Acute Stress Disorder: A Possible Response To Trauma
The National Institute of Mental Health defines a traumatic event as “a shocking, scary, or dangerous experience that can affect someone emotionally and physically.” Examples include experiencing or witnessing an assault, a car crash, a natural disaster, war, or the sudden loss of a loved one.
The way people react after living through a traumatic event can vary widely. Some may feel shaken and may ruminate on the event for a while after, but ultimately move past it without significant ill effects. Others may be deeply affected by the event, potentially developing a clinical mental illness as a result that may require treatment to resolve. Acute stress disorder (ASD)—not to be confused with autism spectrum disorder, which have the same acronym—is one reaction that some people may experience. Read on to find out more about what it is, how it’s diagnosed, and what to do if you’re experiencing symptoms.
What is acute stress disorder?
Acute stress disorder is a type of acute stress response that usually manifests within a month of the experience of a traumatic event. According to the US Department of Veterans Affairs, it’s estimated to occur in anywhere from six to 33% of people who have lived through a traumatic event. It’s also more likely to occur in those who have previously experienced traumatic events, previously experienced post-traumatic stress disorder (PTSD), or have a history of other mental illnesses. Symptoms are usually similar to those of PTSD, such as:
- Vivid and painful flashback memories
- Nightmares
- Intrusive thoughts
- Hypervigilance
- Feeling unsafe
- Self-destructive behavior
- Difficulty sleeping
- Difficulty concentrating
- Feeling numb or hopeless
Acute stress disorder vs. post-traumatic stress disorder
Though ASD and PTSD can both develop after a traumatic event, they have some differences. First, a diagnosis of PTSD requires a broader range of symptoms to be present than a diagnosis of ASD. Next, the other most important differentiator is time. Symptoms of ASD will manifest within a month of the individual experiencing trauma, while PTSD symptoms may not appear until three months after or more. Plus, symptoms of ASD last less than a month, while PTSD symptoms can go on for years if untreated.
PTSD is a serious illness that typically requires therapy and/or medication to address.
DSM-5 diagnostic criteria for acute stress disorder
According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the Fifth Edition (DSM-5), acute stress disorder is classified as a trauma- and stressor-related disorder. In order for a diagnosis to be considered, the individual must have experienced or witnessed something that meets the criteria for a traumatic event as detailed in the guidelines. They must also present with at least nine symptoms from any of the following five categories:
- Intrusion symptoms, such as recurrent, involuntary, and distressing memories, dreams, or flashbacks to the event and/or marked distress in response to reminders of the event
- Negative mood, namely the inability to experience joy, satisfaction, or loving feelings
- Dissociative symptoms, such as an altered sense of reality or the inability to remember some parts of the event
- Avoidance symptoms, or efforts to avoid memories or reminders of the event or things/people/places associated with the event
- Arousal symptoms, like irritability, sleep problems, hypervigilance, and being easily startled
The DSM details that symptoms typically begin immediately after the trauma is experienced and must persist for anywhere from three days to one month for a diagnosis of ASD to be considered. It also notes that they must cause significant distress and/or trouble functioning, and that they must not be due to another condition or substance.
Other conditions ASD could lead to
It’s also worth mentioning that the experience of trauma and the development of ASD could eventually lead to the development of other challenges and conditions as well. It’s part of why seeking support after experiencing a traumatic event and especially if you’re showing signs of ASD can be so important. With the right intervention, you may be able to avoid developing another condition such as:
- Depression
- Panic disorder
- Another type of anxiety disorder
- A substance use disorder
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
Remember, you don’t have to be experiencing specific symptoms to seek help after living through some type of trauma. Virtually anyone can benefit from the compassionate, listening ear of a therapist after going through a difficult or frightening event, whether symptoms are present or not.
Treatment for acute stress disorder
One of the most effective methods for healing from the effects of a traumatic experience—whether it takes the form of ASD, PTSD, or non-clinical effects of trauma—is therapy, which may or may not be recommended in conjunction with medication. Cognitive behavioral therapy (CBT) is one of the most effective modalities, especially trauma-focused CBT. The aim of this approach is to help the individual learn to recognize when distorted thoughts about the event, the world, or themselves are causing them distress. Over time, a cognitive behavioral therapist can then help them learn to shift these thoughts in a more realistic, positive direction.
As a result of this type of gradual cognitive restructuring, it can be easier to cope with signals your brain is sending so you can learn to feel happier, healthier, and more at peace. Additionally, it’s worth noting that research suggests that trauma survivors who receive some form of CBT treatment soon after the event are less likely to develop PTSD later. So if you’ve been through a traumatic event and are experiencing symptoms or simply would like someone to talk to about it, seeking the support of a licensed therapist who practices CBT could be beneficial.
Seeking online therapy for ASD
While seeking therapy is one of the most commonly recommended strategies for someone who has experienced or witnessed a traumatic event, not everyone feels comfortable meeting with a mental health care provider in person. Others may have trouble locating a provider near them or traveling to and from appointments regularly. Whatever the case may be, online therapy can represent a viable alternative in many situations.
With a platform like BetterHelp, you can get matched with a licensed therapist who you can meet with via phone, video call, and/or online chat from the comfort of home or anywhere you have an internet connection. Research suggests that therapy—CBT in particular—is no less efficacious when delivered online than it is when delivered in person. That means you can generally feel confident in choosing whichever format works best for you.
Takeaway
What are the DSM-5 criteria for acute stress disorder?
According to the DSM-5, acute stress disorder (ASD) is a trauma- or stressor-related disorder, which means that for a diagnosis to be considered, the person has had to have some type of trauma exposure and present with nine symptoms from these five categories:
- Intrusion symptoms recurrent, like significant prolonged psychological distress in response to reminders of the event or involuntary, recurrent, and distressing flashbacks, intrusive distressing memories, or dreams related to the event
- Negative mood, particularly being unable to experience positive emotions like satisfaction, joy, or love
- Dissociative reactions, like an altered sense of reality, dissociative amnesia, or being unable to remember parts of the event
- Avoidance symptoms, like attempting to avoid distressing memories of the event or things associated with the event
- Arousal symptoms, including sleep problems, exaggerated startle response, irritability, being easily startled, and hypervigilance
Per the DSM-5, symptoms usually occur immediately after the traumatic experience and must last between three days and one month for acute stress disorder to be considered as a diagnosis. Additionally, for an ASD diagnosis, these symptoms must not be due to substance use or another condition.
Is acute stress disorder in DSM-5?
Yes, acute stress disorder is in the DSM-5, classified as a trauma- or stressor-related disorder.
What is the difference between PTSD and acute stress disorder according to the DSM-5?
The main difference between PTSD and ASD is that symptoms must be present for longer than a month for a PTSD diagnosis. People diagnosed with ASD are very likely to develop PTSD. Over 80% of people with ASD will have PTSD six months later, but not everyone with ASD will develop PTSD.
What are the criteria for F43 0 acute stress reaction?
The International Classification of Diseases or ICD-10 code F430 is used to code an acute stress reaction. In this classification system, it’s also called ASD, psychological shock, or mental shock. ICD-11 was released in 2022, and F430 was renamed QE84. Criteria for an acute stress reaction in the QE84 include:
- Exposure to an event or situation of a highly threatening or horrific nature, including human-made or natural disasters, serious injury or accidents, acute life-threatening illness, torture, terrorism, witnessing the actual or threatened death of others in a sudden, violent, or unexpected manner.
- Development of a response to the stressor that is considered to be normal considering the severity of the stressor, including transient cognitive, emotional, somatic, or behavioral symptoms, like being in a daze, sadness, confusion, anxiety, despair, anger, or stupor. Other signs of anxiety, like sweating, tachycardia, or flushing, are also common.
- Symptoms typically appear within hours or days of the stressful event and generally begin to subside within a few days. Symptoms can persist, but they usually decrease over a month’s time as the person adapts.
How is acute stress disorder treated in the DSM-5?
The DSM-5 does not include any information or guidelines about treatment. The recommended treatment for acute stress disorder is psychotherapy, specifically a type of therapy called trauma-focused cognitive-behavioral therapy. People with ASD who receive treatment may reduce their risk of developing PTSD. Trauma-focused CBT focuses on increasing knowledge about how the brain responds to trauma, managing symptoms, and disputing and identifying cognitive distortions. Exposure therapy is also a part of this type of CBT. Exposure therapy is the standard of care for ASD and involves controlling the patient’s exposure to the source of the trauma to alleviate trauma memory and support fear extinction.
What is the DSM-5 code for post-traumatic stress disorder acute?
The DSM-5 does not have codes, only diagnoses, but many diagnoses have a corresponding code in the ICD-11. The ICD-11 code for post-traumatic stress disorder is 6B40; for acute stress disorder, it’s QE84.
What are 5 symptoms of acute stress?
Acute stress can have many symptoms; five of the most common may be painful and vivid flashbacks, nightmares, intrusive thoughts, hypervigilance, and feeling unsafe. Other symptoms can include self-destructive behavior, difficulty concentrating, difficulty sleeping, and feeling hopeless or numb.
What is an example of an acute stress disorder?
Acute stress disorder is an acute stress response that occurs after a traumatic experience to internal or external cues. When people experience a traumatic event that causes clinically significant distress, like a natural disaster, child abuse, an act of violence, mild traumatic brain injury, or a car crash, they may develop symptoms like having flashbacks or recurrent distressing dreams, verbal or physical aggression, being unable to experience joy, being unable to remember certain aspects of the traumatic event, attempting to avoid reminders of the event, and having sleep problems.
What type of disorder is acute stress?
Acute stress disorder DSM 5 is a trauma- or stressor-related disorder.
What is the best treatment for acute stress disorder?
Trauma-focused CBT that includes exposure therapy is the standard of care for treating ASD, a brief psychotic disorder. Effective treatment with repeated or extreme exposure can help prevent people with ASD from developing PTSD.
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