What is Acute Stress Disorder?

Shannon V. McHugh, PsyD
May 6, 2019

When someone experiences a severe or traumatic event in their life, they can begin to develop disruption in their mental health and overall functioning. Mental health professionals describe these mental, physiological, and emotional changes using a variety of descriptions based on what the person identifies experiencing. Acute stress disorder is one of the classifications that mental health professionals will use to describe the after effects someone experiences after an intense event where the person believed that they were witnessing a serious threat to their life or someone else’s, or when they or someone close to them experienced a serious injury, accident, or violent physical encounter or death. This diagnosis is similar to a more commonly known disorder, post traumatic stress disorder, but has different criteria in several ways which will be described below.


The Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V) describes acute stress disorder as involving the following criteria:

  • Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
    • Directly experiencing the traumatic event(s).
    • Witnessing, in person, the event(s) as it occurred to others.
    • Learning that the event(s) occurred to a close family member or close friend. Note: In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
    • Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse).
  • Presence of nine or more of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:
    • Intrusion Symptoms
      • Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) occurred.
      • Recurrent distressing dreams in which the content and/or effect of the dream are related to the event(s). Note: In children, there may be frightening dreams without recognizable content.
      • Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
      • Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
    • Negative Mood Symptoms
      • Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
    • Dissociative Symptoms
      • An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing).
      • Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
    • Avoidance Symptoms
      • Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
      • Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
    • Arousal Symptoms
      • Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep).
      • Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
      • Hypervigilance
      • Problems with concentration.
      • Exaggerated startle response

Like all mental health disorders in the DSM-V, a person can only be diagnosed with acute stress disorder if they meet the above criteria and the symptoms cause clinically significant problems in the person’s life; this means that the above-mentioned symptoms need to cause impairment in their social, occupational/educational, or other important areas of their life. For acute stress disorder, the symptoms need to present some time between 3 days and 1 month after being exposed to the scary and traumatic experience, and cannot be attributed to a substance dependency or any other mental health issues.

As mentioned above, the symptoms that are present when someone is struggling with acute stress disorder echo the symptoms of PTSD; that is because acute stress disorder is the short-term result of experiencing a traumatic event, and PTSD is the longer-term result. To meet criteria for PTSD, a person must continue to have symptoms in four areas: Intrusive symptoms, negative mood symptoms, avoidance symptoms and hyperarousal symptoms, for longer than one month. Untreated acute stress disorder symptoms can evolve into PTSD and can persist for long periods of time and affect a person severely if not addressed with a mental health professional.

Shannon V. McHugh, PsyD

Dr. Shannon McHugh is a Licensed Clinical and Forensic Psychologist in Los Angeles, California. She specializes in assessment and treatment of children, adolescents, and adults who have developmental and social delays, behavioral difficulties, and those who have experienced traumatic events

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