We all get stressed out from time to time. However, what happens when that brief, overwhelming moment becomes a consistent and extended matter?

This is known as acute stress disorder (ASD). Putting it simply, ASD is a mental illness that causes an unpleasant dysfunctional response to one’s own surroundings and situations following a disturbing or traumatic event.

Due to its link to trauma, ASD is often confused and mistakenly diagnosed as post-traumatic stress disorder (PTSD). However, ASD and PTSD are distinct and separate. ¹

Throughout this article, we’ll explore ASD and its link to stress, trauma, and anxiety. From there, we’ll discuss the best approaches for treatment.

Acute Stress Disorder Symptoms

ASD is marked by a dysfunctional response to a stressful or traumatic event. The symptoms of ASD usually develop two to three days following a traumatic event and can persist days to weeks later.

There are physical and psychological symptoms of ASD. They’re caused by psychological triggers that bring about emotional and biological responses.

Physical Symptoms

The physical symptoms are caused by the overly sensitive nervous system and the rush of adrenaline and include: ²

• Chest and stomach pains
• Difficulty or shifts in breathing
• Headaches
• Nausea
• Palpitations

Psychological Symptoms

The most common psychological symptoms of ASD include: ³

• Avoidance of situations and personal problems
• Dissociation
• Emotional and physical distress
• Re-experiencing trauma

Since psychological symptoms are complex, they’re worth discussing in more detail:

Avoidance Symptoms

Depending on the type of trauma you have, you may avoid people, places, or things that remind you of this event. For example, if you were sexually assaulted at a park, you may avoid that specific park or all parks. In many regards, this is a way to bottle up emotions rather than address them. ⁴

Dissociative Symptoms

Dissociating occurs when you experience a cut-off from reality. There are varying degrees of dissociation and each has different effects. However, it’s important to understand that any kind of dissociation is a serious symptom and should be monitored and reported to a healthcare provider.

Dissociation after a traumatic event is common as it’s often used as a way to cope. Yet, it’s a strategy that only brings temporary solutions to a persistent problem. Long-term dissociation has been shown to actively harm the healing process and hinder the process of contextualizing and moving on from a stressful event. ⁵

Typical signs of dissociation include: ⁶

• Inability or unwillingness to be present during conversations and in moments that might trigger thoughts and emotions tied to the trauma
• Inconsistent connective thoughts and statements (or, thoughts and statements that make no sense)
• Loss of appetite (sometimes weight loss)
• Suicidal ideation (in extreme cases, suicidal actions)
• Trailing thoughts or a wandering mind

Distress Symptoms

Symptoms of distress are more apparent than the other psychological symptoms. Still, some effects of distress aren’t as visually obvious.

For example, it’s common for distress to cause varying social withdraws (i.e. from outside activities and personal relationships). It’s also common for you to have difficulty controlling your emotions and how they’re exhibited outwardly. ⁷

Other psychological and emotional symptoms of distress include: ⁸

• Feelings of aggression, depression, and hopelessness can cause conflict with one’s own life and relationships over time
• Heightened risk of self-harm and in extreme cases suicidal ideation and actions
• Increased anxiety about situations, people, or places
• Loss of interest in activities and hobbies that once brought excitement and joy
• Rumination of one’s own worth and validation

Other physical symptoms of distress can include:

• Aches and pains
• Fatigue (having little to no energy throughout the day)
• Increase in emotional outbursts, like crying spells
• Loss of appetite
• Substance abuse

Re-experiencing Trauma

Re-experiencing a traumatic event is not usually done purposefully. Instead, it occurs through intrusive thoughts.

An intrusive thought is a sudden mental image that can be upsetting, unsettling, or completely strange. While there are varying causes of intrusive thoughts, trauma is one of the most notable. ⁹

Intrusive thoughts are common through flashbacks or nightmares. Often, these dreams or memories will bring about symptoms associated with the trauma, such as dissociation. ¹⁰

What Causes Acute Stress Disorder?

A traumatic event is the direct cause of an ASD response. However, not everyone who experiences trauma will show signs of ASD.

What makes a person susceptible to ASD still isn’t entirely understood. Yet, we do know that people who are in positions where they’re more likely to face trauma (i.e. military, police, firefighters, and medical personnel) are more likely to struggle with the condition. ¹¹

Acute Stress Disorder Diagnosis

Diagnosing ASD is done with a variety of assessments, conversations, and observations conducted by medical professionals. Usually, these assessments occur in a hospital setting following a traumatic event.

The most common way to figure out whether or not you struggle with ASD is through a diagnostic questionnaire. This is performed during the initial triage and observation point of a patient. The questionnaire asks about the traumatic incident in detail to see how you respond to the event and its aftermath. ¹²

Acute Stress Disorder Treatment

To treat ASD, you must address underlying symptoms and find ways to decontextualize yourself from the trauma. This will give you a better chance at discovering peace with the circumstance and garnering the ability to move on. Of course, this isn’t a simple fix and it’s not an easy path to go down.

Treatment usually involves a combination of therapy and treatment, with behavioral and grounding therapy being the most effective. ¹³ A psychotherapist will help you recontextualize your trauma and develop better coping mechanisms for intrusive thoughts and other symptoms.

References

¹ Fanai M, Khan MAB. Acute Stress Disorder. 2023 Jul 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32809650.

² Chu B, Marwaha K, Sanvictores T, Awosika AO, Ayers D. Physiology, Stress Reaction. 2024 May 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 31082164.

³ Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants. Annu Rev Clin Psychol. 2005;1:607-28. doi: 10.1146/annurev.clinpsy.1.102803.144141. PMID: 17716101; PMCID: PMC2568977.

⁴ Coll SY, Eustache F, Doidy F, Fraisse F, Peschanski D, Dayan J, Gagnepain P, Laisney M. Avoidance behaviour generalizes to eye processing in posttraumatic stress disorder. Eur J Psychotraumatol. 2022 Apr 20;13(1):2044661. doi: 10.1080/20008198.2022.2044661. PMID: 35479300; PMCID: PMC9037205.

⁵ Classen C, Koopman C, Spiegel D. Trauma and dissociation. Bull Menninger Clin. 1993 Spring;57(2):178-94. PMID: 8508155.

⁶ Şar V. The many faces of dissociation: opportunities for innovative research in psychiatry. Clin Psychopharmacol Neurosci. 2014 Dec;12(3):171-9. doi: 10.9758/cpn.2014.12.3.171. Epub 2014 Dec 26. PMID: 25598819; PMCID: PMC4293161.

⁷ Anderson RB, Hollenberg NK, Williams GH. Physical Symptoms Distress Index: a sensitive tool to evaluate the impact of pharmacological agents on quality of life. Arch Intern Med. 1999 Apr 12;159(7):693-700. doi: 10.1001/archinte.159.7.693. PMID: 10218748.

⁸ Simon G, Gater R, Kisely S, Piccinelli M. Somatic symptoms of distress: an international primary care study. Psychosom Med. 1996 Sep-Oct;58(5):481-8. doi: 10.1097/00006842-199609000-00010. PMID: 8902899.

⁹ Clark DA, Purdon CL. The assessment of unwanted intrusive thoughts: a review and critique of the literature. Behav Res Ther. 1995 Nov;33(8):967-76. doi: 10.1016/0005-7967(95)00030-2. PMID: 7487857.

¹⁰ Duke LA, Allen DN, Rozee PD, Bommaritto M. The sensitivity and specificity of flashbacks and nightmares to trauma. J Anxiety Disord. 2008;22(2):319-27. doi: 10.1016/j.janxdis.2007.03.002. Epub 2007 Mar 12. PMID: 17434287.

¹¹ Garcia-Esteve L, Torres-Gimenez A, Canto M, Roca-Lecumberri A, Roda E, Velasco ER, Echevarría T, Andero R, Subirà S. Prevalence and risk factors for acute stress disorder in female victims of sexual assault. Psychiatry Res. 2021 Dec;306:114240. doi: 10.1016/j.psychres.2021.114240. Epub 2021 Oct 11. PMID: 34673311.

¹² Kavan MG, Elsasser GN, Barone EJ. The physician’s role in managing acute stress disorder. Am Fam Physician. 2012 Oct 1;86(7):643-9. PMID: 23062092.

¹³ Bryant RA, Harvey AG, Dang ST, Sackville T, Basten C. Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling. J Consult Clin Psychol. 1998 Oct;66(5):862-6. doi: 10.1037//0022-006x.66.5.862. PMID: 9803707.