Author's Note: Post-traumatic stress disorder (PTSD) can develop following an MVA when the patient has been previously diagnosed with mTBI, acute stress disorder (ASD) or post-concussion syndrome (PCS). In this installment, clinical criteria leading to the diagnosis of ASD are reviewed that may give insight into the evolving PTSD.
Acute stress disorder (ASD) is a psychiatric injury with an initial “stressor" that develops following the patient's involvement in or witnessing of a traumatic event.1 Acute stress disorder was introduced in the 1994 Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV).2
ASD Symptoms / Diagnosis
Most people normally experience emotional stress following involvement or exposure to a traumatic event.2 Therefore, a diagnosis of ASD can only be considered when the patient continues to experience ASD symptoms beyond the third day through the end of the first month following a traumatic event.
The DSM-IV lists 14 symptoms that are associated with ASD.1-2 The presence of any nine of the 14 criteria lasting 3-30 days following the traumatic event qualify the ASD diagnosis.1
Intrusions (1-4): Recurrent, involuntary and intrusive memories of the traumatic event. Recurrent distressing dreams of the traumatic event, dissociative flashbacks involving the traumatic event, and intense psychological or physiological reactions that remind them of the traumatic event.
Negative mood (5): An inability to experience positive emotion; emotional numbing.
Dissociative symptoms (6-7): A derealization, depersonalization or disassociated amnesia of the critical events of the trauma.
Avoidance (8-9): Purposeful avoidance of memories, thoughts and feelings of the trauma or avoidance of external reminders of the trauma.
Arousal (10-14): Sleep disturbances, irritable behavior, hypervigilance, inability to concentrate, and exaggerated startle response.
ASD Progressing to PTSD
Many symptoms associated with ASD continue and form the basis of symptoms associated with PTSD. Peritraumatic dissociation, dissociation experienced just after the traumatic event, is the foundation of ASD.1
Clusters, a foundation of PTSD, are not a diagnostic component of ASD. Acute stress disorder is based upon the totality of symptoms described above.2
Acute stress disorder may be predictive of the patient developing PTSD. Two studies of patients involved in motor-vehicle accidents initially diagnosed with ASD developed PTSD 50%-78% when followed up at six and eight months, respectively. These studies suggest a strong relationship, but not a perfect predictor, for an individual developing PTSD following involvement in a MVA and initially diagnosed with ASD.3-5
An ASD downloadable questionnaire, the Severity of Acute Stress Symptoms – Adult (National Stressful Events Survey Acute Stress Disorder Short Scale), that can assist in the clinical assessment of ASD can be accessed through Psychiatry.Org. You can download the questionnaire here.
Editor’s Note: Part 1 of this four-part article appeared in the March web issue; part 2 ran in the April issue.
References
- Evans R. Neurology and Trauma. New York, NY: Oxford University Press, 2006: pp. 617-618.
- Bryant R. Acute Stress Disorder. New York, NY: The Guilford Press, 2016: pp. 21-25.
- Fuglsang A, Hanspeter M, Ulrich S. Does acute stress disorder predict post-traumatic stress disorder in traffic accident victims? Analysis of a self-report inventory. Nordic J Psychiatry, 2004;58(3):223-9.
- Evans R, Op Cit, pp. 96-98.
- Beck J, Coffey S. Assessment and treatment of PTSD after motor vehicle collision: empirical findings and clinical observations. Prof Psychol: Res Pr, 2007 December;38(6):629-639.
