What is acute stress disorder (ASD)? Is it different from post-traumatic stress disorder (PTSD)?
Let’s explore the terminology to understand what these responses to traumatic events have in common and where they differ.
In a recent episode of his podcast series, Things Fall Apart, journalist Jon Ronson discussed the terminology of trauma. He questioned whether the word ‘trauma’ was losing its meaning with too much usage.
There’s a lot to be said about how the terminology is used in a societal sense, but in mental health discourse, the distinctions are very important. Definitions are used for diagnostic purposes. It’s therefore crucial to understand when a response to a traumatic event is normal and when it is in fact a disorder.
But there are also important differences between certain disorders. In particular, acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) have very specific meanings.
In this article, we will discuss what the disorders have in common and where they differ, as well as how this affects treatment and outcomes.
What is Trauma?
In the context of ASD and PTSD, trauma has a specific meaning. It refers to an event which is shocking, scary, or dangerous.
Common examples of traumatic events include:
- Car accidents
- Physical assault
- Sexual assault
- Natural disasters
- War
- Domestic abuse
- Incarceration
- Life-threatening illnesses
- Witnessing a death
Hearing about a traumatic event which happened to a loved one – or their diagnosis of a devastating illness – can also be a trauma.
What is a Normal Response to Trauma?
One person’s response to a trauma can be very different to another’s response to the same trauma. A number of factors, including individual resilience, previous exposure to trauma, training, and a history of mental illness, all play a role.
That being said, there is a distinction between what is considered a ‘normal’ or healthy response and an unhealthy response.
A person’s reaction to trauma is both physical and emotional. The body’s autonomic nervous system becomes hyper-alert as a defense against the danger. What we call stress is a symptom of this alertness lasting an extended period of time. Stress is not unhealthy on its own and is considered normal.
What is Acute Stress Disorder?
If almost everyone experiences stress after a trauma, what is acute stress disorder (ASD)?
ASD is diagnosed when a person has a particularly strong stress response to the trauma that lasts for at least 3 days. It is characterized by a range of symptoms that may include intense fear, helplessness, or horror, as well as dissociative symptoms like feeling numb or detached from one’s emotions or body, having a reduced awareness of one’s surroundings, or experiencing the world as unreal or dreamlike.
But isn’t this the same thing as PTSD?
What is Post-Traumatic Stress Disorder?
Post-traumatic stress disorder (PTSD) has become more widely discussed in recent years. Many people assume that it refers to any prolonged stress response a person experiences after trauma. However, there is a specific condition that needs to be met for a diagnosis of PTSD.
That condition is that the symptoms must be experienced more than a month after the event. This is when it can be considered post-traumatic. It is also the main difference between ASD and PTSD.
PTSD is often preceded by ASD. For some, the symptoms of ASD go away within the first month after the event. For others, they persist, leading to the diagnosis of PTSD.
Is PTSD Always Preceded by ASD?
If ASD occurs immediately after the trauma, and PTSD is when it lasts over a month, it is intuitive that the one leads to the other. But in reality, the response is sometimes delayed.
PTSD symptoms can sometimes emerge weeks, months, or even years after the traumatic experience, bypassing the immediate acute stress reaction phase that characterizes ASD.
This delayed onset of PTSD indicates that individuals can have different trajectories in their response to trauma. Some may experience immediate and intense symptoms that lead to an ASD diagnosis, while others may have a more delayed response, with PTSD symptoms developing over time and becoming more apparent long after the event has occurred.
Is Treatment the Same for ASD and PTSD?
The treatment for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) has similarities, but there are also important differences tailored to the specific characteristics and duration of each condition.
For ASD:
- Immediate intervention is often focused on symptom management and prevention of PTSD. Treatment may include cognitive-behavioral therapy (CBT), particularly techniques aimed at reducing symptoms of anxiety and avoidance, and managing intrusive thoughts.
- Psychological first aid (PFA) is commonly employed immediately following a traumatic event to support individuals and reduce the initial distress.
- Short-term counseling or therapy may be sufficient for some individuals with ASD, focusing on normalizing symptoms and teaching coping strategies.
For PTSD:
- Treatment is typically more prolonged and may involve a range of psychotherapeutic approaches, including prolonged exposure therapy, cognitive processing therapy, and eye movement desensitization and reprocessing (EMDR).
- Medications, such as antidepressants, may be prescribed to manage specific PTSD symptoms like depression and anxiety.
- PTSD treatment often includes long-term strategies to cope with triggers and the long-standing effects of trauma.
Conclusion
Everyone responds to trauma differently, but certain symptoms can indicate that a person has developed a disorder. Within the first month after the incident, ASD may be diagnosed. Treatment is recommended, both to reduce the severity and to prevent it from becoming PTSD.
If the symptoms persist for longer than a month – or if they first present after a month has passed – PTSD may be diagnosed. While treatment is similar for both disorders, it requires a more long-term approach when PTSD is diagnosed.
