Acute Stress Disorder
Acute Stress Disorder (ASD) is a mental health problem that can occur in the first month after a traumatic event. The symptoms of ASD are like PTSD symptoms, but you must have them for longer than one month to have PTSD. Learn more about ASD and treatment options.
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How Common Is ASD?
Studies of ASD vary in terms of the tools used and the rates of ASD found. Overall, within one month of a trauma, survivors show rates of ASD ranging from 6% to 33%. Rates differ for different types of trauma. For example, survivors of accidents or disasters such as typhoons show lower rates of ASD. Survivors of violence such as robbery, assaults, and mass shootings show rates at the higher end of that range.
Who Is at Risk for ASD as a Result of Trauma?
Several factors can place you at higher risk for developing ASD after a trauma:
- Having gone through other traumatic events
- Having had PTSD in the past
- Having had prior mental health problems
- Tending to have symptoms, such as not knowing who or where you are, when confronted with trauma
Does ASD Predict PTSD?
If you have ASD, you are very likely to get PTSD. Research has found that over 80% of people with ASD have PTSD six months later. Not everyone with ASD will get PTSD, though.
Also, those who do not get ASD can still develop PTSD later on. Studies indicate that a small number (4% to 13%) of survivors who do not get ASD in the first month after a trauma will get PTSD in later months or years.
Are There Effective Treatments for ASD?
Yes, a type of treatment called cognitive behavioral therapy (CBT) has been shown to have positive results. Research shows that survivors who get CBT soon after going through a trauma are less likely to get PTSD symptoms later. A mental health care provider trained in treatment for trauma can judge whether CBT may be useful for a trauma survivor.
Another treatment called psychological debriefing (PD) has sometimes been used in the wake of a traumatic event. However, there is little research to back its use for effectively treating ASD or PTSD. It should also be noted that with more severe trauma or reactions such as PTSD, debriefing is not recommended.
Self-care is crucial during and after a crisis or trauma. Self-care can be divided into 3 components:
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Personal safety
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Physical health
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Mindfulness
Personal safety is fundamental. After a single traumatic episode, people are better able to process the experience when they know that they and their loved ones are safe. It can be difficult, however, to gain complete safety during ongoing crises such as domestic abuse, war, or an infectious pandemic. During such ongoing difficulties, people should seek the guidance of experts on how they and their loved ones can be as safe as possible.
Physical health can be put at risk during and after traumatic experiences. Everyone should try to maintain a healthy schedule of eating, sleeping, and exercise. Drugs that sedate and intoxicate (for example, alcohol) should be used sparingly, if at all.
A mindful approach to self-care aims to reduce the feelings of stress, boredom, anger, sadness, and isolation that traumatized people normally experience. If circumstances allow, at-risk individuals should make and follow a daily normal daily schedule, for example, get up, shower, get dressed, go outside and take a walk, and prepare and eat regular meals.
It is useful to practice familiar hobbies as well as activities that sound fun and distracting: draw a picture, watch a movie, or cook.
Community involvement can be crucial, even if it is difficult to maintain human connection during a crisis.
Stretching and exercise are terrific, but it can be equally helpful to sit still and count one’s own breaths or listen carefully for surrounding sounds. People can become preoccupied with the trauma or crisis, and so it is useful to choose to think of other things: read a novel or get engaged with a puzzle. Unpleasant emotions may typically feel “frozen” during and after a trauma, and it can be a relief to find activities that shift the feeling state: laugh, watch a fun movie, do something silly, or draw with crayons. Under stress, people can become short-tempered, even with people they care about.
Spontaneous kindness can be a win/win solution for everyone: sending a nice note, making someone cookies, and offering up a smile may not only be a nice surprise for the recipient, but they can reduce the hopelessness and passivity that tends to be part of the sender’s experience of trauma.
Acute stress disorder (ASD) typically occurs within one month of a traumatic event. Symptoms are similar to those seen in post traumatic stress disorder (PTSD), however this disorder is temporary, lasing from a few days to a month. Some people with this disorder can go on to develop PTSD.
What’s acute stress disorder?
In the weeks after a traumatic event, you may develop an anxiety disorder called acute stress disorder (ASD). ASD typically occurs within one month of a traumatic event. It lasts at least three days and can persist for up to one month. People with ASD have symptoms similar to those seen in post-traumatic stress disorder (PTSD).
What causes acute stress disorder?
Experiencing, witnessing, or being confronted with one or more traumatic events can cause ASD. The events create intense fear, horror, or helplessness. Traumatic events that can cause ASD include a:
- death
- threat of death to oneself or others
- threat of serious injury to oneself or others
- threat to the physical integrity of oneself or others
Approximately 6 to 33 percent of people who experience a traumatic event develop ASD, according to the U.S. Department of Veterans Affairs. This rate varies based on the nature of the traumatic situation.
Who’s at risk for acute stress disorder?
Anyone can develop ASD after a traumatic event. You may have an increased risk of developing ASD if you have:
- experienced, witnessed, or been confronted with a traumatic event in the past
- a history of ASD or PTSD
- a history of certain types of mental problems
- a history of dissociative symptoms during traumatic events
What are the symptoms of acute stress disorder?
The symptoms of ASD include:
Dissociative symptoms
You’ll have three or more of the following dissociative symptoms if you have ASD:
- feeling numb, detached, or being emotionally unresponsive
- a reduced awareness of your surroundings
- derealization, which occurs when your environment seems strange or unreal to you
- depersonalization, which occurs when your thoughts or emotions don’t seem real or don’t seem like they belong to you
- dissociative amnesia, which occurs when you cannot remember one or more important aspects of the traumatic event
Reexperiencing the traumatic event
You’ll persistently re-experience the traumatic event in one or more of the following ways if you have ASD:
- having recurring images, thoughts, nightmares, illusions, or flashback episodes of the traumatic event
- feeling like you’re reliving the traumatic event
- feeling distressed when something reminds you of the traumatic event
Avoidance
You may avoid stimuli that cause you to remember or re-experience the traumatic event, such as:
- people
- conversations
- places
- objects
- activities
- thoughts
- feelings
Anxiety or increased arousal
The symptoms of ASD may include anxiety and increased arousal. The symptoms of anxiety and increased arousal include:
- having trouble sleeping
- being irritable
- having difficulty concentrating
- being unable to stop moving or sit still
- being constantly tense or on guard
- becoming startled too easily or at inappropriate times
Distress
The symptoms of ASD may cause you distress or disrupt important aspects of your life, such as your social or work settings. You may have an inability to start or complete necessary tasks, or an inability to tell others about the traumatic event.
How’s acute stress disorder diagnosed?
Your primary doctor or mental healthcare provider will diagnose ASD by asking you questions about the traumatic event and your symptoms. It’s also important to rule out other causes such as:
- drug abuse
- side effects of medications
- health problems
- other psychiatric disorders
If you don’t already have a primary care doctor or a mental healthcare professional, you can browse doctors in your area through the Healthline FindCare tool.
What’s the long-term outlook?
Many people with ASD are later diagnosed with PTSD. A diagnosis of PTSD is made if your symptoms persist for more than a month and cause a significant amount of stress and difficulty functioning.
Treatment may reduce your chances of developing PTSD. Approximately 50 percent of PTSD cases resolve within six months, whereas others may persist for years.
Can I prevent ASD?
Because there’s no way to ensure that you never experience a traumatic situation, there’s no way to prevent ASD. However, there are things that can be done to reduce your likelihood of developing ASD.
Getting medical treatment within a few hours of experiencing a traumatic event may reduce the likelihood that you’ll develop ASD. People who work in jobs that carry a high risk for traumatic events, such as military personnel, may benefit from preparation training and counseling to reduce their risk of developing ASD or PSTD if a traumatic event does occur. Preparation training and counseling may involve fake enactments of traumatic events and counseling to strengthen coping mechanisms.
Acute stress disorder is a psychiatric diagnosis that may occur in patients within four weeks of a traumatic event. Features include anxiety, intense fear or helplessness, dissociative symptoms, reexperiencing the event, and avoidance behaviors. Persons with this disorder are at increased risk of developing posttraumatic stress disorder. Other risk factors for posttraumatic stress disorder include current or family history of anxiety or mood disorders, a history of sexual or physical abuse, lower cognitive ability, engaging in excessive safety behaviors, and greater symptom severity one to two weeks after the trauma. Common reactions to trauma include physical, mental, and emotional symptoms. Persistent psychological distress that is severe enough to interfere with psychological or social functioning may warrant further evaluation and intervention. Patients experiencing acute stress disorder may benefit from psychological first aid, which includes ensuring the patient’s safety; providing information about the event, stress reactions, and how to cope; offering practical assistance; and helping the patient to connect with social support and other services. Cognitive behavior therapy is effective in reducing symptoms and decreasing the future incidence of posttraumatic stress disorder. Critical Incident Stress Debriefing aims to mitigate emotional distress through sharing emotions about the traumatic event, providing education and tips on coping, and attempting to normalize reactions to trauma. However, this method may actually impede natural recovery by overwhelming victims. There is insufficient evidence to recommend the routine use of drugs in the treatment of acute stress disorder. Short-term pharmacologic intervention may be beneficial in relieving specific associated symptoms, such as pain, insomnia, and depression.
