Stress Disorder ~
Acute Stress Disorder is the anxiety and behavioral
disturbances that may develop within the first month after exposure to
an extreme trauma. Usually, the symptoms begin during or shortly following
the trauma. Such extreme traumatic events include rape or other severe
physical assault, near-death experiences in accidents, witnessing a murder,
or combat. The events of September 11, 2001 are a recent example that meets
the criteria for an extreme traumatic event.
Common presenting signs and symptoms of Acute
Stress Disorder include: generalized anxiety and hyperarousal, avoidance
of situations or stimuli that elicit memories of the trauma, and persistent,
intrusive recollections of the event via flashbacks, dreams, or recurrent
thoughts or visual images. The symptom of dissociation, which is a perceived
detachment of the mind from the emotional state or even the body, is a
critical feature for the diagnosis. Dissociation also is characterized
by a sense of the world as a dreamlike or unreal place, it may be accompanied
by poor memory of the specific events, which in most severe form is known
as dissociative amnesia.
Acute Stress Disorder is a diagnosis made by a
mental health professional. There are specific diagnostic criteria which
must be met before this diagnosis can be made.
A. The person has been exposed
to a traumatic event in which both of the following were present:
If the symptoms and behavioral disturbances of the
Acute Stress Disorder persist for more than 1 month, and if these features
are associated with functional impairment or significant distress to the
sufferer, the diagnosis changes to Post Traumatic Stress Disorder.
1. the person experienced, witnessed, or was
confronted with an event or events that involved actual or threatened death
or serious injury, or a threat to the physical integrity of self or others
2. the person's response involved intense fear,
helplessness, or horror
B. Either while experiencing or after
experiencing the distressing event, the individual has three (or more)
of the following dissociative symptoms:
1. a subjective sense of numbing, detachment,
or absence of emotional responsiveness
2. a reduction in awareness of his or her surroundings
(e.g., "being in a daze")
5. dissociative amnesia (i.e., inability to recall
an important aspect of the trauma)
C. The traumatic event is persistently
re-experienced in at least one of the following ways: recurrent images,
thoughts, dreams, illusions, flashback episodes, or a sense of reliving
the experience; or distress on exposure to reminders of the traumatic event.
D. Marked avoidance of stimuli that arouse
recollections of the trauma (e.g., thoughts, feelings, people, conversations,
E. Marked symptoms of anxiety or increased
arousal (e.g., difficulty sleeping, irritability, poor concentration, hyper
vigilance, exaggerated startle response, motor restlessness).
F. The disturbance causes clinically significant
distress or impairment in social, occupational, or other important areas
of functioning or impairs the individual's ability to pursue some necessary
task, such as obtaining necessary assistance or mobilizing personal resources
by telling family members about the traumatic experience.
G. The disturbance lasts for a minimum
of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic
H. The disturbance is not due to the direct
physiological effects of a substance (e.g., a drug of abuse, a medication)
or a general medical condition, is not better accounted for by Brief Psychotic
Disorder, and is not merely an exacerbation of a preexisting Axis I or
Axis II disorder.
Acute and Post Traumatic Stress Disorders. Mental
Health Report of the Surgeon General, Chapter 4 - Anxiety Disorders. Available
Long PW. Acute Stress Disorder, American Description.
Internet Mental Health. Available at: http://www.mentalhealth.com/dis1/p21-an08.html
Anxiety Disorders, 308.3 Acute Stress Disorder.
Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition
(DSM-IV) Washington D. C.: American Psychiatric Association, 1994
Psychologynet. Anxiety Related Disorders - Diagnostic Criteria.
American Psychological Association. Warning Signs
of Trauma Related Stress. Available at: http://www.apa.org/practice/ptsd.html
The acute responses to loss are not unhealthy or maladaptive responses.
Rather they are normal responses
to an abnormal event.
Kirsti A. Dyer, MD, MS
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