Insight Treatment is Now Clear Behavioral Health!

Acute Stress Disorder: DSM-5 Classification

Home » Our Blog » Acute Stress Disorder: DSM-5 Classification

Clinically Reviewed by:
Lindsey Rae Ackerman, LMFT

Written by:
Alex Salman, MPH on February 23, 2024

The American Psychiatric Association lists Acute Stress Disorder in the DSM-5 under anxiety disorders. This temporary mental health disorder is thought to affect 13%-21% of those who survive a vehicle accident and it affects 20%-50% of those who have survived a traumatic event such as assault, rape, or a mass shooting. Let’s take a closer look at what Acute Stress Disorder (ASD) is, who is at risk, and how this disorder is treated.

What is Acute Stress Disorder (ASD)?

According to the American Psychiatric Association, you need to meet certain criteria for a diagnosis of Acute Stress Disorder (ASD). The first piece of criteria is direct or indirect exposure to a traumatic event. A traumatic event is any event that causes harm to a person, whether it be physical, psychological, or emotional. Indirect exposure to a traumatic event means that simply hearing about something like a school shooting can cause a trauma reaction that results in extreme stress or even posttraumatic stress disorder. The event must include an actual death or the threat of death or serious injury. It can also be a serious injury or threat of such an injury to someone else that you witness that triggers the response. Sexual violation is also a hugely traumatic event that can trigger an acute stress reaction.

Symptoms typically begin immediately, but their appearance may be delayed anywhere from three days to a month after the traumatic event takes place. The symptoms need to last at least three days to receive a diagnosis.

An acute stress reaction needs to impair a person’s daily life in order to be classified under Acute Stress Disorder. This impairment can be a slight disruption or a major one.

There is a need to rule out other causes of the distressing symptoms. They have to be determined to have been caused by the trauma and not a result of an underlying medical condition, alcohol or drug use, or medication.

The final piece of criteria is that the person needs to experience at least nine of the symptoms that are spread throughout five categories. These symptoms are discussed below.

Is An Acute Stress Reaction a Mild Traumatic Brain Injury?

While an acute stress reaction isn’t considered a mild traumatic brain injury, it does have a detrimental effect on the brain. Trauma of any kind, especially prolonged trauma, has a tendency to rewire the neural pathways in the brain. Often, chemicals in the brain are also altered. In this way, we can say that repeated or extreme exposure to traumatic events has the potential to injure the brain.

Who is Most Likely to Suffer From Acute Stress Disorder?

There is no way we can determine without a doubt who will develop Acute Stress Disorder. Some people have a greater risk factor, however, based on their occupation or past history. Responders collecting human remains are at high risk as are police officers repeatedly exposed to trauma such as murders and other violent acts. Military members are at high risk, especially if they see active combat.

The chances of having an episode of ASD are also increased in individuals who:

  • Experienced a traumatic event in the past
  • Have a history of ASD or Posttraumatic stress disorder
  • Have a history of certain types of mental problems, such as anxiety disorders
  • Have a history of dissociative symptoms during traumatic events

What Are the Symptoms of Acute Stress Disorder?

Intrusion Symptoms

These are recurrent events that remind you of the event and cause you to react as though you are experiencing the event again.

  • Memories that show up suddenly, with or without a trigger
  • Nightmares or night terrors
  • Flashbacks that make you feel you are reliving the traumatic event or traumatic events

Negative Mood

These stress reactions are acute and consistent.

  • The inability to experience positive emotions such as joy.
  • May feel totally numb and unable to respond emotionally. Others see you as “shut down”

Dissociative Symptoms

These symptoms make it seem as though you or your surroundings aren’t real. You may describe it as watching yourself from a distance. Dissociative symptoms include:

  • An altered sense of the reality of one’s self or the environment. Nothing seems familiar
  • Amnesia or the inability to remember important aspects of the traumatic event
  • Derealization, or a sense that the environment is unreal or somehow strange
  • Depersonalization, or a sense of being detached from yourself

Avoidance Symptoms

  • You avoid anything that makes you remember the trauma, including distressing memories, thoughts, and feelings
  • You avoid external triggers such as visiting the location of the event

Arousal Symptoms

These feelings of anxiety or increased arousal change the way you react to your environment and the way you respond to certain situations.

  • Feeling wound up and on edge. Unable to sit still for long.
  • Disturbed sleep patterns such as insomnia or restless sleep
  • Irritability
  • Outbursts of verbal or physical aggression
  • Having an exaggerated startle response, especially to sounds
  • Always hypervigilant, as though waiting for something bad to happen
  • Difficulty concentrating

What are Things to Look for in Children?

Children may develop amnesia regarding a traumatic event. They are more likely to experience nightmares and are prone to acting out with violent physical and verbal actions. Their young brains have no way to process extreme trauma or express their feelings in a more productive way. In fact, amnesia may make it impossible for them to even understand why they are acting out. They only know the world is a scary place. A dissociative disorder may begin at this point.

Acute Stress Disorder Vs Post Traumatic Stress Disorder (PTSD)

The major difference between Acute Stress Disorder and Post Traumatic Stress Disorder is the duration of the symptoms. ASD normally goes away with quick treatment. PTSD lasts for months and even years and involves more prolonged psychological distress. When a person does not receive immediate treatment after a traumatic event, they have a greater chance of ASD becoming PTSD. This is also true for those who experience prolonged trauma such as childhood abuse, domestic violence, or combat experience.

Effects of ASD on Daily Life

Acute Stress Disorder can totally disrupt a person’s daily life. They tend to avoid many places and situations they fear will trigger symptoms. Mood swings can make it difficult to maintain healthy personal relationships and symptoms such as the inability to sit still, inability to concentrate, and tendency to strike out with verbal or physical violence can make it impossible to hold a job. When a person feels the world may suddenly explode around them without notice, it becomes difficult to live any type of normal existence.

Acute stress disorder can also be indicative of or lead to further mental disorders such as depression, anxiety, or obsessive-compulsive disorder.

Misconceptions About Acute Stress Disorder

For those who have no knowledge of how trauma can affect a person, there are many misconceptions. These false thoughts can make it difficult for an individual to recognize the symptoms in themselves or their loved ones. This means treatment that is needed may be avoided.

It Will Go Away on Its Own

Acute stress disorder that is left untreated can either become buried within your mind only to arise later or turns into PTSD. Treatment is necessary in order to heal.

Only Military Members Experience Acute Stress Disorder

It was once thought that only war was traumatic enough to cause such a stress reaction but we now know that any traumatic event such as a car accident, prolonged abuse, a violent assault, or even repeated exposure to the results of violence can cause acute stress disorder.

Children Can’t Get Acute Stress Disorder

With children’s tendency to experience event amnesia, it may be difficult to associate the acting-out symptoms with a traumatic event that has occurred or a stress disorder. Children exhibit different symptoms than adults but they are also very highly affected.

Only Those With Existing Mental Health Issues are Susceptible

While those with some mental health conditions, such as extreme anxiety, are more prone to Acute Stress Disorder, anyone is at risk if the trauma is severe or lasts for a long period of time.

Treatment Options for ASD

There are several treatment options for those who are experiencing the symptoms of Acute Stress Disorder. The sooner a person seeks treatment after a traumatic event, the better their chances are of getting through this troubling time without further damage. The most effective treatments include:

Cognitive Behavioral Therapy (CBT) – This treatment is a type of talk therapy that helps a person reframe their thoughts about an event and teaches them how to respond in an appropriate manner, realizing that the trauma was in the past and is not current. Often, the person is taught calming techniques to help with grounding and anxiety attacks.

Exposure Therapy – This involves slowly exposing a person to triggering stimuli so they can learn to deal with troubling emotions. This may include seeing pictures of the event or visiting the place where it occurred.

Medication – Most often, any medication prescribed is meant to reduce feelings of anxiety or depression, so a person is able to better deal with the effects of the trauma.

Virtual Therapy – For many, going to someone in person is even more stressful after a traumatic event because of the intense fear that is present. Online or virtual therapy is a safe yet effective way to get the help that is needed without adding even more stress to the person.

Regardless of the method of treatment you opt for, it is important not to self-medicate with alcohol or drugs as they only add to the problems. In addition, find out if the person you are seeking treatment from is using trauma-informed therapy. Dealing with trauma requires a different approach to treatment and a therapist that is not informed of this method can end up doing more harm.

Contact Clear Behavioral Health’s Virtual Program to learn more about your treatment options.

Leave a Reply

Your email address will not be published. Required fields are marked *

Mental Health Services and Addiction Treatment in Los Angeles
Take the next step. Call us now.

Take the next step. Call us now.

Are you a good fit for an intensive outpatient program?

I struggle with burnout, depression, or anxiety

I am exhausted and no amount of sleep seems to help

I feel overwhelmed by the amount of work I need to do

​​I have tried talk therapy and need more support

Has a clinician referred you to IOP treatment?