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.
Reactive attachment disorder (RAD) is diagnosed only in children and is characterized by inhibited and emotionally withdrawn behaviors toward the child's caregiver(s), along with other social and emotional disturbances. RAD is an adverse reaction to neglect, repeated changes in caregivers (e.g., frequent changes in foster care), or rearing in adverse circumstances (e.g., institutions with inadequate availability of caregivers).
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.
Little is known about the treatment of ASD in children and adolescents. Treatment guidelines are available for the treatment of posttraumatic stress disorder in children and adolescents (Society of Clinical Child and Adolescent Psychology; American Academy of Child and Adolescent Psychiatry; National Institute for Clinical Excellence) and for the treatment of ASD in adults (American Psychiatric Association). However, it is not known whether these same interventions would be beneficial for children and adolescents with ASD.
The most promising intervention for children and adolescents with PTSD and adults with ASD is cognitive-behavioral therapy, which consists of gradually exposing the person to feared thoughts, situations, and activities, and helping the person to develop more accurate and helpful thoughts about him or herself, the trauma, and other people. Again, however, the efficacy of this intervention for children and adolescents in the month immediately following the trauma is unknown.
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. Two small trials suggest that imipramine and morphine may be effective for reducing the likelihood of subsequent PTSD in children who have been acutely burned.
The most promising intervention for children and adolescents with PTSD and adults with ASD is cognitive-behavioral therapy, which consists of gradually exposing the person to feared thoughts, situations, and activities, and helping the person to develop more accurate and helpful thoughts about him or herself, the trauma, and other people. Again, however, the efficacy of this intervention for children and adolescents in the month immediately following the trauma is unknown.
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. Two small trials suggest that imipramine and morphine may be effective for reducing the likelihood of subsequent PTSD in children who have been acutely burned.