Acute stress disorder Health Article

Definition

Acute stress disorder (ASD) is an anxiety disorder characterized by a cluster of dissociative and anxiety symptoms that occur within a month of a traumatic stressor. It is a relatively new diagnostic category and was added to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994 to distinguish time-limited reactions to trauma from the farther-reaching and longer-lasting post-traumatic stress disorder (PTSD). Published by the American Psychiatric Association, the DSM contains diagnostic criteria, research findings, and treatment information for mental disorders. It is the primary reference for mental health professionals in the United States.

Description

ASD, like PTSD, begins with exposure to an extremely traumatic, horrifying, or terrifying event. Unlike PTSD, however, ASD emerges sooner and abates more quickly; it is also marked by more dissociative symptoms. If left untreated, however, ASD is likely to progress to PTSD. Because the two share many symptoms, some researchers and clinicians question the validity of maintaining separate diagnostic categories. Others explain them as two phases of an extended reaction to traumatic stress.

Causes

The immediate cause of ASD is exposure to trauma—an extreme stressor involving a threat to life or the prospect of serious injury; witnessing an event that involves the death or serious injury of another person; or learning of the violent death or serious injury of a family member or close friend. The trauma's impact is determined by its cause, scope, and extent. Natural disasters (floods, earthquakes, hurricanes, etc.) or accidents (plane crashes, workplace explosions) are less traumatic than human acts of intentional cruelty or terrorism. Terrorist-inflicted trauma appears to produce particularly high rates of ASD and PTSD in survivors and bystanders.

Although most people define trauma in terms of events such as war, terrorist attacks, and other events that result in vast loss of life, the leading cause of stress-related mental disorders in the United States is motor vehicle accidents. Most Americans will be involved in a traffic accident at some point in their lives, and 25% of the population will be involved in accidents resulting in serious injuries. The National Comorbidity Survey of 1995 found that 9% of survivors of serious motor vehicle accidents developed ASD or PTSD.

Several factors influence a person's risk of developing ASD after trauma:

• Age—Older adults are less likely to develop ASD, possibly because they have had more experience coping with painful or stressful events.
• Previous exposure—People who were abused or experienced trauma as children are more likely to develop ASD (or PTSD) as adults, because these may produce long-lasting biochemical changes in the central nervous system.
• Biological vulnerability—Twin studies indicate that certain abnormalities in brain hormone levels and brain structure are inherited, and that these increase a person's susceptibility to ASD following exposure to trauma.
• Support networks—People who have a network of close friends and relatives are less likely to develop ASD.
• Perception and interpretation—People who feel inappropriate responsibility for the trauma, regard the event as punishment for personal wrongdoing, or have generally negative or pessimistic worldviews are more likely to develop ASD than those who do not personalize the trauma or are able to maintain a balanced view of life.