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Acute Stress disorder
SYMPTOMSAcute stress disorder is most often diagnosed when an individual has been exposed to a traumatic event in which both of the following were present: The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
The person's response involved intense fear, helplessness, or horror
Acute stress disorder is also characterized by significant avoidance of stimuli that arouse recollections of the trauma (e.g., avoiding thoughts, feelings, conversations, activities, places, people). The person experiencing acute stress disorder also has significant symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).
For acute stress disorder to be diagnosed, the problems noted above must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.
The disturbance in an acute stress disorder must last for a minimum of 2 days and a maximum of 4 weeks, and must occur within 4 weeks of the traumatic event. Symptoms also can not be the result of substance use or abuse (e.g., alcohol, drugs, medications), caused by or an exacerbation of a general or preexisting medical condition, and can not be better explained by a a Brief Psychotic Disorder.
Criteria summarized from:American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
Acute stress disorder is characterized by panic reactions, mental confusion, dissociation, severe insomnia, suspiciousness, and being unable to manage even basic self care, work, and relationship activities. Relatively few survivors of single traumas have this more severe reaction, except when the trauma is a lasting catastrophe that exposes them to death, destruction, or loss of home and community. Treatment includes immediate support, removal from the scene of the trauma, use of medication for immediate relief of grief, anxiety, and insomnia, and brief supportive psychotherapy provided in the context of crisis intervention.
DISTINGUISHING ACUTE TRAUMA FROM PTSD
Discussion with professionals who work with both the acute and the long-term aftermath of trauma has led me to conclude that aside from physical injury due to trauma, acute traumatic reactions may be indistinguishable from PTSD in the body and behavior of the victim. The same disorientation, fear, and indications of ANS activations - elevations in heart rate, blood pressure, respiration, shaking, etc. - may be present.
Identification of a portion of those suffering from PTSD will be straightforward. But others may be difficult to spot owing to complicated life or defensive systems. Evaluation of the state of the ANS will assist in diagnosis and in setting treatment objectives where appropriate.
Possible books to learn more about PTSD.Brett, EA, "The Classification of Posttraumatic Stress Disorder," in van der Kolk, BA, McFarlane, AC, & Weisaeth, L (Eds.), TRAUMATIC STRESS: THE EFFECTS OF OVERWHELMING EXPERIENCE ON MIND, BODY AND SOCIETY, Guilford Press 1996.
Diamond, MC, Scheibel, AB, & Elson, LM, THE HUMAN BRAIN COLORING BOOK, Harper Perenial 1985.
Elliott, Diana M, "Traumatic Events: Prevalence and Delayed Recall in the General Population," Journal of Consulting and Clinical Psychology, 65, 811-820, 1997.
Figley, Charles R., Ph.D., TRAUMA AND ITS WAKE, Volume I: The Study and Treatment of Post-Traumatic Stress Disorder, Brunner/Mazel, 1985.
Gallup, Gordon G., Jr., and Maser, Jack D., "Tonic Immobility: Evolutionary Underpinnings of Human Catalepsy and Catatonia", in Seligman, Martin E. P., and Masser, Jack D., PSYCHOPATHOLOGY: EXPERIMENTAL MODELS, San Francisco: W.H. Freeman and Company, 1977.
Herman, Judith L., MD, TRAUMA AND RECOVERY, Basic Books, 1992.
J˙rgensen, Steen, Cand. Psych., "Bodynamic Analytic Work with Shock/Post-Traumatic Stress", Energy and Character, Vol. 23, No. 2, September 1992.
Kluka, RA, Schlenger, WE, Fairbank, JA, Hough, RL, Jordan, BK, Marmar, CR,, & Weiss, DS, TRAUMA AND THE VIETNAM WAR GENERATION: REPORT OF FINDINGS FROM THE NATIONAL VIETNAM VETERANS READJUSTMENT STUDY, New York: Brunner/Mazel 1990.
Levine, Peter, Ph.D., WAKING THE TIGER : HEALING TRAUMA : THE INNATE CAPACITY TO TRANSFORM OVERWHELMING EXPERIENCES, 1997
Loewenstein, Richard, J., M.D., "Dissociation, Development and the Psychobiology of Trauma", Journal of the American Academy of Psychoanalysis, 21(4), 1993.
Marmar, CR, Weiss, DS, Schlenger, WE, Fairbank, JA, Jorday, K, Kulka, RA, & Hough, RL, "Peritraumatic Dissociation and Posttraumatic Stress in Male Vietnam Theater Veterans," American Journal of Psychiatry , 151, 1994.
Nadel, L & Jacobs, WJ, "The role of the Hippocampus in PTSD, panic, and phobia." In N. Kato (Ed.), HIPPOCAMPUS: Functions and clinical relevance. Amsterdam: Elsevier Science B.V. 1996.
Ornstein, Robert & Thompson, Richard, THE AMAZING BRAIN, Houghton Mifflin, USA, 1986
Puglisi-Allegra, Stephan, and Oliverio, Alberto, PSYCHOBIOLOGY OF STRESS, Kluwer Academic Publishers, 1990.
Selye, Hans, M.D., THE STRESS OF LIFE, McGraw-Hill Book Co., 1984.
van der Kolk, Bessel A, M.D., and Fisher, Rita E., Ed.M., "The Biologic Basis of Posttraumatic Stress", Primary Care, Vol. 20, No. 2, 1993. van der Kolk, Bessel, M.D. (1996a), "The Body Keeps the Score: Memory and the Evolving Psychobiology of Post-traumatic Stress", Harvard Psychiatric Review, Vol., 1, 1994.
van der Kolk, BA, McFarlane, AC, & Weisaeth, L (Eds.) TRAUMATIC STRESS: THE EFFECTS OF OVERWHELMING EXPERIENCE ON MIND, BODY AND SOCIETY Guilford Press 1996.
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