Overview
The essential feature of acute stress disorder is the development of characteristic symptoms lasting from 3 days to 1 month following exposure to one or more traumatic events.

Traumatic events that are experienced directly include, but are not limited to:

  • exposure to war as a combatant or civilian
  • threatened or actual violent personal assault (e.g., sexual violence, physical attack, active combat, mugging, childhood physical and/or sexual violence, being kidnapped, being taken a hostage, terrorist attack, torture)
  • natural or human-made disasters (e.g., earthquake, hurricane, airplane crash)
  • severe accident (e.g., severe motor vehicle, industrial accident)

For children, sexually traumatic events may include inappropriate sexual experiences without violence or injury. A life-threatening illness or debilitating medical condition is not necessarily considered a traumatic event. Medical incidents that qualify as traumatic events involve sudden, catastrophic events (e.g., waking during surgery, anaphylactic shock).

Symptoms
For a diagnosis of acute stress disorder, symptoms must persist for a minimum of three days and last no more than one month after the trauma. If symptoms persist after a month, the diagnosis becomes post-traumatic stress disorder.

Diagnosis with acute stress disorder is warranted if the person presents nine (or more) of the following symptoms, belonging to any of the five categories:

  • Intrusion symptoms (involuntary and intrusive distressing memories of the trauma or recurrent distressing dreams)
  • Negative mood (persistent inability to experience positive emotions such as happiness or love)
  • Dissociative symptoms (time slowing, seeing oneself from an outsider’s perspective, being in a daze)
  • Avoidance symptoms (avoidance of memories, thoughts, feelings, people, or places associated with the trauma)
  • Arousal symptoms (difficulty falling or staying asleep, irritable behavior, problems with concentration)

People with acute stress disorder may also experience a great deal of guilt about not being able to prevent the trauma, or for not being able to move on from the trauma more quickly. Panic attacks are common in the month following a trauma. Children with acute stress disorder may also experience anxiety related to their separation from caregivers.

Development and Course
Acute stress disorder cannot be diagnosed until 3 days after a traumatic event. Although acute stress disorder may progress to posttraumatic stress disorder (PTSD) after 1 month, it may also be a transient stress response that remits within 1 month of trauma exposure and does not result in PTSD. Approximately half of the individuals who eventually develop PTSD initially present with acute stress disorder.

Symptom worsening during the initial month can occur, often as a result of ongoing life stressors or further traumatic events. The forms of reexperiencing can vary across development.

Unlike adults or adolescents, young children may report frightening dreams without content that clearly reflects aspects of the trauma (e.g., waking in fright in the aftermath of the trauma but being unable to relate the content of the dream to the traumatic event).

Children age 6 years and younger are more likely than older children to express reexperiencing symptoms through play that refers directly or symbolically to the trauma. For example, a very young child who survived a fire may draw pictures of flames. Young children also do not necessarily manifest fearful reactions at the time of the exposure or even during reexperiencing. Parents typically report a range of emotional expressions, such as anger, shame, or withdrawal, and even excessively bright positive affect, in young children who are traumatized. Although children may avoid reminders of the trauma, they sometimes become preoccupied with reminders (e.g., a young child bitten by a dog may talk about dogs constantly yet avoid going outside because of fear of coming into contact with a dog).

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