Acute Stress Disorder and PTSD

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Acute stress disorder and post-traumatic stress disorder (PTSD) often go hand-in-hand. This is because a diagnosis of PTSD cannot be made until at least one month after the experience of a traumatic event. Yet, it is likely that people may begin experiencing PTSD-like symptoms soon after a traumatic event.

The 4th edition of the Diagnostic and Statistical Manual of Mental Disorders describes these PTSD-like symptoms occurring within one month of a traumatic experience as Acute Stress Disorder (ASD).


The symptoms of ASD are similar to those of PTSD except they occur soon after the experience of a traumatic event. ASD symptoms include the re-experiencing, avoidance, and hyperarousal symptoms of PTSD. For example, a person with ASD may experience frequent thoughts, memories, or dreams about the traumatic event. They may also constantly feel "on-edge" or try to avoid reminders of the event.

ASD also includes symptoms of dissociation. Dissociation is an experience where a person may feel disconnected from himself and/or his surroundings. Dissociation may range from temporarily losing touch with what is going on around you (such as what happens when you daydream) to having no memories for a prolonged period of time ("blanking out") and/or feeling as though you are outside of your body. You may feel like you are watching yourself as if you were another person.


It is normal to experience certain stress-related symptoms following the experience of a traumatic event. Therefore, to be diagnosed with ASD, a person must meet certain requirements (or criteria). These requirements are described by the DSM-IV and are provided below:

Criterion A

A person must have experienced a traumatic event where both of the following occurred:

  • The person experienced, witnessed, or was confronted with an event where there was the threat of or actual death or serious injury. The event may also have involved a threat to the person's or another person's physical well-being.
  • The person responded to the event with strong feelings of fear, helplessness, or horror.

Criterion B

The person experiences at least three of the following dissociative symptoms during or after the traumatic event:

  • Feeling numb or detached or having difficulties experiencing emotions.
  • Feeling dazed or not entirely being aware of surroundings.
  • Derealization, or feeling as though people, places, and things are not real.
  • Depersonalization or feeling separated and detached from oneself.
  • Dissociative amnesia, or being unable to recall important parts of the traumatic event.

Criterion C

The person has at least one re-experiencing symptom, such as having frequent thoughts, memories, or dreams about the event. This may take the form of "flashbacks" in which the event is experienced as if it were happening against, or nightmares, in which the event is re-lived in some form.

Criterion D

The person attempts to avoid people, places, or things that remind him or her about the event.

Criterion E

The person has hyperarousal symptoms, such as feeling constantly on guard or jumpy, having difficulties sleeping, problems with concentration, or irritability.

Criterion F

The symptoms described above have a great negative impact on the life of the person experiencing them, interfering with work or relationships.

Criterion G

The symptoms last for at least two days and at most four weeks. The symptoms also occur within four weeks of experiencing the traumatic event.

Criterion H

The symptoms are not due to an illness or other medical condition, medication being taken, or alcohol/drug use.


ASD is a serious condition. People with ASD are at greater risk for eventually developing PTSD. Because of the dissociation symptoms of ASD, a person may not be able to recall important parts of the event, as well as the emotions they experienced. This might interfere with a person's ability to fully process the impact of the event and their emotions about the event, hindering the recovery process.

Post-traumatic stress disorder (PTSD) is a difficult-to-treat and heart-wrenching condition that can greatly impact the peace and well-being of survivors of trauma.

It is hoped that by being able to identify acute stress disorder through these criteria, those who are at risk of developing PTSD will be better identified and monitored so that they can be helped before their symptoms progress to PTSD.

There has been debate over how well ASD can predict PTSD—most people with ASD go on to develop PTSD, but many people diagnosed with PTSD do not have a history of prior ASD. Yet, in addition to having predictive value for PTSD, ASD is a serious condition deserving of thoughtful care and treatment in its own right.

If you think you may have ASD, it is important that you meet with a mental health professional trained in assessing and treating ASD. The earlier you recognize and address these symptoms, the greater the chance you have of preventing the development of PTSD, and the greater the chance that you can get started right away in coping with the symptoms you currently have.

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