Symptoms of Acute Stress Disorder

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) says that to receive a diagnosis of ASD, a person must have the following symptoms and circumstances:

• direct or indirect exposure to a traumatic event or stressor, including actual or threatened death, serious injury, or sexual violation
• symptoms that occurred within 3 days to 1 month of the stressor and last at least 3 days
• significant distress that affects or impairs a person’s daily life, such as interfering with work and social activities
• establishing a particular event as the root cause of the symptoms, ruling out other potential causes like physical conditions, medication, or alcohol
• nine or more of the symptoms of ASD across any of these five categories:
  • intrusion
  • negative mood
  • dissociation
  • avoidance
  • arousal

It’s not possible to self-diagnose ASD. An ASD diagnosis must come from the evaluation of a mental health professional or health practitioner.

Intrusive symptoms

Intrusive symptoms are usually recurrent events, such as memories, nightmares, or flashbacks.

They can remind you of the traumatic stressor. Or they can make you feel as though you’re repeatedly re-experiencing the event, causing intense distress.

Intrusive symptoms include:

• distressing memories of the traumatic event
• bad dreams or nightmares related to the event
• dissociative reactions or flashbacks as if the event were recurring
• intense psychological or physiological distress when exposed to cues that resemble or symbolize the event

While everyone can experience intrusive thoughts every now and then, these events are especially uncomfortable for people with ASD.

Experiencing involuntary distressing memories, nightmares, and flashbacks can make you feel like the traumatic event is repeatedly happening. This can incite feelings of fear and hopelessness.

In some cases, other sensory cues like sounds and visuals that symbolize or resemble the traumatic event can trigger intrusive symptoms. This can lead to a dissociative reaction where you completely lose your awareness in the current moment.

Negative mood

Negative mood is characterized by the persistent inability to experience positive emotions like happiness. You may feel incapable of feeling anything other than fear, hopelessness, and sadness due to the traumatic event.

You may even feel numb to other emotions. You may become emotionally unresponsive. Generally, a person with low mood has difficulty expressing positive emotions and often experiences negative thoughts.

Dissociative symptoms

Dissociative symptoms involve a temporary detachment from reality. When this happens, you may feel your reality isn’t real.

Dissociative symptoms include:

• an altered sense of reality of oneself or one’s surroundings, such as seeing oneself from another perspective
• amnesia or the inability to remember important aspects of the traumatic event

Examples of dissociation include derealization and depersonalization:

• In derealization, your environment and surroundings may seem strange or unreal to you. You may feel detached from your external reality.
• In depersonalization, your thoughts and emotions may not seem real to you and as though they belong to someone else. You may feel detached from yourself.

Dissociative symptoms also include dissociative amnesia, memory loss of the traumatic event. You may forget important aspects of the stressor. This isn’t due to other factors that impair memory, such as a head injury or substance use.

Avoidance symptoms

Wanting to avoid anything that reminds you of a traumatic event is a typical response. Avoidance symptoms occur when there’s an effort to avoid distressing triggers that remind you of the traumatic stressor.

Avoidance symptoms include:

• avoiding distressing memories, thoughts, or feelings about the traumatic event
• avoiding external cues that are closely associated with the traumatic event

For example, you may want to avoid the location of the traumatic event. Survivors of car accidents may want to avoid driving past the place where the accident occurred. People grieving a late loved one may seek to avoid their home or workplace.

These external cues can incite negative emotions and feelings, so it’s natural to want to avoid them. However, this can interfere with your daily life.

Arousal symptoms

You may experience symptoms of anxiety and increased arousal with ASD. These symptoms change the way you react to certain situations.

Arousal symptoms include:

• feeling “keyed up”
• disturbance in sleeping patterns
• irritability and outbursts of verbal or physical aggression
• hypervigilance
• difficulty concentrating
• an exaggerated startle response

You may become more sensitive to potential threats or experience an increase in perceived threats than before the traumatic event. While the ability to identify and respond to threats is part of your survival instincts, this increased feeling of being in danger can impact your routine.

Acute stress can last between 3 and 30 days. If your symptoms persist for more than a month, a diagnosis of PTSD may be made. Treatment options include:

• cognitive behavioral therapy (CBT)
• exposure therapy
• medication

You can read more about therapies for trauma here.

Both ASD and PTSD occur after exposure to a traumatic event or stressor. Many of the symptoms also overlap, including dissociative amnesia, avoidance symptoms, and intrusion symptoms.

However, ASD and PTSD differ in several ways:

• A PTSD diagnosis requires meeting a specified number of symptoms within the specific categories. An ASD diagnosis requires at least nine symptoms across any of the five categories.
• ASD includes fear-based symptoms, and PTSD does not.
• Dissociation is a subtype of PTSD, whereas ASD has an entire category dedicated to disassociation.

Though rare, people with ASD may go on to develop PTSD. An estimated 20% to 90% of the general population is exposed to one or more extreme stressful events during their lifetime, but only 1.3% to 11.2% of those with ASD develop PTSD.

ASD can make you feel afraid, hopeless, and anxious. It can negatively affect your daily life and ability to function.

If you’re experiencing symptoms of ASD, a health professional can offer help.

Looking for a therapist, but not sure where to start? Psych Central’s How to Find Mental Health Support resource can help.