Introduction

Acute stress disorder (ASD, also referred to as acute stress reaction, psychological shock, mental shock, or just shock) may be a psychological response to a terrifying, traumatic, or surprising experience. Acute stress disorder is not fatal, but it may bring about delayed stress reactions (better known as Post-Traumatic Stress Disorder or PTSD) if not correctly addressed.

Types of ASD

Sympathetic (also known as 'fight or flight' response)

Sympathetic Acute Stress Disorder is caused by the release of excessive adrenaline and norepinephrine into the nervous system. These hormones may speed up an individual's pulse and rate of respiration, dilate pupils, or temporarily mask pain. This type of ASD developed as an evolutionary advantage to assist humans survives dangerous situations. The 'fight or flight' response may leave temporarily-enhanced physical output, even within the face of severe injury. However, other physical illnesses become more difficult to diagnose, as ASD masks the pain and other vital signs that would otherwise be symptomatic.

Parasympathetic

Parasympathetic Acute Stress Disorder is characterized by feeling faint and nauseous. This response is fairly often triggered by the sight of blood. In this stress response, the body releases acetylcholine. In some ways, this reaction is that the opposite of the sympathetic response, therein it slows the guts rate and may cause the patient to either regurgitate or temporarily lose consciousness. The evolutionary value of this is unclear, although it may have allowed for prey to appear dead to avoid being eaten.

Signs and symptoms

The DSM-IV specifies that Acute Stress Disorder must be accompanied by the presence of dissociative symptoms, which largely differentiates it from PTSD.

Dissociative symptoms include a way of numbing or detachment from emotional reactions, a way of physical detachment - like seeing oneself from another perspective, decreased awareness of one's surroundings, the perception that one's environment is unreal or dreamlike, and the inability to recall critical aspects of the traumatic event (dissociative amnesia).

In addition to those characteristics, ASD are often present within the following four distinct symptom clusters;

Intrusion symptom cluster

Recurring and distressing dreams, flashbacks, and/or memories associated with the traumatic event.

Intense/prolonged psychological distress or somatic reactions to internal or external traumatic cues.

Negative mood cluster

A persistent inability to experience positive emotions such as happiness, loving feelings, or satisfaction.

Avoidance symptom cluster

The avoidance of distressing memories, thoughts, feelings (or external reminders of them) that is closely associated with the traumatic event.

Arousal symptom cluster

Sleep disturbances, hyper-vigilance, difficulties with concentration, easily startled, and irritability/anger/aggression.

Causes

There are several theoretical perspectives on trauma response, including cognitive, biological, and psycho-biological. While PTSD-specific, these theories are still useful in understanding Acute Stress Disorder, as the two disorders share many symptoms. A recent study found that even a single stressful event may have long-term consequences on cognitive function. This result calls the normal distinction between the consequences of acute and chronic stress into question.

Diagnosis

According to the DSM-V, symptom presentation must last for 3 consecutive days to be classified as Acute Stress Disorder. If symptoms persist past one month, the diagnosis of PTSD is explored. There must be a clear temporal connection between the impact of an exceptional stressor and the onset of symptoms; onset is usually within a few minutes or days but may occur up to one month after the stressor. Also, the symptoms show a mixed and rapidly changing picture; although 'daze' depression, anxiety, anger, despair, hyper-activity, and withdrawal may all be seen, nobody symptom dominates for long. The symptoms usually resolve rapidly where removal from the stressful environment is feasible. In cases where the strain continues, the symptoms usually begin to diminish after 24–48 hours and are usually minimal after about three days.

The DSM-V specifies that there is a higher prevalence rate of ASD among females compared to males due to higher risk of experiencing traumatic events and neurobiological gender differences in stress response.

Treatment

This disorder may resolve itself with time or may become a more severe disorder, like PTSD. Creamer et al. found that re-experiences of the traumatic event and arousal were better predictors of PTSD. Early pharmacotherapy may prevent the development of post-traumatic symptoms. Additionally, early Trauma-Focused, Cognitive Behavioral Therapy for those with a diagnosis of ASD can protect a private from developing chronic PTSD.

Studies have been conducted to assess the efficacy of counselling and psychotherapy for people with Acute Stress Disorder. Cognitive Behavioral Therapy, which includes exposure and cognitive restructuring, was found to be effective in preventing PTSD in patients diagnosed with Acute Stress Disorder with clinically significant results at six-month follow-up appointments. A combination of relaxation, cognitive restructuring, imaginal exposure, and in-vivo exposure was superior to supportive counselling. Mindfulness-based stress reduction programmers also appear to be effective for stress management.

In a wilderness context where counselling, psychotherapy, and Cognitive Behavioral Therapy is unlikely to be available, the treatment for acute stress reaction is very similar to the treatment of cardiogenic shock, vascular shock, and hypovolemic shock; that is, allowing the patient to lie down, providing reassurance, and removing the stimulus that prompted the reaction. In traditional shock cases, this generally means relieving injury pain or stopping blood loss. In an acute stress reaction, this might mean pulling a rescuer faraway from the emergency to settle down or blocking the sight of an injured friend from a patient.

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