Acute Stress Disorder: Symptoms, Causes, Evaluation, and Treatment
Acute stress disorder (ASD) is part of those disorders that are related to trauma and stressful events. It lasts between three days and a month; when this period is exceeded, then we speak of post-traumatic stress disorder (PTSD).
What does acute stress disorder consist of? What are your most common symptoms? How can we intervene? How are symptoms assessed? Don’t miss any detail in the following article.
Acute stress disorder: What is it?
Acute stress disorder (ASD) is part of the so-called trauma-related disorders. We find it in the DSM-IV-TR and the DSM-5 (Statistical and Diagnostic Manuals of Mental Disorders).
ASD arises as a result of exposure to a traumatic event or event. Said exposure causes a series of intrusive, dissociative, and avoidance symptoms that cause serious discomfort to the person, as well as significant interference in their lives.
It’s a disorder that generates a lot of suffering, although in this case, it lasts only between three days and a month, which differentiates acute stress disorder from post-traumatic stress disorder (PTSD). When more than a month goes by and the symptoms continue, then we can already talk about PTSD.
A trauma-related disorder
Following the DSM-5 guidelines, ASD is classified as a trauma-related and stressor-related disorder. Trauma, according to the Royal Spanish Academy (RAE), is defined as an emotional shock that produces lasting damage to the unconscious.
Etymologically, the root of the word “trauma” comes from Greek and means “wound”. From psychology, a traumatic event is one related to death, extreme violence, or other similar elements (for example, a serious injury). It must be a very stressful event for the person and difficult to manage or process in order to be able to define it as a traumatic event.
The symptoms of acute stress disorder
The DSM-5 lists a series of diagnostic criteria to be able to speak of an acute stress disorder. In these criteria, we find the symptoms that cause it.
1. Exposure to death, serious injury, or sexual violence
As we said when we talked about a traumatic event, the first criterion to talk about an ASD is exposure to a traumatic and stressful event, such as a death, a serious injury, or a situation of sexual violence. It can be lived in a real way or in the form of a threat.
What forms of exposure do we find? In other words, how can we live that exhibition? There are four different ways:
- A direct experience of the event.
- Being present at the event that happened to someone else (seeing it).
- Knowing that the event has happened to a family member or close friend.
- Being exposed to repulsive details of the event repeatedly. There are certain professions related to this type of exposure, such as police officers and firefighters.
2. Intrusive, dissociative, and other symptoms
In the second criterion of acute stress disorder, we find another series of symptoms. At least nine of these symptoms must be met, which are distributed into five categories (intrusion, negative mood, dissociation, avoidance, and alertness).
Symptoms appear or worsen after the traumatic event. We’re going to analyze them according to the five categories:
- Intrusive symptoms: Memories of the event that are experienced in an intrusive and involuntary way and that generate significant anguish in the person. The experience is recurrent, that is, it’s repeated over time. What happens in the case of children? These symptoms differ, and peculiar or strange games may appear that represent the event or that lead the child to relive it. Besides the memories, dreams related to the trauma may also appear.
- Mood symptoms: In acute stress disorder, mood is also altered. This is negative and is experienced as an inability to experience pleasant and positive emotions or sensations.
- Dissociative symptoms: Dissociation is another central feature in trauma-related disorders. Through it, the person is separated from their reality, or two elements in their psyche are fragmented (for example, memory and identity). Therefore, the sense of reality can be altered and an inability to remember what happened can also appear.
- Avoidance symptoms: The person tries to avoid thinking about the traumatic event. They avoid remembering it because doing so causes them a great deal of anxiety and discomfort, and they also reject everything related to it (people, objects, details).
- Warning symptoms: These include sleep disturbances, hypervigilance, concentration and attention difficulties, irritable and angry behavior, as well as exaggerated startle or fright responses.
Causes
What causes an acute stress disorder? As can be inferred from all of the above, what causes ASD is an event that’s highly stressful and traumatic for the person.
This includes seeing it, experiencing it on one’s own skin, or hearing in detail the trauma experienced by another. If we experience it firsthand, it’ll be more likely to lead to ASD or PTSD and the symptoms will be more intense.
Traumatic events are related to death, violence, and physical or mental injury or damage. This includes everything that has to do with accidents, suicides, abuse, and murders. In other words, they’re very serious events that have a great impact.
Evaluation and treatment of acute stress disorder
To assess acute stress disorder (or PTSD) and, as an initial screening instrument, we find the Davidson Trauma Scale (Davidson, JRT., Book, SW., Colket, JT. et al., 1997). The Echeburúa et al. PTSD Symptom Severity Scale-Revised (EGS-R) is also very useful. (2016). Both are based on the diagnostic criteria of DSM-IV-TR (Davidson) and DSM-5 (EGS-R).
Besides the instruments mentioned, it’ll always be useful and necessary to carry out a good clinical interview with the patient, in addition to follow-up and observation. Everything is important when evaluating, especially in the initial moments of traumatic shock.
The treatment of choice in trauma disorders, according to the Guide to effective psychological treatments by Pérez et al. (2010) and the Manual for the cognitive-behavioral treatment of psychological disorders of Caballo (2002), is that which includes exposure therapy. That is, exposing the subject to trauma, whether in a real, imagined, or symbolic way.
The techniques that include exposure as a fundamental element are usually live exposure, imagination training, and covert or imagined exposure. In the case of live exposure, the patient may be exposed to the details related to the traumatic event, as well as the related people or objects.
Express and process: Key factors
Strategies are used a lot to help the patient express what they experienced, either through writing or art. This allows them to then rewrite the story by including reassuring elements.
The important thing here will be not only the expression of everything that has been repressed but the act of being able to process what happened and rework the memory. You can also work with relaxation or breathing techniques to reduce the levels of anxiety that the patient presents.
“We are healed of suffering only when we experience it in full.”
-Marcel Proust-
Change negative thoughts
Techniques typical of cognitive therapy are also used, such as restructuring. The intention of this method is that the patient eliminates or modifies both the negative and dysfunctional thoughts associated with the trauma, as well as the cognitive distortions that make them process information in an unhealthy or inadequate way.
In addition, in acute stress disorder, it’s very common for catastrophic or negative thoughts related to the future to appear, as the person has felt unprotected for some time. This affects their feeling of security or hope.
Pharmacotherapy
It’s also common to resort to pharmacological treatment, although more in the case of PTSD than in acute stress disorder (because of its short duration). We’re talking about anxiolytic drugs as a complement to psychotherapeutic intervention, although antidepressants have also been used.
Specialized care in acute stress disorder
As we’ve seen, acute stress disorder causes significant interference in a person’s life. Living through a shocking and stressful event that leaves us unprotected and that we’re unable to process is what causes this problem.
In order to treat it, it’ll be essential for the patient to be able to rework what they’ve experienced, process it, and accept it as part of their biography and life story. It’s something that requires time, emotional accompaniment, conscious coping, and specialized attention.
- American Psychiatric Association -APA- (2014). DSM-5. Manual diagnóstico y estadístico de los trastornos mentales. Madrid. Panamericana.
- American Psychiatric Association -APA- (2000). DSM-IV-TR. Diagnostic and statistical manual of mental disorders (4thEdition Reviewed). Washington, DC: Author.
- Belloch, A., Sandín, B. y Ramos, F. (2010). Manual de Psicopatología. Volumen II. Madrid: McGraw-Hill.
- Caballo (2002). Manual para el tratamiento cognitivo-conductual de los trastornos psicológicos. Vol. 1 y 2. Madrid. Siglo XXI (Capítulos 1-8, 16-18).
- Echeburúa, E., et al. (2016). Escala de Gravedad de Síntomas Revisada (EGS-R) del Trastorno de Estrés Postraumático según el DSM-5: propiedades psicométricas. Terapia psicológica, 34(2): 111-128.
- Morales, C. (2006). Evaluación de la escala de trauma de Davidson. Estandarización de la Escala de Trauma de Davidson (DTS).
- Pérez, M., Fernández, J.R., Fernández, C. y Amigo, I. (2010). Guía de tratamientos psicológicos eficaces I y II. Madrid: Pirámide.