Acute stress disorder: how to manage

A car accident. A physical or sexual assault. A natural disaster. The sudden death of a loved one. A worldwide pandemic and shutdown. These terrifying, life-altering, traumatic events can cause you to develop acute stress disorder (ASD). Some may call it an acute stress reaction. Whatever you or your healthcare professional may call it, it is a physical, mental, and emotional reaction to a very traumatic event.

If you think you or someone close to you may be experiencing ASD, this article will help you understand this condition and the treatments available. 

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ASD is a short-term condition. The diagnosis can be made from the day after it happens to 30 days after the traumatic event. Most people who are diagnosed with ASD have a good prognosis. It is possible to recover on your own, even without any treatment. Some people may need medical help if they have severe or persistent symptoms (Bryant, 2019).

ASD is a relatively new psychological diagnosis. An estimated 5–20 percent of people develop ASD after a traumatic event. The American Psychiatric Association (APA) first introduced this diagnosis in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994 (Bryant, 2019).

Although it shares many of the same symptoms as post-traumatic stress disorder (PTSD), ASD is a distinct diagnosis. They both originate from a traumatic event, though. PTSD is diagnosed if symptoms from ASD last longer than one month without resolving either on their own or with medical help, or if they first appear more than 30 days after the traumatic event happened. If you are diagnosed with ASD, you may not go on to develop PTSD. Likewise, some people never have ASD but do develop PTSD (Bryant, 2017a).

Treatment for PTSD is similar to that of ASD. Psychotherapy, including cognitive-behavioral therapy (CBT), and medication may be recommended to help reduce the symptoms. Most people recover from PTSD quickly with a formal diagnosis and treatment. Although it is possible to recover from PTSD without treatment, it can take years, and some people develop chronic, unresolved PTSD (Bryant, 2017a).

A person can develop acute stress disorder at any age after experiencing or witnessing a traumatic event. These traumatic events are typically life-threatening, intensely distressing, and can be emotionally devastating.

Please note that while some people may be triggered emotionally by disturbing scenes on screens (TV, tablet, or phone), those triggers are not considered ASD. ASD usually comes from a personal life-threatening event or the threat of such events, including natural disasters, terrorist attacks, combat, sexual assault, or severe injury from a car or work accident. Some people develop ASD from events that happen to other people that affect them directly, such as the sudden death of a loved one (Bryant, 2019). 

Just because you had a traumatic experience or witnessed a traumatic event does not mean you will definitely develop ASD. Certain people are more at risk than others.

Women are more predisposed to developing ASD. Younger people, especially those under 40, may develop ASD compared to people over 40 years old. People with a history of mental health conditions are more prone to develop ASD. These conditions include anxiety disorder, depression, seeing the world as a frightening place (neuroticism), and a previous history of dissociative symptoms (described below) related to a previous traumatic event. Anyone who experienced or witnessed a traumatic event in the past is also at risk. A person can develop ASD at any point in their life (Gradus, 2017). 

Most people with ASD develop physical and psychological symptoms in response to the intense emotions around the traumatic event.

Physical symptoms

Physical symptoms can include (Bryant, 2019): 

• Nausea

• Pounding or racing heart

• Chest pain

• Headache

• Feeling unable to breathe. 

These symptoms come from the over-activation of the nervous system and the release of stress hormones. These physical symptoms can start right after or within hours of the traumatic event. They will usually go away within a few hours, or in some cases, a few days. For some people, though, these symptoms can last for weeks (Bryant, 2019).

Psychological symptoms

Emotional and psychological symptoms can be very troubling. These are divided into arousal, avoidance, dissociation, intrusion, and negative mood (Bryant, 2019): 

• Arousal is hypervigilance or a state of high alertness when a person is constantly on the lookout for real and perceived danger. Some people can’t sleep or have nightmares. Some people may have difficulty concentrating or focusing on anything—even important things. 

• Avoidance is when a person actively avoids anything—places, people, feelings—related to the traumatic event.  

• Dissociation feels like an out-of-body experience or like time has stopped and things aren’t “real.” Some may try to forget or deny the event happened. 

• Intrusion is when a person has constant thoughts about the traumatic event or experiences flashbacks to it. 

• A negative mood is when people keep their feelings inside but may release them with angry outbursts, a constant bad mood, and an inability to express any positive emotion.  If you have ASD, you may feel awful.

Most people have both physical and emotional symptoms, but not necessarily all of them. Every person’s response to a traumatic event can be as unique as they are. Both physical and emotional symptoms of acute stress disorder usually start immediately after the traumatic event happens. To receive a formal diagnosis of ASD, you have to have symptoms lasting at least 3–30 days (Bryant, 2019). 

You cannot self-diagnose ASD even if you’ve experienced a traumatic event. You have to have symptoms for at least three days and see a healthcare practitioner who can diagnose you. 

When you visit your healthcare professional, they will take a thorough history and do a physical exam. They may refer you to a mental health specialist in psychiatry or psychology. These healthcare professionals diagnose acute stress disorder using the criteria set by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). They use the following criteria to diagnose ASD (Bryant, 2017b, USVA, 2017):

Your healthcare professional does a physical exam to make sure that your symptoms are not caused by a brain injury, serious medical conditions, or other psychiatric disorders. They will also check for other stressors that can mimic ASD symptoms, including substance use with alcohol or drugs (prescribed or recreational). Then they will ask some questions about what started your symptoms.

What happened? 

You’ll be asked about your traumatic event exposure. These include events that happened to you, such as serious injury, threatened death, sexual abuse, and gun violence. You can also be diagnosed with ASD if a traumatic event happened to a loved one or is part of your work.

What are you feeling? 

There are 14 symptoms and you need to have at least nine of them to be diagnosed. These symptoms are listed above under arousal, avoidance, dissociation, intrusion, and negative mood (USVA, 2017). 

How long have you been feeling this way? 

The troubling symptoms need to last for a minimum of three days and up to one month after the traumatic event for an ASD diagnosis. 

How bad are you feeling? 

The symptoms have to be bad enough that you have significant distress and your life is very much affected (i.e., you can’t sleep, go to work, or live your life normally).

Many people recover from traumatic events without any treatment. However, there are effective treatments if your symptoms persist or are severe.

Therapy

Most people being treated for ASD will start managing their symptoms with psychotherapy. While there are many different kinds of psychotherapy, the most recommended for ASD is trauma-focused cognitive behavioral therapy (CBT or TFCBT). This therapy focuses on modifying your thought patterns and behaviors to help you process the traumatic event in a healthy way. CBT or trauma-focused CBT usually starts within two weeks of the traumatic event and lasts for about six weeks total. Each session can be an hour to an hour and a half. This type of therapy reduces the risk of developing post-traumatic stress disorder. If the symptoms last longer than this timeframe, your healthcare professional may change your diagnosis to PTSD and modify your treatment (Carpenter, 2018).

Medication

Most people notice their symptoms of acute stress disorder can improve with therapy alone. However, some people have severe symptoms of anxiety and may require medication. In these cases, medication is often prescribed for a short time only—around six weeks—though some people may require a longer course (Astill Wright, 2019). 

ASD practice guidelines do not usually recommend using benzodiazepines (clonazepam or alprazolam) or sleeping pills (zolpidem). In some people, these medications raise the risk of developing PTSD later on. They are also highly addictive. Some mental health professionals prescribe beta-blockers to decrease some of the physical symptoms of ASD. Some physicians may prescribe antidepressants, but these are more appropriate for long-term treatments. Currently, there is little scientific evidence that any of these prescription medications are effective for treating the symptoms of acute stress disorder (Astill Wright, 2019). 

A traumatic event is almost always unexpected and can’t be timed to occur when your mental health is at its best. However, there are some ways you can lower your risk of developing ASD.

First, if you have symptoms, seek professional help from mental health or other healthcare professionals as soon as possible after the traumatic event. Early treatment can often stave off persistent or worsened symptoms. Sometimes a person has another mental health or underlying medical condition that can increase symptoms of ASD and requires additional treatment.

Second, do not suffer alone. Speak to family members or friends, or consider joining a support group in person or even online.

Third, if your job has a high risk of traumatic events, ask for training to help you manage your mental and physical health. Some employers may offer behavioral coaching or training. People who work in higher-risk jobs have a greater risk of developing ASD (USVA, 2017).

Feeling better afterwards

ASD can happen to anyone after being in or witnessing a traumatic event. While ASD sounds a lot like PTSD, they are not the same thing. ASD usually resolves within 30 days, and PTSD is a chronic condition. Cognitive-behavioral therapy (CBT) treatments for ASD are short, time-limited, and usually successful.

If your symptoms last longer than a month after experiencing a traumatic event, whether with or without any treatment, please visit your mental health or primary healthcare professional.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

May 21, 2021

Written by

Tobi Ash, MBA, RN, BSN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.