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 ASD 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
ASD
12.
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?
Cognitive-behavioral interventions
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?
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 of
debriefing with acutely traumatized individuals.
References
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.
