What is acute stress disorder?
Acute stress disorder (ASD) is a psychiatric diagnosis that can be given to individuals in the first month following a traumatic event. The symptoms that define ASD overlap with those for PTSD, although there are a greater number of dissociative symptoms for ASD, such as not knowing where you are or feeling as if you are outside of your body.
How common is ASD?
Because Acute stress disorder is a relatively new diagnosis, research on the disorder is in the early stages. Rates range from 6% to 33% depending on the type of trauma:
Motor vehicle accidents: Rates of ASD range from approximately 13% 1,2 to 21% 3.
Typhoon: A study of survivors of a typhoon yielded an ASD rate of 7% 4.
Industrial accident: One study found a rate of 6% in survivors of an industrial accident 5.
Violent assault: A rate of 19% was found in survivors of violent assault 6, and a rate of 13% was found among a mixed group consisting of survivors of assaults, burns, and industrial accidents 7. A recent study of victims of robbery and assault found that 25% met criteria for ASD 8, and a study of victims of a mass shooting found that 33% met criteria for ASD 9.
Who is at risk for ASD as a result of trauma?
A few studies have examined factors that place individuals at risk for developing ASD.
One study found that individuals who (1) had experienced other traumatic events, (2) had PTSD previously, and (3) had prior psychological problems were all more likely to develop ASD as the result of a new traumatic stressor 10.
A study of motor vehicle accident survivors found that those individuals (1) with depression symptoms, (2) who had previous mental heath treatment, and (3) who had been in other motor vehicle accidents were more likely to have more severe ASD 11.
A final study suggests that people who dissociate when confronted with traumatic stressors may be more likely to develop ASD12.
How predictive of PTSD is ASD?
A diagnosis of ASD appears to be a strong predictor of subsequent PTSD. In one study, more than three quarters of the individuals who were in motor vehicle accidents and met criteria for ASD went on to develop PTSD 1. This finding is consistent with other studies that found that over 80% of people with ASD developed PTSD by the time they were assessed six months later 6,13.
Are there effective treatments for ASD?
At present, cognitive-behavioral interventions during the acute aftermath of trauma exposure have yielded the most consistently positive results in terms of preventing subsequent posttraumatic psychopathology 14,15,16,17.
Psychological debriefing is an early intervention that was originally developed for rescue workers but has been widely applied in the acute aftermath of potentially traumatic events. It has received much attention in the wake of 9/11. However, there is little evidence to support the continued use ofdebriefing with acutely traumatized individuals.
1. Bryant, R.A., & Harvey, A.G. (2000). Acute Stress Disorder: A handbook of theory, assessment, and treatment. Washington, D.C.: American Psychological Association.
2. Harvey, A.G., & Bryant, R.A. (1998a) Acute Stress Disorder following mild traumatic brain injury. Journal of Nervous and Mental Disease, 186, 333-337.
3. Harvey, A.G., & Bryant, R.A. (1998b). The relationship between Acute Stress Disorder and Posttraumatic Stress Disorder: A prospective evaluation of motor vehicle accident survivors. Journal of Consulting and Clinical Psychology, 66, 507-512.
4. Holeva, V., Tarrier, N., & Wells, A. (2001). Prevalence and predictors of Acute Stress Disorder and PTSD following road traffic accidents: Thought control strategies and social support. Behavior Therapy, 32, 65-83.
5. Stabb, J.P., Grieger, T.A., Fullerton, C.S., & Ursano, R.J. (1996). Acute Stress Disorder, subsequent Posttraumatic Stress Disorder and depression after a series of typhoons. Anxiety, 2, 219-225.
6. Creamer, M., & Manning, C. (1998). Acute Stress Disorder following an industrial accident. Australian Psychologist, 33, 125-129.
7. Brewin, C.R., Andrews, B., Rose, S., & Kirk, M. (1999). Acute Stress Disorder and Posttraumatic Stress Disorder in victims of violent crime. American Journal of Psychiatry, 156, 360-366.
8. Harvey, A.G., & Bryant, R.A. (1999). Acute Stress Disorder across trauma populations. Journal of Nervous and Mental Disease, 187, 443-446.
9. Elklit, A. (2002). Acute Stress Disorder in victims of robbery and victims of assault. Journal of Interpersonal Violence, 17, 872-887.
10. Classen, C., Koopman, C., Hales, R., & Spiegel, D. (1998). Acute Stress Disorder as a predictor of posttraumatic stress symptoms. American Journal of Psychiatry, 155, 620-624.
11. Rothbaum, B.O., Foa, E.B., Riggs, D.S., Murdock, T., & Walsh, W. (1992). A prospective examination of Post-traumatic Stress Disorder in rape victims. Journal of Traumatic Stress, 5, 455-475.
12. Barton, K.A., Blanchard, E.B., & Hickling, E.J. (1996). Antecedents and consequences of Acute Stress Disorder among motor vehicle accident victims. Behaviour Research and Therapy, 34, 805-813.
13. Bryant, R.A., Guthrie, R.M., & Moulds, M.L. (2001). Hypnotizability in Acute Stress Disorder. American Journal of Psychiatry, 158, 600-604.
14. Bryant, R.A., & Harvey, A.G. (1998). The relationship between Acute Stress Disorder and Posttraumatic Stress Disorder following mild traumatic brain injury. American Journal of Psychiatry, 155, 625-629.
15. Bryant, R.A., Harvey, A.G., Dang, S., & Sackville, T. (1998). Assessing Acute Stress Disorder: Psychometric properties of a structured clinical interview. Psychological Assessment, 10, 215-220.
16. Bryant, R.A., Moulds, M., Guthrie, R. (2000). Acute Stress Disorder scale: A self-report measure of Acute Stress Disorder. Psychological Assessment, 12, 61-68.
17. Gidron, Y., Gal, R., Freedman, S.A., Twiser, I., Lauden, A., Snir, Y., & Benjamin, J. (2001). Translating research findings to PTSD prevention: Results of a randomized-controlled pilot study. Journal of Traumatic Stress, 14(4), 773-780.
18. Bryant, R. A., Harvey, A. G., Dang, S. T., Sackville, T., & Basten, C. (1998). Treatment of Acute Stress Disorder: A comparison of cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 66, 862-866.
19. Bryant, R.A., Sackville, T., Dang, S.T., Moulds, M., & Guthrie, R. (1999). Treating Acute Stress Disorder: An evaluation of cognitive behavior therapy and counseling techniques. American Journal of Psychiatry, 156, 1780-1786.
20. Echeburua, E., deCorral, P., Sarasua, B., & Zubizarreta, I. (1996). Treatment of acute Posttraumatic Stress Disorder in rape victims: An experimental study. Journal of Anxiety Disorders, 10, 185-199.
21. Brom, D., Kleber, R.J., & Hofman, M.C. (1993). Victims of traffic accidents: Incidence and prevention of Post-traumatic Stress Disorder. Journal of Clinical Psychology, 49, 131-140.
22. Foa, E. B., Hearst-Ikeda, D., & Perry, K. J. (1995). Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. Journal of Consulting and Clinical Psychology, 63, 948-955.
23. Litz, B.T., Gray, M.J., Bryant, R.A., Adler, A.B. (2002). Early intervention for trauma: Current status and future directions. Clinical Psychology-Science & Practice, 9, 112-134.
24. Mitchell, J.T., & Everly, G.S. (2000). Critical Incident Stress Management and Critical Incident Stress Debriefings: Evolutions, effects and outcomes. In B. Raphael & J.P. Wilson (Eds.), Psychological debriefing: Theory, practice and evidence (pp.71-90). New York, New York: Cambridge University Press.
© 2009 Laura E. Gibson, Ph.D.
The University of Vermont