Acute stress disorder is a psychological condition that occurs when a person experiences intense stress symptoms shortly after a traumatic event. This clinical picture can be observed after a person directly experiences a traumatic event, witnesses such an event, learns about a severe event happening to a close person, or is repeatedly exposed to the details of traumatic events due to his occupation.
Traumatic events are events that challenge a person's life, bodily integrity, perception of safety, or psychological resilience. Examples include traffic accidents, natural disasters, sudden loss, assault, severe injury, witnessing violence, or other life-threatening events.
Acute stress disorder does not mean that every reaction given after a trauma is an "illness." Experiencing fear, sadness, confusion, crying, sleep problems, or absentmindedness after a trauma can be an expected stress reaction for many people. However, if the symptoms significantly affect a person's daily life, functionality, relationships, and sense of security, it is important for him to be evaluated by a mental health professional.
In current diagnostic classifications, acute stress disorder symptoms are expected to last between 3 days and 1 month after the traumatic event. According to DSM-5, this time range is important in distinguishing acute stress disorder from stress reactions occurring in the early post-trauma period and from post-traumatic stress disorder.
What Are the Symptoms of Acute Stress Disorder?
Symptoms of acute stress disorder can vary from person to person. While some people experience intense fear and startle reactions immediately after the event, others may experience numbness, detachment, or a feeling of unreality. Symptoms are generally considered in five main groups.
1. Re-experiencing / Intrusive memories
In this symptom group, the person may feel as if he is reliving the traumatic event in his mind over and over again. Even though the event is over, his mind and body may still react as if danger is present.
Re-experiencing symptoms may include:
- Involuntary and disturbing memories of the event frequently coming to mind
- Having nightmares connected to the traumatic event
- Feeling as if the event is happening all over again
- Being triggered by a sound, smell, image, or similar environment
- Experiencing palpitations, sweating, trembling, or intense fear in the face of triggers
These symptoms do not indicate that the person is "weak." After a trauma, the brain tries to make sense of the experienced event and regulate the perception of danger. However, if these repetitions make the person's daily life difficult, getting support can be beneficial.
2. Negative mood
It can become difficult for people experiencing acute stress disorder to access positive emotions. The person may move away from things he used to enjoy or feel emotionally shut down.
Negative mood symptoms may include:
- Feeling constant fear, guilt, anger, shame, or helplessness
- Experiencing difficulty in feeling emotions such as happiness, peace, or love
- Experiencing hopelessness about the future
- Falling into the thought "I will never be the same again"
- A tendency to blame himself or others for the event
These emotions can be frequently seen after trauma. What is important is the intensity, duration of these emotions, and the extent to which they affect the person's life.
3. Dissociative symptoms
Dissociative symptoms mean that a person feels a temporary disconnection in his connection with himself, his environment, or the event he experienced. In Turkish, this situation is often described as "feeling unreal," "detaching from oneself," or "feeling as if watching events from the outside."
These symptoms may include:
- Perceiving the environment as if it is not real
- The person feeling disconnected from his body
- Experiencing difficulty remembering certain parts of the event
- Change in time perception
- Emotional numbness or a feeling of freezing
These symptoms may be related to the brain trying to protect the person from intense emotional burden immediately after the trauma. However, when they become pronounced and persistent, expert evaluation is important.
4. Avoidance symptoms
Avoidance is the person trying to stay away from thoughts, feelings, people, places, or conversations that remind him of the trauma. Although it may seem relieving in the short term, it can narrow the person's living space in the long term.
Avoidance symptoms are:
- Avoiding talking about the event
- Not going to places that remind him of the trauma
- Staying away from meeting certain people
- Avoiding news, images, or sounds that evoke the event
- Trying to suppress emotions
- A tendency to "act as if nothing happened"
Avoidance is a frequently seen symptom during the acute stress disorder process. However, the more the person avoids, the stronger the fear and threat perception can become. Therefore, safe and gradual approaches are important during the treatment process.
5. Increased arousal symptoms
After a trauma, the body may remain on alert as if it is in danger. This situation can be explained by the nervous system operating in an alarm state.
Increased arousal symptoms may include:
- Being easily startled
- Being constantly on alert
- Difficulty falling asleep or staying asleep
- Anger outbursts or intolerance
- Attention and concentration problems
- Physical tension
- Hypersensitivity to crowds, noise, or sudden movements
If these symptoms significantly disrupt the person's daily functions, an evaluation for acute stress disorder may be necessary.
What Causes Acute Stress Disorder?
Acute stress disorder can develop following a traumatic event. However, not everyone who experiences the same event reacts the same way. This situation is related to the person's previous life experiences, support sources, psychological resilience, the severity of the event, and post-event conditions.
Factors that may be effective in the development of acute stress disorder are:
- The traumatic event being life-threatening in nature
- Experiencing intense fear, helplessness, or terror during the event
- Having previous traumatic experiences
- Lack of social support
- Inability to transition to a safe environment after the event
- Experiencing loss, injury, or serious uncertainty
- Having previous mental struggles
- Experiences of neglect, violence, or insecure attachment during childhood
Acute stress disorder is not a character weakness. The person's body and mind try to protect themselves after an extraordinary event. In some cases, these protective reactions intensify and begin to make the person's life difficult.
How Long Does Acute Stress Disorder Last?
According to the current diagnostic approach, acute stress disorder symptoms last at least 3 days and at most 1 month after the traumatic event. Symptoms can usually begin immediately after the event; however, for it to be evaluated diagnostically, certain duration and symptom criteria must be taken into account.
If symptoms last longer than 1 month, the person may need to be evaluated for post-traumatic stress disorder. This does not mean that PTSD will necessarily develop in everyone experiencing acute stress disorder. However, the prolongation, intensification of symptoms, or significant disruption of daily life may require professional support.
What Is the Difference Between Acute Stress Disorder and Post-Traumatic Stress Disorder (PTSD)?
Acute stress disorder and post-traumatic stress disorder (PTSD) may contain similar symptoms. The main difference is the duration of symptoms and the time of evaluation. While acute stress disorder is evaluated within the first month after trauma, PTSD comes to the agenda when symptoms last longer.
| Comparison Area | Acute Stress Disorder | Post-Traumatic Stress Disorder (PTSD) |
|---|---|---|
| Onset time | Can appear in the first days after the traumatic event | Can develop after trauma; symptoms continue for a longer period |
| Duration | Between 3 days and 1 month | Usually evaluated with symptoms lasting longer than 1 month |
| Symptom structure | Re-experiencing, negative mood, detachment, avoidance, and arousal symptoms can be seen | Similar symptom areas can be seen in a more permanent manner |
| Clinical focus | Evaluation of early-period trauma reactions | Evaluation of prolonged trauma effects |
| Treatment approach | Early support, safety, psychoeducation, and trauma-focused CBT approaches come to the fore | Trauma-focused psychotherapy approaches can be planned longer |
| Purpose | To understand symptoms, ensure safety, support functionality | To address prolonged trauma symptoms, support quality of life |
What Is the Difference Between Acute Stress Disorder and Adjustment Disorder?
It can be natural to feel sad, cry, be afraid, not be able to sleep, or think about the event after a traumatic event. The normal stress reaction usually decreases over time, and the person can gradually return to daily life with support.
Acute stress disorder, on the other hand, points to a more intense, more disruptive, and more pronounced picture. The person may experience serious difficulty fulfilling his daily responsibilities after the event.
In a normal stress reaction:
- Emotions may fluctuate but ease over time
- The person can relax with support
- Daily functions may not be completely disrupted
- Although remembering the event is painful, the person does not organize his whole life by avoiding it
In the case of acute stress disorder:
- Symptoms can be intense and repetitive
- The person may feel as if he is reliving the trauma
- Avoidance behaviors may increase
- Sleep, attention, work, school, and relationships can be significantly affected
- Even when he is safe, his body may remain in an alarm state
What Is the Difference Between Acute Stress Disorder and Panic Attack?
Panic attack is defined by a suddenly starting intense fear or bodily alarm state. Palpitations, shortness of breath, trembling, chest tightness, dizziness, and fear of losing control may be seen.
Acute stress disorder, on the other hand, is a broader symptom pattern that emerges after a traumatic event. Panic-like bodily symptoms can be seen within acute stress disorder; however, acute stress disorder is not solely composed of panic symptoms.
The main differences can be summarized as follows:
| Area | Acute Stress Disorder | Panic Attack |
|---|---|---|
| Trigger | It is related to a traumatic event | Can sometimes happen without a clear trigger |
| Symptom content | Re-experiencing the trauma, avoidance, detachment, being on alert | Sudden bodily fear attack is at the forefront |
| Duration | Can be evaluated between 3 days and 1 month | The attack is usually in the form of shorter-duration waves |
| Main emotion | Trauma-connected fear, helplessness, insecurity | Fear of dying, losing control, or something bad happening |
What Is the Difference Between Acute Stress Disorder and Adjustment Disorder?
Adjustment disorder is related to a person's struggle reaction to a major life change or stressor. Job loss, separation, relocation, academic problems, or intra-family tensions can lay the groundwork for adjustment disorder.
Acute stress disorder, however, emerges after an event of a traumatic nature. The event here generally has a quality that threatens life, safety, or bodily integrity.
The differences can be explained as follows:
- Acute stress disorder is seen after a traumatic event.
- Adjustment disorder can be associated with stressors that are not always traumatic in nature.
- In acute stress disorder, re-experiencing, detachment, and avoidance can be more pronounced.
- In adjustment disorder, sadness, anxiety, anger, or loss of function may be at the forefront.
In both cases, the differential evaluation must be made by a mental health professional.
Who Is More Likely to Experience Acute Stress Disorder?
Acute stress disorder can happen to anyone. However, the risk may be higher in some people. An increase in risk does not mean that the person is weak; the nature of the event, past experiences, and support sources can be decisive in this process.
Groups where it may be seen more frequently are:
- People who experience severe accidents, disasters, assaults, or violence
- Those who witness a traumatic loss
- Those working in fields such as health, security, search and rescue
- People with previous traumatic experiences
- People who experienced unsafe or challenging experiences during childhood
- Those with limited social support
- Those who have difficulty reaching a safe environment after the event
- People who feel intense guilt, shame, or helplessness
These risk factors do not mean a definitive diagnosis. Diagnosis is handled as a result of the person's symptoms, duration, functionality, and clinical evaluation.
Acute Stress Disorder in Children and Adolescents
Acute stress disorder in children and adolescents can manifest differently than in adults. Children may not always be able to articulate what they experience clearly. Therefore, behavioral changes should be monitored carefully.
Symptoms that may be seen in children:
- Repeating the traumatic event in their play
- Fear of separation
- Regression behaviors such as bedwetting
- Nightmares or resistance to sleep
- Sudden anger, crying, or withdrawal
- Not wanting to go to school
- Physical complaints
- Constantly seeking reassurance
- Attention and learning difficulties
In adolescents, symptoms may resemble those of adults more closely. However, risky behaviors, anger outbursts, a drop in school success, social withdrawal, and intense guilt may be observed.
In the approach to children and adolescents, a safe relationship, age-appropriate explanation, maintenance of routines, and family support are important. If symptoms are pronounced, expert support in the field of child and adolescent mental health should be obtained.
How Is Acute Stress Disorder Diagnosed?
The diagnosis of acute stress disorder is handled through a clinical evaluation made by a mental health professional. A definitive decision is not made with a single test. The event the person experienced, his symptoms, the duration of the symptoms, the effect on daily life, and differential conditions are evaluated together.
During the evaluation process, the following can be addressed:
- The nature of the traumatic event
- When the symptoms started
- Whether the symptoms are between 3 days and 1 month
- Re-experiencing, negative mood, detachment, avoidance, and arousal symptoms
- Effects on sleep, work, school, family, and social life
- Whether there is a safety risk
- Other mental or physical conditions that could lead to similar symptoms
In the evaluation of acute stress disorder, how safe the person feels is just as important as his narration. The expert interview should be conducted within a non-judgmental, safe, and supportive framework.
How Is Acute Stress Disorder Treated?
The goals in treating acute stress disorder are to re-support the person's sense of safety, make sense of trauma symptoms, reduce the avoidance cycle, and strengthen daily functionality. The treatment plan must be prepared specifically for the individual.
One of the approaches that comes to the fore the most in this process is the trauma-focused Cognitive Behavioral Therapy (CBT) approach. Current guidelines state that individual trauma-focused CBT approaches are recommended for adults experiencing acute stress disorder or prominent trauma symptoms within the first month after trauma.
In the trauma-focused CBT process, the following areas can be addressed:
- Psychoeducation: What post-traumatic stress reactions are is explained to the person in an understandable language. Thus, the person can find a clearer answer to the question "what is happening to me?"
- Safety and balance studies: It is aimed for the person to notice his physical tension, determine his safe areas, and support his daily routine.
- Thought studies: Thoughts developing after trauma such as "I am to blame," "nowhere is safe," "I can never recover" are addressed. These thoughts are evaluated in a more balanced and realistic manner.
- Reducing the avoidance cycle: The person staying away from everything that reminds him of trauma may be relieving in the short term; however, it can strengthen fear in the long term. In CBT, this cycle is worked on safely, gradually, and accompanied by an expert.
- Processing the traumatic memory: When the person is ready, feelings and thoughts related to the traumatic memory can be addressed in a structured manner. The aim is not to force the person, but to help reduce the effect of the memory on current life.
- Coping skills: Skills such as breath awareness, relaxation, emotion regulation, asking for support, and strengthening the daily routine can be worked on.
Trauma-focused CBT is not applied to everyone in the same way. The person's age, type of trauma, current safety status, severity of symptoms, and support sources are taken into account. While safety, sleep routine, social support, and crisis management are addressed first in some people, a transition to more structured trauma work can be made in others.
The following supportive steps are also important during the treatment process:
- Creating a safe and orderly environment
- Identifying close social support sources
- Regulating sleep, nutrition, and daily routines
- Recognizing triggers
- Not forcing the person to talk about the event
- Informing the family if necessary
- Providing age-appropriate psychological support in children and adolescents
Every treatment process should be planned with an expert evaluation. If the person's symptoms are severe, if he has thoughts of self-harm, if his safety is at risk, or if daily life is significantly disrupted, professional support should be obtained without delay.
What Happens If Acute Stress Disorder Is Not Treated?
Some people experiencing acute stress disorder can recover over time with support and a safe environment. However, in some people, symptoms may prolong, intensify, or pose a risk in terms of post-traumatic stress disorder.
When left untreated or when support is not obtained, the following situations may be seen:
- Increase in avoidance behaviors
- Continuation of sleep problems
- Difficulty in work, school, and relationships
- Persistence of the state of being constantly on alert
- Establishment of intense feelings of guilt or shame regarding the event
- Social withdrawal
- Symptoms lasting longer than 1 month
- Permanence of post-traumatic stress symptoms
These results do not apply to everyone. However, if symptoms significantly affect the person's life, early evaluation and appropriate support are important.
What Should People Experiencing Acute Stress Disorder Do?
The first step for a person experiencing acute stress disorder is safety. If the person is still in danger, the priority is to move to a safe environment and reach the necessary support units. Afterwards, the psychological support process can be planned.
Supportive steps the person can take:
- Connecting with someone he trusts
- Not forcing himself if he is not ready to talk about the event
- Maintaining sleep and eating schedules as much as possible
- Staying away from alcohol or harmful coping ways
- Limiting exposure to intense news, images, or trigger content
- Creating simple daily routines
- Noticing physical tension and using methods to help calm down
- Consulting a mental health professional if symptoms are severe
If there is an emergency risk, thoughts of self-harm, intense helplessness, or a safety issue, emergency help should be obtained without wasting time.
How to Approach Someone with Acute Stress Disorder?
The most important point when approaching someone experiencing acute stress disorder is a reassuring, patient, and non-judgmental attitude. Forcing the person to talk, saying "forget about it," or belittling what he experienced can make the recovery process difficult.
To be supportive, the following can be done:
- Giving the message "you are safe, I am by your side"
- Listening as much as the person wants to tell
- Allowing him to remain silent
- Not acting blaming or questioning
- Helping with daily needs
- Offering support on practical matters such as sleep, food, transportation, appointments
- Encouraging him to get professional support
- Trying to maintain routines in children
Approaches to avoid:
- Saying "don't think about this anymore"
- Comparing by saying "there are those living through worse"
- Forcing him to recount the details of the event
- Accusing the person of weakness
- Expecting him to recover immediately
A supportive approach can help the person regain his sense of control and feeling of safety.
Which Department to Visit for Acute Stress Disorder?
People experiencing symptoms of acute stress disorder can apply to the psychiatry department. A psychiatry specialist can conduct an evaluation and provide guidance regarding diagnosis, differential conditions, and the necessary support plan.
Additionally, psychotherapy support can be obtained from clinical psychologists working in the field of trauma. Working with an expert experienced especially in trauma-focused Cognitive Behavioral Therapy can help address symptoms in a structured manner.
In children and adolescents, it is appropriate to apply to the child and adolescent psychiatry department. Cooperation with the school, family, and social environment can also be part of the evaluation process.