Acute Trauma

There are many different types of trauma, and each type is characterised by general and specific symptoms. The main types of trauma are:

Acute Trauma
Complex Trauma
Chronic Trauma

This blog will explore acute trauma, more commonly known as Acute Stress Disorder (ASD), along with its primary causes and common symptoms.

What is Acute Trauma? (Acute Stress Disorder)

Acute trauma refers to trauma that has occurred due to a single event.^[1] The event itself was so overwhelming that our autonomic nervous system – the branch of the nervous system responsible for survival^[2] – became stuck in its threat response.^[3] The overwhelming threat, which could have been anything from an instance of sexual abuse to a natural disaster, elicited a threat response in the body. This is supposed to happen. Our autonomic nervous system has worked to respond to threats effectively for thousands of years.

However, for some this threat response is dysfunctional and maladaptive. When faced with a threat, it is normal for the ANS to kick into high gear and mobilise for action, or shut us down to prevent a psychological collapse. Once the threat has passed and we are no longer in danger, the ANS should return to normal. This is the case for many, but for some, the ANS remains in high activation and persistently informs the brain and the body that the threat is still present.

What causes Acute Stress Disorder?

Acute Stress Disorder occurs when a person directly experiences or witnesses a traumatic event. For an event to be traumatic, it usually involves the reality or perception that one’s life in danger.

Examples of traumatic events that can lead to ASD include^[4]:

Combat
Terrorist attacks
Sudden grief (death of a loved one)
Physical or sexual assault or abuse
Motor accidents
Natural disasters (floods, earthquakes, fires)
Being diagnosed with a life-threatening condition

Risk Factors for Acute Stress Disorder

ASD can affect some more than others. There are certain risk factors to take into account when assessing a person’s likelihood of developing ASD. These include^[5]:

Availability of resources post-event (food, water, shelter, social support)
Proximity to the event
Similarity to the survivor (if the person was a witness)
Stressors over the previous six months
History of mental illness

Even the healthiest of us can become traumatised, but how that trauma develops and persists varies depending on the above factors. Regarding six-month stressors; when we are frequently stressed, tired, even exhausted, our ability to handle stress diminishes. Stress takes a significant toll on the mind and body, and the longer we are exposed to it, the less resilience we will have in the face of traumatic events.

One’s history of mental illness also plays a role in the onset and severity of ASD and its potential to develop into PTSD. This does not just refer to more extreme examples of mental illness either, such as schizophrenia or other psychotic disorders. More common mental health issues such as depression, anxiety, or substance abuse make it harder for a person to cope with any trauma that occurs in their life, increases the severity of ASD symptoms, and thus increase the likelihood that PTSD will occur.

How is Acute Stress Disorder Diagnosed?

A person may be eligible for a diagnosis if they have experienced the symptoms of Acute Stress Disorder for at least three days. It is not possible to self-diagnose, as an unbiased, objective perspective is needed. A professional healthcare practitioner will assess the person’s symptoms, and if they meet the diagnostic criteria for Acute Stress Disorder (as outlined below), then a diagnosis can be made.

Diagnostic criteria for ASD, according to the Diagnostics and Statistical Manual of Mental Disorders Fifth Edition^[6], include:

Exposure to death or threatened with death, serious injury or sexual violation
Experiencing at least 9-14 associated symptoms, categorised under: intrusion, negative mood, dissociation, avoidance, and arousal
Duration of the disturbance (symptoms must last at least three days)
Significant distress (daily life is impacted by the severity of distress)
Symptoms are not due to other causes (pre-existing health condition, substance abuse)

Symptoms of Acute Stress Disorder

ASD usually shows up within four weeks after the traumatic event. If unresolved, ASD can develop into PTSD. The symptoms of acute ASD are many, and some may be less noticeable than others from an outsider perspective.

The symptoms of ASD include^[7]:

Severe anxiety
Panic
Confusion
Dissociation (numbing, detachment, lack of emotional responsiveness)
Re-experiencing the event (intrusive memories, dreams)
Avoidance (discussion about the event, triggers, loved ones)
Hypervigilance (resulting in insomnia or other sleep problems, poor concentration)
Explosive behaviour (outbursts of anger, high irritability)
Neglect of personal hygiene and grooming
Reduced work or school performance
Substance abuse
Suicidal thoughts
Grief

The Importance of Treatment

The symptoms and effects of acute trauma can be extremely difficult and challenging. It can be hard for an acute trauma survivor to move on from their experience, despite a desire to do so. Due to the related difficulties, some survivors turn to substance use for self-medication.

Alcohol, cannabis, and benzodiazepines are often used to alleviate feelings of stress and overwhelm.^[8] However, self-medication is a dangerous path as the relief provided by substances is only temporary. Whatever distress or discomfort has led the person to substance use will return when the effects of those substances inevitably wear off.

What are the goals of treatment for Acute Stress Disorder?

Treatment for ASD is available and typically involves psychotherapy in the form of trauma-focused Cognitive Behavioural Therapy (TFCBT).^[9] Unlike treatment for PTSD, medication is not usually recommended as a first-line treatment for ASD. If medication is prescribed, it is done so in minimal dosage and for a short course.

Psychotherapeutic treatment for ASD is geared towards:

Reducing the severity of symptoms
Reducing the risk of the client developing PTSD
Restoring a sense of safety and trust in the client

If medication is prescribed, it is used for:

Reduction of the physical symptoms of ASD
Short-term anxiety relief

Acute Stress Disorder is Treatable

Suffering from Acute Stress Disorder can be extremely difficult and challenging, but healing is possible. With professional treatment, the causes of ASD can be addressed and clients can be assessed for any underlying mental health conditions which may be exacerbating their symptoms.

Get in touch

If you have a client, or know of someone who is struggling to heal from psychological trauma, including ASD, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources

^[1] Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/

^[2] Harvard Health. 2011. Understanding The Stress Response – Harvard Health. [online] Available at: <https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response> [Accessed 23 October 2020].

^[3] Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/

^[4] Ada. 2019. Signs Of Acute Stress Disorder | Ada. [online] Available at: <https://ada.com/conditions/acute-stress-disorder/> [Accessed 23 October 2020].

^[5] Eske, J., 2019. Acute Stress Disorder: Symptoms, Causes, And Treatment. [online] Medicalnewstoday.com. Available at: <https://www.medicalnewstoday.com/articles/324354#risk-factors> [Accessed 24 October 2020].

^[6] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013

^[7] Bryant, R., 2019. Acute Stress Disorder In Adults: Epidemiology, Pathogenesis, Clinical Manifestations, Course, And Diagnosis. [online] Uptodate.com. Available at: <https://www.uptodate.com/contents/acute-stress-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-and-diagnosis> [Accessed 23 October 2020].

^[8] Sinha, R., 2008. Chronic Stress, Drug Use, and Vulnerability to Addiction. Annals of the New York Academy of Sciences, 1141(1), pp.105-130.

^[9] Ursano, R., Bell, C., Eth, S., Friedman, M., Norwood, A., Pfefferbaum, B., Pynoos, R., Zatzick, D. and Benedek, D., 2004. Practice Guideline For The Treatment Of Patients With Acute Stress Disorder And Posttraumatic Stress Disorder. [ebook] American Psychiatric Association. Available at: <https://www.researchgate.net/profile/Robert_Ursano/publication/8112203_Guideline_for_the_treatment_of_patients_with_acute_stress_disorder_and_posttraumatic_stress_disorder/links/0912f50a812cea0ae3000000/Guideline-for-the-treatment-of-patients-with-acute-stress-disorder-and-posttraumatic-stress-disorder.pdf> [Accessed 24 October 2020].