Acute Stress Disorder

ASD develops within the first month after a trauma, and its symptoms are similar to those of PTSD, but they are different mental health conditions. Both disorders can cause significant distress and disrupt daily life, including social interactions and routine activities.^[1][2]

The key features of ASD include flashbacks or nightmares, a persistent negative mood, dissociation or memory gaps, active avoidance of trauma reminders, and heightened arousal (such as sleep problems, irritability, or feeling constantly on edge).^[1][2]

Key Takeaways

• Acute stress disorder develops within the first month of experiencing a trauma and is linked to PTSD.

• Both PTSD and ASD result from experiencing trauma, but PTSD is only diagnosed after a month has passed, and can even appear later in life after longer periods.

• If a person has ASD, it does not automatically mean that they will get PTSD, but there is a higher chance.

Understanding Acute Stress Disorder

ASD causes symptoms such as feeling emotionally numb or unable to experience positive emotions following a traumatic event. Individuals with the condition might go out of their way to avoid people, places, or conversations that remind them of the trauma. Many also experience a sense of detachment, as if they're watching life unfold from a distance.^[1][2]

Sadly, people who are exposed to a traumatic experience are not only at risk of emotional or physical injury but may also face social, occupational, economic, and mental health challenges. These impacts can lead to delayed recovery, lengthy hospital stays, increased healthcare costs, reduced productivity, and, in severe cases, unexpected fatalities among survivors.^[2]

ASD arises after disturbing or traumatic occurrences such as car accidents, violent attacks (including sexual or physical assault), terrorism, conflicts, natural disasters, and more. The condition can arise from directly experiencing the event, witnessing it, or even learning about a serious threat to themselves or others.^[2]

A 2024 study found that around 50% of people will face at least one highly stressful event in their lifetime, and that around 22% of adults who go through trauma are likely to develop acute stress disorder. The disorder appears within the first week following the trauma in around 24% of people, and between 11 and 40% of people within 2 weeks.^[2]

Acute Stress Disorder vs PTSD

ASD and PTSD both manifest after trauma and have similar symptoms. The key difference is that while ASD manifests within the first month of a trauma, PTSD is only diagnosed one month or more after the trauma. Studies tracking trauma survivors show that there is a strong link between ASD and PTSD.^[3]

In fact, between 40 and 80% of people diagnosed with ASD go on to meet criteria for PTSD at some point in their lives. However, between 4 and 13% of people who develop PTSD in the months or years following a trauma never had ASD during the first month. This means that ASD increases the risk of PTSD, but having ASD does not mean that PTSD will follow.^[1][3]

Causes and Risk Factors

ASD is triggered by experiencing a traumatic event, but not everyone exposed to trauma develops the disorder. Instead, it arises from a combination of the trauma’s characteristics and the individual’s vulnerabilities. Recent studies highlight that psychological, physical, and environmental factors all contribute to ASD.^[1]

Psychologically and physically, previous life experiences such as having a neurotic personality, a history of past trauma, or pre-existing mental health problems, put a person at risk of acute stress reactions​. This is likely to be because the stress-response system is already compromised.^[1]

On the environmental side, the severity and type of trauma also play a key role, with more intense or life-threatening events (especially interpersonal violence like assault or rape) associated with higher rates of ASD​. Assault survivors show ASD more often than those with fewer personal traumas, particularly if there is a lack of social support for the survivor​.^[1]

Complications

Like all mental health disorders, people who suffer from untreated ASD are likely to experience impaired functioning and be unable to work, remain present in relationships, or even complete basic tasks like driving due to their terrifying symptoms. Common symptoms that may lead to avoidance behavior include distressing memories or flashbacks.^[2]

Unfortunately, ASD can lead to substance use disorders, PTSD, or suicide, making it imperative to seek professional help immediately after any traumatic event. Following urgent medical care, it is critical to seek support from a psychologist and psychiatrist. Below, you will find more information on diagnostic criteria, evidence-based treatments and management strategies.^[2]

Symptoms and Diagnosis of Acute Stress Disorder

People with ASD often feel a sense of helplessness, intense fear, or shock shortly after the event. In addition to flashbacks or unwanted memories of the trauma, many people with ASD are stuck in a mental loop, where they are forced to continually relive the traumatic experience, causing severe distress.^[2]

According to a 2023 review of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5), which is used by professionals worldwide, symptoms of acute stress disorder can be divided into 5 categories. These include intrusive thoughts, a persistently low mood, dissociation (detaching from reality), avoidance, and arousal or hypervigilance.^[4][6]

To be diagnosed with ASD, a person must experience at least 9 or more of the symptoms listed below, starting between 3 and 28 days after the trauma, and the symptoms must cause significant distress or impairment in functioning. If symptoms persist beyond a month, PTSD may be diagnosed instead.^[4]

Here are the 5 categories of ASD symptoms:^[4]

Intrusive Symptoms

Intrusive symptoms involve re-experiencing the trauma in unwanted ways. These could include recurring memories of the traumatic event, trauma-themed nightmares, flashbacks, or vivid reliving of the trauma, and intense psychological or physical distress when reminded of the trauma (triggers provoke extreme fear or panic-like physical symptoms)​.^[4]

Negative Mood

Negative emotions are normal from time to time, but if a person experiences a persistently low mood after trauma, it could be a symptom of ASD. This could take the form of feeling numb or manifest as being unable to experience any happiness, satisfaction, or love in the aftermath of the trauma​. Additionally, it could look like being completely overwhelmed with distress.^[4]

Dissociative Symptoms

Dissociation is a detachment from reality and can also include memory gaps. When dissociation occurs, a person feels distant from themselves or their surroundings. It is akin to being dazed and feeling like the world is unreal. Another symptom of dissociation is amnesia, or forgetfulness, when a person is unable to recall important aspects of the trauma.^[4]

Avoidance Symptoms

Avoidance describes the deliberate effort to avoid anything that provokes memories of the traumatic occurrence. This includes thoughts or feelings related to the event, as well as external reminders (people, places, activities, conversations, objects) that trigger recollections of the trauma​.^[4]

Arousal Symptoms

Arousal describes a sense of being highly alert to danger, even though it has passed. Common signs of heightened arousal are sleep disturbances, irritable or angry outbursts without much provocation, being jumpy or flinching, or having difficulty concentrating. A person with these symptoms may constantly look around to check that they are safe if they are in a public space.^[4]

Can it Be Prevented?

Research on preventing ASD focuses on early interventions and protective factors to reduce the risk of severe stress reactions after trauma. Trauma-focused cognitive-behavioral therapy (TF-CBT), when applied early, has shown promise. If the therapy is administered in days or weeks after the trauma, it can alleviate ASD symptoms and lower the likelihood of developing PTSD​.^[1]

In terms of medication, preliminary studies suggest that taking an alpha-1 blocker might be beneficial. A 2023 paper found that giving this medication to trauma survivors with ASD resulted in only 22% developing PTSD by 6 months, compared to approximately 67% in prior studies​. However, this is emerging research, and the standard treatment for ASD is TF-CBT.^[3]

Researchers have also identified protective factors that may help to prevent individuals who have experienced trauma from developing ASD. A large study of college students traumatized during the COVID-19 outbreak found that those with higher resilience, strong social support, and healthy coping strategies had significantly fewer acute stress symptoms than their peers​.^[5]

Treatment for Acute Stress Disorder

Managing a traumatic event requires a team-based approach, involving healthcare professionals from a wide range of fields, including emergency room doctors and nurses, possible specialist doctors if surgery is required, psychiatrists, and social workers. As soon as the trauma survivor is physically stable, seeing a psychologist is the next step.^[4]

Therapy

There are many different forms of therapy available, with the most well-documented one for treating recently experienced trauma being CBT. There are a number of specific forms of CBT, each with a different focus. Trauma-focused CBT (TF-CBT) and exposure therapy are short-term interventions specifically aimed at helping people to get through trauma.^[1][4]

When received as soon after a trauma as possible, TR-CBT has been found to reduce acute stress and may prevent the onset of PTSD. Trauma-focused CBT therapy sessions can be directed online, via video or audio calls, as well as in-person. This form of therapy explains normal responses to trauma and teaches self-management skills.^[4]

It also challenges cognitive distortions (negative irrational thoughts), and can include aspects of exposure therapy. Exposure therapy is another standard treatment for ASD and PTSD, where survivors gradually talk about the trauma in a way that feels safe. At times, symptoms may initially worsen with treatment, but this is the case with all trauma-focused interventions.^[4]

Medication

While preliminary studies have shown that treating ASD sufferers with alpha-1 blockers might be beneficial, there is currently no high-quality evidence for treating ASD with medication. Most pharmacological recommendations for ASD are based on PTSD studies, and include a range of medications such as:^[3][4]

• Selective Serotonin Reuptake Inhibitors (SSRIs)

• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

• Venlafaxine (Effexor XR)

• Second-Generation Antipsychotics (SGAs)

• Beta-Blockers (Propranolol)

• Alpha-1 Selective Adrenergic Blockers (Prazosin)

These medications are used to treat different aspects of PTSD symptoms and do not necessarily prevent PTSD. Therefore, medical practitioners may not even prescribe any medication to a person with ASD, as early trauma-focused CBT is considered the first-line treatment for helping to alleviate acute stress.^[4]

Living with Acute Stress Disorder

Living with ASD can be emotionally excruciating, but research highlights several coping strategies that can help with recovery alongside professional treatment. Seeking social support by connecting with trusted friends, family, or support groups can provide comfort and help survivors to process the trauma in a safe environment.^[5]

Support groups are beneficial for both survivors with and without other social support. Going through a trauma can be an isolating experience, as loved ones who haven’t had the same experience are not able to fully understand and relate.

It’s also important to practice self-care in the immediate aftermath of trauma. Experts recommend first ensuring the trauma survivor’s basic needs and safety are taken care of. This could look like a secure environment, getting enough sleep and nutrition, and not hesitating to ask for help with daily tasks if feeling overwhelmed​.^[4]

Another key self-help approach is to use adaptive coping strategies rather than avoidance. This includes techniques such as deep breathing, relaxation exercises, or mindfulness meditation to calm the body’s stress response.^[5]

Final Thoughts

Going through a trauma is hard enough without having to relive it constantly through intrusive thoughts, memories, and dreams. Fortunately, with early intervention in the form of trauma-focused CBT therapy, there is a much higher chance of recovering from the traumatic event free from acute stress disorder.

While research is in the early stages, there are no known medications that can be used to prevent or treat ASD, but medical professionals may use various PTSD medications to help alleviate symptoms. It is important to prioritize therapy as soon as a trauma has occurred, as tragically, untreated ASD can lead to chronic PTSD, substance use disorder, or even suicide.

In addition to finding professional support for mental health, research suggests that social support, self-care, and mindfulness techniques may prevent ASD from manifesting in trauma survivors. However, these strategies should be used alongside trauma-focused CBT, and can provide a sense of connection and relief.

If you, or someone you love, has gone through a deeply disturbing traumatic experience, know that it is possible to recover and reach a place of total serenity. Life is full of twists and turns, but it’s important to focus on the light at the end of the tunnel. By taking action and seeking professional help, you are taking the first step towards the light.