Acute stress reaction

Essential Features:

• Exposure to an event or situation (either short- or long-lasting) of an extremely threatening or horrific nature. Such events include, but are not limited to, directly experiencing natural or human-made disasters, combat, serious accidents, torture, sexual violence, terrorism; assault, acute life-threatening illness (e.g., a heart attack); witnessing the threatened or actual injury or death of others in a sudden, unexpected, or violent manner; and learning about the sudden, unexpected or violent death of a loved one.
• The development of a response to the stressor that is considered to be normal given the severity of the stressor. The response to the stressor may include transient emotional, somatic, cognitive, or behavioural symptoms, such as being in a daze, confusion, sadness, anxiety, anger, despair, overactivity, inactivity, social withdrawal, amnesia, depersonalization, derealisation, or stupor. Autonomic signs of anxiety (e.g., tachycardia, sweating, flushing) are common and may be the presenting feature.
• Symptoms typically appear within hours to days following the stressful event, and usually begin to subside within a few days after the event or following removal from the threatening situation, when this is possible. In cases where the stressor is ongoing or removal is not possible, symptoms may persist but are usually greatly reduced within approximately 1 month as the person adapts to the changed situation.

Additional Clinical Features:

• Acute Stress Reaction in help-seeking individuals is usually, but not necessarily, accompanied by substantial subjective distress and/or interference with personal functioning.

Developmental Presentations:

• In children, responses to stressful events can include somatic symptoms (e.g., stomachaches or headaches), disruptive or oppositional behaviour, regression, hyperactivity, tantrums, concentration problems, irritability, withdrawal, excessive daydreaming, increased clinginess, bedwetting, and sleep disturbances. In adolescents, responses can include substance use and various forms of acting out or risk-taking.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with Adjustment Disorder and Post-Traumatic Stress Disorder: If symptoms have not begun to diminish within about 1 week of the stressor ceasing (or within about 1 month in the case of continuing stressors), a diagnosis such as Adjustment Disorder or Post-Traumatic Stress Disorder should be considered, depending on the nature of the symptoms.
• Boundary with Acute and Transient Psychotic Disorder: Acute and Transient Psychotic Disorder, like Acute Stress Reaction, has an acute onset and may occur in response to a traumatic experience. Acute Stress Reaction does not typically include psychotic symptoms such as hallucinations or delusions that are characteristic of Acute and Transient Psychotic Disorder.
• Boundary with other mental disorders: The symptoms do not meet the diagnostic requirements for another mental disorder, such as Acute and Transient Psychotic Disorder, a Depressive Disorder, an Anxiety or Fear-Related Disorder, or a Dissociative Disorder.