Acute Stress Disorder in Teens

Acute stress disorder is a psychological response to a traumatic or upsetting event. This is more than the expected natural response to such an event; symptoms can last between four days and four weeks. ^[1]

What is acute stress disorder?

Acute stress disorder goes beyond the typical reaction of your child or teenager to a traumatic or upsetting event. They may experience nightmares and go out of their way to avoid places or people they find triggering.

These events can include the death of a loved one, assault, serious harm, or a near-death experience. Such events don’t have to be directly experienced; acute stress disorder can also be caused by learning about the event, witnessing it, or being exposed to specific details. ^[2]

Children and teenagers with acute stress disorder display similar symptoms to PTSD. However, they do not last as long. Individuals with symptoms that last longer than four weeks may meet the criteria for a PTSD diagnosis. ^[3]

Who is at risk of acute stress disorder?

Teenagers and children who have previously been exposed in any form to traumatic events are the most susceptible to developing acute stress disorder ^[3]. Additional risk factors include: ^[2]

• A previously existing mental health disorder
• Poor coping mechanisms
• High emotional reactivity
• Girls can be more at risk than boys
• The severity of the traumatic event
• If the traumatic event caused any physical injury or disability

Acute stress disorder symptoms in children and teenagers

The criteria for a diagnosis of acute stress disorder according to the DSM-5 ^[2] states an individual must have experienced, or indirectly exposed to, a traumatic event as well as displaying at least 8 of the following symptoms:

• Recurring stressful/traumatic memories
• Having repetitive dreams and nightmares of the event
• Flashbacks of the traumatic event
• Continued distress in response to things that may remind them of the event
• Lack of happiness
• Feeling detached from their emotions and reality
• Dissociative amnesia (such as not being able to remember what they did at school that day or what they had for lunch)
• Avoidance of things, places, or people that remind them of the traumatic event
• Sleep problems
• High irritability in reaction to very little
• Being abnormally alert of their surroundings, especially in a place that reminds them of the event
• Easily distracted, which may impact their educationand social life
• Sudden involuntary reflexes, especially if they have experienced assault

These symptoms will start no later than four days after the traumatic event and stop after four weeks. If they continue after four weeks, they may meet the criteria for a PTSD diagnosis ^[3].

What causes acute stress disorder in teenagers?

Acute stress disorder is in reaction to a traumatic event. Common causes include: ^{[2] [3]}

• Death of a loved one
• A near-death experience involving themselves or a loved one
• A serious injury, especially if it causes a permanent disability
• Sexual or physical assault
• Natural disaster

These do not need to have been experienced first-hand. Acute stress disorder in teenagers can be in reaction to these events happening to a family member or close friend and being told about the traumatic event long after it occurred.

The exact cause of why some people develop acute stress disorder is unknown ^[1]. It may be a result of increased brain activity which causes a different response to a traumatic experience than normal ^[4].

‘Fear conditioning’ is the psychological response where a traumatic event is associated with something (for example, a smell or a sound) or somewhere. Similar responses to the traumatic event can be triggered in people with acute stress disorder in future encounters with these associations ^[5].

Treatment of acute stress disorder in teenagers

Acute stress disorder may resolve itself over time, but treatment can prevent more severe stress-related disorders from developing. A doctor or mental health professional may advise a combination of treatments depending on the symptoms experienced and the traumatic event.

• Trauma-focused cognitive behavioral therapy (TF-CBT) can help to deal with some of the stressors and triggers related to the event, reducing the amount of fear conditioning and preventing future PTSD. ^[6]
• Mindfulness iseffective in managing stress and improving coping mechanisms ^[7].
• There are currently no medications commonly used to treat acute stress disordereffectively. However, other medication may be used to reduce related symptoms, such as Prazosin, to aid sleep ^[1]. 

Differential diagnosis

A mental health professional may also consider other conditions similar to acute stress disorder, such as ^[1]:

• PTSD if symptoms have continued for more than fourweeks
• Adjustment disorder
• Brief psychotic disorder
• An organic disorder such as a brain injury
• Mood disorders such as major depressive disorder