Acute Stress Disorder

To be diagnosed with acute stress disorder, the Diagnostic and Statistical Manual of Mental Disorders outlines a series of symptoms that fall into five larger categories. Those categories include intrusion symptoms, negative mood, dissociative symptoms, avoidance symptoms, and arousal symptoms. 

Intrusion symptoms 

Intrusion symptoms for acute stress disorder may include the following:

• Repetitive dreams about or related to the traumatic event—In children, you may notice a sleep disturbance like night terrors or sleepwalking
• Flashbacks of the event
• Uncontrolled, recurring, and distressing memories related to the trauma. The Diagnostic and Statistical Manual of Mental Disorders notes that in children, this symptom might look like repetitive games or play that follow factors of the event
• Prolonged or intense mental distress² when exposed to any situation that reminds the individual of the traumatic event

Negative mood symptoms for acute stress disorder may include the following:

• Difficulty experiencing positive emotions like happiness, feelings of love, or contentment

The dissociative symptoms of acute stress disorder may consist of the following:

• Loss of memory regarding aspects of the traumatic event (also known as dissociative amnesia)
• A sense of detachment from the self and emotions
• In children, they may reenact the trauma in play

Avoidance symptoms for acute stress disorder may include the following:

• Attempts to avoid memories, thoughts, or feelings about the traumatic event
• Attempts to avoid places, people, or ideas that are reminiscent of the event

Arousal symptoms for acute stress disorder may include the following:

• Irritability or angry outbursts with little to no provocation
• Difficulty falling or staying asleep 
• Difficulty concentrating and distractibility 
• Hypervigilance
• Startle reflex (an exaggerated response such as jumping at sudden movement, loud noises, or other stimuli)

According to the Diagnostic and Statistical Manual of Mental Disorders, these symptoms must occur in the window between three days and four weeks after the traumatic event, cause impairment or disruption in day-to-day function, and must not be related to any other medical condition or substance use to qualify for a diagnosis of acute stress disorder. The American Psychiatric Association offers a scale that clinicians can use to assess the severity of symptoms, ranging from none to extreme.

ASD is the response to a traumatic event like an assault or a highly stressful occurrence. Researchers are uncertain what causes a person to respond differently than others after a traumatic event. Most models developed to explain this response fall under the umbrella of “fear conditioning.” 

Fear conditioning occurs when a traumatic event is linked to neutral stimuli and causes the body to react to the neutral stimulus even when the traumatic stimulus is absent. For example, if a person is physically attacked on a dock, they may afterward respond with fear to the smell of salt water. 

Often, healthy individuals adapt to fear from trauma through extinction learning. Extinction learning is a mechanism in which the body gradually adapts to trauma triggers, reducing the fear reaction over time. A person can be susceptible to an acute fear response if this process fails. 

Acute stress disorder risk factors

There are a few risk factors associated with acute stress disorder, including the following: 

• A poor emotional support system
• A history of other mental health conditions
• A more severe trauma (for example, rape, assault, or physical injury)
• A history of avoidance
• Additional stress during or soon after the traumatic event, including loss of job, home, or family member
• A personality predisposed to worry

A trauma trigger³ is a sensory experience, memory, or event that reminds an individual of the traumatic event they experienced. Traumatic situations that may trigger acute stress disorder include but are not limited to the following: 

• Experiencing a natural disaster firsthand, such as a tornado or hurricane
• Child abuse 
• Any type of assault, including sexual assault 
• Witnessing a violent event such as a fight, a shooting, or a severe car accident
• Participation or experience in war situations
• Difficult childbirth
• Traumatic brain injury
• Experiencing an accident such as a fall, a car wreck, or any other accident that causes physical injury

The most common and effective treatment for acute stress disorder is psychotherapy, more specifically, a form of cognitive-behavioral therapy (CBT)⁴ called trauma-focused CBT. Other forms of treatment may include medication and lifestyle habits that may benefit mental health and well-being.  

Medication 

Minimal evidence supports the use of medication to treat ASD. However, certain medications may reduce symptoms, including selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Other medications have been proposed to inhibit memory consolidation in the posttraumatic period, but study results are limited. Consult your primary care provider, psychiatrist, or another medical doctor before starting, changing, or stopping a medication for any condition.

Other treatments for acute stress disorder

In addition to treating acute stress disorder (ASD) with psychotherapy, a therapist or medical professional may also advise the following lifestyle habits to manage symptoms:

• Avoid alcohol or other drugs as coping mechanisms
• Seek emotional support through friends and family
• Promote better sleep by following good sleep hygiene practices and sticking to a sleep schedule
• Practice mindfulness exercises like meditation, visualization, or deep breathing
• Prioritize healthy eating and stay physically active

Therapy is the most effective treatment for ASD. Cognitive-behavioral therapy (CBT) is commonly used for ASD, as well as other mental health conditions like anxiety disorders, adjustment disorder, or depressive disorders. CBT is designed to help the recipient identify negative thoughts and behavior patterns and learn strategies to redirect these negative thoughts and behaviors into more positive channels. 

Therapy may be attended in traditional, in-person sessions at an office, in a group setting, or online. Online therapy has become more prevalent in recent years as technology allows distance participation. Today, many therapists work exclusively in an online space. Online therapy platforms like BetterHelp enable people to match with a therapist online and meet with them over video conferencing, messaging, or the phone. 

Immediate acute stress disorder resources

The Rape, Abuse, and Incest National Network (RAINN) has a hotline dedicated to supporting individuals experiencing sexual assault, harassment, or intimate partner violence. Contact them anytime by calling 800-656-HOPE (4673) or using the online chat. 

Additionally, for those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Additional acute stress disorder resources

Additional resources to explore ASD include:

• The National Institute of Mental Health (NIMH)
• The National Center for PTSD (a subsidiary of the US Dept of Veteran Affairs)
• The American Psychological Association (APA) 

The American Psychiatric Association has also published content with guidelines on how to cope after a disaster and how to help children cope with traumatic events. Following these steps can help some people avoid experiencing post-traumatic stress disorder (PTSD) or acute stress disorder. 

Even with early treatment of acute stress disorder (ASD) through psychotherapy, post-traumatic stress disorder can become a chronic illness in those who have had a strong reactive response to a traumatic event. The use of psychedelics like psilocybin, MDMA, and ketamine has shown promise as a treatment approach to post-traumatic stress disorder. The FDA has slowly started to open avenues to use these types of treatments for PTSD and depression, with one MDMA study scheduled for FDA approval in 2022. 

ASD was designated as a mental health condition in the most recent Diagnostic and Statistical Manual of Mental Disorders in part to assist in predicting post-traumatic stress disorder. However, recent studies indicate that ASD does not accurately predict post-traumatic stress disorder, as trauma-exposed individuals may follow one of four trajectories: resilient, worsening, recovery, or chronically distressed. As of the most recent studies, early intervention in the form of cognitive behavioral therapy for ASD is the most effective way to limit symptoms of post-traumatic stress disorder.

20%-50% of people

ASD occurs more frequently in those who experience or witness trauma involving interpersonal assault (for example, rape or violent crime), affecting between 20% to 50% of the people harmed or witness to the harm.¹

¹Johns Hopkins

More statistics on acute stress disorder 

• The likelihood of developing ASD is greater if the traumatic events experienced are severe and continual.
• Those who are involved in a traumatic accident, such as a car accident or severe burns, experience ASD at a rate of less than 20%. 
• ASD is diagnosed more frequently in women (23%) than in men (8%). In one study, 92% of women and 57% of men developed post-traumatic stress disorder (PTSD) 6 months later. 
• Early trauma-focused cognitive behavioral therapy is effective in treating ASD and in preventing complex post-traumatic stress disorder (PTSD) in those diagnosed with ASD. 

Acute Stress Disorder & Trauma 

Acute Stress Disorder Diagnosis

Acute Stress Disorder Vs PTSD