Acute stress disorder natural history, complications and prognosis
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If left untreated, 50% of patients with acute stress disorder may progress to develop post traumatic stress disorder. Common complications of acute stress disorder include interference with sleep, energy levels, and capacity to attend to tasks, generalized withdrawal, and progression to post traumatic stress disorder. Prognosis is generally good, and the majority of individuals experiencing acute stress disorder recover completely. If the disorder lasts more than 4 weeks, a significant percentage will develop posttraumatic stress disorder (PTSD). Of individuals who have cognitive-behavioral therapy (CBT) shortly after frightening events, only about 10% to 20% develop PTSD.
- In the initial days and weeks after a traumatic event, trauma survivors typically display symptoms of marked distress, but then the majority of people tend to adapt, and these symptoms remit.
- Persons may develop an acute stress reaction, within minutes of a traumatic event. 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 occur at the same time as or within a few minutes of the traumatic event, and in majority of cases disappear within hours or days. Patients with traumatic stress often present with general symptoms, such as gastrointestinal disorders, headaches, rheumatic pain, skin disorders, cardiovascular symptoms, difficulty sleeping, or psychological problems such as anxiety and depression.
- Acute stress disorder cannot be diagnosed until 3 days after a traumatic event. Although acute stress disorder may progress to posttraumatic stress disorder (PTSD) after 1 month, it may also be a transient stress response that remits within 1 month of trauma exposure and does not result in post traumatic stress disorder (PTSD). Approximately half of individuals who eventually develop post traumatic stress disorder (PTSD) initially present with acute stress disorder. Symptom worsening during the initial month can occur, due to ongoing life stressors or further traumatic events.
- The forms of reexperiencing can vary across development. Young children may report frightening dreams without content that clearly reflects aspects of the trauma, unlike adults and adolescents. Children age 6 years and younger are more likely than older children to express reexperiencing symptoms through play that refers symbolically to the trauma. Young children also do not necessarily manifest fearful reactions at the time of the exposure to the trauma or even during reexperiencing. In young children who are traumatized, parents typically report a range of emotional expressions, such as shame, anger, or withdrawal, and even excessively bright positive affect.
- The intent of the ASD diagnosis is to facilitate identification and treatment of acute stress responses. Treatment of ASD can have a significant benefit of limiting subsequent posttraumatic stress disorder (PTSD).
Acute Stress Disorder may interfere with sleep, energy levels, and capacity to attend to tasks. This disorder can result in generalized withdrawal from many threatening situations (e.g., medical appointments, absenteeism from work). Half of the individuals who develop Post-traumatic Stress Disorder initially present with Acute Stress Disorder. Individuals may be indifferent to maintaining their health and safety. There is a possibility of progression to posttraumatic stress disorder. Feelings of despair can be severe enough to qualify as a major depressive episode.
The majority of individuals experiencing acute stress disorder recover completely. If the disorder lasts more than 4 weeks, a significant percentage will develop posttraumatic stress disorder (PTSD). Of individuals who have cognitive-behavioral therapy (CBT) shortly after frightening events, only about 10% to 20% develop PTSD. 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. Approximately between 40 and 80 percent of those with ASD develop subsequent PTSD; that is, half or more of people with ASD do not experience chronic PTSD. Only approximately 30 to 60 percent of those who eventually develop PTSD meet criteria for acute stress disorder (ASD) in the acute phase, indicating that most people who develop PTSD are not detected by the diagnosis. 
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