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Synonyms
Acute stress response; Stress reaction
Short Description or Definition
Acute stress disorder (ASD) is defined in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association 2013) by a pattern of symptoms associated with exposure to an actual or threatened trauma or stressor. Exposure may involve (1) direct experience of traumatic events, (2) personally witnessing events, (3) learning of events that occurred to others, and (4) repeated or extreme exposure to details of traumatic events. Symptoms associated with the exposure may include intrusion symptoms (i.e., involuntary memories, distressing dreams, flashbacks, intense responses to triggers), negative mood, dissociative symptoms, avoidance symptoms, and symptoms of physiological arousal (i.e., sleep disturbance, irritability/anger, hypervigilance, poor concentration, and exaggerated startle response). To be diagnosed as ASD, symptoms must persist for at least 3 days and not longer than a month (at which point they might be more representative of posttraumatic stress disorder).
Categorization
The disorder is classified with the trauma- and stressor-related disorders in DSM-5.
Current Knowledge
Development and Course
Prevalence rates for ASD tend to vary in association with the nature or severity of the stressor and situational factors following the onset of the stressor (e.g., the persistence of the initial threat). Prevalence rates tend to be higher if the trauma involves interpersonal violence, and these rates have been reported to range from as much as 20% to 50% of such cases. Other common index traumas include motor vehicle accidents, severe burns, work-related or industrial accidents, and traumatic medical events. In a 2011 review of studies reporting incidence of ASD associated with a variety of stressors, Bryant found rates of ASD ranging from 7% to 28%, with a mean incidence rate of 13%. By definition, ASD cannot be diagnosed beyond 1 month from the onset of the stressor or trauma. During this period, symptoms may worsen along with exacerbation of stress. Women appear to be at higher risk for the development of ASD. The risk of ASD also appears to increase among individuals who have a history of other psychological disorders and who perceive the index trauma as more severe.
Associated Disorders and Current Research
Originally, ASD was developed to identify individuals who may eventually develop symptoms of posttraumatic stress disorder (PTSD). Acute stress disorder remains strongly associated with PTSD, with at least half of trauma survivors who have a diagnosis of ASD progressing to PTSD. Among individuals with a diagnosis of PTSD, it is estimated that 48% originally had symptoms of ASD. Acute stress disorder is a narrower form of an acute stress reaction with a prominent anxiety or fear component. The diagnosis of adjustment disorder more appropriately captures the breadth of disruptive psychological reactions to stress or trauma that may be characterized by grief, anger, depression, etc. Acute stress disorder may also be difficult to distinguish from postconcussive symptoms following head trauma. These two disorders share many physiological, cognitive, emotional, and behavioral sequelae (e.g., sensitivity to environmental stimuli, difficulty concentrating, and irritability). Recent research has revealed that individuals exposed to experimentally induced acute psychosocial stressors exhibit impairments in attentional processes and spatial working memory (e.g., Sänger et al., 2014; Olver et al., 2015).
Assessment and Treatment
A diagnosis of ASD should capture an individual’s current distress and indicate the importance of facilitating treatment and resources. An essential feature of assessment involves the identification of an index stressor or trauma. Assessment and treatment may be complicated in situations involving persistent threat. Given the temporal proximity to traumatic events associated with a diagnosis of ASD (i.e., as little as 3 days), it may be important to rule out physical or medical conditions associated with trauma or to facilitate medical stabilization and treatment. Acute stress disorder may be assessed with measures such as the Acute Stress Disorder Scale (Bryant et al., 2000) and the National Stressful Events Survey Acute Stress Disorder Short Scale (Kilpatric et al., 2013).
Given the relatively brief course of symptoms associated with ASD, it has been difficult to establish an evidence base for potential interventions. Generally, once ASD has been diagnosed, it is helpful to provide psychoeducation and normalization regarding common psychological reactions to trauma, along with normative expectations for recovery. Given the likelihood that individuals with ASD may go on to develop PTSD, it may be helpful to facilitate case management and referrals for mental health treatment including psychopharmacological or psychotherapeutic treatments for posttraumatic stress.
During the acute phase of recovery from a stressor or trauma, it may also be possible to provide brief interventions for cognitive and physiological symptoms of anxiety. These may include strengths-based coping strategies, behavioral strategies for addressing symptoms of anxious arousal (e.g., relaxation training), and elements of trauma-focused cognitive-behavioral therapies to address common negative or catastrophic thoughts associated with the trauma.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association Publishing.
Bryant, R. A. (2010). Acute stress disorder as a predictor of posttraumatic stress disorder: A systematic review. The Journal of Clinical Psychiatry, 72(2), 233–239.
Bryant, R. A., Moulds, M. L., & Guthrie, R. M. (2000). Acute stress disorder scale: A self-report measure of acute stress disorder. Psychological Assessment, 12(1), 61–68.
Bryant, R. A., Friedman, M. J., Spiegel, D., Ursano, R., & Strain, J. (2011). A review of acute stress disorder in DSM-5. Depression and Anxiety, 28(9), 802–817.
Kilpatrick, D. G., Resnick, H. S., & Friedman, M. J. (2013). National stressful events survey ASD short scale (NSESSS-ASD). Arlington: American Psychiatric Association.
Olver, J. S., Pinney, M., Maruff, P., & Norman, T. R. (2015). Impairments of spatial working memory and attention following acute psychosocial stress. Stress and Health, 31(2), 115–123.
Sänger, J., Bechtold, L., Schoofs, D., Blaszkewicz, M., & Wascher, E. (2014). The influence of acute stress on attention mechanisms and its electrophysiological correlates. Frontiers in Behavioral Neuroscience, 8, 353.
Ursano, R. J., Bell, C., Eth, S., Friedman, M., Norwood, A., Pfefferbaum, B., ... & Charles, S. C. (2004). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. The American Journal of Psychiatry, 161(Suppl 11), 3–31.
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Klyce, D.W. (2018). Acute Stress Disorder. In: Kreutzer, J.S., DeLuca, J., Caplan, B. (eds) Encyclopedia of Clinical Neuropsychology. Springer, Cham. https://doi.org/10.1007/978-3-319-57111-9_9182
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