Acute Stress Disorder


Acute Stress Disorder, Acute Traumatic Stress Disorder

  • Pathophysiology
  • Diagnosis
  • DSM IV
  1. Exposure to Traumatic event
    1. Experienced or witnessed actual or threatened death, serious injury or threat to integrity AND
    2. Response involved intense fear, helplessness or horror
  2. Associated dissociative symptoms (at least 3 present)
    1. Numb, detached or emotionally unresponsive
    2. Dazed or reduced awareness of surroundings
    3. Derealization
    4. Depersonalization
    5. Dissociative Amnesia with inability to recall important aspects of the Trauma
  3. Traumatic event is persistently reexperienced (at least 1 present)
    1. Images
    2. Thoughts
    3. Dreams
    4. Illusions
    5. Flashbacks
    6. Re-living experience
    7. Reminders of Trauma cause distress
  4. Marked avoidance of stimuli (e.g. places, people, conversations, activities) that recall the Trauma
  5. Marked anxiety or arousal
    1. Insomnia
    2. Irritability
    3. Poor concentration
    4. Hypervigilance
    5. Increased startle response
    6. Motor restlessness
  6. Clinically Significant distress or Impairment
  7. Onset within 4 weeks of the Trauma
  8. Duration of symptoms 2 days to 4 weeks
  9. Not due to other cause (e.g. CD, medication, medical condition, brief Psychotic Disorder)
  10. References
    1. (2000) DSM, 4th edition, APA, p. 471-2
  • Management
  1. See Psychological First Aid
  2. Background
    1. Up to 50% of Acute Stress Disorder cases progress to PTSD
    2. Early multi-session psychological interventions may be helpful in the prevention of developing PTSD
      1. Roberts (2019) Cochrane Database Syst Rev 8(8):CD006869 +PMID: 31425615 [PubMed]
    3. However, single debriefing session does not prevent PTSD development
      1. Rose (2002) Cochrane Database Syst Rev (2):CD000560 +PMID: 12076399 [PubMed]
  3. Cognitive Behavioral Therapy (CBT) by Psychology
    1. See Relaxation Training
    2. Posttraumatic reaction education
    3. Progressive Muscle Relaxation
    4. Imagined Traumatic memory exposure
    5. Cognitive restructuring of distorted Trauma-related beliefs
    6. Graduated exposure to avoided situations
  4. Intervention strategies by physician (empiric methods in parallel to CBT)
    1. Promote sense of safety
      1. Avoid conversations, news reports about major Traumatic events
    2. Promote sense of calm
      1. Employ Relaxation Techniques
    3. Promote sense of self-efficacy
      1. Return to pre-Trauma ability to overcome adverse events
      2. Become involved in community activities
    4. Promote connectedness
      1. Re-connect with family and friends
    5. Instill hope
      1. Reassure that CBT will help the patient return to normal responses to triggers
    6. Hobfoll (2007) Psychiatry 70(4): 283-315 [PubMed]
  5. Medications
    1. No specific medications are recommended for treatment of Acute Stress Disorder
      1. Bertolini (2022) Cochrane Database Syst Rev 2(2):CD013443 +PMID: 35141873 [PubMed]
    2. Consider management of comorbid conditions and transient symptoms
      1. Insomnia management
      2. Major Depression Management
  • Precautions
  1. Critical Incident Stress Debriefing
    1. Not recommended due to poor efficacy and risk of harm
  • Complications
  1. Risk of progression to PTSD (up to 50% of cases)
    1. See Posttraumatic Stress Disorder Risk Factors