The Difference Between Acute Stress Disorder and PTSD

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What are trauma-related disorders?

Experiencing a traumatic event or period in life can make it difficult to think normally. Often people go through a period of anxiety, stress, and acute fear. Returning to a state of normality can take time.

Many people gradually heal and return to normal function, but some develop a long-term trauma-related disorder that can affect their daily lives.

What is acute stress disorder or ASD?

When a person experiences a traumatic event or is exposed to long-term trauma, they may develop acute stress disorder¹ (ASD). ASD can majorly impact a person’s life, making them feel disconnected from the world, constantly anxious, stressed, angry, and ashamed.

People may feel overwhelming fear when exposed to places, people, and ideas that remind them of their traumatic experiences. They may also frequently relive the traumatic episode. These symptoms can develop quickly after exposure to trauma but usually become less severe after a few weeks.

Symptoms that persist over a month may be considered post-traumatic stress disorder (PTSD)², which has similar symptoms to ASD. The primary difference between the two is that PTSD lasts longer.

It is a good idea to seek professional advice if you experience any symptoms of ASD after a traumatic experience. Even if you feel your symptoms are not intense, talking through your experience may help to prevent symptoms from developing further. It is always helpful to seek support.

Some examples of extremely traumatic events that may cause ASD to include:

  • A car crash

  • Natural disaster

  • Sexual assault

  • The death of a loved one

  • Threats of death or sexual assault

  • Exposure to long-term trauma, such as being a prisoner of war

  • Violent or emotionally traumatic relationship

  • Family violence

  • Robbery or hostage situation

  • Exposure to war

  • Living in a war zone

People can also develop ASD from an indirect experience of trauma, such as hearing about a family member’s death or working as a police officer on a violent or stressful crime.

Health professionals like doctors, mental health workers, and therapists may also experience ASD due to hearing accounts of trauma or witnessing patients in great distress.

Symptoms of ASD

People are diagnosed with ASD if they experience eight or more of the following symptoms within one month after the traumatic experience:

  • Persistent thoughts like flashbacks of distressing scenes from the traumatic event or dreams about the experience

  • Feeling as if the traumatic event is happening again, potentially through vivid flashbacks

  • Feeling extreme psychological distress or physical distress when reminded of the traumatic event through environmental or personal triggers

  • A constant inability to feel positive emotions like happiness or love

  • Feeling disconnected from reality

  • Partial amnesia (memory loss) of the traumatic event

  • Trying to avoid memories, thoughts, or any feelings associated with the traumatic event

  • Trying to stay away from other physical reminders of the traumatic event, which can include places, people, objects, and conversations connected to it

  • Inability to sleep or experiencing disrupted sleep

  • General irritability and potentially angry outbursts

  • Paranoia or hypervigilance — being constantly aware of potential or imagined danger

  • Inability to concentrate

  • Being easily startled by sudden movements or certain noises

The symptoms must significantly impact the person’s ability to function in their daily lives. The therapist will also evaluate whether the symptoms might be caused by alcohol or other drugs; if so, the person will not be diagnosed with ASD but may have a substance use disorder.

How common is ASD?

The likelihood of developing ASD depends on the nature and severity of the trauma. However, it is currently estimated that between 15 and 40 percent of people exposed to a traumatic experience may develop ASD.

The numbers are different in different studies and likely depend on the nature of the trauma and the specifics of how the diagnosis is made.

Who is at risk for ASD as a result of trauma?

Anyone who experiences a traumatic event is at risk of developing ASD, but some factors can increase a person’s likelihood of developing the condition. These include:

  • Having a psychiatric disorder before the traumatic incident

  • Being physically injured by the event

  • Having loved ones or acquaintances be among the people who lost their lives or received an injury in the event

  • Seeing dead or injured people 

These factors increase the risk of a person who has experienced trauma developing ASD and/or PTSD.

Are there effective treatments for ASD?

Psychotherapy is among the most widely used treatments for acute stress disorder. This type of treatment involves talking with a professional therapist. Although this may sound simple, it can be very effective.

There are many different psychotherapy methods, and a therapist may choose one or more methods to use with a particular person suffering from ASD.

One of the most commonly used methods in people suffering from trauma is a unique type of cognitive behavioral therapy (CBT), known as trauma-focused CBT.

In this therapy, the therapist will help the individual see their developing beliefs around the traumatic event. The therapist will also help the individual replace negative beliefs or irrational thoughts with healthier alternatives.

CBT can help the individual work through a traumatic event's stress, which may prevent acute stress disorder from evolving into PTSD.

What is PTSD?

PTSD is similar to ASD. Exposure to a traumatic event or long-term situation in which death, serious bodily harm, or sexual assault occur or are threatened can lead to PTSD.

Similar to ASD, post-traumatic stress disorder can also develop from hearing an account of trauma or witnessing the aftermath of a traumatic event.

PTSD is a long-term condition that is characterized by symptoms that:

  • Last over a month

  • Occur independently of a pre-existing medical condition, injury, or any form of alcohol or substance use

  • Impact the person’s life by making daily functioning difficult. For example, people may find they have to avoid certain situations, places, or people that may trigger memories of the traumatic episode.

These symptoms are similar to ASD. However, in people with PTSD, symptoms persist for longer than one month. For people with PTSD, their symptoms may severely disrupt their daily lives.

Symptoms of PTSD 

If you have PTSD, you may experience various symptoms, including:

Intrusive thoughts, feelings, and memories

PTSD can bring on a series of thoughts, feelings, and memories about the traumatic event/period that can cause distress. You may feel like you’re reliving the trauma through sudden flashbacks. These can feel very real and are a source of anxiety for many people with PTSD.

It is important to have a support network around you composed of people who understand what you have been through and can look out for you during these episodes. 

Dreams or nightmares about the traumatic experience are also very common for people with PTSD. These can be recurrent and may affect your sleep. It can be worthwhile seeking medical advice when experiencing trauma-related dreams, as a lack of sleep is never helpful for an anxious mind.

Doctors may offer prescription medications to help you get the rest you need.

Other symptoms include frequent episodes of zoning out or spacing out. From the outside, it may look to others like you have a vacant, dazed expression and are not paying attention to what’s happening. You may need gentle prompting to return to the present moment. 

You may also experience bodily reactions when you’re reminded of the trauma. This can include things like shaking or twitching or even feeling like you’re reliving the physical experience of the trauma.

Avoidance symptoms are also a key sign of PTSD. You may actively and persistently avoid any reminders of the traumatic experience. These reminders could be internal (like particular thoughts, memories, and emotions) or external (like topics of conversation, people, places, items, and situations).

Persistent changes in mood and thought patterns

You might be unable to remember some or all of the traumatic experiences.

Many people with PTSD develop negative, false, or distressing beliefs about themselves or the world, like ‘I am broken’ or ‘the world is a cruel place.’

Mistaken beliefs about the causes of the trauma are also common, such as believing that the event was your fault. This negatively affects your mood and can make it more difficult to maintain healthy relationships.

You may also experience ongoing negative emotions, like constant rage, fear, shame, guilt, and/or despair. It may be hard to feel happy, excited, or uplifted. You may lose interest in the activities you used to enjoy.

You may feel isolated from others around you, especially if they do not understand what you went through.

Increased arousal and reactivity

You may constantly feel irritable and be easily angered.

You may find that you tend to engage more in self-destructive or risky behaviors, like driving too fast, abusing drugs and alcohol, or having unsafe sex. It's not unusual to feel like you are always looking for danger. The world may feel like a more threatening place after a traumatic experience, making it difficult to relax.

It is also common for people with PTSD to be easily startled; sudden sounds or movements can be frightening and may even cause a flashback to the trauma.

It may also be more difficult for people with PTSD to concentrate. This can make it hard to work, study, or even hold a conversation.

Sleeping difficulties are common for people with PTSD due to increased brain alertness and stimulation. Nightmares related to the traumatic event can also disrupt the person’s sleep.

Does ASD predict PTSD?

Those who experience ASD are more likely to develop PTSD. Studies³ have found that approximately half of all people who experience ASD will develop PTSD. 

The lowdown

Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are very similar conditions. ASD is a common response to a traumatic experience; symptoms include anxiety, social withdrawal, mental stimulation, insomnia, and flashbacks.

Symptoms of ASD usually last for several days after the event and up to one month. Symptoms of ASD that persist longer than a month may be cause for concern. 

PTSD is an anxiety disorder affecting people who have had traumatic experiences. PTSD is a long-term, chronic condition that can make people withdrawn, anxious, easily startled, and prone to vivid flashbacks. Many people with ASD develop PTSD in the long term.

  1. Acute stress disorder | NIH: National Library of Medicine

  2. Post-traumatic stress disorder and acute stress disorder I (2005)

  3. What is posttraumatic stress disorder (PTSD)? | American Psychiatric Association

Other sources:

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