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.
- 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 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).
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).
Symptoms of acute stress disorder may include the following:
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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.