Acute Stress Disorder

Acute Stress Disorder (ASD) is a mental disorder characterized by intense psychological reactions that emerge shortly after a severe traumatic event such as a life-threatening incident, serious injury, sexual assault, or a similarly extreme situation. Although Acute Stress Disorder shares many symptoms with Post-Traumatic Stress Disorder (PTSD), it differs in terms of onset and duration. It typically develops between three and thirty days after the event, and if early intervention is not provided during this period, there is a possibility that it may progress to PTSD.

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Acute Stress Disorder DSM-5 Diagnostic Criteria

According to the DSM-5, the following conditions must be met in order to diagnose Acute Stress Disorder:

  • Exposure to a Traumatic Event: The individual must have been exposed to trauma in one of the following ways:
    • Directly experiencing the event
    • Witnessing the event as it occurred to others
    • Learning that a close person was exposed to a traumatic event
    • Experiencing repeated or extreme exposure to aversive details of the trauma (e.g., watching recordings of the event)
  • At Least 9 Symptoms: At least nine symptoms must be observed, drawn from more than one of the following five categories:
    • Intrusion symptoms
    • Negative mood
    • Dissociative symptoms
    • Avoidance symptoms
    • Arousal symptoms
  • Duration of Symptoms: Symptoms must persist for 3 to 30 days following the traumatic event.
  • Functional Impairment: The symptoms must lead to significant impairment in the individual’s social, occupational, or personal life.

Not better explained by another condition: The symptoms must not be related to substance use, another mental disorder, or a medical condition.

Symptoms of Acute Stress Disorder

ASD may present with a broad range of symptoms accompanied by intense stress at both psychological and physiological levels.

1. Involuntary Re-Experiencing (Intrusion) Symptoms

  • Recurrent, distressing thoughts or images related to the trauma
  • Trauma-themed nightmares
  • Intense distress when encountering cues that remind the individual of the trauma

2. Dissociative Symptoms

  • Emotional numbing toward the surroundings, a sense of unreality (derealization)
  • Feeling detached from oneself (depersonalization)
  • Inability to recall parts of the event or memory gaps

3. Negative Mood

  • A persistent state of fear, tension, hopelessness, or inner restlessness

4. Avoidance Symptoms

  • Avoiding feelings, thoughts, or environments that remind the individual of the trauma
  • Withdrawing from social relationships

5. Arousal Symptoms

  • Sleep disturbances
  • Exaggerated startle response and outbursts of anger
  • Difficulty concentrating
  • Hypervigilance

These symptoms severely affect the individual’s quality of life and generally lead to marked functional impairment.

Causes (Etiology) of Acute Stress Disorder

In the development of Acute Stress Disorder, not only the characteristics of the trauma but also the individual’s biological and psychosocial makeup are influential.

1. Characteristics of the Trauma

  • The event occurs suddenly, unexpectedly, and beyond the individual’s control
  • It has a life-threatening nature
  • It involves physical injury or sexual assault
  • Repeated or prolonged traumatic exposure

2. Biological and Neuropsychiatric Factors

  • Dysfunctions in the HPA axis (hypothalamic–pituitary–adrenal)
  • Dysregulation in cortisol levels
  • Imbalance between the amygdala and the prefrontal cortex
  • Variability in serotonin and norepinephrine levels

3. Psychosocial Factors

  • A pre-trauma history of anxiety or depression
  • Low social support
  • Experiences of neglect or abuse during childhood
  • A sensitive personality structure, introversion, or low self-esteem

Risk Factors for Acute Stress Disorder

Certain individual or environmental conditions may increase the likelihood of developing ASD:

  • Previous traumatic experiences
  • Female sex
  • Low socioeconomic conditions
  • A family history of mental illness
  • Severe injury or painful experiences
  • Employment in high-stress occupations such as soldier, police officer, or health care worker

Recognizing these risks is important for early intervention and preventive psychiatric approaches.

Diagnosis of Acute Stress Disorder

The diagnosis of ASD is established on the basis of a comprehensive psychiatric evaluation and DSM-5 diagnostic criteria.

The diagnostic process includes the following steps:

  • Assessment of symptoms that begin within 3 to 30 days after the trauma
  • Confirming that at least nine symptoms are present and that they come from at least three symptom clusters
  • Ruling out PTSD, panic disorder, depression, substance use, or organic causes
  • In addition to clinical interviews, using scales such as the Acute Stress Disorder Scale (ASDS), PCL-5, or CAPS

Because ASD may be overlooked, particularly in emergency evaluations after disasters, accidents, or violence, clinicians should conduct a careful assessment.

Treatment of Acute Stress Disorder

With appropriate treatment approaches, ASD may resolve without progressing to long-term psychiatric disorders. The treatment process should be individualized and multidimensional.

1. Psychological Interventions

  • Psychological First Aid: Following trauma, the individual’s safety, physical needs, and social support are prioritized. This early intervention is effective in mitigating the effects of traumatic stress.
    • Restructuring trauma-related thoughts
    • Reducing avoidance behaviors
    • Developing coping skills for stress
    • Applying desensitization techniques
  • Exposure Therapy: Avoidance is reduced and anxiety decreases through structured reprocessing of traumatic memories.
  • Supportive Counseling: The aim is to help the individual understand and regulate emotions and to make meaning of the experienced trauma.

2. Pharmacotherapy

In ASD, medication is generally a secondary option; however, if symptom severity is high, short-term use may be preferred. The treatment process should be conducted under specialist supervision and in combination with psychotherapy.

  • Anxiolytics: Short-term use may alleviate symptoms in individuals with severe anxiety; however, due to the risk of dependence, it should be applied with caution.
  • Antidepressants: SSRI or SNRI medications are preferred in cases of marked depressed mood and intense anxiety. These medications may also reduce the likelihood of developing PTSD.
  • Hypnotics: They may be used short-term to regulate sleep problems commonly observed after trauma; however, long-term use is not recommended.

3. Family and Social Support

Support from close others is vital in the recovery process for individuals with ASD. Family members should be informed about the nature of the disorder, the effects of stress, and communication styles. Community-based support systems are also important for individuals who have lost their home, job, or loved ones after trauma.

Effects on Daily Life

Although it is a short-term condition, ASD may severely affect daily functioning.

  • Functional Impairment: In the days following trauma, inability to attend work or school is common.
  • Social Withdrawal: Feelings of shame, fear, and helplessness may restrict social interactions.
  • Disruptions in Sleep and Eating Patterns: Daily routines may be disturbed.
  • Risk of Progression to PTSD: Approximately 40% of cases without early intervention may progress to PTSD (Bryant, 2011).

For this reason, psychoeducation, follow-up, and supportive therapeutic approaches should be initiated early in individuals diagnosed with ASD.

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