Acute Stress Disorder (ASD) and Post Traumatic Stress Disorder (PTSD): A Help Guide
Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are related anxiety disorders that may develop as being part of one or several traumatic events or experiences. This would involve things you found terrifying and/or disturbing, left you feeling helpless, and included harm or the threat of harm to you or others.
You do not have to have directly experienced the trauma yourself to develop ASD or PTSD. These anxiety disorders can develop even if you were a witness to the trauma, or involved in the aftermath of it.
PTSD is commonly associated with soldiers and veterans, but events or traumas that have been known to trigger ASD or PTSD in people are wide-ranging and can include war, terrorism, natural disasters, fire events, car crashes, physical and sexual assault and being the victim or witness of a crime. Other less obvious causes of ASD and PTSD include bullying, abuse, childhood neglect, unexpected death of a family member or friend, complicated childbirth, and long-term illness.
It's important to note that post-traumatic stress disorder does not always develop immediately after a trauma. While symptoms usually develop within three months of the traumatic incident, your symptoms might start as late as six months after the fact. And there is argument that if the trauma is repressed, new or worse symptoms can develop years later, such as in some cases of repeat sexual abuse and childhood neglect. This is sometimes called 'complex PTSD'.
Acute stress disorder is also called ' acute stress reaction' or 'psychological shock'.
It's normal to feel anxious, upset, and even disconnected from life and those around you after experiencing something traumatic and frightening. So most people will have at least mild ASD after a trauma and will exhibit some of the symptoms below.
But if you can't seem to get back to normal and your stress continues for more than a month or worsens, it's likely you are suffering from PTSD.
Symptoms of ASD and PTSD tend to fall into three categories.
Re-experiencing the event
- Reliving the event through flashbacks, memories, or dreams that feel stressful
- Unable to stop thinking about what happened
- Strong physical reactions to thinking about the event including a pounding heart, sweating, and feeling sick
Avoidance and Numbing
- Memory loss and blackout around the trauma
- Trying to avoid anything that reminds you of the trauma including people, places, and activities
- Unable to connect with those you used to be close to
- Feelings of shame, guilt, self-blame, depression and helplessness
- Reduced libido or interest in social contact
- Substance abuse such as alcohol, drugs, or overeating
- Feeling numb and like nothing is real or important
- Doom about the future such as thinking you will never again have a normal life
- Unexplained illness or pains
Hyperarousal and Anxiety
- Feeling distressed and anxious all the time
- Restlessness and an inability to concentrate
- Sleep problems including not being able to get to sleep, not being able to stay asleep, and/or having nightmares
- Feeling vigilant and 'on edge' including being easy to startle
- Being irritable and moody or prone to outbursts of anger
Additional symptoms in children can include:
- re-enacting the experience through play or pretend
- frightening dreams without recognisable content
- fretting about death and dying
- regression including whining, thumb sucking, being clingy
Acute stress disorder involves symptoms lasting a month or less. If your psychological stress lasts more than a month, the diagnosis becomes post-traumatic stress disorder.
PTSD therefore tends to be a result of more extreme experiences, especially those which involve assault or are a threat to life. This includes terrorism, abuse, being a victim of crime, kidnappings, and environmental disasters. Those who witness difficult events but whose wellbeing is not threatened, such as seeing an accident or finding out a loved one has a life-threatening illness, are not a likely to experience full-blown post-traumatic stress disorder.
ASD should not, however, be taken any less seriously than PTSD. It's very important to seek help for ASD, as treatment means it is less likely todevelop into the more difficult to manage post-traumatic shock disorder.
Complex PTSD is the result of repeat trauma, such as abuse or torture. It starts weeks or months after the difficult experience but is often not recognised until years later. It can involves additional symptoms to general PTSD, including not being able to trust others and feeling cut off and 'disassociated' from others and what is going on around you as well as from your emotions. It can also involve an increased tendency to take risks.
Again, it's normal to feel feel distressed and emotionally shaken after experiencing or witnessing an event that is frightening, out-of-control, and potentially life-threatening.
So acute stress disorder is a reasonably common stress reaction that eventually fades after several days or weeks.
As for PTSD, it's estimated that up to a third of people who suffer a traumatic experience will actually develop it. And research findings vary, but it's found that more women than men experience PTSD, estimated at 8-13% likely for men and 20-30% likely for women.
Though people of all ages, backgrounds and ethnicities are affected by ASD and PTSD, there is naturally a higher chance of developing one of these anxiety disorders if you are engaged in certain occupations that involve a higher level of exposure to trauma. These include the armed forces, the police, journalism, the prison service, the fire and ambulance services, and emergency personnel.
Children can and do suffer from both anxiety disorders. While it was previously reported that children are less likely to develop PTSD after trauma than adults, it has recently been found that in addition to suffering greatly from traumatic events, if a child's parents then develop PTSD, this in and of itself can negatively affect a child.
There are psychological and physical reasons for the extreme way some people react to trauma. For example, flashbacks are the brain's way of determining how best to be prepared should such an experience happen again. The adrenaline the body produces following a trauma is the body's flight-or-flight response, designed to help you defend against danger. If your trauma was extreme, then this response can stay on and leave you constantly edgy. It's as if the body expects more danger and can't relax.
But it's not known exactly why some people develop PTSD and others only experience ASD or just mild stress.
New research around PTSD does show, however, that there are certain factors that seem to increase your capacity to develop the disorder following a traumatic experience. These factors include:
- already experiencing high levels of life stress at time of trauma
- previous exposure to traumatic experiences as a child
- abusive childhood
- history of mental health issues such as depression
The nature of the trauma itself also affects the possiblity of PTSD. It has been found that the more extreme the trauma the more likely those who experience or witness it are of developing PTSD. This is found to be especially true if the trauma was intentionally imposed by another person and is life-threatening, such as cases of physical or sexual attack, torture, or terrorism.
There is also some research to suggest that certain individuals may be genetically pre-disposed to developing PTSD. Such findings include linking a lower level of certain proteins and peptides in the brain to an increased sensitivity to fear, and a theory that those with a small hippocampus volume in the brain may be more likely to develop PTSD when trauma is experienced.
There is no blood test for PTSD or ASD. Like all psychological conditions, diagnosis is carried out on the basis of a thorough and detailed talk with a health care professional. This might be a psychologist, psychotherapist, psychiatrist, or psychiatric nurse. If you go to your GP, and your symptoms have been present for four weeks or more, they will refer you to one of the specialists listed.
The mental health care professional you talk to will use their best judgement and follow the guidelines recommended by the psychological health advisory board of their country. In America, this will be the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Here in the UK, doctors might consult the recommendations of the DSM-5 but follow PTSD diagnostic guidance put forth by the National Institute for Health and Care Excellence (NICE).
After ascertaining that you have experienced an initial traumatic event, the health care professional will look for four general criteria, much like the symptoms list above. These are signs of re-experiencing the event, avoidance, mood changes and anxiety, and also differences in your sleep patterns.
For a diagnosis of ASD such symptoms as those listed above should be present for a minimum of two days and a maximum of four weeks. Symptoms must occur within four weeks of the traumatic event.
If symptoms of psychological stress have gone on for over four weeks, the diagnosis will be PTSD.
PTSD responds well to treatment, even if you only seek help long after the event that caused the trauma. The treatment will be tailored to your needs and will thus depend on how severe your symptoms are and how long you have been suffering.
There is no medication that will cure your PTSD or ASD. In some cases medication like anti-depressants is prescribed as part of your treatment. Its purpose is to manage the secondary symptoms of PTSD like depression and anxiety, so that you can benefit more from other psychological treatments. But medication can not get rid of the cause of your PTSD, nor is it always a required part of treatment.
Any of the following treatment options may be recommended for ASD and PTSD:
Watchful Waiting: This involves carefully monitoring your symptoms to see if they naturally improve or get worse. This is usually recommended if your symptoms are mild and have been present for less than four weeks after the traumatic event. Within a month of paying attention to how you are feeling you will be asked to return to your health care professional to go over how you are doing.
Psychotherapy: Talking therapies help you work through the event in a supportive, safe environment, and help you find coping strategies that work for you.
Cognitive Behavioural Therapy (CBT): This is an evidence-based form of psychotherapy that has been found to help those with ASD and PTSD. CBT helps you focus on taking charge of your thought cycles, and trauma-focussed CBT uses mental images of the traumatic event to help you gain control of your distress. This is the intervention most often recommended for children and adolescents.
Family Therapy: Suffering from PTSD can affect your ability to communicate with those around you, and may even affect your capacity to be interested in your relationships. Family therapy can help others around you understand and support you.
Eye Movement Desensitisation Reprocessing (EMDR): This involves making several sets of side-to-side eye movements while recalling the traumatic incident you encountered. The aim is to help your brain to focus on the flashbacks you experience as part of PTSD, so you can come to terms with the event and think in a more positive manner.
If you have experienced symptoms for less than a month following a trauma and feel you have ASD, the risk of not seeking treatment is that it will develop into PTSD, which can be more severe and harder to treat.
Not treating PTSD can cause seriously affect your life in almost all areas. The anxiety and hyperarousal of PTSD can make leading a regular life far more challenging. It's not unusual for sufferers to have difficulty holding down a job and/or a relationship. If you already have a family, it can cause strain with your loved ones. In some unfortunate cases the mood swings that PTSD causes or exacerbates can result in domestic violence. Untreated PTSD is also a common precursor to substance abuse such as alcoholism or drug addiction.
Other mental health conditions can develop alongside PTSD and this is more likely if it remains untreated. This includes panic disorder, bipolar disorder, phobias, and depression which can involve self-harming and suicidal thoughts.
If you suspect you are suffering from ASD or PTSD it's important to find the help you need. Here are various resources you might find useful.
Recommended books about managing trauma include:
- Understanding Trauma: How to Overcome Post-Traumatic Stress. Dr. Roger Baker
- Overcoming Childhood Trauma: A Self Help Guide Using Cognitive Behavioural Techniques. Dr. Helen Kennerley.
- The Survivor’s Guide to Recovery from Rape and Sexual Abuse. Robert Kelly, Fay Maxted, Elizabeth Campbell.
You may also be interested in our other articles on managing traumatic experiences:
- 7 Warning Signs You Are Suffering Acute Stress Reaction (Emotional Shock)
- Post Traumatic Stress Disorders due to Natural Disasters
- Cumbria Shootings: Counselling for Post-Traumatic Stress Disorder (PTSD)
Useful Telephone Numbers
Combat Stress 24 hr hotline: 0800 138 1619
Samaritans: 08457 90 90 90
Saneline: 0845 767 8000
Counselling and Therapeutic Services and Organisations
There are many trained professionals who will be able to support you such as counsellors, psychotherapists, psychologists and psychiatrists.
Counselling and psychotherapy clinics - search through online directories for one in your area. Harley Therapy is one such private practice in London, UK that can assist with ASD and PTSD treatment. Most workplace insurances now cover visits to a therapist, enquire with human resources at your organisation.
The NHS - an alternate to a private practice in the UK is seeing your GP and asking for a referral to a specialist.
Mental Health Charities - organisations such as MIND, Rethink, Mental Health Foundation and Combat Stress UK may provide support groups, therapy and advice in your local area. You might want to call your local council to enquire about such organisations in your area.
You might also find our guide to low cost counselling useful in your search.
ASK US A QUESTION
ARE YOU A JOURNALIST WRITING ABOUT THIS TOPIC?
If you are a journalist writing about this subject, do get in touch - we may be able to comment or provide a pull quote from a professional therapist.
National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060.
Kulka, R.A., Schlenger, W.A., Fairbanks, J.A., Hough, R.L., Jordan, B.K., Marmar, C.R.,... Cranston, A.S. (1990). Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
Gabbay, V., Oatis, M.D., Silva, R.R., & Hirsch, G. (2004). Epidemiological aspects of PTSD in children and adolescents. In Raul R. Silva (Ed.),Posttraumatic Stress Disorder in Children and Adolescents: Handbook (1-17). New York: Norton.
Kessler, R.C., Berglund, P., Delmer, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6): 593-602.
Tanielian, T. & Jaycox, L. (Eds.). (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation.
Diagnostic and statistical manual of mental disorders (DSMIV). (2004) Washington, DC: American Psychiatric Association.
World Health Organisation. (1992). ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. Geneva. World Health Organisation.