A review of acute stress disorder in DSM-5

Abstract

Acute stress disorder (ASD) was introduced into DSM-IV to describe acute stress reactions (ASRs) that occur in the initial month after exposure to a traumatic event and before the possibility of diagnosing posttraumatic stress disorder (PTSD), and to identify trauma survivors in the acute phase who are high risk for PTSD. This review considers ASD in relation to other diagnostic approaches to acute stress responses, critiques the evidence of the predictive power of ASD, and discusses ASD in relation to Adjustment Disorder. The evidence suggests that ASD does not adequately identify most people who develop PTSD. This review presents a number of options and preliminary considerations to be considered for DSM-5. It is proposed that ASD be limited to describing severe ASRs (that are not necessarily precursors of PTSD). The evidence suggests that the current emphasis on dissociation may be overly restrictive and does not recognize the heterogeneity of early posttraumatic stress responses. It is proposed that ASD may be better conceptualized as the severity of acute stress responses that does not require specific clusters to be present.

Acute stress disorder and defense mechanisms: a study of physical trauma patients admitted to an emergency hospital

“…10,38,39 Furthermore, a previous study that (Table 5). as depression, anxiety, and academic performance in a population of medical students continuously exposed to this stressful area of education.…”

“…Studies highlight that the prevalence of ASD can vary from 7 to 28% among trauma sufferers. 10 Researchers have diagnosed ASD in 16% of 62 hospitalized motor vehicle accident victims and in 14% of 79 patients hospitalized after traumatic brain injury. 11,12 A longitudinal study using DSM-IV criteria found evidence for ASD in 10% of a total of 1,129 patients from five large trauma centers in Australia who suffered traumatic injury.…”

Acute stress disorder and the transition to posttraumatic stress disorder in children and adolescents: Prevalence, course, prognosis, diagnostic suitability, and risk markers

“…Moreover, given the discrepancy between the prevalence of ASD—based on both the DSM‐IV and particularly the DSM‐5 algorithms—and the number of participants reporting impairment, the acute diagnosis has limited utility for identifying clinically significant traumatic stress in the acute phase in youth. This insensitivity to acute impairment is at odds with one of the main purposes for ASD, that is, identifying cases that warrant treatment in the acute phase (Bryant, Friedman, & Spiegel, 2011). This weakness largely stems from the large number of symptoms required; reducing the threshold to four symptoms (while retaining the impairment criterion) doubled the prevalence of identified disorder.…”

The psychological impact of the rapid diagnostic centres in cancer screening: A systematic review

“…According to the DSM V, acute stress disorder associated with a traumatic event occurs between two days and four weeks after the event (Bryant, Friedman, Spiegel, Ursano, & Strain, 2011). After this time, a chronic stress response diagnosis such as post-traumatic stress disorder can be made in patients meeting the criteria (Bryant et al, 2011).…”