Psychological Disorders: Acute Stress Disorder
American
Description
A. The person has been exposed to a traumatic event in which both
of the following were present:
1.
the person experienced, witnessed, or was confronted with an event
or events that involved actual or threatened death or serious injury,
or a threat to the physical integrity of self or others
2.
the person's response involved intense fear, helplessness, or horror
B. Either while experiencing or after experiencing the distressing
event, the individual has three (or more) of the following dissociative
symptoms:
1.
a subjective sense of numbing, detachment, or absence of emotional
responsiveness
2.
a reduction in awareness of his or her surroundings (e.g., "being
in a daze")
3.
derealization
4.
depersonalization
5.
dissociative amnesia (i.e., inability to recall an important aspect
of the trauma)
C. 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.
D. Marked avoidance of stimuli that arouse recollections of the trauma
(e.g., thoughts, feelings, conversations, activities, places, people).
E. Marked symptoms of anxiety or increased arousal (e.g., difficulty
sleeping, irritability, poor concentration, hypervigilance, exaggerated
startle response, motor restlessness).
F. The disturbance causes clinically significant distress or impairment
in social, occupational, or other important areas of functioning or
impairs the individual's ability to pursue some necessary task, such
as obtaining necessary assistance or mobilizing personal resources
by telling family members about the traumatic experience.
G. The disturbance lasts for a minimum of 2 days and a maximum of
4 weeks and occurs within 4 weeks of the traumatic event.
H. The disturbance is not due to the direct physiological effects
of a substance (e.g., a drug of abuse, a medication) or a general
medical condition, is not better accounted for by Brief Psychotic
Disorder, and is not merely an exacerbation of a preexisting Axis
I or Axis II disorder.
European
Description
A transient disorder of significant severity which develops in an
individual without any other apparent mental disorder in response
to exceptional physical and/or mental stress and which usually subsides
within hours or days. The stressor may be an overwhelming traumatic
experience involving serious threat to the security or physical integrity
of the individual or of a loved person(s) (e.g. natural catastrophe,
accident, battle, criminal assault, rape), or an unusually sudden
and threatening change in the social position and/or network of the
individual, such as multiple bereavement or domestic fire. The risk
of this disorder developing is increased if physical exhaustion or
organic factors (e.g. in the elderly) are also present.
Individual
vulnerability and coping capacity play a role in the occurrence and
severity of acute stress reactions, as evidenced by the fact that
not all people exposed to exceptional stress develop this disorder.
The symptoms show great variation but typically they include an initial
state of "daze", with some constriction of the field of
consciousness and narrowing of attention, inability to comprehend
stimuli, and disorientation. This state may be followed either by
further withdrawal from the surrounding situation (to the extent of
a dissociative stupor), or by agitation and overactivity (flight reaction
of fugue). Autonomic signs of panic anxiety (tachycardia, sweating,
flushing) are commonly present. The symptoms usually appear within
minutes of the impact of the stressful stimulus or event, and disappear
within 2-3 days (often within hours). Partial or complete amnesia
for the episode may be present.
Diagnostic
Guidelines
There must be an immediate and clear temporal connection between the
impact of an exceptional stressor and the onset of symptoms; onset
is usually within a few minutes, if not immediate. In addition, the
symptoms:
(a)
show a mixed and usually changing picture; in addition to the initial
state of "daze", depression, anxiety, anger, despair, overactivity,
and withdrawal may all be seen, but no one type of symptom predominates
for long;
(b) resolve rapidly (within a few hours at the most) in those cases
where removal from the stressful environment is possible; in cases
where the stress continues or cannot by its nature be reversed, the
symptoms usually begin to diminish after 24-48 hours and are usually
minimal after about 3 days.
This
diagnosis should not be used to cover sudden exacerbations of symptoms
in individuals already showing symptoms that fulfil the criteria of
any other psychiatric disorder, except for those in F60 (personality
disorders). However, a history of previous psychiatric disorder does
not invalidate the use of this diagnosis.
Includes:
* acute crisis reaction
* combat fatigue
* crisis state
* psychic shock