ICD-10 code: F43.0
Acute stress disorder (ASD) is part of a cluster of diagnoses called the trauma- and stressor-related disorders. Trauma- and stressor-related disorders are a group of psychiatric conditions that include:
These disorders are characterized by an adverse reaction to one or more traumatic or unusually stressful experiences.
The Diagnostic and Statistical Manual of Mental Disorders-5th Edition defines traumatic events as situations in which the individual experiences, is threatened with, or witnesses serious injury, death, or sexual violence. Repeated exposure to extreme details of traumatic events as part of an individual's employment (e.g., a police officer or social worker who regularly encounters details of child abuse) also qualifies as a traumatic event.
PTSD and ASD are both characterized by a set of adverse cognitive, behavioral, and emotional changes that occur after experience of one or more traumatic events. Both disorders are characterized by intrusive and upsetting memories of the traumatic event(s), adverse cognitive and emotional changes (e.g., very negative beliefs about the world; persistent dysphoria or anger), avoidance behaviors (including avoiding thinking about the event), and increased autonomic reactivity. Acute stress disorder is diagnosed when the symptoms occur in the month following the traumatic event. PTSD is diagnosed when the symptoms persist for one month or longer following the traumatic event.
ASD is a psychiatric disorder that occurs between 3 days and 1 month after a traumatic event. The epidemiology of the disorder varies depending on location and context; for example, rates of ASD are likely to be elevated among groups who have recently experienced a major traumatic event (e.g., a terrorist attack or natural disaster).
Among individuals who have experienced a traumatic event, rates of ASD following the trauma are relatively higher (20 - 50%) for interpersonal traumatic events such as assault or witnessing a mass shooting, relatively lower (13 - 21%) for motor vehicle accidents, and lower still (6 - 12%) for industrial accidents. Because acute stress symptoms often occur in the immediate aftermath of a trauma, a diagnosis should not be made until at least 3 days after the event, and then only when the individual experiences impairment or distress associated with at least nine of the following symptoms (symptoms may be from any or all categories):
Although they do not count toward the diagnosis of ASD, other reactions such as panic attacks, chaotic or impulsive behavior, and guilty ruminations about the causes of the traumatic event are common.
ASD severity can range from mild to very severe. In severe cases, ASD can lead to inability to attend or concentrate at work or school and can interfere with the person's relationships. Little is known about the comorbidity of ASD with non-trauma- and stressor-related disorders. However, ASD is known to be a major risk factor for the development of PTSD.
Little is known about the neurobiology of ASD. The disorder's short duration makes it difficult to study, and as such much more is known about PTSD than about ASD. Additionally, researchers are often interested in ASD as it relates to the development of PTSD, rather than as a disorder of interest in its own right. Nevertheless, some neurobiological abnormalities have been identified in ASD specifically, including altered activity in the amygdala, orbitofrontal cortex, and dorsolateral prefrontal cortex, which are involved in emotion generation and regulation.
ASD is treatable. Published treatment guidelines for ASD are available from the American Psychiatric Association.
Clinical research suggests that the following treatments are effective for reducing symptoms of ASD and/or preventing the development of PTSD among individuals with a diagnosis of ASD:
Additional Treatments to Consider
Little is known about the potential efficacy of pharmacological interventions for ASD, due in large part to the definitional short duration of the disorder. Small trials have investigated escitalopram, propranolol, gabapentin, and benzodiazepines as potential agents prevent the development of PTSD, but studies generally have not found a difference from placebo. However, the American Psychiatric Association states that selective serotonin reuptake inhibitors may be prescribed for individuals with ASD on the basis of the limited findings in ASD and the known efficacy of these medications for reducing symptoms of PTSD. One randomized controlled trial combined CBT with hypnosis and found a small positive additive effect for hypnosis for reducing re-experiencing symptoms.
Of note, the intervention known as critical incident stress debriefing may actually be harmful and is not recommended as an intervention for healthy people. A group of principles collectively referred to as "psychological first aid" has also been identified as potentially promising. These principles include promoting: a sense of safety, calming, a sense of self- and community efficacy, connectedness, and hope. These principles have shown value individually; however, little is known about the efficacy of, or best way to implement, psychological first aid as a public health intervention.