Acute Stress Disorder (ASD) is a psychiatric disorder characterized by the rapid onset of severe psychological symptoms following exposure to a traumatic event involving actual or threatened death, serious injury or sexual assault. While ASD shares many symptoms with Post-Traumatic Stress Disorder (PTSD), it differs in terms of onset and duration. The disorder typically emerges between three and thirty days after the traumatic event, and without early intervention, it may progress to PTSD.

DSM-5 Diagnostic Criteria for Acute Stress Disorder

According to DSM-5, the diagnosis of ASD requires the following criteria:

• Exposure to a traumatic event: The individual must have been exposed through one or more of the following:
  • Directly experiencing the event
  • Witnessing the event as it occurred to others
  • Learning that a close family member or friend experienced the traumatic event
  • Repeated or extreme exposure to details of the trauma (for example, viewing videos of the event)
• At least 9 symptoms: Nine or more symptoms from any of the following five categories must be present:
  • Intrusion symptoms
  • Negative mood
  • Dissociative symptoms
  • Avoidance symptoms
  • Arousal symptoms
• Duration of symptoms: Symptoms must last from 3 to 30 days following the trauma.
• Functional impairment: Symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

Exclusion: Symptoms cannot be better explained by substance use, another mental disorder or a medical condition.

Symptoms of Acute Stress Disorder

ASD manifests across psychological and physiological domains with a wide range of symptoms.

1. Intrusion Symptoms

• Recurrent and distressing trauma-related thoughts or images
• Nightmares containing trauma-related content
• Intense psychological distress when exposed to trauma reminders

2. Dissociative Symptoms

• Sense of unreality or detachment from surroundings (derealization)
• Feeling detached from oneself (depersonalization)
• Memory gaps regarding parts of the traumatic event

3. Negative Mood

• Persistent fear, tension, hopelessness or inner restlessness

4. Avoidance Symptoms

• Avoidance of trauma-related thoughts, feelings or environments
• Social withdrawal

5. Arousal Symptoms

• Sleep disturbances
• Exaggerated startle response or irritability
• Difficulty concentrating
• Hypervigilance

These symptoms significantly interfere with daily functioning and often lead to marked impairment.

Etiology of Acute Stress Disorder

The development of ASD depends on both the characteristics of the trauma and the biological and psychosocial vulnerabilities of the individual.

1. Trauma Characteristics

• Sudden, unexpected and uncontrollable nature of the event
• Life-threatening circumstances
• Physical injury or sexual assault
• Repetitive or prolonged trauma

2. Biological and Neuropsychiatric Factors

• Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis
• Dysregulation of cortisol levels
• Imbalance between amygdala hyperactivity and prefrontal cortex inhibition
• Alterations in serotonin and norepinephrine regulation

3. Psychosocial Factors

• Pre-existing anxiety or depressive disorders
• Lack of social support
• History of childhood abuse or neglect
• Personality traits such as sensitivity, introversion and low self-esteem

Risk Factors for Acute Stress Disorder

The likelihood of ASD increases with certain individual and environmental factors:

• Previous exposure to trauma
• Female gender
• Low socioeconomic status
• Family history of psychiatric disorders
• Severe physical injury or pain
• Occupations such as emergency medical personnel, soldiers or police officers

Diagnosis of Acute Stress Disorder

Diagnosis is made through detailed psychiatric assessment and DSM-5 criteria.

Steps in the diagnostic process include:

• Assessment of symptoms occurring 3–30 days after trauma
• Presence of nine or more symptoms across at least three symptom clusters
• Differential diagnosis to rule out PTSD, depression, panic disorder, substance use and organic brain conditions
• Use of standardized tools such as the Acute Stress Disorder Scale (ASDS), PCL-5 or CAPS when appropriate

ASD is often overlooked in emergency psychiatric evaluations after disasters, accidents or violence, highlighting the need for systematic clinical assessment.

Treatment of Acute Stress Disorder

ASD can be effectively managed before progressing to chronic psychiatric disorders. Treatment must be individualized and multidisciplinary.

1. Psychological Interventions

• Psychological First Aid: Ensures safety, addresses immediate physical needs and provides social support directly after trauma.
• Cognitive Behavioral Therapy (CBT):
  • Restructuring trauma-related thoughts and beliefs
  • Reducing avoidance behaviors
  • Improving coping skills
  • Applying desensitization techniques
• Exposure Therapy: Facilitates processing of trauma memories through controlled and structured re-experiencing.
• Supportive Counseling: Helps individuals regulate emotions and find meaning in the traumatic experience.

2. Pharmacotherapy

Medication is not first-line but may be used for short-term symptom relief:

• Anxiolytics: Benzodiazepines such as lorazepam, for cautious short-term use
• Antidepressants: SSRIs such as sertraline or escitalopram in cases with depressive symptoms or high PTSD risk
• Hypnotics: Short-term use for severe insomnia

Pharmacological approaches should always be combined with psychotherapy.

3. Family and Social Support

Social support is critical for recovery. Families should be educated about the temporary nature of the disorder and trained in effective communication and supportive behavior. Community-based services are especially important for those who lost their homes, jobs or loved ones.

Impact on Daily Life

Although temporary, ASD severely disrupts daily life.

• Functional Impairment: Inability to attend work or school in the days following trauma
• Social Withdrawal: Feelings of shame, fear or helplessness limit social interactions
• Sleep and Eating Disturbances: Disrupted daily routines
• Risk of PTSD: Up to 40% of untreated ASD cases progress to PTSD (Bryant, 2011)

Therefore, early detection, psychoeducation and supportive interventions are essential to recovery.