Acute Stress Disorder

Research on acute stress disorder (ASD) is in its infancy. The DSM-IV stipulates that the following conditions must be met to meet the criteria for diagnosis of ASD:

• Exposure to a traumatic event.
• At least three dissociative symptoms.
• At least one re-experiencing symptom.
• A marked avoidance to the stressor.
• And marked anxiety or arousal when reminded of the traumatic event.

ASD occurs in the first month following trauma, and is generally a precursor to post-traumatic stress disorder (PTSD). This study wanted to analyze the incidence and nature of ASD in different trauma groups. A sample of motor vehicle accident (MVA), severe burn, industrial accident, and non-sexual assault patients were selected. The authors used the ASD-1, which is a 19-question interview that inquires about symptoms, to assess their 102 subjects.

A diagnosis, according to the DSM-IV, of ASD was found in 13 patients. Most interestingly, however, was the fact that many patients almost met the criteria for ASD, except they did not quite have enough dissociative symptoms to fulfill the diagnostic requirements. In all, approximately 30% of MVA patients met the clinical or subclinical diagnostic criteria, while 28% of the industrial accident patients did.

"Consistent with previous studies, the majority of subclinical diagnoses did not meet criteria for the dissociative cluster. Relatedly, a prospective investigation of ASD after MVAs reported that 60% of patients who met all criteria except dissociation met criteria for PTSD 6 months posttrauma. Taken together, it is possible that the requirement that the emphasis on dissociative symptoms in the ASD criteria may result in severely distressed survivors not being diagnosed with ASD. These findings suggest that future revisions of the ASD criteria may consider alternative paths by which an ASD diagnosis can be made; for instance, ASD could be diagnosed either with or without dissociative reactions."

Harvey AG, Bryant RA. Acute stress disorder across trauma populations. Journal of Nervous and Mental Disorders 1999;187(7):443-446.