Trauma- and stressor-related disorder with onset 3 days to 1 month after a traumatic event (direct exposure or indirectly experienced), characterized by intrusive memories, avoidance of associated stimuli, and changes in mood and arousal that impair daily functioning
Prevalence: occurs in 20-50% of victims or witnesses of trauma involving interpersonal assault (e.g., rape, witnessing a shooting), < 20% following trauma without interpersonal assault (e.g. motor vehicle accidents, traumatic brain injury, severe burns)
25-50% of ASD cases will resolve without formal intervention.
This is an important point to emphasize with patients, who otherwise may be further distressed by the notion that they are fated to suffer an extended course.
WHEN TO REFER
Seek psychiatric care, particularly in cases of continued distress or potential for self-harm.
ASD can progress to PTSD if symptoms do not resolve within 1 month of exposure.
ASD was introduced in the DSM-IV to identify patients at risk for PTSD; criteria were narrower (notably requiring dissociative symptoms to be present) and did not reliably predict PTSD.
There is still uncertainty regarding factors that predict ASD or interventions that prevent PTSD.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). Arlington, VA: American Psychiatric Publishing.
Barton KA, Blanchard EB, Hickling EJ. Antecedents and consequences of acute stress disorder among motor vehicle accident victims. Behav Res Ther. 1996;34(10):805-13. [PMID:8952123]
Benedek MB, Friedman MJ, Zatzick DF, Ursano RJ. (2009). Guideline watch (March 2009): practice guidelines for the treatment of patients with acute stress disorder and posttraumatic stress disorder. American Psychiatric Association.
Bryant RA, Harvey AG, Dang ST, Sackville T. (1998). Assessing acute stress disorder: psychometric properties of a structured clinical interview. Psychological Assessment 10(3), 215-220.
Bryant, R. A. (2017). Acute stress disorder and posttraumatic stress disorder. (pp. 161-184). Washington, DC, US: American Psychological Association. doi:10.1037/0000019010
Bryant RA, Harvey AG. Acute stress disorder: a critical review of diagnostic issues. Clin Psychol Rev. 1997;17(7):757-73. [PMID:9397336]
Bryant RA, Mastrodomenico J, Felmingham KL, et al. Treatment of acute stress disorder: a randomized controlled trial. Arch Gen Psychiatry. 2008;65(6):659-67. [PMID:18519824]
Bryant RA, Creamer M, O'Donnell M, et al. Acute and Chronic Posttraumatic Stress Symptoms in the Emergence of Posttraumatic Stress Disorder: A Network Analysis. JAMA Psychiatry. 2017;74(2):135-142. [PMID:28002832]
Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther. 2000;38(4):319-45. [PMID:10761279]
Gelpin E, Bonne O, Peri T, et al. Treatment of recent trauma survivors with benzodiazepines: a prospective study. J Clin Psychiatry. 1996;57(9):390-4. [PMID:9746445]
Gradus JL. Prevalence and prognosis of stress disorders: a review of the epidemiologic literature. Clin Epidemiol. 2017;9:251-260. [PMID:28496365]
Guthrie RM, Bryant RA. Auditory startle response in firefighters before and after trauma exposure. Am J Psychiatry. 2005;162(2):283-90. [PMID:15677592]
Howlett JR, Stein MB. Prevention of Trauma and Stressor-Related Disorders: A Review. Neuropsychopharmacology. 2016;41(1):357-69. [PMID:26315508]
Kornør H, Winje D, Ekeberg Ø, et al. Early trauma-focused cognitive-behavioural therapy to prevent chronic post-traumatic stress disorder and related symptoms: a systematic review and meta-analysis. BMC Psychiatry. 2008;8:81. [PMID:18801204]
Nestadt, P.S., Speed, T.J., Keefe, F. J. and Dimsdale, J. E. (2017). “Stress and psychiatry”. In Kaplan and Sadock’s comprehensive textbook of psychiatry (10th ed.). Edited by: Sadock, B. J., Sadock, V. A., and Ruiz P.: Philadelphia, PA: Lippincott
Ozer EJ, Best SR, Lipsey TL, et al. Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull. 2003;129(1):52-73. [PMID:12555794]
Ponniah K, Hollon SD. Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: a review. Depress Anxiety. 2009;26(12):1086-109. [PMID:19957280]
Ursano RJ, Bell C, Eth S, et al. Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Am J Psychiatry. 2004;161(11 Suppl):3-31. [PMID:15617511]
Acute Stress Disorder is a sample topic from the Johns Hopkins Psychiatry Guide.
Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Complete Product Information.