What is Acute Stress Disorder?
Acute Stress Disorder (ASD) was first recognized as a new medical condition in 1994. This was done to provide medical services to patients experiencing recent traumas which insurance companies did not cover because they were in the early stages. Moreover, it was aimed at identifying people at risk of developing Post Traumatic Stress Disorder (PTSD) after a traumatic event, so that early treatment could be initiated.
ASD refers to intense stress reactions that last for at least three days but not more than four weeks. If these reactions persist for more than four weeks, they may qualify for a PTSD diagnosis. ASD was identified to describe stress reactions that were either overlooked or mistaken for other disorders. Initially, to diagnose ASD, symptoms of disconnection from reality were required. However, this is not a compulsory criterion anymore, but it still forms part of the diagnostic guidelines.
In 2013, with the introduction of a new edition of the Diagnostic Manual of Mental Disorders, the diagnostic criteria for ASD underwent several changes. ASD was moved from being categorized under anxiety disorders to a new category of trauma and stressor-related disorders. The idea was to better differentiate its features. In this new edition, unlike the previous one, symptoms of disconnection from reality are not necessary for diagnosing ASD.
Further details about the cause, how widespread it is, the biological process responsible, medical history, physical examination, assessment, treatment, side effects, prognosis, alternative diagnoses, patient education, and improvement of treatment outcomes for ASD will be discussed in this article.
What Causes Acute Stress Disorder?
Surveys have shown that between 20 to 90% of people go through one or more extremely stressful events at some point in their lives. Even though many people experience extreme stress, only 1.3 to 11.2% of them end up developing Acute Stress Disorder (ASD), which can sometimes evolve into long-term conditions like PTSD (Post Traumatic Stress Disorder).
While there isn’t a lot of information on what specifically increases the risk of developing ASD after traumatic situations, it’s believed that the same factors that increase the risk for PTSD can also apply to ASD since the two are very similar.
According to various studies, these risk factors can be divided into three categories:
1. Factors that existed before the trauma: Being female, having an intellectual disability, limited education, having experienced traumatic events in the past, having a history of psychiatric or personality disorders, and genetics.
2. Factors related to the actual trauma: The severity of the trauma, assaults, rape, and physical injuries.
3. Factors that happen after the trauma: Developing Acute Stress Disorder, having an abnormally fast heart rate, having a low socioeconomic status, experiencing severe physical pain, staying in an intensive care unit, suffering a brain injury, having symptoms of disconnect from reality, becoming disabled, or experiencing additional stressful events later on.
Please note that these risk factors come from surveys and studies, which means they indicate a higher chance of developing ASD, not a certainty.
Risk Factors and Frequency for Acute Stress Disorder
Acute Stress Disorder (ASD) was included in the DSM-IV about 20 years ago. However, data about the frequency of this disorder, especially in everyday people, isn’t widely available. ASD is a separate disorder from Post Traumatic Stress Disorder (PTSD), but the differences between them are not entirely clear, which makes it difficult to measure the prevalence of ASD.
The rate of ASD tends to change depending on the type of study and the nature of the trauma involved. Some studies have reported that within a week after a traumatic event, 24.0% to 24.6% of individuals experienced ASD. And 1-2 weeks after a traumatic event, the prevalence can be anywhere between 11.7% and 40.6%.
Few studies have also focused on certain populations. For instance, one analysis performed in 2018 looked at the prevalence of ASD among individuals involved in road traffic accidents. The study found an average prevalence of 15.81%. In this analysis, a total of 2989 accident patients from eight countries were studied. The results highlight the importance of identifying early signs of ASD and providing the necessary treatment.
- Among children aged 7 to 17 years old who had a traumatic experience, 14.2% experienced ASD within the first two weeks.
- At nine weeks after the traumatic event, the prevalence of PTSD among these children was 9.6%.
- In another study, mothers of prematurely born babies were found to have a significantly higher ASD prevalence of 14.9%, compared to mothers of full-term babies who had no instances of ASD.
Signs and Symptoms of Acute Stress Disorder
Acute stress disorder (ASD), as defined by the American Psychiatric Association’s DSM-5, is a condition that is categorized by specific criteria. These include:
- Exposure to a traumatic event, physically, sexually, or mentally
- Presentation of more than eight varying symptoms. These symptoms, which fall into five categories, include:
1. Intrusion symptoms:
- Recurrent distressing memories of the traumatic event. In children, this can be seen in repetitive theme-based games.
- Repetitive dreams about the traumatic event. Nightmares may be present in children.
- Flashbacks to the traumatic event.
- Intense or prolonged mental or physical distress when reminded of the traumatic event.
2. Negative mood:
- Inability to feel happiness, success, or love.
3. Dissociative symptoms:
- Feeling detached from oneself and emotions.
- Dissociative amnesia (not related to intoxication or traumatic brain injury).
4. Avoidance symptoms:
- Avoiding thoughts, memories, and feelings about the traumatic event.
- Avoiding people and places that remind one of the traumatic event.
5. Arousal symptoms:
- Problems with sleep, such as difficulty falling asleep or staying asleep.
- Experiencing irritability and rage with little to no provocations
- Being unusually alert to one’s surroundings
- Being distractible
- Having an unusually strong reaction to sudden events
- The symptoms need to last for a period between three days and four weeks.
- The symptoms significantly impact normal functioning.
- The symptoms are not related to substance use or other medical conditions like traumatic brain injury.
Meeting these criteria would be indicative of ASD.
Testing for Acute Stress Disorder
- Acute stress disorder (ASD) is a mental health condition
- ASD can show up in physical ways like a rapid heart rate
- ASD can even affect brain scans
- There aren’t any reliable lab tests or imaging to diagnose ASD
- Doctors diagnose ASD mainly through an in-depth look at your health history and a physical exam
- Paying close attention to a patient’s behavior and being a good listener when the patient talks about their experience can give a lot of helpful information
- Some patients might not be able to share all their feelings or background during the first visit, so they might need to come back a few more times
- There are also valid and fast questionnaires that can help doctors evaluate if a child or an adult has ASD
- For children, there is a checklist called the Child Stress Reaction Checklist (CSDC), which can quickly measure symptoms of ASD and post-traumatic stress disorder (PTSD) in children ages 2 to 18
- For adults, there’s a questionnaire specifically made for diagnosing ASD
Treatment Options for Acute Stress Disorder
After a traumatic event, it’s critical that the person affected stays safe and knows where to turn for help. Support can play a vital role in recovery. Emotional comfort can come from close relationships with friends and family, and if those aren’t available, healthcare providers can help by explaining what to expect in the aftermath of such an event and offering coping strategies. Practical help may also be needed, as the aftermath can involve police reports, finding medical professionals, securing time off work, and dealing with health insurance. If disability occurs due to an accident, more extensive medical support may be necessary.
Regular check-ups, for at least six months, are recommended for anyone who’s been through significant trauma. During these visits, it’s also crucial to check for suicidal feelings, especially for those with risk factors or existing mental health conditions like depression.
One of the most effective treatments for acute stress disorder (ASD) is a form of cognitive-behavioral therapy (CBT) designed specifically for trauma, known as trauma-focused CBT. This therapy can be provided online, over the phone, or in-person, and it aims to increase understanding of trauma, manage symptoms, correct false or inaccurate thoughts, and gradually expose the person to the source of their trauma in a controlled way. This type of therapy helps to reduce the fear associated with the traumatic memory.
However, asking a patient to detail their trauma and feelings within the first 72 hours has not been found to prevent the development of PTSD, so it’s not routinely recommended.
When it comes to medication, there’s little solid evidence to suggest that any one drug can effectively treat ASD. Some trials have looked at drugs like serotonin reuptake inhibitors (SRIs) and propranolol, but results have been mixed. The approaches used often rely on studies related to PTSD due to their similarities with ASD.
SRIs, which include SSRIs and SNRIs, are among the most studied medications for PTSD and have shown promising results. For instance, paroxetine is FDA-approved to treat PTSD. Three SSRIs and one SNRI have the most robust evidence and are typically the first choices of medication for PTSD. Second-generation antipsychotics may sometimes be used alongside SRIs, particularly in patients with associated anxiety and depression who haven’t responded adequately to the former. Meanwhile, benzodiazepines are generally not recommended for PTSD treatment due to their lack of effectiveness and potential adverse effects. Beta-blockers such as propranolol have been shown to not reduce PTSD incidence but they can ease physical symptoms like a rapid heart rate and sweating. More research is needed before they can be routinely prescribed for PTSD patients.
Other treatments like electroconvulsive therapy (ECT) have shown promise for PTSD patients also struggling with depression. Yet, the evidence supporting mood stabling drugs is limited and they usually have little effect on PTSD. Some reports suggest that lamotrigine and gabapentin could help with nightmares and flashback, but more research is required to support this claim.
Specific treatments can be applied to address symptoms like sleep disturbances, including insomnia and nightmares, common in PTSD. However, SRIs and benzodiazepines have not been found to be effective. But prazosin, an alpha-1 selective adrenergic blocker, can be beneficial in managing these sleep issues. Other supplemental treatments, such as eszopiclone, olanzapine, and risperidone, have also shown efficacy.
What else can Acute Stress Disorder be?
Possible diagnoses for acute stress disorder (ASD) could be a range of conditions, including:
- Post-Traumatic Stress Disorder (PTSD), where the symptoms persist for more than four weeks.
- An Adjustment disorder, which lacks the features necessary to diagnose ASD.
- Brief psychotic disorder, a condition related to stress that also lasts less than four weeks. The symptoms are more widespread and usually less intense.
- Natural conditions such as a mild traumatic brain injury, which could be hard to identity based solely on an examination of the nervous system, or a brain tumor, which might be indicated by certain symptoms such as localized nervous system deficits or headaches.
- Mood disorders including major depressive disorder, which is characterized by enduring feelings of sadness and other depression-related symptoms.
The exact cause would be determined by a healthcare professional through careful examination of symptoms and, where appropriate, additional testing.
What to expect with Acute Stress Disorder
Recent research indicates a strong link between Acute Stress Disorder (ASD) and the later development of Post-Traumatic Stress Disorder (PTSD). This study also noticed that abnormalities Captured by a brain scan (fMRI) can correlate with the severity of future PTSD.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that PTSD symptoms disappear in about half of the patients within three months. However, to reduce the chance of the condition returning, it’s advised to continue medication for at least six months to a year.
Most people diagnosed with PTSD will recover in the following years, with the most significant improvements seen in the first year. Unfortunately, about one-third of PTSD patients still experience symptoms for over two years, and are at risk of turning to substances as a coping mechanism.
People with ASD are also particularly vulnerable, being 24 times more likely to die from a suicide attempt than those without it. Interestingly, one study also reported that patients diagnosed with a stress disorder are twice as likely to die from any cause than those who don’t.
People suffering from PTSD or ASD may start avoiding situations that remind them of their traumatic experience. For instance, if a person had a car accident, they may stop driving. This avoidance can lead to severe consequences like losing their job due to absence or poor performance, which can result in financial strain and even homelessness. Additionally, their social relationships may also suffer, leading to break-ups, further complicating their emotional well-being.
Possible Complications When Diagnosed with Acute Stress Disorder
Acute Stress Disorder (ASD) can result in different mental health issues. These include:
- Mood Disorders: Includes depressive disorders, which may occur with or without suicidal thoughts, as well as anxiety and panic disorders.
- Substance Use Disorders: This can lead to alcohol abuse and illegal drug dependency.
Preventing Acute Stress Disorder
Teaching patients about their condition is a crucial part of managing stress disorders. It’s important for patients to understand that it’s normal to have a strong emotional response, which usually fades within a few days to a week in most cases. It’s not something that is likely to persist for a long time. Patients should be encouraged to avoid situations that trigger memories of the stressful event – this could even include watching certain television shows that follow a similar theme.
Patients are also recommended to spend time with their family and be patient with themselves during this time. It’s also essential for patients to be involved in the planning of their own treatment. This includes understanding the different therapy options as well as being aware of the possible side effects of these treatments. This engagement helps in better coping with the disorder and facilitates recovery.