Acute Stress Disorder (ASD)
The high-stress demands of practicing can leave physicians and dentists uniquely susceptible to burnout and mental health conditions like anxiety and depression. This can be especially true for medical professionals on the front lines, responding to crises like the COVID-19 pandemic.
In this post, we are going to examine Acute Stress Disorder (ASD), another serious condition that can occur in environments where individuals are exposed to trauma.
What is ASD?
Acute Stress Disorder (ASD) is a trauma related disorder with an onset of three days to one month after experiencing a traumatic event, either through direct or indirect exposure. It is characterized by intrusive memories, changes in mood, and avoidance of associated stimuli.
While the prevalence rates of ASD vary due to multiple factors, including different types of trauma, the average is 19%. Females, those under 40, those with a history of past trauma and/or PTSD, those with other mental health conditions, and those who have a history of dissociative reactions to past traumatic events are more susceptible to ASD.
ASD is a temporary condition with symptoms that persist from three days to a month after a traumatic event, which cause clinically significant distress or impairment in functioning. Symptoms are divided into five categories and include:
- Intrusion symptoms (re-experiencing the event through intrusive and distressing memories, dreams, or flashbacks).
- Negative mood (inability to experience positive emotions).
- Dissociative symptoms (an altered sense of reality or surroundings or of oneself/inability to remember an important aspect of the traumatic event).
- Avoidance symptoms (efforts to avoid distressing memories, thoughts, feelings or external reminders associated with the traumatic event).
- Arousal symptoms (sleep disturbances; irritable behavior and angry outbursts; hypervigilanc; problems with concentratio; exaggerated startle response).
The diagnosis of ASD is based on history and an exam. A professional will screen for exposure to a traumatic event and an individual’s response to it, and may use screening tools such as The Acute Stress Disorder Structured Interview or The Acute Stress Disorder Scale. Practitioners will also rule out differential diagnoses, such as PTSD, adjustment disorder, traumatic brain injury (can occur concurrently), effects of medications and/or substance use, and other psychiatric illnesses.
The goals of treatment are to reduce symptoms, increase functioning, and prevent the development of PTSD. Treatments include:
- Psychotherapy, including Cognitive Behavioral Therapy (CBT)
- Medications (antidepressants, anticonvulsants)
- Mindfulness and other stress-management techniques
While some ASD cases will resolve without formal interventions, in other instances individuals will go on the develop PTSD.
While symptoms are similar to those found in PTSD, there are a few key differences including when a diagnosis can be made (PTSD symptoms must be present for at least a month). Further, criteria for PTSD includes non-fear-based symptoms (e.g. destructive behavior, exaggerated blame of self or others, feeling isolated) whereas ASD does not. PTSD includes a dissociative subtype, whereas depersonalization and derealization are included in the symptoms of ASD. Finally, PTSD requires meeting a certain number of symptoms within established clusters, while the symptoms of ASD are not classified within clusters (therefore an individual meets a diagnosis based on expression of symptoms in total).
While it is often not possible to prevent a traumatic event, there are steps individuals can take to help prevent developing further complications, including consulting a professional following a traumatic event, seeking support, and getting treatment for any other underlying mental health conditions. For those who have jobs with a high risk of exposure to trauma (e.g. first responders or emergency room physicians), preparedness training may help.
These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described above and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.
Johns Hopkins Medicine
U.S. Department of Veterans Affairs, National Center for PTSD
Medical News Today