This disorder is characterized by marked anxiety, feelings of unreality or of being in a dream (dissociative symptoms), and other symptoms that occur within 1 month after exposure to an extremely stressful trauma (stressor), which could be considered life-threatening to the individual or to someone else. Hopelessness can appear along with guilt at having survived the event if others did not. These feelings have a negative impact on relationships or work performance. Decreased emotional responsiveness may be reflected in difficulty enjoying any of life's previous pleasures. Individuals may neglect their basic personal health and even their safety. Impulsiveness and risk-taking behaviors can suddenly appear, in contrast to the individual's usual personality.
Acute stress disorder is distinguished from other stress disorders by duration. The diagnosis is not applicable if symptoms are from a drug effect or medical condition; nor is acute stress disorder diagnosed if symptoms could be better explained by a brief psychotic disorder or deterioration of a pre-existing mental disorder. Symptoms usually last at least 2 days but not more than 4 weeks. If symptoms last longer, a diagnosis of post-traumatic stress disorder (PTSD) is usually made. Therefore, diagnosing acute stress disorder can identify those who will develop a more chronic condition. Identifying acute stress disorder is also useful because disorganized behavior can leave the individuals unable to care for themselves, thus requiring treatment.Risk: More women than men tend to suffer from anxiety disorders. Genetic factors may play some role, but specific genes have not been identified. Other risk factors include loss of a family member, bodily injury, being depressed, losing your home, or exposure to toxins (Lubit). Incidence and Prevalence: Some studies have shown that acute stress disorder has prevalence between 14% to 33% in people who have experienced extreme trauma such as a car accident or witnessing a drive by shooting; 80% of patients who had a diagnosis of post-traumatic stress disorder experienced car accidents and violent crimes (DSM-IV-TR 470). |
Source: Medical Disability Advisor
History: A diagnosis is based on criteria listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). The history, psychiatric interview, and mental status exam of an individual who has experienced or witnessed a traumatic event are used to establish whether the individual's response or behavior meets the diagnostic criteria. The event must have involved another person’s death or must have threatened the individual or another person with serious injury or loss of physical integrity. The individual's response is that of intense fear, helplessness, and/or horror. Either while experiencing or after experiencing the event, the individual has at least three of the following dissociative symptoms: a sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of surroundings or the feeling of being in a daze; feelings of strangeness about the world (derealization); feeling distant from one's own thoughts, feelings, or body (depersonalization); or the inability to recall an important aspect of the trauma.
The traumatic event is persistently re-experienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashbacks; a sense of reliving the experience; or distress when exposed to reminders of the traumatic event. There is marked avoidance of thoughts, feelings, conversations, activities, places, people, or other stimuli that remind the individual of the traumatic event. There are marked symptoms of anxiety or increased arousal, such as difficulty sleeping, irritability, poor concentration, exaggerated alertness (hypervigilance), tendency to jump or flinch at loud noises or sudden movements (exaggerated startle response), or hyperactivity (motor restlessness). The symptoms result in significant distress, impaired relationships, or problems functioning at work or in other activities, but are not merely an exacerbation of a pre-existing psychiatric disorder. Physical exam: The exam may show signs of a physical trauma if one occurred, and could show evidence of restlessness or increased startle response. Tests: Tests do not establish this diagnosis. However, the post-traumatic scales on tests such as the Minnesota Multiphasic Personality Inventory-2 revised may be elevated, and psychological tests may also reveal symptoms related to anxiety. Laboratory studies such as a complete blood count and metabolic panel may be helpful to rule out a medical cause for their symptoms. |
Source: Medical Disability Advisor
| Psychotherapy is usually designed to allow full expression of the emotions and images connected with the trauma. The individual's story may be told and retold, to minimize the chance that he or she will disconnect from the reality of that experience. It may be done as individual or group therapy, or as hypnotherapy. Although psychotherapy is designed to enable individuals to somehow process and integrate this overwhelming experience into their lives, behavioral and cognitive therapies address coping with anxiety symptoms rather than exploring unconscious conflicts. Behavioral therapy aims to gradually increase exposure to the anxiety-provoking situation. Sedating medication, beta blockers and antidepressants may also be helpful. Patients should have 4 to 5 therapy sessions (Lubit). |
Source: Medical Disability Advisor
| The majority of individuals experiencing acute stress disorder recover completely. If the disorder lasts more than 4 weeks, a significant percentage will develop post-traumatic stress disorder (PTSD). Overall, one-tenth of those with acute stress disorder will remain unchanged or become worse. Behavioral therapy has been shown to reduce the progression of acute stress disorder into post traumatic stress disorder by 10% to 20%. Decreased functioning following previous stresses, lack of a support system, substance abuse, and the coexistence of other psychiatric disturbances can negatively affect the outcome of the disorder. |
Source: Medical Disability Advisor
| Individuals may be indifferent to maintaining their health and safety. Impulsive, risk-taking behavior can lead to injury. There is a possibility of progression to post-traumatic stress disorder. Feelings of despair can be severe enough to qualify as a major depressive episode. |
Source: Medical Disability Advisor
Work accommodations may include modifying the work space to decrease noise and visual distractions; introducing the individual to new or stressful situations gradually under appropriate supervision and support; providing some flexibility in work schedule to attend therapy appointments; allowing work-at-home or job-sharing opportunities; allowing break time according to individual needs rather than a fixed schedule; providing praise and positive reinforcement; and allowing workers to phone supportive friends, family members, or professionals during the workday.
If the traumatic event leading to the acute stress disorder occurred at work, accommodations may include placing the individual in a different job environment. Similarly, duties that remind the individual of the event (such as driving in the event of a motor vehicle accident) may be avoided for a time-limited period. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has a diagnosis of acute stress disorder been confirmed?
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Has the stressful event been identified?
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Have underlying medical conditions and other psychiatric disorders been identified or ruled out?
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Does individual have an underlying condition or experience that may impact recovery?
Regarding treatment:
- Does individual need more frequent therapeutic encounters?
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Would individual benefit from the addition of another type of therapy or a change in therapist?
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Has individual taken medication as prescribed?
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Does individual experience medication side effects that may interfere with use or benefit from that particular medication?
Regarding prognosis:
- Have symptoms persisted beyond 4 weeks?
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Should diagnosis be changed to post-traumatic stress disorder?
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Are coexisting psychiatric conditions being appropriately addressed?
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Would individual benefit from substance abuse rehabilitation?
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If a functional support system is not available, would the individual benefit from involvement in group therapy or a community support group?
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Source: Medical Disability Advisor
| CitedFrances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.Lubit, Roy. "Acute Treatment of Disaster Survivors." eMedicine. Eds. Jennifer S. Berg, et al. 17 Jun. 2004. Medscape. 24 Feb. 2005 <http://emedicine.com/med/topic3540.htm>. |
Source: Medical Disability Advisor
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