Acute stress disorder and post-traumatic stress disorder (PTSD) can both develop following exposure to a traumatic event. Each causes significant functioning difficulties in one or more areas of your life. While many of the symptoms of these disorders overlap, they differ in terms of symptoms as well as symptom onset and duration.1
What Can Cause Acute Stress Disorder & PTSD?
There are a variety of causes of ASD and PTSD. Either can develop from a sudden, traumatic event, including physical, emotional, or mental trauma. To add, other causes include sudden traumatic death of a loved one, physical threats towards one’s safety, experiencing war, living in warzones and surviving natural disasters, car accidents, gun trauma, sexual abuse/rape, any kind of abuse, receiving a medical diagnosis of a terminal illness, and chronic exposure to trauma.
Characteristics of Acute Stress Disorder
Acute stress disorder is a traumatic stress response that can occur if you have been exposed to one or more events in which death, serious injury, or sexual assault are threatened or actually occur.1 The prevalence of acute stress disorder following a traumatic experience varies between 6-50%, depending upon the type of trauma.
This disorder can be prevalent in helping professions like social workers, professional counselors, first responders, and police officers, as well as and among the loved ones of trauma survivors as a result of hearing details or witnessing the aftermath of a trauma.1,2,3
Acute stress disorder is characterized by symptoms that:
- Persist between 3 days and a month following a traumatic experience
- Cause disruption in one or more areas of your life
- Are not the result of medical conditions, physical injury, or substance/alcohol use
If you have acute stress disorder you will experience nine or more symptoms from these categories:1
- Intrusive symptoms: Recurrent distressing memories, dreams, flashbacks, dissociation, and/or intense psychological or physical distress in response to reminders of the traumatic event(s). (Note: Children tend to demonstrate these types of symptoms through repetitive, serious play in which they reenact parts of the trauma.)
- Negative mood: An inability to experience positive emotions such as happiness, peacefulness, contentment, or love.
- Dissociative symptoms: A change in your perception of reality. Symptoms might include feeling dazed or “zoned out,” like you are seeing yourself from outside of your body, like parts of your body are not actually part of you, and/or that time has slowed. You might forget all or parts of the traumatic event, even though you were conscious while it occurred.
- Avoidance symptoms: Making an effort to avoid memories, thoughts, emotions, people, places, situations, and things that remind you of the trauma.
- Arousal symptoms: Finding it difficult or impossible to calm or relax your mind and body. These types of symptoms include:
- Increased difficulty falling and/or staying asleep
- Becoming more easily startled
- Always scanning your surroundings for possible threats
- Concentration difficulties
Symptoms of PTSD
Similar to acute stress disorder, PTSD can occur if you have been exposed to one or more events in which death, serious injury, or sexual assault are threatened or actually occur. You might also experience PTSD as a result of hearing the details of someone else’s traumatic experiences or witnessing the aftermath of their trauma.1,2,3,4
PTSD is characterized by symptoms that:
- Persist for more than four weeks
- Aren’t due to a medical condition, injury, or alcohol/substance use
- Cause difficulty in your ability to function in one or more areas of your life
If you have PTSD, you will experience these symptoms from these categories:
- Intrusive symptoms: Involuntary, recurrent, distressing memories or dreams/nightmares related to the traumatic event. Reliving of the trauma through dissociation (i.e., “zoning out” or “spacing out”), flashbacks (visual, auditory, emotional, or physical). Intense body/mind reactions to external or internal reminders of trauma.
- Avoidant symptoms: Active and persistent avoidance of reminders of the trauma including memories, thoughts, feelings, people, places, objects, discussions, and situations.
- Persistent negative changes in mood and thoughts:
- Inability to remember part or all of the traumatic event(s)
- Distressing negative beliefs about oneself, others, and/or the world (e.g., “I am damaged,” “I can’t trust anyone,” “The world is a horrible place.”)
- Distorted beliefs about why the trauma occurred or the consequences that might cause you to blame yourself or others for it
- Ongoing negative mood (e.g., rage, horror, fear, shame, guilt, despair)
- Inability to experience positive emotions like love, joy, hope, excitement
- No longer interested in things you used to enjoy
- Feeling isolated from others
- Increased arousal and reactivity:
- Irritability, anger, and/or aggressive outbursts
- Engaging in self-destructive or high risk behaviors
- Always looking for threats and unable to relax
- Startling more easily
- Experiencing concentration difficulties
- Having sleep problems
Understanding Acute Stress Disorder vs PTSD
The main differences between acute stress disorder and PTSD are related to symptom onset and duration, as well as the number and type of symptoms experienced.1
According to clinical psychologist Colleen Becket-Davenport, Psy.D., “The key difference between Acute Stress Disorder and Posttraumatic Stress Disorder (PTSD) is time. Most people who go through a traumatic event will experience some symptoms of acute stress (e.g. nightmares, trouble sleeping, having physical and/or emotional reactions to things that remind them of the traumatic event), but only a small percentage of people go on to develop PTSD. For most people, the symptoms will fade in the days, weeks, or even months following the trauma.”8
Here are the main differences between acute stress disorder and PTSD:4,5,6
- Symptom onset: With acute stress disorder, symptom onset occurs within hours or days of the traumatic event; with PTSD, symptoms might begin within hours or days of the trauma, or might have a delayed onset of months or even years after the traumatic event.
- Symptom duration: With acute stress disorder, symptom duration lasts a minimum of three days and a maximum of four weeks; with PTSD, symptoms last a minimum of four weeks.
- Number and type of symptoms: With acute stress disorder, you will experience nine or more symptoms from any of the five categories; with PTSD, you will experience one or more intrusive symptoms and avoidant symptoms, and two or more symptoms of negative changes in mood/thoughts and increased arousal/reactivity.
- Recommended treatment: With acute stress disorder, recommended treatments include cognitive behavioral therapy (CBT) and exposure therapies, and in some cases, medication; with PTSD, recommended treatments are CBT, prolonged exposure therapy, eye movement desensitization and reprocessing (EMDR), stress inoculation therapy, imagery rehearsal, and in some cases, medication.
PTSD vs Acute Stress Disorder: What Are the Similarities?
Acute stress disorder and PTSD both occur in response to exposure to a traumatic event or series of events. You are at risk of developing either disorder if you have been exposed to one or more events in which death, serious injury, or sexual assault are threatened or actually occur.1 These disorders also develop among those who work in helping professions (e.g., social workers, professional counselors, first responders, and police officers) or among the loved ones of trauma survivors as a result of hearing details or witnessing the aftermath of trauma.1,2,3
There is substantial overlap in the symptoms of acute stress disorder and PTSD, and these symptoms will lead to difficulty functioning in one or more areas of your life (e.g., work/school, social life, family).
Similar symptoms between acute stress disorder and PTSD include:1
- Recurrent distressing memories, dreams, flashbacks (i.e., reliving), and/or dissociation (Children tend to demonstrate these types of symptoms through repetitive, serious play in which they reenact parts of the trauma)
- Intense psychological/physical distress in response to reminders of the traumatic event(s)
- An inability to experience positive emotions such as happiness, peacefulness, contentment, or love
- An inability to remember all or parts of the traumatic event(s)
- Actively trying to avoid anything that reminds you of the trauma (e.g., thoughts, feelings, places, people, objects)
- Increased irritability and anger
- Difficulty relaxing and “letting your guard down”
- Exaggerated startle response
- Sleep issues
- Concentration problems
Can Acute Stress Disorder Turn Into PTSD?
Acute stress disorder can turn into PTSD, but several factors influence whether or not this will happen. Among those with acute stress disorder who develop PTSD, rates have been found to diminish as time passes.7 Remember, for the majority of those experiencing acute stress disorder, symptoms will resolve on their own within the four-week period following the trauma. There is also evidence that those who participate in CBT for acute stress disorder are less likely to develop PTSD.7
Factors that influence whether acute stress disorder turns into PTSD include:7
- Additional stressors experienced after the traumatic event
- Use of maladaptive coping strategies
- Negative interpretations of their traumatic stress reactions
Becket-Davenport encourages, “Acute Stress Disorder can turn into PTSD, but it doesn’t necessarily have to. Many people who experience symptoms of acute stress go on to recover well from their traumatic event. People who have experienced prior traumas, particularly childhood traumas, are more likely to experience PTSD after a traumatic event. People who cope via avoidance are also more likely to experience PTSD. It’s important for people to have space to process their traumatic event in the days and weeks following the trauma. However, this does not mean that people should be pushed to retell or relive the event. Rather, people should have the opportunity to talk about how they are feeling and how they felt during the event. This can be helpful for recovery.”8
The Importance of Treatment for Traumatic Disorders
Untreated trauma can worsen symptoms long-term. The brain learns to cope with trauma responses that can lead to disruptions with work, relationships, and sleep. Insomnia, nightmares, mood issues such as anxiety and anger, and hopelessness are common reactions to untreated trauma. It can also lead to physical symptoms such as stomach issues, heart issues, and physical weakness.9
Treatment Options
- Cognitive processing therapy (CPT): A specific kind of CBT used to help people reframe the traumatic experience in a more adaptive and helpful way over the course of about 12 sessions
- Trauma focused CBT: Used for children and teens who have experienced a traumatic event. It is a targeted form of CBT that involves reprocessing the trauma with a structured treatment plan provided in 12-24 sessions. Sessions involve individual therapy and also conjoint therapy with the parent and caregiver.
- Eye movement desensitization and reprocessing (EMDR): A form of therapy that involves guided eye movements intended to evoke memories related to the traumatic experience followed by verbal processing of these with the therapist
- Medications are sometimes used to treat the symptoms of ASD and PTSD. Medications include SSRIs, SNRIs, beta-blockers, MAOIs and over-the-counter drugs.
Where to Find a Therapist
You can find a therapist by asking for a referral from your primary care physician, calling the number on the back of your insurance card, or searching an online therapist directory. All licensed therapists are equipped to help people struggling with mental health issues and may have formal training in treating this issue, but it can be helpful to look for someone with experience treating trauma and training in the specific therapy techniques listed above. Reading reviews and looking at clinician bios to understand the scope of their practice can give you an idea of whether their experience suits your situation. Many therapists offer a free phone consultation to help you know if you’ll be a good fit.
Final Thoughts
Acute stress disorder and PTSD are natural responses to trauma and not reflections of weakness. If you have one of these disorders, you have an invisible injury that will either heal on its own or require professional help. Don’t hesitate to let your loved ones and physician know what you’re experiencing. Reach out to a professional counselor, psychologist, or psychiatrist who can assess your symptoms and provide treatment.
Acute Stress Disorder vs. PTSD Infographics
