Acute Stress Disorder is a trauma-related mental disorder that occurs following exposure to a traumatic event involving actual or threatened death, serious injury, or threat to physical integrity of oneself or others

The individual experiences intense fear, helplessness, or horror during or immediately after the traumatic event

Symptoms develop shortly after the trauma and last from 3 days to 1 month

Epidemiology

• Common following severe traumatic experiences

• Occurs after events such as natural disasters, accidents, violence, assault, war, or serious medical emergencies

• A proportion of patients with acute stress disorder may later develop post-traumatic stress disorder

Risk Factors

Trauma-Related Factors

• Severity and duration of traumatic exposure

• Direct exposure to life-threatening events

• Repeated trauma exposure

Individual Factors

• Previous trauma history

• Previous mental health disorders

• Limited social support

• High emotional vulnerability

Biological Factors

• Dysregulation of stress response pathways

• Increased activity of the hypothalamic–pituitary–adrenal axis

Pathophysiology

Acute stress disorder develops due to abnormal processing of traumatic experiences involving:

• Increased stress hormone activation

• Heightened fear response from the amygdala

• Impaired regulation from the prefrontal cortex

• Altered memory processing leading to intrusive recollections

Clinical Presentation

Symptoms usually occur within 4 weeks of the traumatic event

Intrusion Symptoms

• Re-experiencing the traumatic event

• Flashbacks

• Distressing memories

• Trauma-related nightmares

Avoidance Symptoms

• Avoidance of thoughts related to the trauma

• Avoidance of places, people, or situations associated with the event

Negative Mood and Cognitive Symptoms

• Fear

• Helplessness

• Detachment

• Difficulty remembering aspects of the event

• Negative emotional state

Arousal Symptoms

• Hypervigilance

• Increased startle response

• Irritability

• Sleep disturbance

• Difficulty concentrating

Diagnostic Criteria (DSM-5 Based)

Diagnosis requires:

• Exposure to a traumatic event

• Presence of symptoms from intrusion, avoidance, negative mood, dissociation, and arousal categories

• Symptoms lasting from 3 days to 1 month after trauma

• Clinically significant distress or impairment

• Symptoms not caused by substances or another medical condition

Differential Diagnosis

• Post-traumatic stress disorder

• Adjustment disorder

• Major depressive disorder

• Generalized anxiety disorder

• Panic disorder

• Substance-induced anxiety disorder

• Delirium

Investigations

Diagnosis is clinical

Investigations may be required to exclude physical injuries or medical causes

Possible investigations include:

• Full physical assessment

• Mental state examination

• Substance use assessment

• Relevant investigations based on the nature of trauma

Management

Management aims to provide psychological support, reduce distress, and prevent progression to chronic trauma-related disorders

Non-Pharmacological Management

• Reassurance and emotional support for patient and family

• Provide a safe and supportive environment

• Psychoeducation about normal trauma reactions

• Supportive psychotherapy

• Cognitive Behavioural Therapy (CBT)

• Encourage healthy coping strategies

• Address social support needs

Pharmacological Management

Medication is not routinely required for all patients

Acute Anxiety or Agitation

Clonazepam PO 0.5–2 mg once daily to every 12 hours

Duration:

• Use for short-term treatment only

• Maximum duration 2 weeks

• Gradually taper before stopping

Important Notes

• Prolonged benzodiazepine use may interfere with psychological adaptation after trauma

• Long-term benzodiazepine therapy should be avoided

Referral

Refer to the next level of care when:

• Symptoms persist beyond expected duration

• There is inadequate response to treatment

• There are significant comorbid psychiatric conditions

• There is severe functional impairment

• There is suicidal risk

Prognosis

• Many patients recover with early psychological support

• Some patients may progress to post-traumatic stress disorder

• Early intervention and social support improve outcomes

Patient Education

Patients and families should understand:

• Stress reactions after trauma are common

• Recovery may occur gradually

• Avoiding all reminders of trauma may prolong symptoms

• Psychological support improves recovery

• Seek medical review if symptoms persist or worsen