Acute Stress Disorder

What is Stress Disorder?

This disorder is characterized by marked anxiety, feelings of being in a daze or dream, as well as other symptoms. It arises soon after an extraordinarily terrifying event, something life threatening to the person or someone else. The individual may subsequently show decreased emotional responsiveness, feel detached from his or her body, mind, or surroundings, or have amnesia about the event (these symptoms of dissociation could be to protect themselves from the intensity of the experience). Hopelessness can appear along with guilt at having survived the event if others did not. These feelings have a negative impact on relationships or work performance.

Decreased emotional responsiveness can manifest as difficulty enjoying any of life's previous pleasures. There can be guilt feelings just going about the daily tasks of life; the person may feel more responsible for the event than is justified. Feelings of despair can be severe enough to qualify as a major depressive episode. Individuals may neglect basic personal health and safety issues. Impulsiveness and risk-taking behaviors can suddenly appear, which is a change from the person's usual personality.

It is distinguished from other stress disorders by duration. Symptoms usually last at least two days but not more than four weeks. If symptoms last longer, a diagnosis of posttraumatic stress disorder (PTSD) is usually made. Therefore, diagnosing acute stress disorder can identify those who will develop a more chronic condition. Identifying acute stress disorder is also useful because disorganized behavior can leave the individuals unable to care for themselves, thus requiring treatment. The diagnosis is not applicable if symptoms are from a drug effect or medical condition; it is likewise not diagnosed if symptoms could be better explained by a brief psychotic disorder or deterioration of a preexisting mental disorder.

How is it diagnosed?

History is of surviving or witnessing a life-threatening event that generated intense fear, helplessness, or horror in the individual. At least three of the following must be present: becoming numb or detached, a reduced awareness of surroundings like being in a trance, feelings of strangeness about the world (derealization), feeling removed and distant from one's own thoughts, feelings, or body (depersonalization), or having amnesia for the event.

The event is frequently re-experienced as either an image that recurs, a thought, a dream, an illusion, a flashback, feelings of distress with any reminder of the event, or vividly reliving the experience. The person will consistently avoid any reminders of the event, such as people, places, or activities associated with it.

Serious anxiety can be seen in the form of hypervigilance. Individuals may also be easily startled, irritable, have trouble concentrating, and have sleep difficulties. The symptoms result in impaired relationships or occupational functioning.

Physical exam could show signs of a physical trauma if one occurred.

Tests do not establish this diagnosis.

How is Stress Disorder treated?

Psychotherapy is usually designed to allow full expression of the emotions and images connected with the trauma. The person's story may have to be told and retold, to minimize the chance for dissociating from it. Therapy is designed to enable individuals to somehow process and integrate this overwhelming experience into their lives. It may be done as individual or group therapy or as hypnotherapy. Sedating medication may also be helpful.

Medications

Information	Brand	Generic	Label	Rating
	Paxil	Paroxetine

Topamax (Topiramate), Prozac (Fluoxetine), Tegretol (Carbamazepine), Celexa (Citalopram), Ativan (Lorazepam), Xanax (Alprazolam), Klonopin (Clonazepam)

What might complicate it?

Individuals may be indifferent to maintaining their health and safety. Impulsive, risk-taking behavior can lead to injury. There is an increased risk of progression to posttraumatic stress disorder.

Predicted outcome

One-third recover completely, with the rest going on to develop posttraumatic stress disorder (PTSD). Overall, one-tenth of those with acute stress disorder will remain unchanged or become worse.

Alternatives

Other possibilities are head trauma, substance abuse, panic disorder, obsessive-compulsive disorder, dissociative disorders, borderline personality disorder, brief psychotic disorder, major depressive episode, adjustment disorder, and malingering.

Appropriate specialists

Psychiatrist or psychologist.

Last updated 21 December 2015