Acute Stress Disorder: Causes, Diagnosis, And Treatment

Stress can be a natural byproduct of changes that cause physical, psychological, mental, or emotional tension. After you experience or witness a traumatic situation or event, it can take time to refocus and get yourself back on track. Self-care, support, and time are sometimes enough to recover and move forward from these events. However, in people with acute stress disorder (ASD), recovery may be more complex. In this article, we’ll explore acute stress disorder, its causes and criteria for diagnosis, and some of the treatments available.

About stress disorders 

Stress disorders encompass a range of conditions that can arise in response to traumatic events or comorbid mental health conditions. 

Posttraumatic Stress Disorder (PTSD) is one of the most well-known stress disorders, characterized by persistent distress following such events. Acute Stress Disorder (ASD) have similar symptoms with PTSD but occurs immediately after the trauma and typically lasts for a shorter duration. 

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), both PTSD and ASD are serious conditions that require proper diagnosis and treatment to manage their impact on mental health.

What is acute stress disorder?

Acute stress disorder (ASD) was introduced in 1994 into the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV.)

The general current diagnostic standard for a psychiatric diagnosis of ASD resembles that of post-traumatic stress disorder (PTSD). The main difference between the two is that a diagnosis of ASD is provided within four weeks after a traumatic event. 

Causes of acute stress disorder

Although more research needs to be undertaken into factors that may put certain individuals at an increased risk of developing ASD, the condition typically occurs after a particularly stressful and upsetting event. A person may develop acute stress disorder if they have experienced or witnessed an unexpected stressful event in life, such as:

• War

• A major disaster

• A serious injury or accident

• A terrorist attack

• Assault

• Rape

• Domestic violence

• Sudden bereavement

Diagnosis of acute stress disorder

The symptoms of acute stress disorder typically last at least three days and up to four weeks. A doctor or therapist may also need to rule out other potential causes of your symptoms, including:

• Health problems

• Drug or alcohol use

• Medication side effects

• Other psychiatric disorders

One common feature in the diagnosis of ASD is the feeling of detachment from threatening ideas and emotions. This may also be characterized by you viewing the world as being unreal or as though you are living in a dream. Dissociative amnesia, where you have a poor memory of traumatic events, can be another sign that you have ASD.

Acute stress disorder vs. PTSD

The defining symptoms of ASD often overlap with those of post-traumatic stress disorder. However, the main difference between the two conditions is time. If your symptoms last longer than one month and if they cause you great distress or an inability to function as normal after a traumatic event, your diagnosis may then be changed to chronic PTSD, provided you meet the criteria for this disorder.

Current treatments for acute stress disorder

Sometimes, no treatment at all is needed for ASD as the symptoms can go away after you have processed the traumatic situation. However, some people may benefit from professional support.

A key element of treating ASD can be regaining your sense of empowerment through the following goals:

• Break down your problems into manageable pieces

• Develop and utilize coping skills

• Learn techniques to reduce emotional arousal

• Manage your emotions and thoughts

• Create a restful sleep routine

Cognitive behavioral therapy (CBT)

Trauma-focused CBT is a form of talk therapy that's built around the concept that thinking a certain way can fuel some mental health challenges due to a traumatic event. CBT can guide you to understand your thought patterns and to identify any that are unhelpful. You can then work to change the way you think, which may help you experience more positive emotions. Your thought patterns might become more helpful and less worrisome over time.

In cognitive behavioral therapy, mental health concerns are often broken down into five areas:

• Actions

• Situations

• Physical feelings

• Emotions

• Thoughts

CBT has its roots in the concept that each of these areas is interconnected and affects the other. CBT may enable you to identify and pinpoint specific concerns and solve them using psychological debriefing.

Medications

According to the Cleveland Clinic, there isn’t much evidence on the use of medication for acute stress disorder, but medication may be prescribed if a person develops PTSD. For example, you may be prescribed selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), or beta-blockers. Beta-blockers may relieve some symptoms that arise when your body releases stress hormones. These drugs do not act like tranquilizers and don’t typically cause drowsiness, so you can likely function normally without concern. It’s important to always consult a doctor before deciding to start or stop a new medication.

Who is most at risk for acute stress disorder?

Although anyone can develop acute stress disorder (ASD) after enduring a trauma, certain groups tend to run a higher risk of ASD, according to the American Psychiatric Association.

These include:

• People with a history of PTSD, ASD, or other mental health conditions

• People with a history of experiencing dissociative symptoms at times of trauma

• Individuals who have been through a traumatic event in their past

Effects and symptoms of acute stress disorder

When you have been exposed to a very stressful or traumatic event and go on to develop ASD, your symptoms may develop within hours or even minutes. For some people, these symptoms may pass quickly For others, they may last for days or several weeks. If you're worried that you or someone close to you may develop ASD, consider looking out for some of the following symptoms:

Physical symptoms

Physical symptoms are often caused by stress hormones being released into your bloodstream as well as over-activity of nervous signals to different parts of your body. According to the American Psychiatric Association, symptoms may include:

• Nausea

• Palpitations

• Headaches

• Chest pain

• Breathing problems

• Abdominal pain

Psychological symptoms

You may also experience some of the following symptoms:

• A tendency to isolate from friends and family

• Lack of enjoyment with activities you used to enjoy

• Anxiety

• Sadness

• Tearfulness

• Low mood

• Poor concentration

• Irritability

• A feeling of being tense or on guard

• Restlessness

• A tendency to be easily startled

• Recurrent intrusive and unpleasant flashbacks or dreams

• Self-destructive or reckless behavior

Dissociative symptoms

Dissociative symptoms may include:

• Feelings of emotional detachment

• Avoidance of people, places, and anything else that may trigger memories of the traumatic event

• A sensation that your emotions or thoughts don't belong to you or don't seem real

• Reduced awareness of life around you

• Altered sense of reality

• A sensation that your environment seems unreal or strange

• Difficulty concentrating

• Inability to remember some of the crucial aspects of the traumatic event (dissociative amnesia)

What if symptoms persist?

As discussed above, if symptoms of ASD last for more than a month after a traumatic event, it may be important for you to speak to a doctor to be assessed for post-traumatic stress disorder (PTSD). Both acute stress disorder and PTSD can often be overcome with the help of a counselor or a medical professional. If you've been through an event that has had a significant effect on you, it might be time to seek help.

Therapy for individuals with acute stress disorder

Experiencing stress can have negative physical and mental health benefits that may worsen if left unaddressed. Working with a therapist may help you understand the severity and impact of your stress. If your symptoms make it difficult to leave home, you might consider online therapy, which research has shown to be just as effective as in-person therapy. 

BetterHelp is an online counseling platform that has thousands of licensed therapists who have experience in a variety of areas, including stress. You can be matched with a therapist who has experience treating acute stress disorder and any other concerns you’re facing. Online counseling removes many of the stressful barriers to traditional therapy, such as affordability, transportation, and time constraints. 

The effectiveness of online therapy

Researchers have found that internet-based cognitive behavioral therapy (ICBT) helps “provide patients a better understanding of their illness.” ICBT programs have been shown to be effective in managing participants’ overall stress by reducing its severity and decreasing urges and stress levels. Online therapy has also been shown to increase life satisfaction and cognition.