Acute Stress Disorder

Acute Stress Disorder: Is This a Nervous Breakdown?

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Acute stress disorder is relatively uncommon disorder afflicting people who have been exposed to a traumatic event, such as being a combat zone or surviving a serious car wreck. Read more to find out about its causes, symptoms, and treatment.

 

Acute Stress Disorder: What Does it Mean?

Acute stress disorder is the diagnosis of a group of symptoms that occur within one month after a traumatic event. The traumatic event could be a serious threat to life, a severe injury or another person’s death. The symptoms include feeling numb, dissociated and detached.

 

Stats: How Many Suffer from this Disorder?

Approximately 6 to 33% of people who experience a trauma will go on to develop acute stress disorder, according to the National Center for PTSD. Research indicates that women are more likely to be diagnosed with the condition than men.

 

Acute Stress Disorder and Psychogenic Shock: The Stressor

Psychogenic shock is the medical term used to describe the shock reaction after seeing or experiencing a traumatic event. It refers to the physical bodily reaction of a drop in blood pressure, which causes the individual to feel dizzy and may result in fainting.

 

What is a Stress Reaction?

A stress reaction is a symptom or symptoms, that occurs immediately or shortly after a traumatic or stressful event. The symptoms may last for only a few minutes or for several weeks. As well as emotional reactions, stress reactions also refer to physical reactions such as an increased heart rate, nausea, and headaches.

 

Signs and Symptoms of ASD

 

What are the Common Behaviors/Characteristics?

Some of the most common characteristics and behaviors of acute stress disorder are acting dissociated, having disturbed dreams and being in a negative or irritable mood.

Testing: What are the Diagnostic Criteria Per the DSM 5?

The DSM 5 diagnostic criteria for acute stress disorder is:

  1. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
  • Directly experiencing the traumatic event(s).
  • Witnessing, in person, the events(s) as it occurred to others.
  • Learning that the traumatic events(s) occurred to a close family member or close friend. Note: In cases of actual or threatened death of a family member or friend, the events(s) must have been violent or accidental.
  • Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: This does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work related.
  1. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:

Intrusion symptoms

  • Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
  • Recurrent distressing dreams in which the content and/or affect (emotional tone) of the dream are related to the events(s). Note: In children older than 6, there may be frightening dreams without recognizable content.
  • Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). Note: In children, trauma-specific reenactment may occur in play.
  • Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic events.

Negative Mood

  • Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

Dissociative Symptoms

  • An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing.)
  • Inability to remember an important aspect of the traumatic events(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).

Avoidance symptoms

  • Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
  • Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

Arousal symptoms

  • Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep)
  • Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
  • Hypervigilance
  • Problems with concentration
  • Exaggerated startle response
  1. The duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria.
  2. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  3. The disturbance is not attributable to the physiological effects of a substance (e.g., medication or alcohol) or other medical condition (e.g., mild traumatic brain injury) and is not better explained by brief psychotic disorder.”

Acute Stress Disorder and Other Conditions

Acute Stress Disorder vs Acute Stress Reaction

Unlike acute stress disorder, an acute stress reaction will usually stop within a very short time frame after the traumatic event. It is normal for the body and mind to have some reactions to any sort of trauma and so an acute stress reaction is not unusual.

When an acute stress reaction becomes persistent, lasts longer than expected and is coupled with several other reactions, that is when a doctor or other mental health professional will look into a diagnosis of acute stress disorder.

Acute Stress Disorder vs PTSD

An acute stress disorder can often be a precursor to a diagnosis of PTSD. If a person diagnosed with acute stress disorder is still showing symptoms after a month following the trauma, then the medical professional will begin the diagnosis process for PTSD.

Some research shows that up to 80% of people diagnosed with acute stress disorder will go on to develop PTSD. On the other hand, many people diagnosed with PTSD do not always have a prior diagnosis of acute stress disorder.

Related Conditions

Although research into the subject is still ongoing, there have been some studies that indicate a link between acute stress disorder and cardiovascular disease, diabetes, gastrointestinal disease, fibromyalgia, chronic fatigue syndrome, musculoskeletal disorders, and others.

Acute Stress Disorder In Adults/Children

There is currently no clear research that indicates whether acute stress disorder is more prevalent among children or adults. However, one study found that after a traumatic car accident, between 8 to 24% of children and adolescents met the criteria for acute stress disorder, whereas between 21 to 23.6% of adults will develop acute stress disorder after a trauma.

Signs that a child is suffering from the disorder are similar to the symptoms for adults but may also include ‘acting out’ the traumatic event -for example, repeatedly crashing toy cars together after a serious car accident.  Children who have acute stress disorder will also be more disorganized in their retelling/ description of the traumatic incident.

Example Case of Acute Stress Disorder

After being present during a movie theatre shooting, Robert began to have nightmares. Several weeks after the event, he still found it impossible to focus on his work, felt ‘jumpy’ and disconnected from the world around him. He became hypervigilant and unable to sleep. As a result of these symptoms, he was diagnosed with acute stress disorder.

Acute Stress Disorder

How to Deal/Coping With Acute Stress Disorder

Look out for These Complications/Risk Factors

The main risk factor for people with acute stress disorder is developing PTSD. There is also some evidence that suggests that physical conditions, such as fibromyalgia and cardiovascular disease, may occur alongside or as a result of the condition.

As with many mental health disorders, there is an increased risk of risky or life-threatening behaviors. The risk of self-harming and suicidal urges may be increased so sufferers and their loved ones should be aware of the signs and symptoms of these behaviors. Excessive alcohol consumption and drug use should be avoided due to the risk of addiction or abuse.

Acute Stress Disorder Treatment

The main treatment is a combination of cognitive behavioral therapy (CBT) and medication. CBT has shown a high success rate in helping sufferers with their symptoms and may also prevent the disorder from progressing into PTSD.

Some studies have also shown that hypnosis can significantly reduce the symptoms of post-traumatic stress, which may also be applicable for treating the symptoms of acute stress disorder.

Exposure therapies, such as psychological debriefing, have been used in the past as a treatment for acute stress disorder. However, some recent research has shown that the use of debriefing can exasperate symptoms and can cause more trauma. It is now recommended that such treatments are avoided.

Possible Medications for Acute Stress Disorder

There is not a specific medication prescribed for this disorder, but a doctor will usually prescribe a psychotropic medication, SSRIs, anti-anxiety medication or antidepressants. These medications will help with the individual symptoms of the disorder, such as anxiety, depression or high arousal.

Home Remedies to help Acute Stress Disorder

There currently are no home remedies specifically recommended for helping those with this disorder. Instead, it is recommended to see a doctor or mental health professional.

However, some people may find that alternative methods of helping with anxiety could help. For example, mindfulness or using relaxation techniques can both help to reduce anxiety levels and may also help improve sleep.

Living with Acute Stress Disorder

The prognosis for people with acute stress disorder and PTSD is usually positive: 50% of people with PTSD who got treatment had their treatment cases resolved within six months. However, this relies on people seeking treatment for the condition, so it is extremely important that help is sought after a trauma if there is a concern.

Living with the symptoms of acute stress disorder can be extremely difficult and tough to cope with. It’s important to find a good support system, both through medical professionals and in an individual’s personal life.

Although acute stress disorder is very much considered a treatable condition, it’s vital to practice self-care and be accountable for managing your own symptoms. Remember to avoid behaviors that could worsen symptoms, such as overuse of alcohol, taking drugs or skipping prescribed medication.

Insurance Coverage for Acute Stress Disorder

Each insurance company will have their own policy on acute stress disorder; contact the provider in question in order to find out more information.

How to Find a Therapist

What Should I be Looking for in a LMHP?

When choosing a Licensed Mental Health Practitioner (LMHP), look for someone with experience in acute stress disorders, PTSD or that area of mental health. A specialization in anxiety would be particularly useful.

Check your state’s accreditation system to help you find someone properly qualified. Look for a LMHP’s website or social media and check for references from previous patients.  You can also ask the professional themselves to provide you with some references, although do be aware that they probably won’t choose to show you any negative reviews!

Questions to Ask a Potential Therapist

Ask a potential therapist about their experience in treating anxiety, acute stress disorder and PTSD. Ask them to explain their methods of treatment to find out if their methods are something you’re comfortable with.

Create a list of questions before you contact a potential therapist. This will help you remember as well as give you an opportunity to think about what’s important to you in a therapist.

Remember to ask about insurance and other financial-related areas. For example, check if there’s a charge for missing an important due to sickness or any other unavoidable occurrence.

Acute stress disorder is undeniably difficult to live with. However, it is very treatable when diagnosed in time and dealt with correctly. If you or someone you know has experienced a trauma, don’t be afraid to seek help in the immediate aftermath. Everyone reacts differently to trauma and having an emotional reaction is completely normal. There are plenty of resources out there to help you navigate through any tough times ahead.

 

Acute Stress Disorder Resources and Support Helpline

PTSD: National Center for PTSD: https://www.ptsd.va.gov/public/problems/acute-stress-disorder.asp

National Suicide Prevention Lifeline: 1-800-273-8255

Crisis Text Line: Text CONNECT to 741741

The Sidran Institute: https://www.sidran.org/

PTSD Foundation of America: http://ptsdusa.org/

Resources:

https://www.ptsd.va.gov/public/problems/acute-stress-disorder.asp

https://patient.info/health/stress-management/acute-stress-reaction

http://traumadissociation.com/acutestressdisorder

https://www.barendspsychology.com/acute-stress-disorder-facts/

https://www.psychiatry.org/File%20Library/Patients-Families/APA_Understanding-Mental-Disorders_Stories-Acute-Stress-Disorder-Mary-and-Robert.pdf

http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd.pdf

Meiser-Stedman, R., Yule, W., Smith, P., Glucksman, E., & Dalgleish, T. (2005). Acute stress disorder and posttraumatic stress disorder in children and adolescents involved in assaults or motor vehicle accidents. American Journal of Psychiatry, 162, 1381-1383.

Forbes, D., Creamer, M., Phelps, A., Bryant, R., McFarlane, A., Devilly, G. J., … & Newton, S. (2007). Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder. Australian & New Zealand Journal of Psychiatry, 41, 637-648.

Holeva, V., Tarrier, N., & Wells, A. (2001). Prevalence and predictors of acute stress disorder and PTSD following road traffic accidents: Thought control strategies and social support. Behavior Therapy, 32, 65-83.

Salmond, C. H., Meiser‐Stedman, R., Glucksman, E., Thompson, P., Dalgleish, T., & Smith, P. (2011). The nature of trauma memories in acute stress disorder in children and adolescents. Journal of Child

Psychology and Psychiatry, 52, 560-570.

 

 

About the Author Depression Alliance Staff

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