Chapter 2: Managing Stress
Acute Stress Disorder
Acute Stress Disorder is a caused by trauma (traumatic stress) and lasts at least 3 days. The DSM-5 manual states that stressful events which do not include severe and traumatic components do not lead to Acute Stress Disorder; Adjustment Disorder may be an appropriate diagnosis.
Many other causes of trauma are possible.
Note: The International Classification of Diseases refers to Acute Stress Reaction, which is slightly different and results from an “exceptionally stressful life event” or “continous trauma”, and typically lasts between a few hours and a few days. Both Acute Stress Disorder and Acute Stress Reaction have symptoms which are similar to Posttraumatic Stress Disorder.
Acute Stress Disorder DSM-5 Diagnostic Criteria
A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
- Directly experiencing the traumatic event(s).
- Witnessing, in person, the events(s) as it occurred to others.
- Learning that the traumatic events(s) occurred to a close family member or close friend.
Note: In cases of actual or threatened by death of a family member or friend, the events(s) must have been violent or accidental. - Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
Note: This does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work related.
B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:
- Intrusion symptoms
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
- Recurrent distressing dreams in which the content and/or affect of the dream are related to the events(s). Note: In children older than 6, there may be frightening dreams without recognizable content.
- Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). Note: In children, trauma-specific reenactment may occur in play.
- Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic events.
- Negative Mood
- Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
- Dissociative Symptoms
- An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from ano