Clinical features

Acute stress reactions, as defined in ICD-10, are transient reactions to exceptional physical and/or mental stress. There is an initial stage of a 'daze', including narrowing of attention, inability to comprehend stimuli, and disorientation. This is followed by a rapidly changing picture of symptoms that may include withdrawal from the surrounding situation, flight reactions, panic anxiety and autonomic hyperarousal, depression, anger, or despair. Symptoms usually begin to diminish after 24 to 48 h and should be minimal after about 3 days.

In contrast, acute stress disorder, as defined in DSM-IV, is only diagnosed if the psychological symptoms persist for more than 2 days. Dissociative symptoms dominate the symptom pattern. Dissociation refers to a disruption of the usually integrated feelings of consciousness, memory, identity, or perception of the environment. Symptoms include a subjective sense of numbing or detachment, reduced awareness of surroundings, derealization, depersonalization, or dissociative amnesia. In addition, patients with acute stress disorder experience symptoms that are typical of PTSD, namely re-experiencing aspects of the event, avoidance of reminders of the event, and hyperarousal symptoms. Acute stress disorder is seen in DSM-IV as a precursor of PTSD. If the re-experiencing, avoidance, and hyperarousal symptoms persist for more than 4 weeks, PTSD is diagnosed.

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