Acute Stress Disorder

What is acute stress disorder?

Acute stress disorder (ASD) is a short-term mental health condition that can occur within the first month after experiencing a traumatic event. It involves stress responses, including:

• Anxiety.
• Intense fear or helplessness.
• Experiencing flashbacks or nightmares.
• Feeling numb or detached from one’s body.
• Avoiding situations, places or other reminders related to the traumatic event.

Examples of traumatic events include:

• Natural disasters, such as a tornado, fire or flood.
• Sexual assault.
• Physical assault.
• Verbal abuse.
• Witnessing bodily harm or death.
• Serious accidents, such as a car accident.
• Experiencing a severe injury or sudden illness.
• War.

Acute stress disorder can affect a person at any stage of life — childhood, adolescence and adulthood.

What’s the difference between acute stress disorder and PTSD?

The main difference between acute stress disorder and post-traumatic stress disorder (PTSD) is the length of the symptoms.

Acute stress disorder involves stress reactions that happen between three days and four weeks following a traumatic event. Stress reactions lasting longer than four weeks may meet the criteria for PTSD.

The American Psychiatric Association first classified acute stress disorder as a mental health diagnosis in 1994 in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

What’s the difference between adjustment disorder and acute stress disorder?

Adjustment disorder is a mental health condition that happens in response to a stressful life event. The emotional and behavioral symptoms are generally considered more intense than what would be expected for the type of event that occurred.

The difference between acute stress disorder and adjustment disorder is that the stressful event in adjustment disorder (such as losing your job or the ending of a relationship) is typically less traumatic than an event that causes acute stress disorder (such as sexual assault or surviving a mass shooting).

How common is acute stress disorder?

It’s difficult for researchers to assess how common acute stress disorder is. This is partly because people may not seek professional help until their symptoms meet the criteria for PTSD.

According to various studies, the prevalence of acute stress disorder following a traumatic event may range from 6% to 33%. The rates also differ for different types of trauma. For example, survivors of accidents or natural disasters show lower rates of ASD. Survivors of violence, such as assaults and mass shootings, show higher rates of ASD.

What are the symptoms of acute stress disorder?

Symptoms of ASD are psychological and behavioral stress responses. They may include:

• Recurring, uncontrollable and distressing memories of the event.
• Recurring nightmares.
• Flashbacks of the traumatic event.
• Intense psychologic or physical distress when you’re reminded of the event.
• Persistent difficulty feeling positive emotions, such as happiness, contentment or loving feelings.
• An altered sense of reality, like feeling you’re in a daze or as if time is passing in slow motion.
• Memory loss regarding important aspects of the traumatic event.
• Efforts to avoid distressing memories, thoughts or feelings associated with the event.
• Efforts to avoid external reminders associated with the event (people, places or things).
• Disturbed sleep.
• Irritability or anger outbursts.
• Excessive attention to the possibility of danger (hypervigilance).
• Difficulty concentrating.
• An exaggerated response to loud noises, sudden movements or other stimuli (startle reflex).

What causes acute stress disorder?

It’s unclear why people respond differently to traumatic events.

One theory involves the concept of “fear conditioning.” This happens when your body exhibits a fear response to certain stimuli associated with a traumatic event. For example, if you were in a car accident and you had fast food in your vehicle and it was nighttime, future encounters with the smell of fast food at night may trigger your body to have the same fear response that you did during the traumatic event even though there’s no threat to your safety.

Some people may adapt to fear conditioning via extinction learning, which involves a gradual reduction in response to the traumatic triggers. If this doesn’t work, you could develop acute stress disorder and potentially PTSD.

What are the risk factors for acute stress disorder?

Acute stress disorder risk factors may include:

• History of prior mental health condition(s) (including prior trauma).
• Catastrophic worry.
• Avoidant coping style.
• Minimal support system.

What are the complications of this condition?

The main complication of acute stress disorder is the potential development of post-traumatic stress disorder (PTSD). PTSD may develop if acute stress disorder isn’t treated.

How is acute stress disorder diagnosed?

There’s no test to diagnose acute stress disorder. Instead, a healthcare provider makes the diagnosis after conducting a thorough psychosocial assessment. They’ll ask about your current symptoms and about your medical and mental health history.

Providers use criteria explained in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to diagnose acute stress disorder.

What is the treatment for acute stress disorder?

Psychotherapy (talk therapy) is the main treatment for acute stress disorder. A form of cognitive behavioral therapy (CBT) called trauma-focused CBT is especially effective.

This therapy takes place with a trained, licensed mental health professional, such as a psychologist or psychiatrist. It provides support, education and guidance to you and, if necessary, your family/support system.

Trauma-focused CBT involves:

• Learning about how your body responds to trauma and stress.
• Symptom management skills.
• Identifying and reframing problematic thinking patterns.
• Exposure therapy.

Exposure therapy involves safely exposing you to your sources of fear and avoidance. People with acute stress disorder may avoid things or situations that they associate with the traumatic event. Because of this, they aren’t able to learn that they can manage their fears when presented with these stimuli. Therapists use exposure therapy for people who have ASD to slowly encourage them to enter situations that cause them anxiety and to try to stay in that situation so that they can learn to cope.

Other treatments for acute stress disorder

While there’s minimal evidence supporting the use of medications to treat acute stress disorder, some medications may alleviate the symptoms of PTSD, including:

• Selective serotonin reuptake inhibitors (SSRIs).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs).

Can acute stress disorder be prevented?

You can’t necessarily prevent a traumatic event. But research shows that the intensity of acute stress disorder symptoms is manageable. The following can help:

• Personal safety: Experiencing a sense of safety is crucial following a traumatic event. The support of loved ones and professionals trained to provide assistance and guidance following a traumatic event can be greatly beneficial.
• Physical health: It’s important to maintain a healthy daily routine following a traumatic event. Prioritizing a healthy diet, sleep schedule and involvement in physical activity and mindfulness exercises (like meditation) are important. You should avoid the use of alcohol or other substances as temporary coping tools.
• Emotional support: It’s vital to seek emotional support from family and friends following a traumatic event. If this isn’t possible, healthcare providers can serve as support.
• Follow up with your healthcare team: It’s important to seek treatment with your healthcare provider and/or mental health provider following a traumatic event.

What is the prognosis of acute stress disorder?

The prognosis (outlook) for acute stress disorder varies. If symptoms are untreated, the potential for further difficulties increase, including:

• Alcohol use disorder and/or substance use disorder.
• Other mental health conditions, like PTSD, anxiety, depression or panic disorder.
• Thoughts about suicide/harming yourself or others.
• Problems at work and in your relationships.

If you or a loved one are experiencing suicidal thoughts, dial 988 on your phone to reach the Suicide and Crisis Lifeline.

How do I take care of myself if I have acute stress disorder?

In addition to seeking professional treatment for acute stress disorder, you may benefit from positive activities, including:

• Engaging in exercise to help reduce stress.
• Setting realistic goals and seeing them through to completion.
• Spending time with people you trust and educating them about your experience and ways in which they can be supportive.
• Identifying and seeking out comforting situations and places.
• Attending a trauma support group.
• Prioritizing patience and self-care. It’s important to remember that symptoms will improve gradually, not immediately.

When should I see my healthcare provider?

It’s also important to see your medical healthcare provider and/or mental health provider regularly following a traumatic event.

When should I go to the emergency department?

If you’re experiencing thoughts of suicide or self-harm, it’s crucial to contact 911, go to the nearest emergency department or call 988 to reach the Suicide and Crisis Lifeline.

A note from Cleveland Clinic

It may be very difficult to seek professional help following a traumatic event. Know that treatment for acute stress disorder (ASD) is important, and with time, treatment can help you feel better. Talk to your healthcare provider about treatment options, and remember that they’re available to help and support you.