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, symptoms of distress, chaotic and impulsive behavior, and post-concussive symptoms.

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.

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.[2][3][4][5][6][7][8][9][10][11]
  • Patients may complain of loss of appetite, changes in weight, trouble going to sleep or staying asleep, fatigue, and hair loss

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 following:
    • 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

  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. Ehlers, A; Mayou, R.A; Bryant, B (2003). "Cognitive predictors of posttraumatic stress disorder in children: results of a prospective longitudinal study". Behaviour Research and Therapy. 41 (1): 1–10. doi:10.1016/S0005-7967(01)00126-7. ISSN 0005-7967.
  3. Warda G, Bryant RA (1998). "Cognitive bias in acute stress disorder". Behav Res Ther. 36 (12): 1177–83. PMID 9745802.
  4. Dunmore E, Clark DM, Ehlers A (2001). "A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault". Behav Res Ther. 39 (9): 1063–84. PMID 11520012.
  5. Smith K, Bryant RA (2000). "The generality of cognitive bias in acute stress disorder". Behav Res Ther. 38 (7): 709–15. PMID 10875192.
  6. Bryant RA, Panasetis P (2001). "Panic symptoms during trauma and acute stress disorder". Behav Res Ther. 39 (8): 961–6. PMID 11480836.
  7. Nixon RD, Bryant RA (2003). "Peritraumatic and persistent panic attacks in acute stress disorder". Behav Res Ther. 41 (10): 1237–42. PMID 12971943.
  8. Bryant, R. (2011). Post-traumatic stress disorder vs traumatic brain injury. Dialogues in Clinical Neuroscience, 13(3), 251–262.
  9. Meares S, Shores EA, Taylor AJ, Batchelor J, Bryant RA, Baguley IJ; et al. (2008). "Mild traumatic brain injury does not predict acute postconcussion syndrome". J Neurol Neurosurg Psychiatry. 79 (3): 300–6. doi:10.1136/jnnp.2007.126565. PMID 17702772.
  10. Kirmayer, Laurence J. (1996). "Confusion of the senses: Implications of ethnocultural variations in somatoform and dissociative disorders for PTSD": 131–163. doi:10.1037/10555-005.
  11. Hinton DE, Lewis-Fernández R (2011). "The cross-cultural validity of posttraumatic stress disorder: implications for DSM-5". Depress Anxiety. 28 (9): 783–801. doi:10.1002/da.20753. PMID 21910185.



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