Acute Stress Disorder (ASD)

Acute Stress Disorder (ASD), as outlined in the DSM-5, is a psychiatric condition characterised by the development of severe anxiety, dissociation, and other symptoms that occur within a month after exposure to a traumatic event. Here’s a breakdown of the criteria for an Acute Stress Disorder diagnosis:

Exposure to Traumatic Event: The individual must have been exposed to actual or threatened death, serious injury, or sexual violation. This exposure can occur in one (or more) of the following ways:

• Directly experiencing the traumatic event.
• Witnessing, in person, the event as it occurred to others.
• Learning that the traumatic event occurred to a close family member or close friend (in cases of actual or threatened death of a family member or friend, the event must have been violent or accidental).
• Experiencing repeated or extreme exposure to aversive details of the traumatic event (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse).

1. Intrusive Symptoms: The person repeatedly faces involuntary, upsetting memories of the traumatic incidents; often has disturbing dreams about these events; experiences dissociative episodes (like flashbacks), where they feel or behave as if the traumatic events are happening again; undergoes severe or extended emotional distress when confronted with things that remind them of the trauma, either internally or externally; and exhibits strong physical responses to reminders that are similar or related to the traumatic events.
2. Negative Mood: Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
3. Dissociative Symptoms: An altered sense of the reality of one’s surroundings or oneself (e.g., feeling as though one is in a dream, time slowing); inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
4. Avoidance Symptoms: Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s); efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
5. Arousal Symptoms: Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep); irritable behaviour and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects; hypervigilance; problems with concentration; exaggerated startle response.
6. Duration: For a diagnosis of ASD, the symptoms must last for a minimum of three days to a maximum of one month following the traumatic event. Note: symptoms typically begin immediately after the trauma; persistence for at least three days and not longer than a month is needed to meet ASD criteria. It’s important to note that Acute Stress Disorder is distinct from Posttraumatic Stress Disorder (PTSD), which has a longer duration of symptoms and can develop after the period characteristic of ASD. The diagnosis and treatment of ASD are crucial as it can potentially progress to PTSD if not addressed. Treatment often involves trauma-focused psychotherapy and, in some cases, medication to manage symptoms.
7. Functional Significance: The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
8. Exclusion: The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition (e.g., mild traumatic brain injury) and is not better explained by brief psychotic disorder.