Acute Stress Disorder – Causes – Symptoms – Treatment
Acute stress disorder Definition
Acute stress disorder (ASD) is an anxiety disorder characterized by a cluster of dissociative and anxiety symptoms occurring within one month of a traumatic event. (Dissociation is a psychological reaction to trauma in which the mind tries to cope by ‘‘sealing off ’’ some features of the trauma from conscious awareness).
Acute stress disorder Description
Acute stress disorder is a new diagnostic category that was introduced in 1994 to differentiate time-limited reactions to trauma from post-traumatic stress disorder (PTSD).
Acute stress disorder Causes
By definition, acute stress disorder is the result of a traumatic event in which the person experiences or witnesses an event that causes the victim/witness to experience extreme, disturbing or unexpected fear, stress, (and sometimes pain) and that involves or threatens serious injury, perceived serious injury (usually to someone else), or death. Acute stress reaction is a variation of Post-Traumatic Stress Disorder (PTSD) and is the mind's and body's response to feelings (both perceived and real) of intense helplessness.
Symptoms of acute stress reaction
The symptoms show great variation but typically 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 quickly followed by either further withdrawal from the surrounding situation (to the extent of a dissociative stupor), or by agitation and overeactivity, anxiety, impaired judgement, confusion, detachment, and depression. Autonomic signs of panic anxiety (tachycardia, sweating, flushing) are also commonly present.
The symptoms usually appear within minutes of the impact of the stressful stimulus or event, and disappear within 2–3 days (often within hours). Partial or complete amnesia for the episode may be present.
Symptoms of acute stress disorder
Common symptoms sufferers of acute stress disorder experience are: numbing; detachment; derealization; depersonalization or dissociative amnesia; continued re-experiencing of the event by such ways as thoughts, dreams, and flashbacks; and avoidance of any stimulation that reminds them of the event. During this time, they must have symptoms of anxiety, and significant impairment in at least one essential area of functioning. Symptoms last for a minimum of 2 days, and a maximum of 4 weeks, and occur within 4 weeks of the event
Diagnostic guidelines
There must be an immediate and clear temporal connection between the impact of an exceptional stressor and the onset of symptoms; onset is usually within a few minutes, if not immediate. In addition, the symptoms show a mixed and usually changing picture; in addition to the initial state of "daze", depression, anxiety, anger, despair, overactivity, and withdrawal may all be seen, but no one type of symptom predominates for long; resolve rapidly (within a few hours at the most) in those cases where removal from the stressful environment is possible; in cases where the stress continues or cannot by its nature be reversed, the symptoms usually begin to diminish after 24–48 hours and are usually minimal after about 3 days.
The diagnostic criteria for ASD, per the Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision) (DSM-IV-TR), is as follows:
A. Exposure to a traumatic event
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")
(3) derealization
(4) depersonalization
(5) dissociative amnesia (i.e., inability to recall an important aspect of the trauma)
C. Persistent reexperience 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, conversations, activities, places, people).
E. Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, 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 event.
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 stress disorder Treatment
This disorder may resolve itself with time or may develop into a more severe disorder such as PTSD. However, results of Creamer, O'Donnell, and Pattison's (2004) study of 363 patients suggests that a diagnoses of Acute Stress Disorder had only limited predictive validity for PTSD. Creamer et al. did however find that re-experiences of the traumatic event and arousal were better predictors of PTSD. Medication can be used for a very short duration (up to four weeks)[citation needed].
A number of studies have been conducted to assess the efficacy of counselling and psychotherapy for people with ASD. Cognitive behavioral therapy which included exposure and cognitive restructuring was found to be effective in preventing PTSD in patients diagnosed with ASD with clinically significant results at 6 months follow-up. A combination of relaxation, cognitive restructuring, imaginal exposure, and in vivo exposure was superior to supportive counselling[4].
Acute stress disorder Prognosis
Prognosis for this disorder is very good. If it should progress into another disorder (usually PTSD), success rates can vary according to the specifics of that disorder.
http://en.wikipedia.org/wiki/Acute_stress_reaction
