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.