Acute stress disorder and post-traumatic stress disorder (PTSD) often go . The Relationship Between PTSD and Other Anxiety Disorders. disorder within 1 month of their trauma with the Acute Stress Disorder Inventory, a structured tive studies of the relationship between acute stress dis-. Although interviews are normally the gold standard for diagnosis, the possibility of preconceptions about the relation between acute stress disorder and PTSD.
This physiological preparation might save our lives, but for some people, this activation is a one-way ticket and their bodies may not be as prepared to handle the aftermath. In this case of a persistent stress responsenot only has the person not been able to process their experience and feelings around the original trauma, but they are also frequently suffering through this heightened fight-or-flight reaction.
This disordered experience can be very distressing. It makes sense that we would endure significant distress after a traumatic event—be it a natural disaster, a violent assault, a car accident, or even just hearing in detail about the anguish someone else has experienced.
But as this distress lasts beyond a couple of days, it can be classified as a disorder in need of therapeutic attention. Comparing acute stress disorder vs. With either disorder, the best chances for recovery are with early and comprehensive treatment, so an individual can finally process their pain and stress and develop coping strategies in the face of future stressors and triggers.
When symptoms of serious psychological distress occur shortly after a traumatic experience—within the first month after—and those symptoms last for three days or more, this condition is called acute stress disorder ASD.
While it is very natural to experience distress and have difficulty processing our experiences of trauma, when this lasts for more than a couple of days, it may call for some caring support to help a person move through and past their pain and stress.
Similar to a fresh wound that should not be ignored because of the danger that it can quickly escalate and even introduce additional illnesses, acute stress disorder should be immediately treated for the best outcomes as a person has the opportunity to successfully process their traumatic experiences.
Post-traumatic stress disorder PTSD is characterized by later-stage symptoms of distress and difficulty in coping with the aftermath of trauma. It is only after symptoms have been present for more than a month that a diagnosis of PTSD can be determined. But, unlike cases of acute stress disorder, symptoms of PTSD may develop months or even years after the original traumatic event takes place.
Intrusive symptoms, which refer to any memories, dreams, or flashbacks that arise and elicit a strong reaction. Negative mood, which can include thoughts, feelings, and a general sense of heaviness—often seeming as if the person is blocked from feelings such as happiness and love. They may also lose interest in the activities and things they previously favored. Hyperarousal symptoms, including sleeplessness, hypervigilance, irritability, angry outbursts, difficulty concentrating, and generally feeling on edge.
Post-traumatic stress disorder can persist for a long time if not treated, and it can severely disrupt the life a person wants and has created for themselves. Partial support for the vicious cycle hypothesis comes from the previously mentioned NWS survey. Similarly, even after controlling for the same demographic variables in the previous analysis age, race, and education as well as alcohol or drug use at the initial assessment, the occurrence of an assault during the follow-up period nearly tripled the use of alcohol at the follow-up assessment and nearly doubled the use of drugs.
Unfortunately, these authors did not investigate whether any of these reciprocal effects of alcohol and drug use with trauma exposure were mediated by the development of PTSD.
Nonetheless, it is clinically relevant to be aware that alcohol and substance abusing patients are at elevated risk for exposure to trauma, and therefore at elevated risk for the development of PTSD, and patients with PTSD are at elevated risk for developing alcohol substance use problems. General Considerations The assessment of PTSD and ASD requires at minimum an assessment of the person's trauma history, obtaining information on both the objective features of the trauma s i.
In principle, each of these content areas can be assessed through clinician interviews, self-report measures, or a combination of the two. In part, this is because it is assumed that clinicians will have a better understanding of the diagnostic criteria and will better able to judge whether or not a particular patient complaint falls within the category. For example, DSM differentiates recurrent, intrusive, distressing thoughts or recollections about the trauma Criterion B1 from flashbacks Criterion B3.
The difference between these two symptoms is that flashbacks have a quality of feeling as though it is happening right now, whereas intrusive recollections are clearly recognized as a memory for a past event. Patients, however, may not make this differentiation and, as a result, may rate the same event as two separate symptoms and thereby elevate the overall severity score.
For example, patients who lose consciousness during the trauma or were under the influence of drugs or alcohol may have gaps in their knowledge for what happened, but such gaps may be due to either a failure to encode the relevant memory or normal sources of forgetting, rather than the kind of cognitive avoidance mechanism envisioned in the diagnostic criteria.
- Acute Stress Disorder vs. PTSD: How They Differ, and Why It Matters
- Acute stress and post-traumatic stress disorders
The primary disadvantage of clinician-administered measures is that they can be time consuming to administer. Self-report measures, which are often validated against interview measures, have the advantage that they can be mailed to patients ahead of time and filled out at their leisure or completed while waiting to see the clinician. With regard to offering patients information about prognosis, monitoring natural recovery, or evaluating treatment response, dimensional assessment utilizing reliable and valid assessment instruments is frequently more helpful than simple diagnostic decisions and clinician impressions of severity as they provide greater information, are more sensitive to change either worsening or improvingand treatment effects observed in the clinic can be compared with treatment effects reported in the research literature to help the clinician set reasonable expectations with the patient and for both the clinician and the patient to understand how their symptom level or treatment response compares to that of others.
Accordingly, we recommend clinicians incorporate the use of formal assessment instruments into their practice and, to this end we provide a brief review of commonly used assessment instruments. For even greater detail on the assessment of psychological trauma and PTSD, the interested reader is referred to Wilson and Keane.
Post-Traumatic Stress Disorder and Acute Stress Disorder I
Assessing Trauma Several instruments have been developed to assess for the experience of traumatic events that vary substantially in their level of specificity and comprehensiveness about various types of traumas. Note the following example: Sometimes things happen to people that are extremely upsetting—things like being in a life-threatening situation, such as a major disaster, a very serious accident or fire; being physically assaulted or raped; seeing another person killed or dead, or badly hurt; or hearing about something horrible that has happened to someone you are close to.
At any time during your life, have any of these kinds of things happened to you? The advantage of such an open-ended approach to assessing for potentially traumatic events is that it does not require the patient's experience to fit into a predetermined mold and instead permits the patient to report whatever experiences they have had and the interviewer, through follow-up questioning, can elicit information to determine if the event meets both of the objective threat and subjective reaction criteria to qualify as a traumatic event.
The disadvantages, however, are 1 such an approach provides little context for assessment by way of explaining the nature of traumatic events so that intent of the questions will be clear to the patient and help to focus the discussion on the kinds of events of interest; and 2 the range of examples cited fails to include several types of events that are potentially traumatic events but, for one reason or another, the patient may not report to the interviewer, such as sexual assaults that fall short of the patient's definition of rape because of who the perpetrator was e.
Contrast the approach taken by the SCID with that taken in the epidemiological NWS, in which the researchers were specifically interested in the prevalence of violent crime, which is illustrated by how they assessed for instances of rape.
Another type of stressful event that many women have experienced is unwanted sexual advances. Women do not always report such experiences to the police or other authorities or discuss them with family or friends.
The person making the advances isn't always a stranger, but can be a friend, boyfriend, or even a family member. Such experiences can happen at any time in a woman's life—even as a child.
Regardless of how long ago it happened or who made the advances, has a man or boy ever made you have sex by using force or threatening to harm you or someone close to you? Just so there is no mistake, by sex we mean putting a penis in your vagina. Additional questions with a similar level of specificity were used to ask about non-sexual assault and other potentially traumatic events. The key here is to ask clear operationally defined and, in the case of interpersonal violence, behaviorally specific questions instead of relying on the patient's implicit definitions of certain terms, such as rape and sex.
Post-Traumatic Stress Disorder and Acute Stress Disorder I
Specific potentially traumatic events that are covered in most of the trauma-screening measures used in clinical research include rape; other forms of sexual assault e. Several treatment outcome studies that have used the CAPS as the primary outcome measure require a minimum score of 50 for entry into the study and a commonly agreed upon score reflecting a good outcome is a score less than This scale, called the Trauma Screening Questionnaire TSQconsists of 10 items from the PSS-SR that are rated by the patient in simple yes or no fashion based on whether or not the patient experienced any of the items at least two times in the past week.
Using the cut-off score of 6 or greater, TSQ was found to have excellent sensitivity, specificity, and power index values ranging between 0. Whether assessing PTSD severity by interview or self-report, it is common to use the last month as the time frame for the initial assessment to insure that duration criteria has been met. However, it is common to reduce the time frame to the last one or two weeks in order to assess symptom change over the course of treatment, particularly when visits are scheduled relatively close together.
One final self-report measure that deserves mention because of its good psychometric properties and common use in both research and clinical practice is the Impact of Event Scale IES. However, it has been found in several outcome studies to be sensitive to treatment-related changes in post-trauma symptomology following psychotherapy 29 and pharmacotherapy. At present, the best available instruments for the purpose of diagnosing and quantifying the severity of ASD consist of a pair-related measures developed by Bryant and colleagues: A Handbook of Theory, Assessment, and Treatment, 13 along with instructions for scoring and interpreting the results.
The primary limitation is that, depending on the complexity of patient's problems, it can take several hours to complete. To facilitate its administration, the SCID does contain a series of 12 screening questions that cover alcohol and substance use disorders, the anxiety disorders except for PTSD and ASDand eating disorders.
The MINI 34 is a briefer instrument that covers the major Axis I disorders mood disorders, anxiety disorders except for ASD, alcohol and substance use disorders, eating disorders, and psychotic symptoms along with an optional module for assessing antisocial personality disorder. Therefore, it is often helpful to supplement a thorough diagnostic interview with severity measures.
The Hamilton Rating Scales for depression 35 and anxiety 36 are brief clinician administered rating scales commonly used in both research and clinical practice. While neither of these scales can yield a formal diagnosis of depression or any specific anxiety disorder, they have been found to be sensitive to psychological and pharmacological treatment-related changes across a variety of psychiatric conditions. Well-validated self-report measures of depression and anxiety that are widely used in research and clinical practice and have been found to be responsive to treatment-related changes are the Beck Depression Inventory 37 and the state-anxiety portion of the State-Trait Anxiety Inventory.
By convention, PTSD cannot be diagnosed until a minimum of 30 days after the traumatic event because longitudinal studies have shown that PTSD-like symptoms are transient for most people following exposure to a trauma and will resolve without need for intervention. By contrast, individuals with PTSD three months or more after the trauma chronic PTSD are unlikely to experience symptom resolution without intervention.
The diagnosis of acute stress disorder ASD is a recent attempt to identify, within the first 30 days following exposure to trauma, those individuals who are most likely to develop chronic PTSD in order to facilitate early intervention. Several interview and self-report instruments have been developed and validated for the assessment of PTSD, ASD, and common associated psychopathology, which yield helpful information in the diagnosis and treatment of post-trauma stress reactions.
A subsequent paper to be published in an upcoming issue of this journal will review the empirical status of psychological and pharmacological treatments for PTSD and ASD.
Acute stress and post-traumatic stress disorders | Trauma | ReachOut Australia
Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association; Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol. Post-traumatic stress disorder in the national comorbidity survey. A prospective examination of post-traumatic stress disorder in rape victims.
Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Neuroendocrinology of trauma and posttraumatic stress disorder.
American Psychiatric Press; Initial post-traumatic urinary cortisol levles predict subsequent symptoms in motor vehicle accident victims. A prospective study of heart rate respose following trauma and the subsequent development of posttraumatic stress disorder. Pierre Janet and the breakdown of adaptation in psychological data.
A synthesis and critique. A Handbook of Theory, Assessment, and Treatment. American Psychological Association; The relationship between acute stress disorder and posttraumatic stress disorder: A prospective evaluation of motor vehicle accident survivors.
A 2-year longitudinal analysis of the relationship between violent assault and substance use in women.What You'll Learn - Post-Traumatic Stress Disorder VLA
J Consul Clin Psychol. Assessing psychological trauma and PTSD. Standardized self-report measures of civilian trauma and posttraumatic stress disorder. A clinician rating scale for assessing current and lifetime PTSD: Assessment of a new self-rating scale of post-traumatic stress disorder.
Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Brief screening instrument for post-traumatic stress disorder.