Acute Stress Disorder

Definition

Acute stress disorder is the initial psychological reaction to witnessing or experiencing psychological trauma. The Diagnostic and Statistical Manual of Mental Disorders (DSM) characterizes ASD by the fulfillment of certain criteria:

• A.
  Having experienced intense fear, helplessness, or horror in response to a traumatic experience
• B.
  Displaying three or more of the following dissociative symptoms

  • 1.
    Emotional numbing
  • 2.
    Detachment, or absence of emotional responsiveness
  • 3.
    Reduction in awareness of surroundings
  • 4.
    Derealization or depersonalization
  • 5.
    Dissociative amnesia
• C.
  Exhibiting at least one symptom from each of the following groups

  • 1.
    Reexperiencing (i.e., recurring thoughts, memories, dreams, or flashbacks)
  • 2.
    Avoidance of trauma-related stimuli (i.e., deliberately avoiding reminders of the trauma)
  • 3.
    Anxiety or increased arousal (i.e., increased autonomic nervous system activity)
  • 4.
    Significant distress or functional impairment that persists from a minimum of 2 days to a maximum of 4 weeks.

If the duration of the disorder exceeds 4 weeks, PTSD is diagnosed.

Evolution of the ASD Diagnosis

The notion of ASD was first introduced in 1994 in DSM-IV to describe the stress reaction that occurs during the first month following a traumatic event. The motivation in establishing this diagnosis was to discern between trauma survivors who experience a transient stress reaction to trauma, from those who suffer acute stress and are likely to develop PTSD. This allowed the prevention of pathologizing the overwhelming majority of people who, when exposed to trauma, experience normative and transient stress reactions. It also improved psychological treatment and intervention following traumatic experiences.

Studies on both adults and children that first assessed ASD and subsequently evaluated PTSD in the same subjects indicate that although about 75% of those with an ASD diagnosis went on to develop PTSD, many who subsequently developed PTSD did not qualify for the acute stress diagnosis. This suggests that most people diagnosed with ASD are prone to develop PTSD, while many people who are not diagnosed as suffering from ASD do subsequently develop PTSD. In light of these studies, it has been argued that the diagnostic criteria for ASD should be revised.

Critics of the ASD diagnosis have noted that the display of dissociative symptoms emphasized in the DSM criteria is insufficient in predicting PTSD. It has also been argued that the primary function of an ASD diagnosis is as a predictor for PTSD due to the similarity of their symptoms. Hence, the main difference between the two diagnoses is the duration of the symptoms, which does not justify the use of an autonomous ASD diagnosis. Some have called for ASD to be removed altogether from the expected DSM - V. The case for its inclusion would be strengthened by evidence that ASD is indeed a useful predictor of PTSD.

Treatment

ASD is characterized by the fragmentation of memories and cognitive schemes, coupled with difficulty in the retrieval of specific memories and the inability to encode them in time. Additionally, ASD is a transitional state between the traumatic experience and potential PTSD. Therefore, treatment of ASD is mainly focused on cognitive therapy and the prevention of PTSD.

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