Acute stress disorder

Acute Stress Disorder (ASD) is a common acute posttraumatic syndrome, which is strongly associated with the later development of Posttraumatic Stress Disorder. It is also known as acute stress reactions (ASR). Acute stress disorder (ASD) is a common acute posttraumatic syndrome, which is strongly associated with the later development of Posttraumatic Stress Disorder. Acute stress disorder represents both an acute pathological reaction to trauma and the role of dissociative phenomena in both short-term and long-term reactions to trauma.

Acute Stress Disorder was introduced into DSM-IV to describe acute stress reactions (ASRs) that occur in the initial month after exposure to a traumatic event and before the possibility of diagnosing Posttraumatic Stress Disorder, and to identify trauma survivors in the acute phase who are high risk for Posttraumatic Stress Disorder.

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)
DSM-5 code 308.3 (F43.0)

A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
 * 1) Directly experiencing the traumatic event(s).
 * 2) Witnessing, in person, the event(s) occurred to a close family memory or close friend.
 * 3) Experiencing repeated or extreme exposure to aversive details of the traumatic event(s).

B. Presence of nine or more of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic even(s) occurred:"

Intrusion Symptoms
 * 1) Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
 * 2) Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s).
 * 3) Dissociative reactions in which the individual feels or acts as if the traumatic event(s) were recurring.
 * 4) Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

Negative Mood
 * 1) Persistent inability to experience positive emotions.

Dissociative Symptoms
 * 1)  An altered sense of the reality of one's surroundings or oneself.
 * 2)  Inability to remember an important aspect of the traumatic events(s).

Avoidance Symptoms
 * 1)  Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
 * 2)  Efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

Arousal Symptoms
 * 1)  Sleep disturbance.
 * 2)  Irritable behavior and angry outbursts typically expressed as verbal or physical aggression toward people or objects.
 * 3)  Hypervigilance.
 * 4)  Problems with concentration.
 * 5)  Exaggerated startle response.

C. Duration of the disturbance is 3 days to 1 month after trauma exposure."

D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance, or other medical condition and is not better explained by brief psychotic disorder.

Dissociative symptoms and the link to Posttraumatic Stress Disorder
The previous version of the DSM manual, known as the DSM-IV-TR, described the dissociative symptoms from criteria B, using more concise technical terms. The dissociative and intrusive symptoms are described as follows.

Diagnosing Acute Stress Disorder (ASD)
The Acute Stress Disorder Structured Interview (ASDI) is a structured clinical interview for diagnosing Acute Stress Disorder, and is based on the DSM-IV criteria. The Acute Stress Disorder Scale (ASDS) is a self-report measure of ASD symptoms. It measures four clusters of symptoms: dissociation, re-experiencing, avoidance and arousal. The Stanford Acute Stress Reaction Questionnaire (SASRQ) is a similar self-report measure for Acute Stress Disorder. Acute Stress Disorder: A handbook of theory, assessment, and treatment (Bryant and Harvey, 2000) gives the ASDI and ASDS criteria in detail in the Appendix.

Acute Stress Reaction in the ICD10
This is coded as F43.0 in the ICD-10, and referred to as Acute stress reaction. The description is:

"A transient disorder that develops in an individual without any other apparent mental disorder in response to exceptional physical and mental stress and that usually subsides within hours or days. Individual vulnerability and coping capacity play a role in the occurrence and severity of acute stress reactions. The symptoms show a typically mixed and changing picture and include an initial state of 'daze' with some constriction of the field of consciousness and narrowing of attention, inability to comprehend stimuli, and disorientation. This state may be followed either by further withdrawal from the surrounding situation (to the extent of a dissociative stupor - F44.2), or by agitation and over-activity (flight reaction or fugue). Autonomic signs of panic anxiety (tachycardia, sweating, flushing) are commonly present. The symptoms usually appear within minutes of the impact of the stressful stimulus or event, and disappear within two to three days (often within hours). Partial or complete amnesia (F44.0) for the episode may be present. If the symptoms persist, a change in diagnosis should be considered."