Acute Stress Disorder

In the weeks after a traumatic event, you may develop an anxiety disorder called acute stress disorder (ASD). ASD typically occurs within one month of a traumatic event. It lasts at least three days and can persist for up to one month. People with ASD have symptoms similar to those seen in post-traumatic stress disorder (PTSD).

What causes acute stress disorder?

Experiencing, witnessing, or being confronted with one or more traumatic events can cause ASD. The events create intense fear, horror, or helplessness. Traumatic events that can cause ASD to include a:

  • death
  • a threat of death to oneself or others
  • a threat of serious injury to oneself or others
  • a threat to the physical integrity of oneself or others

Approximately 6 to 33 per cent of people who experience a traumatic event develop ASD, according to the U.S. Department of Veterans Affairs. This rate varies based on the nature of the traumatic situation.

Who’s at risk for acute stress disorder?

Anyone can develop ASD after a traumatic event. You may have an increased risk of developing ASD if you have:

  • experienced, witnessed, or been confronted with a traumatic event in the past
  • a history of ASD or PTSD
  • a history of certain types of mental problems
  • a history of dissociative symptoms during traumatic events

What are the symptoms of acute stress disorder?

The symptoms of ASD include: 

Dissociative symptoms

You’ll have three or more of the following dissociative symptoms if you have ASD:

  • feeling numb, detached, or being emotionally unresponsive
  • reduced awareness of your surroundings
  • derealization, which occurs when your environment seems strange or unreal to you
  • depersonalization, which occurs when your thoughts or emotions don’t seem real or don’t seem like they belong to you
  • dissociative amnesia, which occurs when you cannot remember one or more important aspects of the traumatic event

Reexperiencing the traumatic event

You’ll persistently re-experience the traumatic event in one or more of the following ways if you have ASD:

  • having recurring images, thoughts, nightmares, illusions, or flashback episodes of the traumatic event
  • feeling like you’re reliving the traumatic event
  • feeling distressed when something reminds you of the traumatic event


You may avoid stimuli that cause you to remember or re-experience the traumatic event, such as:

  • people
  • conversations
  • places
  • objects
  • activities
  • thoughts
  • feelings

Anxiety or increased arousal

The symptoms of ASD may include anxiety and increased arousal. The symptoms of anxiety and increased arousal include:

  • having trouble sleeping
  • being irritable
  • having difficulty concentrating
  • being unable to stop moving or sit still
  • being constantly tense or on guard
  • becoming startled too easily or at inappropriate times


The symptoms of ASD may cause you distress or disrupt important aspects of your life, such as your social or work settings. You may have an inability to start or complete necessary tasks, or an inability to tell others about the traumatic event.

How’s acute stress disorder diagnosed?

Your primary doctor or mental health care provider will diagnose ASD by asking you questions about the traumatic event and your symptoms. It’s also important to rule out other causes such as:

  • drug abuse
  • side effects of medications
  • health problems
  • other psychiatric disorders

How’s acute stress disorder treated?

Your doctor may use one or more of the following methods to treat ASD:

  • psychiatric evaluation to determine your specific needs
  • hospitalisation if you’re at risk of suicide or harming others
  • assistance in obtaining shelter, food, clothing, and locating family, if necessary
  • psychiatric education to teach you about your disorder
  • medication to relieve symptoms of ASD, such as anti-anxiety medications, selective serotonin reuptake inhibitors (SSRIs), and antidepressants
  • cognitive behavioural therapy (CBT), which may increase recovery speed and prevent ASD from turning into PTSD
  • exposure-based therapies
  • hypnotherapy

What’s the long-term outlook?

Many people with ASD are later diagnosed with PTSD. A diagnosis of PTSD is made if your symptoms persist for more than a month and cause a significant amount of stress and difficulty functioning. Treatment may reduce your chances of developing PTSD. Approximately 50 per cent of PTSD cases resolve within six months, whereas others may persist for years.

Can I prevent ASD?

Because there’s no way to ensure that you never experience a traumatic situation, there’s no way to prevent ASD. However, there are things that can be done to reduce your likelihood of developing ASD. Getting medical treatment within a few hours of experiencing a traumatic event may reduce the likelihood that you’ll develop ASD. People who work in jobs that carry a high risk for traumatic events, such as military personnel, may benefit from preparation training and counselling to reduce their risk of developing ASD or PSTD if a traumatic event does occur. Preparation training and counselling may involve fake enactments of traumatic events and counsel to strengthen coping mechanisms.

Credit: Timothy J. Legg, PhD, PsyD, CRNP, ACRN, CPH for HealthLine, 28 November 2017