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Acute stress disorder (ASD) FAQ

Posted by shadowlight and co on May 19, 2010

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What is acute stress disorder?

Acute stress disorder (ASD) is an anxiety disorder characterized by a cluster of dissociative and anxiety symptoms that occur within a month of a traumatic stressor.

What causes it?

ASD, like PTSD, begins with exposure to an extremely traumatic, horrifying, or terrifying event. Unlike PTSD, however, ASD emerges sooner and abates more quickly; it is also marked by more dissociative symptoms. If left untreated, however, ASD is likely to progress to PTSD. Because the two share many symptoms, some researchers and clinicians question the validity of maintaining separate diagnostic categories. Others explain them as two phases of an extended reaction to traumatic stress.

What are the risk factors?
  • Age—Older adults are less likely to develop ASD, possibly because they have had more experience coping with painful or stressful events.
  • Previous exposure—People who were abused or experienced trauma as children are more likely to develop ASD (or PTSD) as adults, because these may produce long-lasting biochemical changes in the central nervous system.
  • Biological vulnerability—Twin studies indicate that certain abnormalities in brain hormone levels and brain structure are inherited, and that these increase a person’s susceptibility to ASD following exposure to trauma.
  • Support networks—People who have a network of close friends and relatives are less likely to develop ASD.
  • Perception and interpretation—People who feel inappropriate responsibility for the trauma, regard the event as punishment for personal wrongdoing, or have generally negative or pessimistic worldviews are more likely to develop ASD than those who do not personalize the trauma or are able to maintain a balanced view of life.
What are the symptoms?

Acute stress disorder may be diagnosed in patients wh

  1. lived through or witnessed a traumatic event to which they
  2. responded with intense fear, horror, or helplessness, and are
  3. currently experiencing three or more of the following dissociative symptoms:
        • psychic numbing
        • being dazed or less aware of surroundings
        • derealization
        • depersonalization
        • dissociative amnesia

Other symptoms that indicate ASD are:

  • Reexperiencing the trauma in recurrent dreams, images, thoughts, illusions, or flashbacks; or intense distress when exposed to reminders of the trauma.
  • A marked tendency to avoid people, places, objects, conversations, and other stimuli reminiscent of the trauma (many people who develop ASD after a traffic accident, for example, refuse to drive a car for a period of time).
  • Hyperarousal or anxiety, including sleep problems, irritability, inability to concentrate, an unusually intense startle response, hypervigilance, and physical restlessness (pacing the floor, fidgeting, etc.).
  • Significantly impaired social functions and/or the inability to do necessary tasks, including seeking help.
  • Symptoms last for a minimum of two days and a maximum of four weeks, and occur within four weeks of the traumatic event.
  • The symptoms are not caused by a substance (medication or drug of abuse) or by a general medical condition; do not meet the criteria of a brief psychotic disorder; and do not represent the worsening of a mental disorder that the person had before the traumatic event.

People with ASD may also show symptoms of depression including difficulty enjoying activities that they previously found pleasurable; difficulty in concentrating; and survivor’s guilt at having survived an accident or escaping serious injury when others did not.


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