Alberto is a twenty year old boy. One day, while he was stopped at a traffic light with his car, he watched another speeding car pass by him. He followed the car with his eyes and, to his surprise, saw him recessed against a parked truck. The car turned a bell and the driver did not leave the interior of the vehicle. Alberto approached to try to help, but the driver did not move. Alberto knew he was dead. Since then, our protagonist takes two weeks with insomnia and is unable to not think about that event. He feels irritated and suffers panic attacks. What happens to our friend? Suffer an acute stress disorder.
- 1 Diagnostic Criteria for Acute Stress Disorder
- 2 Features that support the diagnosis
- 3 Treatment
Diagnostic Criteria for Acute Stress Disorder
Through the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) we will deepen the acute stress disorder.
A. The traumatic event
The subject has been exposed to death, serious injury or sexual violence, whether real or threatening, in one (or more) of the following ways:
- Direct experience of the traumatic event, that is, when we are the protagonists of the event.
- Direct presence of the event occurred to others. For example, witness a traffic accident or a natural disaster.
- Knowledge that the traumatic event has occurred to a close relative or a close friend.
- Repeated or extreme exposure to repulsive details of the traumatic event. For example, professionals who work in palliative care and are in direct contact with dying patients.
Presence of nine (or more) of the following symptoms of any of the five categories of intrusion, negative mood, dissociation, avoidance and alertness, which begins or worsens after the traumatic event:
- Presence of distressing and recurring, involuntary and intrusive memories of the event.
- Recurring distressing dreams in which the content of the dream is related to the event.
- Dissociative reactions in which the individual feels or acts as if the traumatic event is repeated.
- Intense or prolonged psychological distress, or important physiological reactions in response to internal or external factors that symbolize or resemble an aspect of the traumatic event. For example, if you have a traumatic experience with the car, everything that symbolizes or resembles a car can cause discomfort.
5. Persistent inability to experience positive emotions. This disability is lengthened in time between three days and one month after the event.
6. Sense of reality altered. It can refer to both the environment and oneself.
7. Inability to remember an important aspect of the traumatic event. In this case, the main cause would be dissociative amnesia instead of factors such as an injury, alcohol, drugs or any other substance.
8. The person strives to avoid memories, thoughts or distressing feelings associated with the traumatic event. These memories, thoughts or feelings, are presented automatically and are difficult to control.
9. Efforts to avoid external reminders that awaken memories, thoughts or feelings distressing associated with the traumatic event. For example, if a relative has passed away, the affected subject tries to avoid seeing photos in which the relative leaves, or avoids entering his room, smelling his perfume, seeing his clothes, etc.
10. Sleep disturbance. This alteration can range from difficulty falling asleep, to keep it at night or wake up early, as well as the presence of excessive sleepiness during the day or periods of insomnia.
11. Irritable behavior and outbursts of fury which are typically expressed as verbal or physical aggression against people or objects. Outbursts of fury and irritability trigger without any provocation or with very little. The behavior becomes obviously hostile.
13. Problems with concentration. Faced with an episode of acute stress, attention and concentration can be easily affected, since attention can be diverted again and again to the events of the traumatic event.
14. Exaggerated startle response.
One of the main features of acute stress disorder is the appearance of symptoms associated with a Duration between three days and one month after the traumatic event.
The effects of acute stress disorder cause clinically significant discomfort and influences social, labor and other important areas for the subject. It is a dysfunctional disorder that does not allow the subject to live their day to day normally.
Acute stress disorder cannot be associated with any physiological effect of any substance (drugs, alcohol, medications, etc.). It is also not due to a medical condition and is not best explained by a brief psychotic disorder.
Features that support the diagnosis
In general, people who suffer from this disorder usually have catastrophic or negative thoughts about your role in the incident. Some of the most recurring thoughts are those in which the subject feels that he could have done something else to avoid the event or that in which he is blamed because he believes he could have had a more successful behavior.
Memories of the traumatic event can cause panic attacks during the first month after the event. These attacks can be elicited both by the memory of the event and spontaneously. Risk and reckless behavior can also be observed in subjects suffering from this disorder. For example, they can drive recklessly, have impulsive behavior or gamble uncontrollably.
The most frequent treatment is cognitive-conductal therapy. Through this therapy, one works at the level of thought, behavior and emotions. It deepens the maladaptive thoughts of the subject and is replaced by functional thoughts. The detection of this type of thoughts and the substitution by thoughts that allow the subject to improve their stress levels are practiced in therapy. In this way, it will also influence your emotions and your behavior.
Aspects such as relaxation are important in therapy. It is common that in the acute stress disorder the individual may suffer from panic attacks, so it is essential to learn to detect body signals and intrusive thoughts in order to prevent these attacks. On the other hand, pharmacological treatments also become important when the patient's symptoms worsen. Antidepressants and anxiolytics can provide support, as long as you work at a psychological level..
American Psychiatric Association (2014). Diagnostic and statistical manual of mental disorders. Madrid: Pan American Medical Editorial.