Acute Stress Disorder (ASD) 101 – A Guide
Acute stress disorder (ASD), also called acute stress reaction or shock, is a condition that affects how a person thinks, feels, and responds to traumatic stressors. It arises in response to the experience or witnessing of a painful, terrifying, or emotionally stressful event which could involve the threat of death, actual death, injury or violence. It is estimated that up to 20% of people exposed to traumatic events can develop ASD and up to half of those can develop post-traumatic stress disorder (PTSD) later.
Causes of ASD
A number of traumatic or life-changing events can bring about ASD. What qualifies as traumatic for one person may have a much lesser impact on another. People who witness, but are not the direct victim of an event can still develop ASD. Deliberate crimes such as rape, sexual abuse, domestic violence, robbery, and assault have the highest rates of producing ASD and subsequent PTSD. Motor vehicle accidents, workplace accidents, fires, and natural disasters are also common causes of ASD.
ASD Risk Factors
Several factors can increase a person’s likelihood of developing ASD following a traumatic event:
- Presence of another mental illness or substance abuse
- Previous mental or physical trauma
- Current or past PTSD relating to a similar event
- Degree of exposure to the event
- Intrusion including memories and dreams
- Negative mood including lack of happiness
- Dissociation including being in a haze or daze or feeling out of body
- Arousal including inability to sleep or concentrate
ASD vs. PTSD
While often used interchangeably, several factors differentiate ASD from PTSD. Most people with ASD receive a diagnosis within a month of the traumatic event. People who meet the ASD diagnostic criteria after this time period would instead receive a PTSD diagnosis, overriding ASD.
Dissociation further separates the two disorders. Dissociative symptoms involve anomalies in thought patterns, self-awareness, or memory specific to the trauma and unrelated to another mental disorder or drug abuse. A bout of dissociation can vary in intensity and duration based on individual factors.
At least three dissociative symptoms must be present for a person to receive an ASD diagnosis. Qualifying symptoms include: memory loss, depression, loss of identity, sensory disturbances, and suicidal behaviors. People with PTSD can, but may not have symptoms of dissociation.
The Link Between ASD and PTSD
Studies show that without treatment, over three-fourths of people with ASD meet the guidelines for PTSD after roughly six months. Due to the complex nature of trauma, it is difficult to apply a single diagnostic standard to the entire population. People with some symptoms of ASD, but who lack dissociative symptoms may still develop PTSD.
ASD Treatment Options
While some people are able to manage ASD on their own, the complex mechanisms involved may promote symptoms of future PTSD. Coupled with counseling and individualized treatment considerations, cognitive behavioral therapy (CBT) can help patients manage both ASD and PTSD. A typical CBT process begins by desensitizing the patient to traumatic triggers by creating positive or neutral associations. Under guided hypnosis, a patient can subconsciously develop new patterns of thinking and feeling about the trauma. A therapist will help the patient better understand and come to terms with the trauma.
Because a major component of ASD lies in the subconscious, holistic therapy can supplement CBT. Through art, music, or physical activities, a patient can uncover valuable clues about their trauma that can aid in recovery.
The Importance of Individualized Treatment
The effects of trauma vary from person to person. Genetic, environmental, and behavioral factors all affect how a person responds to and copes with a traumatic event. As such, a clinician should evaluate the whole person and work together with the patient to create a personalized treatment plan. Tailored therapies can help prevent the onset of PTSD and help treat the patient for co-occurring substance abuse if present.
- Gibson, Laura E., Acute Stress Disorder, U.S. Department of Veterans Affairs, 3 January 2014, http://www.ptsd.va.gov/professional/treatment/early/acute-stress-disorder.asp
- Duckworth, Ken; Freedman, Jacob L., Dissociative Disorders, NAMI, November 2012, http://www2.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/By_Illness/Dissociative_Disorders.htm