Acute stress disorder

Most people by now have heard about post-traumatic stress disorder (PTSD), which is marked by recurring flashbacks or dreams about a traumatic event, as well as by other symptoms such as difficulty sleeping or interacting with people in certain situations. But recently I consulted with a colleague about an elderly man who was suffering from a related problem: acute stress disorder.

The experience reminded me that although acute stress disorder is more common than PTSD, it's less well known. That's too bad, because many people who suffer from acute stress disorder would benefit from treatment.

Here's the story that got my attention. A 70 year-old man living in Massachusetts was driving a car and got into an accident. His wife, who was riding in the passenger seat, nearly died.

Fortunately, she recovered—but only after spending several weeks in the hospital and in a rehabilitation center. During the first few weeks, the elderly driver was extremely anxious. My colleague, a social worker helping the family, told me that the man jumped when he heard a siren or a honking horn. He told her he felt as if he was sleepwalking through conversations with family members. He felt guilty that he wasn't harmed in the accident. He dreamt of the events leading up to the collision, but in these dreams he swerved, narrowly avoiding the other car.

My colleague thought initially the man might be suffering from PTSD, but given the short time frame, I thought it was more likely that he was experiencing acute stress disorder.

The two disorders are similar, but are differentiated by the length of time symptoms persist. Symptoms of both disorders include:

• Being easily startled
• Flashbacks or dreams about a traumatic event
• Withdrawing from people and certain situations
• Feeling numb or detached
• Difficulty sleeping

In acute stress disorder, these symptoms last at least two days, but less than one month. PTSD is diagnosed when the symptoms persist for one month or longer.

Studies show that 14% to 33% of people who have been exposed to a severe trauma experience acute stress disorder. Some of them will go on to develop PTSD, which affects about 10% to 14% of women, and 5% to 6% of men, at some point in their lives.

Acute stress disorder can develop in anyone who has experienced something extremely stressful. Other factors heighten the risk, including a psychiatric disorder, lack of supportive friendships, and emotional deprivation during childhood.

Fortunately, treatments can help many people. Cognitive behavioral therapy, which aims to identify and change exaggerated responses and distorted ways of thinking, is often tried first. The goal is to reduce the emotional hold of the original trauma, while also reducing anxiety in other situations. Medication, including benzodiazepines, is sometimes prescribed for people who have trouble sleeping, severe anxiety, or both.

But because acute stress disorder, by its very nature, is short-lived, many people either do not need psychotherapy or find that their symptoms diminish before they seek help.

That's actually what happened to the elderly man I first mentioned. After about three weeks, as his wife's condition improved, her husband also began to feel better. Although he still thought of the accident, the images became less disturbing and intrusive. He started sleeping better, and slowly became less jumpy and anxious.

Last I heard, he and his wife were both back at home, and getting back to normal.

Have you or someone you know experienced a traumatic event, such as a car accident? Did you suffer from any anxiety symptoms afterwards? How did you deal with them?

Dr. Michael W. Kahn is an Assistant Professor in the Department of Psychiatry at Harvard Medical School, and is medical Director of Ambulatory Psychiatry at the Beth Israel Deaconess Medical Center in Boston.

Anxiety and Phobias
Anxiety disorders—which include panic attacks, post-traumatic stress disorder, obsessive-compulsive disorder, and phobias—are among the most common mental illnesses, affecting about 23 million American adults. Thankfully, never before have there been so many therapies to help control anxiety. Coping With Anxiety and Phobias is a special report from Harvard Medical School that provides up-to-date information on these treatments, as well as information on the many types of anxiety disorders, their symptoms, causes, and getting a proper diagnosis.

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