Acute stress disorder is diagnosed when symptoms occur directly after the trauma but resolve within one month, while PTSD can only be diagnosed when symptoms persist beyond one month. Both are characterized by symptoms that include upsetting memories, avoidance of trauma reminders, and impairments in normal routines and functioning.
What Is Acute Stress Disorder?
Acute stress disorder is a relatively new diagnosis that is given after someone experiences trauma. It has similar symptoms to PTSD, but does not last as long. Acute stress disorder is a diagnosis used to help clinicians flag people at risk of developing PTSD following a traumatic experience like an accident, injury, or assault. Individuals who have acute stress disorder are at higher risk for PTSD, and the hope is that early treatment can slow or stop this progression.
ASD as a diagnosis helps to differentiate between different mental health issues and attempts to correct misdiagnoses such as adjustment disorders. More recently, ASD is considered a “trauma” diagnosis as opposed to a form of anxiety, as the field of psychology is learning more about trauma and the layers of impact it can have on people.
How Common Is Acute Stress Disorder?
Because many people may not seek treatment or may wait to seek treatment after a traumatic experience, it is difficult to identify the exact number of people who suffer from acute stress disorder.
Here are several statistics on the prevalence of traumatic events, acute stress disorder and PTSD:2,4,5
- 50-90% of people will experience a traumatic event in their lifetime
- About 19% people of trauma survivors will develop acute stress disorder
- It is estimated that 80% of people diagnosed with acute stress disorder develop PTSD
- Women are twice as likely to develop PTSD after a traumatic event than men
Certain types of traumatic events are more likely to lead to the development of acute stress disorder, including:
- 13-21% of people involved in a motor vehicle accident
- 14% of people who have a brain injury
- 24% of people who experience assault
- 59% of people who are raped
Acute Stress Disorder vs PTSD
The symptoms of Acute Stress Disorder are very similar to the symptoms of PTSD with the following exceptions:1,5
- Acute stress disorder is diagnosed when the symptoms occur 3-30 days after the trauma, and PTSD is diagnosed when the symptoms occur and persist beyond the 30 day mark.
- PTSD categorizes symptoms into clusters, with a certain number of symptoms needed in each cluster. Acute stress disorder does not categorize symptoms.
- PTSD includes other behavioral and non-fear-based symptoms like destructive behaviors, negative thoughts and beliefs, or self-blaming thoughts.
- PTSD includes a dissociative subtype to describe people who have detachment or dissociation from their body or experiences as a symptom
What Causes an Acute Stress Reaction?
Acute stress disorder can be traced back to a specific external experience that was traumatic, upsetting, or scary. A traumatic event is defined as directly experiencing, witnessing or directly learning the details of an event that could have resulted in death, serious injury, or sexual violence.1
Examples include:
- Natural disasters such as fires, floods or earthquakes
- Physical or sexual altercations/assaults
- Motor vehicle accidents
- Plane crashes
- War
- Refugee camps
When the brain senses danger, it cues the nervous system, and activates an instinctual fight or flight response. It is normal to experience a fight or flight response during a traumatic event, but a percentage of people will find that this response is continuously activated afterwards by things that remind them of the traumatic event.7
Who Is Most at Risk for Acute Stress Disorder?
The majority of people who experience a traumatic event do not experience lasting symptoms. Interestingly, research suggests that people who have lower cortisol before and during a traumatic event are more likely to develop symptoms of a prolonged/chronic stress response that can manifest as PTSD.7
Certain populations are at higher risk for developing acute stress disorder after experiencing a traumatic event. Men are more likely to experience trauma compared to women (6 out of 10 men vs 5 out of 10 women), but women are more likely to develop symptoms of a trauma disorder compared to men (10% of women vs 4% of men). Veterans are also at higher risk for PTSD because of the heightened likelihood of direct exposure to traumatic events.5
Acute Stress Disorder Symptoms
Acute stress disorder is diagnosed when people have been exposed directly or indirectly to a traumatic event AND also experience at least 9 of the following symptoms for 3 days up to 1 month:1
- Recurring, uncontrollable, and intrusive distressing memories of the event
- Recurrent distressing dreams of the event
- Feelings that the traumatic event is recurring (i.e. flashbacks)
- Intense psychological 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 (i.e. happiness, excitement)
- 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 (trouble falling or staying asleep or feeling unrested after sleep)
- Irritability or angry outbursts
- Excessive alertness (hypervigilance)
- Difficulty concentrating or focusing
- An exaggerated response to loud noises, sudden movements, or other stimuli (startle response)
*Many people with Acute Stress Disorder have their diagnosis updated and changed to PTSD after the 30 day mark
Avoidance
The stress hormones and chemicals released during fight or flight responses cause the person’s heart rate and breathing to speed up, provide a surge of energy, and cause a person to become more alert. Symptoms of acute stress disorder like hypervigilance, exaggerated startle response, insomnia, irritability and anxiety are also common byproducts of the fight or flight response. People with acute stress disorder and PTSD actively try to avoid things, situations and thoughts of the traumatic event because these reminders can trigger the fight/flight response.
Anxiety & Mood Changes
Research suggests that in people with PTSD, the fight or flight response begins to interfere with brain chemicals like serotonin, dopamine and norepinephrine that impact mood, anxiety, and energy levels.7
How Is Acute Stress Disorder Diagnosed?
Acute stress disorder can be diagnosed by a doctor or licensed medical or mental health professional. Often, acute stress disorder is first diagnosed when a person who has experienced a recent trauma makes an appointment to discuss treatment for one or more of their symptoms.
For example, a person may be diagnosed by a primary care doctor if they make an appointment for insomnia that began recently after a traumatic event. Those who are diagnosed by mental health professionals are often diagnosed in the first intake appointment with a counselor or psychologist.
Acute Stress Disorder Treatment
Treatment for acute stress disorder usually involves counseling, and in some instances, medication.2,8 Because people who are diagnosed with acute stress disorder have experienced a very recent trauma, they are more likely to need help accessing necessary resources. These might include referrals to financial or housing resources, a rape crisis center, legal aid, or medical treatment. A counselor, doctor, or other treatment provider may offer to help connect people with these resources, but this is considered separate from the actual treatment of the trauma.
Therapy
Therapy for acute stress disorder is typically provided by a therapist, clinical social worker, or psychologist with specialized training in trauma. Different counselors will have training in different styles and approaches to treating trauma disorders.
Many different types of therapy have some research to support they can be effective at reducing symptoms of acute stress disorder, including:2
- Cognitive Behavioral Therapy (CBT) which involves a structured approach to modifying patterns of thinking and behaving to reduce symptoms and improve functioning
- Prolonged exposure therapy, which is a form of CBT that helps people gradually desensitize themselves to traumatic memories and reminders
- Cognitive processing therapy (CPT) which is 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 which is used for children and teens who have experienced a traumatic event and is a targeted form of CBT that involves reprocessing the trauma in a structured treatment provided in 12-24 sessions. Sessions involve individual therapy and also conjoint therapy with the parent and caregiver.
- Acceptance and Commitment Therapy is a newer type of third wave behavioral therapy useful in helping people improve acceptance and tolerance of difficult thoughts and feelings while responding (behaving) in more effective ways that align with their values
- Eye movement desensitization and reprocessing (EMDR) which is 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
- Somatic Experiencing which is a newer and less researched form of therapy being used to treat trauma disorders which incorporates body-focused exercises to increase awareness and discharge residual trauma effects without traditional talk therapy
- Psychodynamic therapy, an older and lesser-used therapy which involves exploring deeper underlying issues and conflicts through a long-term course of individual therapy
Medication
Medication is sometimes prescribed by a doctor, psychiatrist, or other licensed prescriber to alleviate symptoms of acute stress disorder. In most cases, people with acute stress disorder are only recommended for medication when they are also receiving therapy, and when symptoms are severe or not responding to therapy alone.
In these instances, one or more of the following medications may be recommended:2,7
- Antidepressants: SSRI’s, Tricyclic antidepressants or MAOI’s
- Anti-anxiety medications: benzodiazepines, SSRI’s or beta blockers
- Sleep aids: sedatives or natural compounds like melatonin or magnesium
- Hydrocortisone: research suggests that people who are given a dose of hydrocortisone following a traumatic event are less likely to develop PTSD
Self-Help for Acute Stress Disorder
If you have experienced a recent traumatic event and are experiencing signs and symptoms of acute stress disorder, you should seek the help of a professional counselor. Early treatment can help reduce symptoms and, in some cases, prevent the development of PTSD.
In addition to formal treatment, there are also some ways you can manage and reduce symptoms on your own, including:
Stay Active & Social
Continue seeing friends and family and engaging in hobbies and physical activity. You may not feel motivated or interested in these activities but engaging in them anyway often helps to improve symptoms and functioning.
Reduce Avoidant Behaviors
While you may want to avoid situations, places, or even thoughts of the trauma, doing so often worsens symptoms. Make an effort to stick to your normal routine even if this includes encountering a trigger and try not to over rely on distraction tactics.
Start a Meditation or Mindfulness Routine
Meditation and mindfulness have many proven benefits for your health and mental health including reducing stress, insomnia, anxiety, and depression and helping improve focus and performance.
Avoid Unhealthy Coping Skills
People who are experiencing high levels of distress are more likely to fall into unhealthy patterns of behavior like overeating, overspending, or using drugs or alcohol to cope. These behaviors are more likely to become problematic when they are used to avoid, escape or cope with negative stress and emotions.
Set & Work Towards Future Goals
Setting and working towards goals is important in helping people remain hopeful about the future, guarding against depression and anxiety and providing a sense of meaning and purpose.
Find Silver Linings
No one wants, deserves, or is glad to have experienced a traumatic event, but people who find a way to make meaning from these painful experiences are better able to cope and move forward with their lives. Silver linings could come in the form of becoming clearer about what matters to you, deepening relationships with certain people, or using your experience to help other people who are experiencing a similar situation.
How to Get Help for Acute Stress Disorder
If you have experienced, witnessed, or have been impacted by a traumatic event, you should reach out to a professional mental health counselor or therapist for help, especially if you notice changes in your mood or thinking that make it hard to function normally.
Some of the best methods for finding a counselor include:
- Conducting an online search for therapists near you
- Using a free online directory
- Calling the number on the back of your insurance card for a list of in-network therapists
- Logging on to your insurance company’s portal to access a list of in-network therapists
- Contacting your primary care doctor to request a mental health counseling referral
- Going through your employer’s EAP program (if offered) to utilize included mental health benefits
What to Ask Before Beginning Therapy
Once you have a short list of therapists or counselors, the next step would be to make phone calls to get more information about which counselor is the best fit for your needs. Most counselors offer a free consultation to potential new clients.
Some of the questions/factors to consider when choosing a therapist include:
- Whether the counselor is in-network with your insurance plan
- What the out-of-pocket cost of sessions will be (according to your insurance plan or the provider’s self-pay rate)
- Whether the counselor has current availability to accept you as a client
- Whether the counselor is trained and experienced in treating trauma disorders
- The style and type of counseling the counselor provides
- Your overall comfort and compatibility with the counselor’s style
Remember that counselors are paid to provide a service to you. If you begin counseling and do not feel like your counselor is a good match or if you are not making progress, you could have a much different experience with a different counselor. Just like medications and other treatments, it can take more than one attempt before you find something that works for you.
How to Get Help for a Loved One
If someone you care about has experienced something traumatic, it can be difficult to know how to help them. It is important to keep communication open and encourage your loved one to get treatment, asking them what you can help with to make that happen.
Some of the following are good methods of supporting a loved one who has experienced a traumatic event:8
Open Up Lines of Communication
Let the person know you are there if they need help or want to talk. It can be really hard for people to talk about traumatic experiences so don’t be surprised or offended if they decline your offer. Keep the invitation open so they know they can reach out to you if they change their mind.
Express Concern
If you notice changes in their mood or behavior, let them know what you are noticing and that you want to know how they are doing. Don’t push and if they become defensive, just take a step back and reiterate that you care about them and are concerned for their wellbeing.
Encourage Treatment
If the signs or symptoms that are concerning to you continue, help in any way they need during the aftermath of the trauma. When possible, try to ask them for ways you can help instead of assuming roles or responsibilities for them that they didn’t ask you to take on.
Continue to Check In
instead of waiting for them to contact you, check in on the person periodically. Effects of trauma can be lasting and the recovery period can be difficult, but it is easier when people feel like they are not completely alone. Even though they might not have it in them to reach out to you, they may be really glad to hear from you.
When Acute Stress Reaction Symptoms Persist
Long-term and continual exposure to acute stress which results in acute stress responses can be a major risk factor for later development of PTSD. There is a high correlation between acute stress reactions and PTSD as the prolonged exposure can leave individuals feeling challenged in regulating their own emotions as the body is not built to function with a baseline of consistent trauma.9
Can You Prevent an Acute Stress Reaction?
Due to the nature of acute stress, there is only so much prevention one can do to prevent or be prepared for traumatic events. Reactions are our body’s natural way of responding to an event or situation so they cannot be prevented, however learning more about your emotional triggers can be helpful in teaching your mind to cope in healthier ways. Working with a therapist to address these issues can be helpful and prevent future stress reactions. Working in situations that involve witnessing trauma may involve you going through trauma training, which can help you with your stress reactions. Outside of attempting to live a healthy life, both physically and mentally, there is little prevention available.
For Further Reading
Those wanting more information, resources, or support for acute stress disorder, PTSD or trauma can visit the following sites:
