Understanding the Differences Between Acute Stress Disorder vs PTSD

Acute stress disorder and post-traumatic stress disorder have many of the same diagnosis criteria. The key difference between ASD and PTSD is the timeframe in which the traumatic events happened. Acute stress disorder is experienced within the first month after experiencing a traumatic event, while PTSD is experienced at least a month after the traumatic event.

Key Points

• In both ASD and PTSD, you must have experienced a traumatic event
• ASD is experienced within the first month of the post-traumatic event and requires a combination of symptoms across different categories.
• PTSD is experienced a month or longer after the traumatic event and has a more specific range of symptoms.

What are the key differences between ASD and PTSD?

Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are both mental health diagnoses that you may have after experiencing a traumatic event. The main difference between ASD and PTSD is the timeframe after which the traumatic event occurred.

Traumatic Event

ASD and PTSD have the same definition of a traumatic event exposure, which is an actual or threatened death, serious injury, or sexual violation.[1] This exposure can be a traumatic event

• you experienced yourself
• you witnessed happening to someone else
• you learned of a violent event or death experienced by a friend or family member
• you experienced repeated exposure to traumatic events such as that experienced by first responders.

Timeframe

Acute stress disorder (ASD) is a mental health condition experienced within the first month of exposure to a traumatic event.[2] You began experiencing these symptoms immediately after the traumatic event, and they last for at least three days and up to a month. The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.

Post-traumatic stress disorder (PTSD) is a mental health condition where symptoms are present a month or longer after the traumatic event is experienced.[3] The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.

Symptoms

The symptoms of PTSD and ASD are similar but differ in a few ways. PTSD must meet a set number of criteria in each of the four categories, while ASD must meet a total of nine symptoms from the five categories: intrusion, negative mood, dissociation, avoidance, and arousal.

Symptoms of PTSD

The following are the four categories with how many symptoms must be met for each category for a PTSD diagnosis according to the DSM-5.[4]

Intrusion Symptoms (one or more symptoms)

• Recurrent, involuntary, and intrusive distressing memories
• Recurrent distressing dreams or nightmares
• Feeling like you are reliving the event, aka flashbacks
• Seeing, hearing, or smelling something that causes you to relive the event. This is a trauma reminder, cue, or trigger. Examples of a trauma trigger can be news reports, seeing an accident, or hearing fireworks.

Avoidance Symptoms (one or more symptoms)

• Attempts to avoid distressing thoughts, memories, or feelings connected to the traumatic event.
• Attempts to avoid reminders that cause distressing thoughts, memories, or feelings connected to the traumatic event. This can include people, places, things, conversations, activities, and situations.

Negative Mood Symptoms (two or more symptoms)

• Unable to remember key aspects of the traumatic event (this is due to dissociative amnesia and not alcohol, drugs, or a head injury).
• Constant and exaggerated negative beliefs about yourself or others.
• Distorted beliefs about the cause of the traumatic event which result in self-blame.
• Constant negative emotional state (fear, anger, horror, guilt, shame).
• Diminished interest in activities that used to be pleasurable
• Feeling estranged from others
• Inability to experience positive emotions (unable to feel happy or experience satisfaction or loving feelings).

Arousal Symptoms (two or more symptoms)

• Difficulty sleeping (problems falling or staying asleep, fitful sleep).
• Angry outbursts or irritable behavior that can be verbally or physically aggressive towards people or things.
• Hypervigilance.
• Problems with concentration.
• Exaggerated startle response.

Symptoms of ASD

To receive an ASD diagnosis, you must have a total of nine symptoms from the five categories. They can be any combination of intrusion, avoidance, negative mood, arousal symptoms, and a category specific to ASD, dissociative symptoms.[4]

Dissociative Symptoms

• Experiencing an altered sense of reality. This can be of oneself or one’s surroundings.
• Unable to remember key aspects of the traumatic event (due to dissociative amnesia, not because of things such as alcohol, drugs, or head injury).

What factors contribute to their development?

Anyone can develop ASD or PTSD, no matter their age or gender. Some risk factors can increase the chances of developing ASD or PTSD. Unfortunately, many of them are not under your control. For example, PTSD is more common after certain types of trauma, such as combat experiences and sexual assault. Factors that have been shown to increase one’s risk of developing ASD and/or PTSD include: [5,6]

• Having experienced previous traumatic events
• Having previously had PTSD
• Having previous mental health conditions
• Having dissociative symptoms during previous trauma experiences
• Having a long-lasting or very intense traumatic event
• Getting injured during a traumatic event

Having acute stress disorder increases the likelihood of having post-traumatic stress disorder. Research shows that 80% of people diagnosed with ASD have PTSD six months later.[7] There is a small percentage of people, 4%-13%, that do not experience ASD in the first month after their traumatic experience but go on to develop PTSD months or years later.[8]

ASD & PTSD Treatment

What happens after the traumatic event is important. Stress can make PTSD more likely, while social support can make it less likely.

Acute Stress Disorder Treatment

Trama-focused cognitive behavioral therapy (TF-CBT) is an effective treatment for ASD. Traumatic event survivors who receive TF-CBT soon after their trauma have lower rates of developing PTSD later on.

Post-Traumatic Stress Disorder Treatment

Three effective trauma-focused psychotherapy treatment options for PTSD exist. They are: [9]

• Cognitive Processing Therapy (CPT): The goal of CPT is to learn skills to understand how trauma has changed your thoughts and feelings. By changing how you think about the trauma, you can alter your feelings.
• Prolonged Exposure Therapy (PE): In this therapeutic approach, you talk about your trauma repeatedly until the memories of it are no longer upsetting. The goal is you will have more control over your thoughts and feelings about the trauma, and you will be able to go places and do things that you previously were avoiding because of the trauma.
• Eye Movement Desensitization and Reprocessing (EMDR): While discussing the trauma, you focus on specific eye movements, hand movements, or sounds. This approach helps your brain process the traumatic memories in a safe and controlled manner.

Recovering from ASD and PTSD

ASD and PTSD have many of the same contributing factors to their development. The key difference is the timeframe in which symptoms manifest and persist. Early interventions after a trauma with someone with ASD may prevent them from developing PTSD later on. With proper evidence-based treatment, it is possible to recover from PTSD. If you or a loved one have experienced a traumatic event, seek mental health care as soon as possible to prevent and relieve acute stress disorder symptoms and PTSD.