Acute Stress Disorder: What It Is and How to Treat It
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Hearing about the trauma that led to your loved one's PTSD may be painful for you and even cause you to relive difficult events. You may find yourself avoiding his or her attempts to talk about the trauma or feeling hopeless that your loved one will get better. At the same time, you may feel guilty that you can't fix your loved one or hurry up the process of healing.
Acute Stress Disorder
If you think you may have post-traumatic stress disorder, make an appointment with your doctor or a mental health professional. Here's some information to help you prepare for your appointment, and what to expect. Take a trusted family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you. Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on.
Your doctor may ask:. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Diagnosis To diagnose post-traumatic stress disorder, your doctor will likely: Perform a physical exam to check for medical problems that may be causing your symptoms Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders DSM-5 , published by the American Psychiatric Association.
More Information Cognitive behavioral therapy Psychotherapy. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. References Posttraumatic stress disorder.
Arlington, Va. Accessed Dec. Clinician's guide to medications for PTSD. Treatment of PTSD. Coping with traumatic stress reactions. Helping a family member who has PTSD. Post-traumatic stress disorder. National Institute of Mental Health. Posttraumatic stress disorder. National Alliance on Mental Illness. Rothbaum BO. Psychotherapy for posttraumatic stress disorder in adults. What is posttraumatic stress disorder?
A reduction in awareness of his or her surroundings e. Dissociative amnesia i. The traumatic event is persistently reexperienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.
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Marked avoidance of stimuli that arouse recollections of the trauma e. Marked symptoms of anxiety or increased arousal e. The disturbance lasts for a minimum of two days and a maximum of four weeks, and occurs within four weeks of the traumatic event. The disturbance is not due to the direct physiologic effects of a substance e. Reprinted with permission from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.
Not all trauma victims want or need professional assistance. Those who refuse help may not be in denial, but may see themselves as more resilient or able to rely on the support of family and friends. Physicians should support patients who want to talk about their experience, but not push those who prefer not to. Within minutes of a traumatic event, persons may develop an acute stress reaction. This is a transient condition involving a broad array of signs and symptoms, including depression, anxiety, fatigue, difficulties with concentration and memory, hyperarousal, and social withdrawal. These occur at the same time as or within a few minutes of the traumatic event, and in most cases disappear within hours or days.
Therefore, physicians are encouraged to ask the patient about trauma or recent stressful events. Excessive safety behavior e. Mental defeat i. Nowness of trauma memories i. Information from references 16 through It covers the major symptoms of ASD and has been proven reliable and valid.
A cut-off score based on a cluster of items shows a sensitivity of 95 percent and a specificity of 83 percent for the diagnosis of ASD. Each item is rated on a five-point scale, with total scores ranging from 19 to The authors recommend a cutoff score of Referral to a psychologist or psychiatrist may be necessary if symptoms worsen or persist. It is helpful to assist the patient in understanding that acute responses to trauma are common and often transient, and are not a sign of mental illness.
Encouraging positive ways to cope and providing resources e. Patients may benefit from education on coping with acute responses e. Psychological first aid is thought to be the most appropriate intervention for persons experiencing distress or decrements in functioning immediately after trauma. Respond to contact initiated by patient by introducing self, inquiring about immediate needs, and assuring confidentiality.
Enhance immediate and ongoing safety while providing physical and emotional comfort. Calm, stabilize, and orient emotionally overwhelmed patients, and discuss the role of medication. Obtain information on nature and severity of experiences, concerns about post-trauma circumstances, separation from loved ones, physical or mental health problems, losses, extreme feelings of guilt or shame, thoughts about harming self or others, social support, prior alcohol or drug use, and prior exposure to trauma.
Offer practical assistance, identify immediate needs, clarify needs, discuss an action plan, and address needs. Enhance access to and use of primary support persons and local community resources. Provide basic information about stress reactions; review common psychological reactions to traumatic experiences and losses; discuss physical and emotional reactions; provide basic information on coping strategies, simple relaxation techniques, and management of anger and other emotions; assist with sleep problems; and address alcohol and substance use. Provide direct links to additional services, refer as appropriate, and promote continuity in helping relationships.
Information from references 1 , 11 , 23 , 25 , and Physicians should closely monitor physical and psychological symptoms of all patients who have experienced trauma.
The Physician's Role in Managing Acute Stress Disorder - American Family Physician
Although most trauma survivors recover without any formal professional help, 20 a significant number benefit from psychological or psychiatric assistance. Physicians should refer patients who have prolonged reactions that cause distress or affect interpersonal relationships and daily functioning. In addition, it is important to follow up with survivors of trauma because problems may not resolve, new problems may develop, and relapse may occur.
Although limited evidence exists for providing direct psychological intervention within the first month after trauma, the use of cognitive behavior therapy CBT has been supported in situations where the threat has subsided and stability has returned. CBT alone or in combination with hypnosis is more effective than supportive counseling in preventing PTSD in mixed-trauma patients with ASD, and effects are generally maintained over three years.
Patients who maintain or reestablish a sense of safety have a decreased risk of posttraumatic stress disorder; physicians are encouraged to take measures in which patients are brought to a safe place and assured safety. Because of patient concerns about family members, it is important to provide information about their well-being. Limiting exposure to news media stories about traumatic events is also recommended.
Some anxiety is normal, but it becomes problematic when it interferes with sleep, eating, hydration, decision making, and conducting normal tasks. Physicians may encourage therapeutic grounding i. Patients feel better when they can overcome threats and solve their own problems. Physicians may remind patients of their pre-trauma sense of self-efficacy i. Connection allows patients to obtain essential information and to gain social support and a sense of community.
Patients should be counseled about services and support-seeking connections with others—especially loved ones—as quickly as possible. Physicians should provide formal support if informal support is unavailable. Maintaining a reasonable degree of hope helps to combat the shattered worldview, foreshortened future, and catastrophizing that may occur after trauma. Information from reference Psychological debriefing is a short intervention provided immediately after a person has experienced trauma. Critical Incident Stress Debriefing is a widely used version that is often part of a multicomponent program.
However, most studies that have shown benefits have methodologic limitations.
It appears that use of Critical Incident Stress Debriefing at best results in no effect and at worst harms participants by impeding natural recovery. Therefore, this practice is not warranted.
Few studies have evaluated the pharmacologic treatment of ASD. In a retrospective study, imipramine Tofranil or fluoxetine Prozac relieved ASD-associated symptoms in 81 and 75 percent, respectively, of children with ASD following burn injuries. In a retrospective study of 10 adults who had ASD after a burn injury, all reported symptom improvement i.
Currently, there is insufficient evidence to recommend the routine use of pharmacologic measures for the treatment of ASD, and there is clearly no support for drug therapy instead of CBT. Short-term less than six weeks pharmacologic intervention may be beneficial in relieving targeted specific symptoms associated with the event e.
What is PTSD?
Department of Veterans Affairs and U. Department of Defense. Data Sources: EBSCO Host and PubMed searches were completed using the key term acute stress disorder separately and in combination with assessment, diagnosis, management, treatment, and clinical practice guidelines.