Definition

Acute stress disorder (ASD) is an anxiety disorder characterized by a cluster of dissociative and anxiety symptoms occurring within one month of a traumatic event. (Dissociation is a psychological reaction to trauma in which the mind tries to cope by "sealing off" some features of the trauma from conscious awareness).

  Description

Acute stress disorder is a new diagnostic category that was introduced in 1994 to differentiate time-limited reactions to trauma from post-traumatic stress disorder (PTSD).

  Causes and symptoms

Acute stress disorder is caused by exposure to trauma, which is defined as a stressor that causes intense fear and, usually, involves threats to life or serious injury to oneself or others. Examples are rape, mugging, combat, natural disasters, etc.

The symptoms of stress disorder include a combining of one or more dissociative and anxiety symptoms with the avoidance of reminders of the traumatic event. Dissociative symptoms include emotional detachment, temporary loss of memory, depersonalization, and derealization.

Anxiety symptoms connected with acute stress disorder include irritability, physical restlessness, sleep problems, inability to concentrate, and being easily startled.

  Diagnosis

Diagnosis of acute stress disorder is based on a combination of the patient's history and a physical examination to rule out diseases that can cause anxiety. The essential feature is a traumatic event within one month of the onset of symptoms. Other diagnostic criteria include:

• The symptoms significantly interfere with normal social or vocational functioning
• The symptoms last between two days and four weeks.

  Treatment

Treatment for acute stress disorder usually includes a combination of antidepressant medications and short-term psychotherapy.

  Alternative treatment

Acupuncture has been recommended as a treatment for acute stress disorder. Some other alternative approaches, including meditation, breathing exercises, and yoga, may be helpful when combined with short-term psychotherapy. Homeopathic treatment and the use of herbal medicine and flower essences also can help the person with acute stress disorder rebalance on the physical, mental, and emotional levels.

  Prognosis

The prognosis for recovery is influenced by the severity and duration of the trauma, the patient's closeness to it, and the patient's previous level of functioning. Favorable signs include a short time period between the trauma and onset of symptoms, immediate treatment, and appropriate social support. If the patient's symptoms are severe enough to interfere with normal life and have lasted longer than one month, the diagnosis may be changed to PTSD. If the symptoms have lasted longer than one month but are not severe enough to meet the definition of PTSD, the diagnosis may be changed to adjustment disorder.

Patients who do not receive treatment for acute stress disorder are at increased risk for substance abuse or major depressive disorders.

  Prevention

Traumatic events cannot usually be foreseen and, thus, cannot be prevented. However, in theory, professional intervention soon after a major trauma might reduce the likelihood or severity of ASD. In addition, some symptoms of acute stress disorder result from biochemical changes in the central nervous system, muscles, and digestive tract that are not subject to conscious control.

   Key Terms:

Depersonalization A dissociative symptom in which the patient feels that his or her body is unreal, is changing, or is dissolving. Derealization A dissociative symptom in which the external environment is perceived as unreal. Dissociation A reaction to trauma in which the mind splits off certain aspects of the trauma from conscious awareness. Dissociation can affect the patient's memory, sense of reality, and sense of identity. Trauma In the context of ASD, a disastrous or life-threatening event.

   Resources:

Books

• "Acute Stress Disorder." In Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994.
• Corbman, Gene R. "Anxiety Disorders." In Current Diagnosis. Vol. 9. Ed. Rex B. Conn, et al. Philadelphia: W. B. Saunders Co., 1997.
• Eisendrath, Stuart J. "Psychiatric Disorders." In Current Medical Diagnosis and Treatment, 1998. 37th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1997.
• Kabat-Zinn, Jon. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Bantam Doubleday Dell Publishing Group, Inc., 1990.
• "On-Call Problems: Insomnia." In Surgery On Call, ed. Leonard G. Gomella and Alan T. Lefor. Stamford: Appleton & Lange, 1996.