Acute Stress Disorder

ByJohn W. Barnhill, MD, New York-Presbyterian Hospital
Reviewed/Revised Aug 2023

Acute stress disorder is an intense, unpleasant, and dysfunctional reaction beginning shortly after an overwhelming traumatic event and lasting less than a month. If symptoms persist longer than a month, people are diagnosed as having posttraumatic stress disorder (PTSD).

(See also Overview of Trauma- and Stressor-Related Disorders.)

People with acute stress disorder develop acute stress reactions that appear within a month of their exposure to a traumatic event. These stress reactions include having increased anxiety, mentally re-experiencing the traumatic event, avoiding reminders of the trauma, displaying negative mood, developing dissociative symptoms (including derealization and amnesia), and showing increased arousal.

People with this disorder may have dissociative symptoms. For example, they may feel emotionally numb or disconnected from themselves. They may feel that they are not real.

The degree of distress following a traumatic event in people with acute stress disorder tends to be greater than that experienced in people with an adjustment disorder.

The number of people with acute stress disorder is unknown. The likelihood of developing acute stress disorder is greater when traumatic events are severe or recurrent.

Diagnosis of Acute Stress Disorder

  • A doctor's evaluation, based on standard psychiatric diagnostic criteria

Acute stress disorder is diagnosed when people have been

  • Exposed directly or indirectly to a traumatic event

In addition, they also must have had at least 9 of the following symptoms for 3 days up to 1 month:

  • Recurring, uncontrollable, and intrusive distressing memories of the event

  • Recurring distressing dreams of the event

  • Feelings that the traumatic event is recurring—for example, in flashbacks

  • Intense psychological or physical distress when reminded of the event (for example, by entering a similar location, or by hearing sounds similar to those heard during the event)

  • A persistent inability to experience positive emotions (such as happiness, satisfaction, or loving feelings)

  • An altered sense of reality (for example, feeling in a daze or as if time has slowed)

  • Memory loss for an important part of the traumatic event

  • Efforts to avoid distressing memories, thoughts, or feelings associated with the event

  • Efforts to avoid external reminders (people, places, conversations, activities, objects, and situations) associated with the event

  • Disturbed sleep

  • Irritability or angry outbursts

  • Excessive attention to the possibility of danger (hypervigilance)

  • Difficulty concentrating

  • An exaggerated response to loud noises, sudden movements, or other stimuli (startle response)

In addition, symptoms must cause significant distress or significantly impair functioning.

Doctors also check to see whether symptoms could result from use of a drug or another disorder.

Treatment of Acute Stress Disorder

  • Self-care

  • Psychotherapy

  • Sometimes medications

Many people recover from acute stress disorder once they are removed from the traumatic situation and given appropriate support in the form of understanding, empathy for their distress, and an opportunity to describe what happened and their reaction to it. Some people benefit from describing their experience several times. Friends and loved ones can often provide this support. Otherwise, doctors or other mental health care professionals are helpful.

Sometimes doctors temporarily give medications to relieve anxiety or help people sleep, but other medications (such as antidepressants) are usually not given unless they are prescribed to treat a co-occurring disorder.


Self-care is crucial during and after a crisis or trauma. Self-care can be divided into 3 components:

  • Personal safety

  • Physical health and practical support

  • Mindfulness

Personal safety is fundamental. After a single traumatic episode, people are better able to process the experience when they know that they and their loved ones are safe. It can be difficult, however, to gain complete safety during ongoing crises such as domestic abuse, war, or an infectious pandemic. During such ongoing difficulties, people should seek the guidance of experts on how they and their loved ones can be as safe as possible.

Physical health can be put at risk during and after traumatic experiences. Everyone should try to maintain a healthy schedule of eating, sleeping, and exercise. Medications and substances that sedate (for example, antianxiety medications) and intoxicate (for example, alcohol) should be used sparingly, if at all. Practical support includes assistance with housing, legal support, insurance, and other issues that need to be addressed but can be overwhelming.

A mindful approach to self-care aims to reduce the feelings of stress, boredom, anger, sadness, and isolation that traumatized people normally experience. If circumstances allow, at-risk individuals should make and follow a normal daily schedule (for example, get up, shower, get dressed, go outside and take a walk, and prepare and eat regular meals).

It is useful to practice familiar hobbies as well as activities that sound fun and distracting: draw a picture, watch a movie, or cook.

Interactions with family and friends and community involvement can be crucial, even if it is difficult to maintain human connection during a crisis.

Stretching and exercise are beneficial, but self-soothing techniques such as counting one's own breaths, meditating, or self-hypnosis can be equally helpful.

Under stress, people can become short-tempered, even with those they care about. Friends and family can be expecially helpful in reaching out and providing expressions of concern and comfort. Sending a nice note, making someone cookies, and offering up a smile may not only be a nice surprise for the recipient, but they can reduce the hopelessness and shame that tend to be part of the experience of trauma.


Education can help the person understand the stress response and the natural course of symptom improvement. Cognitive-behavioral therapies can help by allowing the person to process traumatic memories in a safe setting, correct maladaptive thoughts about the trauma or responses to it, and discuss the trauma in one's own words once the person is able to do so.


No medications are particularly helpful in reducing the symptoms of acute stress disorder or preventing it from developing into full-blown PTSD. Medications may be given to help with insomnia, anxiety, and agitation, but prolonged use appears to interfere with recovery.

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