Acute Stress Disorder

Acute stress disorder (ASD) is a psychiatric diagnosis that was introduced into the DSM-IV in 1994. The current diagnostic criteria for acute stress disorder are similar to the criteria for post traumatic stress disorder (PTSD) although the criteria for ASD contain a greater emphasis on dissociative symptoms and the diagnosis can only be given within the firs month after a traumatic event.

Because acute stress disorder is a relatively new diagnosis, research on the disorder is in the early stages. Studies of acute stress disorder have utilized a variety of measurement tools with varying degrees of reliability and validity.

While many studies have examined factors that place individuals at risk for developing PTSD, only a handful of studies have examined risk factors for the development of acute stress disorder. One retrospective study found that individuals with exposure to prior trauma, individuals with prior PTSD, and individuals with more psychiatric dysfunction were all more likely to develop acute stress disorder when confronted with a new traumatic stressor.

Acute stress disorder and post traumatic stress disorder differ in two fundamental ways. The first difference is that the diagnosis of acute stress disorder can be given only within the first month following a traumatic event. If post-traumatic symptoms were to persist beyond a month, the clinician would assess for the presence of PTSD.

The acute stress disorder diagnosis would no longer apply. Acute stress disorder also differs from PTSD in that it includes a greater emphasis on dissociative symptoms. An acute stress disorder diagnosis requires that a person experience three symptoms of dissociation while the PTSD diagnosis does not include a dissociative symptom cluster. Because acute stress disorder is a relatively new diagnosis, there are few well-established and empirically validated measures to assess it.

In terms of effective acute stress disorder treatments, cognitive-behavioral interventions during the acute aftermath of trauma exposure have yielded the most consistently positive results in terms of preventing subsequent post-traumatic psychopathology.

Psychological debriefing is an early intervention that was originally developed for rescue workers that has been more widely applied in the acute aftermath of potentially traumatic events. Random clinical trials (RCT) of debriefing have yielded inconsistent findings in terms of its efficacy.

A review of the literature on debriefing RCTs concluded that there is little evidence to support the continued use of debriefing with acutely traumatized individuals. The originators of the debriefing model have made the cogent argument that most of the debriefing RCTs to date have studied only one component of the longer-term and more comprehensive Critical Incident Stress Management model. It is possible that this more comprehensive intervention would prove efficacious but to date no RCTs have been conducted using the full intervention.