Acute stress disorder history and symptoms: Difference between revisions

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Revision as of 02:55, 8 February 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Symptoms of acute stress disorder include dissociative symptoms, symptoms of reexperiencing the traumatic event, avoidence symptoms, symptoms of anxiety or increased arousal, and symptoms of distress.

History

Since traumatic events can lead to a wide variety of emotional reactions, the treating clinician must understand that underneath the individual’s reaction is an attempt to cope with the traumatic event. The majority of individuals have some symptoms after a significant traumatic event. However, a minority have sufficient symptoms to fulfill the diagnostic criteria for acute stress disorder (ASD).
All trauma victims may not want or need professional assistance. Individuals who refuse help may not be in denial, but may see themselves as more resilient or able to rely on the support of friends and family. Physicians should support patients who want to talk about their experience, but should not push those who prefer not to seek professional help. Early management and identification of acute stress disorder can decrease the percentage of patients who develop post traumatic stress disorder.
All patients should have a thorough assessment of psychiatric and medical history, with particular attention paid to the following:^[1]
- Baseline mental status
- Baseline functional status
- Medical history to include any injury such as mild- traumatic brain injury (TBI)
- Medications to include medication allergies and sensitivities such as prescription medications, nutritional or herbal supplements, and over-the- counter (OTC) medications (caffeine, energy drinks or use of other substances)
- Past psychiatric history to include prior treatment for mental health and substance use disorder, and past hospitalization for depression or suicidality
- Current life stressors.

In addition to using diagnostic criteria to assess for ASD, physicians may use self-report instruments such as the Acute Stress Disorder Scale (see appendix at http://psych.on.ca/files/nonmembers/AcuteStressDisorderScale_DRN_March_5_2010.pdf). This is a 19-item inventory based on the Acute Stress Disorder Interview 21 and designed to assist physicians in the diagnosis of ASD.^[2]^[3]

Symptoms

Individuals with acute stress disorder may experience panic attacks in the initial month after trauma exposure that may apparently occur spontaneously or may be triggered by trauma reminders.
There may be significant separation anxiety, in children, possibly manifested by excessive needs for attention from caregivers.
In bereavement following a death that occurred in traumatic circumstances, the symptoms of acute stress disorder can involve acute grief reactions. In such cases, reactions to the loss may involve reexperiencing, dissociative, and arousal symptoms, such as intrusive memories of the circumstances of the individual’s death, anger about the death, disbelief that the individual has died.
The symptoms of acute stress disorder may vary cross-culturally, particularly with respect to dissociative symptoms, avoidence, nightmares, and somatic symptoms. Cultural syndromes and terminology of distress shape the symptom profiles of acute stress disorder. In the initial months after trauma exposure some cultural groups may display variants of dissociative responses, such as possession or trancelike behaviors. Panic symptoms may be salient in acute stress disorder among Cambodians because of the association of traumatic exposure with panic-like khyâl attacks.

Symptoms of acute stress disorder may include the following:


Type of Symptoms	Symptoms

Dissociative symptoms	A reduced awareness of surroundings Feeling numb, detached or being emotionally unresponsive Derealization, which occurs when the environment seems unreal or strange Depersonalization, which occurs when the thoughts or emotions don’t seem real or don’t seem like they belong to oneself Dissociative amnesia, which occurs when one cannot remember the important aspects of the traumatic event
Reexperiencing the traumatic event	Feeling like reliving the traumatic event Feeling distressed when something reminds of the traumatic event Having recurring images, thoughts, nightmares, illusions, or flashback episodes of the traumatic event Having catastrophic or extremely negative thoughts about their role in the traumatic event, their response to the traumatic experience. For example, an individual with acute stress disorder may feel guilty about not having prevented the traumatic event or about not adapting to the experience more successfully
Avoidence	An individual may avoid stimuli that cause him/her to remember or reexperience the traumatic event, such as: People Conversations Places Objects Activities Thoughts Feelings
Anxiety or increased arousal	The symptoms of anxiety and increased arousal include the folowing: Having trouble sleeping Being irritable Having difficulty concentrating Being unable to stop moving or sit still Being constantly tense or on guard Becoming startled too easily or at inappropriate times
Distress	The symptoms of ASD may cause distress or disrupt important aspects of the life, such as work or social settings. An individual may have an inability to start or complete necessary tasks or an inability to tell others about the traumatic event
Chaotic or impulsive behavior	Individuals may drive recklessly, make irrational decisions, or gamble excessively
Postconcussive symptoms	Postconcussive symptoms such as dizziness, headaches, sensitivity to light or sound, irritability, and concentration deficits, which occur frequently following mild traumatic brain injury, are frequently seen in individuals with acute stress disorder Postconcussive symptoms are equally common in non- brain-injured and brain-injured populations, and the frequent occurrence of postconcussive symptoms could be attributable to acute stress disorder symptoms

References

↑ Susskind O, Ruzek JI, Friedman MJ (2012). "The VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress (update 2010): development and methodology". J Rehabil Res Dev. 49 (5): xvii–xxviii. PMID 23015590.
↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association, 2013. Print.
↑ Bryant, Richard A.; Moulds, Michelle L.; Guthrie, Rachel M. (2000). "Acute stress disorder scale: A self-report measure of acute stress disorder". Psychological Assessment. 12 (1): 61–68. doi:10.1037/1040-3590.12.1.61. ISSN 1939-134X.

[pmid23015590-1] Susskind O, Ruzek JI, Friedman MJ (2012). "The VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress (update 2010): development and methodology". J Rehabil Res Dev. 49 (5): xvii–xxviii. PMID 23015590.

[2] Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association, 2013. Print.

[BryantMoulds2000-3] Bryant, Richard A.; Moulds, Michelle L.; Guthrie, Rachel M. (2000). "Acute stress disorder scale: A self-report measure of acute stress disorder". Psychological Assessment. 12 (1): 61–68. doi:10.1037/1040-3590.12.1.61. ISSN 1939-134X.

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@@ Line 18: / Line 18: @@
 ==Symptoms==
-Individuals with acute stress disorder commonly engage in catastrophic or extremely negative thoughts about their role in the traumatic event, their response to the traumatic experience, or the likelihood of future harm. For example, an individual with acute stress disorder may feel excessively guilty about not having prevented the traumatic event or about not adapting to the experience more successfully(Ehlers et al. 2003; Warda and Bryant 1998). Individuals with acute stress disorder may also interpret their symptoms in a catastrophic manner, such that flashback memories or emotional numbing may be interpreted as a sign of diminished mental capacity(Dunmore et al. 2001; Smith and Bryant 2000). It is common for individuals with acute stress disorder to experience panic attacks in the initial month after trauma exposure that may be triggered by trauma reminders or may apparently occur spontaneously(Bryant and Panasetis 2001; Nixon and Bryant 2003). Additionally, individuals with acute stress disorder may display chaotic or impulsive behavior. For example, individuals may drive recklessly, make irrational decisions, or gamble excessively. In children, there may be significant separation anxiety, possibly manifested by excessive needs for attention from caregivers. In the case of bereavement following a death that occurred in traumatic circumstances, the symptoms of acute stress disorder can involve acute grief reactions. In such cases, reexperiencing, dissociative, and arousal symptoms may involve reactions to the loss, such as intrusive memories of the circumstances of the individual’s death, disbelief that the individual has died, and anger about the death. Postconcussive symptoms (e.g., headaches, dizziness, sensitivity to light or sound, irritability, concentration deficits), which occur frequently following mild traumatic brain injury, are also frequently seen in individuals with acute stress disorder(Bryant 2011a). Postconcussive symptoms are equally common in brain-injured and non–brain-injured populations, and the frequent occurrence of postconcussive symptoms could be attributable to acute stress disorder symptoms(Meares et al. 2008).
+*Individuals with acute stress disorder may experience panic attacks in the initial month after trauma exposure that may apparently occur spontaneously or may be triggered by trauma reminders.
+*There may be significant separation anxiety, in children, possibly manifested by excessive needs for attention from caregivers.
-The profile of symptoms of acute stress disorder may vary cross-culturally, particularly with respect to dissociative symptoms, nightmares, avoidance, and somatic symptoms (e.g., dizziness, shortness of breath, heat sensations). Cultural syndromes and idioms of distress shape the local symptom profiles of acute stress disorder. Some cultural groups may display variants of dissociative responses, such as possession or trancelike behaviors in the initial month after trauma exposure(Kirmayer 1996). Panic symptoms may be salient in acute stress disorder among Cambodians because of the association of traumatic exposure with panic-like khyâl attacks, and ataque de nervios among Latin Americans may also follow a traumatic exposure(Hinton and Lewis-Fernández).
+*In bereavement following a death that occurred in traumatic circumstances, the symptoms of acute stress disorder can involve acute grief reactions. In such cases, reactions to the loss may involve reexperiencing, dissociative, and arousal symptoms, such as intrusive memories of the circumstances of the individual’s death, anger about the death, disbelief that the individual has died.
+*The symptoms of acute stress disorder may vary cross-culturally, particularly with respect to dissociative symptoms, avoidence, nightmares, and somatic symptoms. Cultural syndromes and terminology of distress shape the symptom profiles of acute stress disorder. In the initial months after trauma exposure some cultural groups may display variants of dissociative responses, such as possession or trancelike behaviors. Panic symptoms may be salient in acute stress disorder among Cambodians because of the association of traumatic exposure with panic-like khyâl attacks.
@@ Line 45: / Line 46: @@
 *Feeling distressed when something reminds of the traumatic event
 *Having recurring images, thoughts, nightmares, illusions, or flashback episodes of the traumatic event
+*Having catastrophic or extremely negative thoughts about their role in the traumatic event, their response to the traumatic experience. For example, an individual with acute stress disorder may feel guilty about not having prevented the traumatic event or about not adapting to the experience more successfully
 |-
 | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
@@ Line 73: / Line 75: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *The symptoms of ASD may cause distress or disrupt important aspects of the life, such as work or social settings. An individual may have an inability to start or complete necessary tasks or an inability to tell others about the traumatic event
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+:Chaotic or impulsive behavior
+| style="padding: 5px 5px; background: #F5F5F5;" |
+Individuals may drive recklessly, make irrational decisions, or gamble excessively
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+:Postconcussive symptoms
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Postconcussive symptoms such as dizziness, headaches, sensitivity to light or sound, irritability, and concentration deficits, which occur frequently following mild traumatic brain injury, are frequently seen in individuals with acute stress disorder
+*Postconcussive symptoms are equally common in non- brain-injured and brain-injured populations, and the frequent occurrence of postconcussive symptoms could be attributable to acute stress disorder symptoms
 |-
 |}