Acute stress disorder history and symptoms

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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.
• Within minutes of a traumatic event, patient may develop an acute stress reaction. Acute stress reaction is a transient condition involving a broad array of signs and symptoms, including anxiety, depression, fatigue, difficulties with memory and concentration, hyperarousal, and social withdrawal. These symptoms occur at the same time as or within a few minutes of the traumatic event, and usually in majority of cases disappear within hours or days. Patients with traumatic stress often present with general symptoms, such as difficulty sleeping, headaches, gastrointestinal disorders, skin disorders, rheumatic pain, cardiovascular symptoms, or psychological problems such as depression or anxiety.

• All patients should have a thorough assessment of psychiatric and medical history, with particular attention paid to the following:
  • 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.

Symptoms

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
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