling dazed, experiencing an altered perception of time, difficulty remembering the event
Intrusion: Recurrent, involuntary flashbacks of the event, nightmares about the event
Negative mood: A generalized low mood, difficulty feeling and/or expressing positive emotions
If you are concerned about any symptoms, you can try using the Ada app for a free assessment.
ASD versus PTSD
Many of the symptoms of ASD are almost identical to those of PTSD. However, a diagnosis of PTSD will only be considered if the symptoms persist for more than 30 days or first appear more than one month after the trauma has occurred.
Though many people who are diagnosed with ASD do not go on to develop PTSD, it is thought that having the former may increase a person’s risk of developing the latter. A prompt diagnosis of ASD can help people manage the condition and reduce the risk of them developing PTSD.
Causes
Acute stress disorder can develop after a person, of any age, experiences or witnesses a deeply distressing or traumatic event – often one that is life-threatening or perceived as life-threatening. Examples include:
Natural disasters, such as floods, fires or earthquakes
Serious accidents
Physical or sexual assault, including domestic abuse
Combat
Terrorist attacks
Sudden death of a loved one
Receiving a life-threatening diagnosis
Facing a seemingly impossible challenge, e.g. related to one’s job or career
Seeing a traumatic event on television or in other media is not typically considered a trigger for ASD.
People can develop ASD after experiencing one or more traumatic events. A traumatic event can cause significant physical, emotional, or psychological harm.
Among others, possible traumatic events can include:
the death of a loved one
the threat of death or serious injury
natural disasters
motor vehicle accidents
sexual assault, rape, or domestic abuse
receiving a terminal diagnosis
surviving a traumatic brain injury
Risk factors
Not everyone who experiences trauma will develop ASD. A number of factors may increase the risk of a person developing the condition. These include:
Being female
A history of trauma
A history of mental health conditions
The severity of the traumatic event
Neurotic personality traits, e.g. experiencing the world as largely threatening, distressing and unsafe
Avoidance as a coping mechanism
Diagnosis
A doctor’s evaluation, based on specific criteria
Acute stress disorder is diagnosed when people have been
Exposed directly or indirectly to a traumatic event
In addition, they also must have had at least 9 of the following symptoms for 3 days up to 1 month:
Recurring, uncontrollable, and intrusive distressing memories of the event
Recurring distressing dreams of the event
Feelings that the traumatic event is recurring—for example, in flashbacks
Intense psychologic or physical distress when reminded of the event (for example, by entering a similar location, or by sounds similar to those heard during the event)
A persistent inability to experience positive emotions (such as happiness, satisfaction, or loving feelings)
An altered sense of reality (for example, feeling in a daze or as if time has slowed)
Memory loss for an important part of the traumatic event
Efforts to avoid distressing memories, thoughts, or feelings associated with the event
Efforts to avoid external reminders (people, places, conversations, activities, objects, and situations) associated with the event
Disturbed sleep
Irritability or angry outbursts
Excessive attention to the possibility of danger (hypervigilance)
Difficulty concentrating
An exaggerated response to loud noises, sudden movements, or other stimuli (startle response)
In addition, symptoms must cause significant distress or significantly impair functioning.
Doctors also check to see whether symptoms could result from use of a drug or another disorder.
Treatment
acute stress disorder mindfulness
Practicing mindfulness-based techniques can help manage stress and anxiety.
A healthcare professional will work closely with a person to develop a treatment plan that meets their individual needs. Treatment for ASD focuses on reducing symptoms, improving coping mechanisms, and preventing PTSD.
Treatment options for ASD may include:
Cognitive behavioral therapy (CBT). Doctors usually recommend CBT as the first-line treatment for people with ASD. CBT involves working with a trained mental health professional to develop effective coping strategies.
Mindfulness. Mindfulness-based interventions teach techniques for managing stress and anxiety. These can include meditation and breathing exercises.
Medications. A healthcare professional may prescribe antidepressants or anticonvulsants to help treat a person’s symptoms.