Acute stress disorder

Acute stress disorder is tested as a timing question: a client seen days to weeks after a trauma has a different diagnosis, and a different counselor task, than one seen months later.

Criteria at exam depth. The exposure requirement matches PTSD: actual or threatened death, serious injury, or sexual violence, experienced directly, witnessed, learned about in a close family member or friend, or through repeated or extreme work exposure to aversive details. The client then has at least 9 of 14 symptoms drawn from any of five categories:

• Intrusion: distressing memories, nightmares, flashbacks, distress or physiological reactions to cues.
• Negative mood: persistent inability to feel positive emotions.
• Dissociative: an altered sense of reality (feeling in a daze, detached, or as if it happened to someone else) or inability to remember important parts of the event.
• Avoidance: of memories or of external reminders.
• Arousal: sleep disturbance, irritability, hypervigilance, poor concentration, exaggerated startle.

Duration is 3 days to 1 month after the trauma. Symptoms often begin right away but must persist at least 3 days. They cause distress or impairment and are not due to a substance, a medical condition such as mild traumatic brain injury, or a brief psychotic disorder.

Hinge differentials.

• PTSD: the same clusters lasting more than 1 month. ASD does not convert automatically; if significant symptoms persist past a month, reassess for PTSD.
• Normal stress response: transient distress without enough symptoms or impairment; dissociative detachment and broader symptom burden point to ASD.
• Adjustment disorder: follows a non-traumatic stressor, or a trauma when the full ASD symptom count is not met.
• Mild traumatic brain injury: shares concentration and sleep problems; screen for head injury after blasts, assaults, or crashes.
• Panic disorder: attacks are unexpected and not tied to trauma cues.

On the NCMHCE. Assess safety, suicide risk, and substance use, and screen for head injury when the event involved physical impact. Offer psychological first aid principles: safety, calming, connection to supports, self-efficacy, and practical help. Provide psychoeducation that acute stress reactions often improve, which counters catastrophic thinking. Brief trauma-focused CBT started in the weeks after the event has support for clients with ASD. Single-session psychological debriefing that pushes everyone to recount the trauma is not recommended and may hinder recovery. Monitor symptoms as the one-month point approaches rather than discharging early. Respect cultural norms around disclosure and support.

Clinical Pearl: At least 9 of 14 symptoms, lasting 3 days to 1 month after a trauma = acute stress disorder. Past a month, reassess for PTSD; do not convert automatically, and avoid single-session debriefing.