Understanding Acute Stress Disorder: Types, Symptoms, and Treatment
Trauma Care • Psychiatry • Emergency Medicine
Understanding Acute Stress Disorder (ASD)
Acute Stress Disorder is an early traumatic stress response occurring within the first days to one month after exposure to actual or threatened death, serious injury or sexual violation. It shares symptom clusters with PTSD but is time‑limited; early identification allows targeted support and, when needed, brief trauma‑focused interventions to reduce progression to PTSD.
Diagnostic timing & core symptom clusters
- Timing: symptoms begin after traumatic exposure and last from 3 days up to 4 weeks. If symptoms persist beyond 1 month, consider PTSD.
- Symptom clusters (one or more): intrusion (distressing memories, nightmares, flashbacks), negative mood, dissociation (numbing, detachment, reduced awareness), avoidance, and marked arousal/reactivity.
Common precipitants
- Single‑incident traumas (road traffic collisions, assaults, disasters), acute medical emergencies (ICU admission, severe injury), witnessing death/injury, or exposure to traumatic material in professional contexts (first responders).
Assessment checklist
- Confirm exposure to qualifying traumatic event and onset/timing of symptoms (document dates).
- Assess symptom clusters: intrusion, negative mood, dissociation, avoidance, arousal — use brief scales (e.g., the Acute Stress Disorder Scale) where available.
- Evaluate immediate safety: suicidal ideation, risk of self‑harm, substance misuse, and ability to care for self.
- Screen for medical contributors (head injury, hypoxia, intoxication) and provide relevant medical stabilisation if required.
Immediate management — Psychological First Aid (PFA)
- Ensure safety and basic needs (shelter, food, medical care), provide practical support and information, and stabilise acute distress using grounding and breathing techniques.
- Use practical, brief communications: listen without pressure, normalise common reactions, and avoid forced debriefing of traumatic memories in the immediate aftermath.
- Identify social supports and help reconnect the person with family, friends or community resources.
Early psychological interventions
- Watchful waiting and monitoring is appropriate for many—most recover naturally within weeks with support and safety.
- Offer brief trauma‑focused CBT (single‑session or multi‑session) for individuals with high symptom levels or functional impairment to reduce risk of transition to PTSD. Interventions include imaginal processing, cognitive restructuring and behavioural exposure where indicated.
- Provide skills: grounding, paced breathing, sleep hygiene, and problem‑solving to manage practical stressors.
Medication & symptomatic treatment
- No medication is specifically approved for ASD. Short‑term use of anxiolytics may be considered for severe acute agitation or insomnia but avoid routine benzodiazepine use due to dependency and interference with psychological processing.
- Use antidepressants (SSRIs) when comorbid major depression or persistent anxiety emerges — usually considered if symptoms persist and meet criteria for PTSD or other disorders.
When to escalate / red flags
- Active suicidal ideation or self‑harm, severe dissociation impairing safety, psychotic symptoms, inability to care for self, or ongoing exposure to threat—urgent psychiatric/medical intervention required.
- Persistent severe symptoms beyond 4 weeks—refer for specialist trauma services as PTSD may be developing.
Case vignette
Patient: R., 26, was involved in a workplace explosion and hospitalised. Three days after discharge R. reports intrusive flashbacks, nightmares, emotional numbing and avoidance of the workplace, affecting sleep and returning to work. Management: ensure medical stability, provide psychological first aid, teach grounding and breathing skills, involve employer for phased return and social support, and offer brief trauma‑focused CBT sessions. Symptoms reduced over 6 weeks and R. gradually resumed duties; if symptoms had persisted beyond 4 weeks a PTSD pathway would be initiated.
தமிழில் — சுருக்கம்
Acute Stress Disorder என்பது பாதிப்பான சம்பவத்துக்குப் பிறகு முதல் 3 நாடுகளிலிருந்து 4 வாரத்திற்குள் தோன்றும் மனஉளைச்சல் பதிலாகும். மனநிலையை படிப்படியாக உறுதிப்படுத்துதல், Psychological First Aid மற்றும் குறுகிய மனநலம் சார்ந்த சிகிச்சைகள் தேவையானவை.
Practical tips for clinicians
- Document exact dates of trauma and symptom onset; use brief screening tools to monitor severity and recovery trajectory.
- Use PFA in emergency and medical settings; arrange early follow‑up within 1–2 weeks to reassess and offer brief therapy if symptoms severe or impairing.
- Coordinate with occupational, social and primary care services to address practical stressors (finance, housing, work) that prolong recovery.
Key takeaways
- Acute Stress Disorder occurs within days to 4 weeks after trauma and includes intrusion, negative mood, dissociation, avoidance and arousal symptoms.
- Most individuals recover with safety, social support and Psychological First Aid; offer brief trauma‑focused CBT for severe cases to reduce progression to PTSD.
- Escalate urgently for suicidality, severe dissociation or persistent symptoms beyond 4 weeks and coordinate multidisciplinary care for recovery.