Acute stress disorder and posttraumatic stress disorder (PTSD) are debilitating psychiatric conditions that may occur following traumatic events or severe stressors. Generally, these two conditions have similar diagnostic criteria, with acute stress disorder marked by symptoms for less than 1 month and PTSD with symptoms lasting 1 month or more. The exact mechanism by which PTSD develops in the brain is not known. Groups at risk for developing PTSD include women, people with low socioeconomic status, previously married people, and people younger than 65 years. Symptoms must include exposure to a stressor, intrusive thoughts or perceptions, avoidance, negative cognitions or emotions, and marked arousal and reactivity. Early treatment of acute stress disorder may prevent progression to PTSD. Treatment is primarily trauma-based psychotherapy, although medications may be used for symptom management and treating comorbid psychiatric conditions such as depression or panic attacks. Patients with PTSD should not be treated with benzodiazepines due to worsening morbidity. Treatment of PTSD limits the course of the condition and reduces comorbidities.
Case 2. EK, a 35-year-old, presents to your office with insomnia, anxiety, and hypervigilance since an accident 6 months ago when his car was run off the road by an intoxicated driver. He reports panic episodes while driving that have progressed to chest pain and dizziness when he sits in the driver’s seat of a vehicle. He has developed nightmares about reliving the accident. He is unable to tolerate driving and has to request rides to work from friends and family. He says that his friends have expressed concern that he is more irritable and less social than before, particularly during these drives.
Definitions
The American Psychological Association defines trauma as an emotional response to an event such as an accident, crime, natural disaster, physical or emotional abuse, neglect, experiencing or witnessing violence, death of a loved one, or war.1
Although trauma is not rare, intense or repeated trauma can have lasting effects on psychologic and physiologic health. Trauma-related disorders include reactive attachment disorder, disinhibited social engagement disorder, and adjustment disorder.2 This section focuses on acute stress disorder and posttraumatic stress disorder (PTSD).
Epidemiology
Acute stress disorder and PTSD are debilitating psychiatric conditions that may occur following traumatic events or severe stressors. Anyone exposed to trauma is at risk for acute stress disorder and PTSD. However, not everyone who experiences a traumatic event develops a pathologic response. The exact mechanism by which PTSD develops in the brain is not known.
The lifetime prevalence for PTSD is roughly 6.1%, with higher rates occurring in women, Native Americans, people with low socioeconomic status, previously married individuals, and people younger than 65 years.3 The higher rate in Native Americans is thought to be because of a high rate of trauma and comorbidities and limited access to mental health resources from the Indian Health Service.4
Approximately one-half of people with acute stress disorder will develop PTSD.5 Several factors predispose individuals to development of PTSD, including the type of event, the number of events, and biologic factors.6 Research hints at genetic and epigenetic components of PTSD.6
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