Crisis Acute Stress Disorder and PTSD

Before we get into the details of the effects of exposure to traumatic stress, a quick word needs to be said about the difference between the immediate response to a traumatic stressor and more long-term responses.

Certainly, when we are in the midst of a situation of extreme and potentially traumatic stress, the potential for psychological crisis to emerge is high. A crisis is defined as a temporary state of upset and disorganization, characterized by an inability to cope with a particular situation or stimulus using customary methods. The crisis literature is extensive, and for more information the reader is directed to Slaikeu (1990). However, PTSD is about the aftermath of such a crisis, both the relatively short-term effects (acute-more than 1 month but less than 3 months), long-term effects (3 months or more), or even the delayed effects (onset of symptoms 6 months after an event).

Responses to traumatic stressors can be as varied as there are people in the world. A crisis may not necessarily lead to a mental disorder or psychiatric diagnosis. Some severe responses that would certainly constitute a crisis but not necessarily a diagnosable mental disorder are referred to as peritraumatic reactions-reactions that occur during the impact or immediate phase of a stressor (Shalev, 1996). Some peritraumatic responses are agitation, stupor, panic, numbing, freezing up, disorganization, and even dissociation. The key thing to remember is that these responses are temporary and transient and may occur in isolation. They go away, and they don't cluster together into Acute Stress Disorder (ASD).

Acute Stress Disorder is a formal mental disorder identified in the DSM-IV-TR. If someone meets criteria A1 and A2 and experiences qualified symptoms, he or she may meet criteria for ASD. Their symptoms have to last a minimum of 2 days and a maximum of 4 weeks, after which PTSD will be diagnosed. Three of the following dissociative symptoms must be present: a subjective sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of his or her surroundings (e.g., being in a daze); derealization; deper-sonalization; or dissociative amnesia (an inability to recall an important aspect of the trauma). They must also have at least one reexperiencing symptom, one avoidance symptom, and marked symptoms of anxiety or arousal, such as difficulty sleeping, irritability, poor concentration, or exaggerated startle. Research has shown that as much as 80 percent of those who suffer from ASD will develop PTSD (Brewin, Andrews, Rose, & Kirk, 1999).

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