Psych · General adult psychiatry — trauma and stressor-related disorders
Acute stress disorder
Also known as ASD · Acute stress reaction (related ICD construct — not identical) · Post-traumatic acute stress syndrome (descriptive) · Early post-trauma stress syndrome
Exam-exhaustive fellowship reference on acute stress disorder — DSM-5-TR Criterion A, 3-day to 1-month window, ≥9 of 14 symptoms, DSM-IV dissociation change, limited PTSD predictive utility, differentials, psychological first aid, prohibition of mandatory single-session debriefing, trauma-focused CBT evidence (Bryant trials), selective pharmacology, ICD-11 contrast, and special populations. FRANZCP-primary, globally tagged.
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Red flags
- Active suicidal ideation, planning, or inability to stay safe after trauma — structured risk assessment and appropriate setting intensity
- Ongoing interpersonal or sexual violence, stalking, or unsafe discharge destination — safeguarding before outpatient psychology booking alone
- Altered consciousness, focal neurology, or amnesia out of proportion — exclude TBI, seizure, intoxication, and medical catastrophe first
- Acute agitation with risk of harm in ED/ward — medical resuscitation and least-restrictive behavioural emergency care
- Forced single-session psychological debriefing of all trauma-exposed people — not evidence-based for PTSD prevention
- Chronic daily benzodiazepines started for acute trauma distress without exit plan — dependence and blocked processing
Meet the patient
A 26-year-old cyclist was hit by a car ten days ago. The fractures were minor and the orthopaedic team is delighted. She is not. She replays the headlights every night, sleeps two hours, feels "like I'm watching myself from the ceiling," and now takes a forty-minute detour to avoid the intersection. Her partner says she jumps when a door closes.[1][3]
Every examiner's question hangs off this woman: is this a disorder yet, what do you offer this week, and what do you never do? Count the days, count the symptoms, and keep the debriefing manual on the shelf.[1][3][8]
References12ShowHide
- [1]Bryant RA, Friedman MJ, Spiegel D, Ursano R, Strain J A review of acute stress disorder in DSM-5 Depress Anxiety, 2011.PMID 21910186
- [2]Bryant RA Acute stress disorder as a predictor of posttraumatic stress disorder: a systematic review J Clin Psychiatry, 2011.PMID 21208593
- [3]Bryant RA The Current Evidence for Acute Stress Disorder Curr Psychiatry Rep, 2018.PMID 30315408
- [4]Bryant RA, Sackville T, Dang ST, Moulds M, Guthrie R Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counseling techniques Am J Psychiatry, 1999.PMID 10553743
- [5]Bryant RA, Mastrodomenico J, Felmingham KL, Hopwood S, et al. Treatment of acute stress disorder: a randomized controlled trial Arch Gen Psychiatry, 2008.PMID 18519824
- [6]Bryant RA, Harvey AG, Dang ST, Sackville T, Basten C Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling J Consult Clin Psychol, 1998.PMID 9803707
- [7]Bryant RA, Moulds ML, Nixon RV Cognitive behaviour therapy of acute stress disorder: a four-year follow-up Behav Res Ther, 2003.PMID 12643970
- [8]Rose S, Bisson J, Churchill R, Wessely S Psychological debriefing for preventing post traumatic stress disorder (PTSD) Cochrane Database Syst Rev, 2002.PMID 12076399
- [9]Maercker A, Brewin CR, Bryant RA, Cloitre M, et al. Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11 World Psychiatry, 2013.PMID 24096776
- [10]Ehlers A, Clark DM A cognitive model of posttraumatic stress disorder Behav Res Ther, 2000.PMID 10761279
- [11]Bryant RA, Creamer M, O'Donnell M, Silove D, McFarlane AC The capacity of acute stress disorder to predict posttraumatic psychiatric disorders J Psychiatr Res, 2012.PMID 22088925
- [12]Classen C, Koopman C, Hales R, Spiegel D Acute stress disorder as a predictor of posttraumatic stress symptoms Am J Psychiatry, 1998.PMID 9585712