Acute Stress Disorder (ASD)

What is acute stress disorder?

Acute stress disorder (ASD), sometimes known as acute stress reaction, is an anxiety disorder that may develop in the weeks following direct or indirect exposure to a traumatic event. Direct exposure involves experiencing trauma directly, e.g., a serious injury, violence or death threats.  Indirect exposure may include witnessing or hearing about traumatic events happening to others. It can impact adult individuals. ASD can develop in teens and children too.

During a period of traumatic stress or danger, our bodies and minds go through physiological and mental changes. Our breathing and heart rate increase, sending us into ‘flight or fight’ mode. In the moment of danger, this response may save our lives, but once the threat has passed, these responses can have major disruptions, and it can be difficult to convince our minds that we are indeed safe again. ^[6]

Individuals that develop acute stress disorder mentally relive the trauma of the traumatic event and can suffer from increased anxiety. 

As these symptoms occur, it can be difficult for the individual to process the original trauma, reducing the continued stress responses. However, without the right help and support, this can have significant personal and economic effects on an individual's life. 

Approximately 19% of people who experience a traumatic event will develop ASD. However, this response can vary significantly depending on the type and intensity of trauma experienced. ^[5]

Acute stress disorder symptoms

Acute stress disorder is characterized by nine or more symptoms from five main categories: intrusion, negative mood, dissociation, avoidance, and arousal ^[3].

Intrusion symptoms

Psychological symptoms related to the traumatic event repeatedly and uncontrollably invading an individual’s thoughts. They include:

• Distressing memories of the trauma can be recurrent, distressing, and involuntary
• Nightmares relating directly to the traumatic event will be recurring
• Flashbacks differ from distressing memories. During flashbacks, the individual will feel and act as if the event was occurring again
• Physical or emotional distress can be caused by exposure to trauma reminders.

Negative Mood symptoms

These symptoms are related to stress and lack of sleep and negatively affect the individual's overall mood. This is characterized by:

• Continual inability to experience positive emotions 

Dissociation symptoms

This is a way that the body copes with too much stress. Dissociative symptoms include:

• Altered sense of reality - meaning that surroundings may seem strange and unreal to the individual. Feeling numb, detached or emotionally unresponsive
• Inability to recall the trauma in detail or its entirety, known as dissociative amnesia

Avoidance symptoms

These symptoms mean that an individual alters standard behavior to avoid reminders of the traumatic event, such as:

• Avoidance of intrusive memories or thoughts of the trauma
• Avoidance of external reminders of the trauma, including people, places and activities

Arousal symptoms

These symptoms are related to your body’s constantly heightened reactions. These can include:

• Disturbed sleep - difficulty initiating or maintaining quality sleep
• Irritability or angry outbursts with little provocation
• Hypervigilance - where the body remains in ‘fight or flight’ mode after a traumatic event has passed
• Difficulties focusing
• Exaggerated startle response is an unconscious defensive response to an unexpected stimulus

Diagnosing acute stress disorder

A healthcare professional, usually your primary doctor, will diagnose ASD. They will assess your mental state by asking questions about your personal history and trauma. They can also carry out a physical examination.

The primary objective is to understand the individual's unique case and determine any other causes or medical conditions. 

A doctor will diagnose ASD when a person has been exposed to a traumatic event and has at least nine of the above symptoms, lasting from 3 days up to a month. 

Causes of acute stress disorder

Acute stress disorder may occur when an individual is exposed to one or more stress factors. It can be an overwhelming, severe trauma (e.g., death threat, domestic abuse). However, stress factors can come from everyday life as well.  

These may be from a single event (e.g., an injury) or multiple events (e.g., financial or personal setbacks). ^[1]. Here are some examples: 

• Domestic abuse
• Sudden loss of a loved one
• Severe injury
• Major catastrophes, e.g. earthquakes, pandemics
• Loss of a job
• Sexual assault

Acute stress disorder risk factors

Anyone can develop ASD after experiencing trauma. However, a few groups are more at risk ^[8]. Risk factors include:

• Those that have experienced trauma in the past
• A history of acute stress disorder or post-traumatic stress disorder (PTSD)
• Those who may be exposed to traumatic or stressful events due to their career

Prevention of acute stress disorder

As this disorder manifests due to traumatic events and situations, which are difficult to predict, acute stress disorder is very challenging to prevent. However, if you experience a traumatic event, it is possible to reduce the likelihood of experiencing ASD.

After a traumatic event, an individual should seek medical help to process the event safely and be fully informed. 

Those who work in areas with an increased risk of traumatic events, such as the police, military and paramedic responders, may benefit from counseling and other preparation training to reduce the risk of ASD by strengthening coping mechanisms. 

If you believe your acute stress reaction symptoms are developing into a mental health condition, then you should seek early treatment immediately.

Acute stress disorder treatment

There are usually two main treatment options for acute stress disorder: self-care and Cognitive Behavioral Therapy. 

Self-care can offer immediate health benefits for an individual as this strategy can be implemented without the help of a professional. It is made up of three parts:

• Personal safety - this is the starting point for treatment. Ensuring that the individual is safe and that the trauma will not reoccur. It is easier to process a traumatic event when an individual feels secure. However, it is sometimes difficult to guarantee safety in an ongoing situation such as war, domestic abuse or a pandemic.
• Physical health - maintaining physical health can be complex for those with ASD. Maintaining a schedule to ensure that eating, sleeping and exercising are well-regulated will help rebalance the nervous system. Avoiding recreational drugs and alcohol will help as well.
• Mindfulness - a mindful approach to daily life is a good way to reduce the boredom, stress, anger, sadness and isolation that people with trauma experience. If possible, individuals should make and follow a daily schedule or routine and maintain hobbies, interests, and human connections. 

Cognitive Behavioral Therapy (CBT) is usually carried out with the help of a therapist, who will help you explore your feelings and traumas in a safe environment. The therapy focuses on educating on trauma psychology, enabling you to identify and understand your reactions and empowering you to alleviate your symptoms. The aim is to normalize the stress response and encourage the patient to view reminders of the trauma as not dangerous. ^[7]

Acute stress disorder vs. PTSD - What's the difference?

Acute stress disorder and post-traumatic stress disorder (PTSD) are fundamentally very similar. Both mental disorders manifest after a traumatic event and have similar symptoms. 

The main difference between acute stress disorder and post-traumatic stress disorder is the timing. ASD typically begins immediately after a traumatic event and lasts from 3 days to a month. PTSD, on the other hand, may take up to 6 months after a traumatic event to develop, and symptoms last for more than a month.

ASD is not always a precursor to PTSD. The relationship between the two psychiatric disorders is not a straightforward one. Not all individuals that have ASD go on to develop PTSD. Similarly people living with PTSD may not have experienced ASD. ^[2].