What Is Acute Stress Disorder?

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Acute stress disorder (ASD) is ongoing distress that occurs within a month of experiencing or witnessing a traumatic event such as a death, serious injury, or assault. Symptoms may include negative mood, intrusive thoughts and flashbacks, avoidance of situations associated with the event, and feeling on high alert.

This article will discuss the symptoms, diagnosis, and treatment of ASD.

Acute Stress Disorder Symptoms

Verywell / Michela Buttignol


According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the handbook used by mental health professionals to diagnose mental disorders, the symptoms of acute stress disorder fall into categories of intrusion, negative mood, dissociation, avoidance, and arousal.

Intrusion Symptoms

  • Recurrent involuntary and distressing memories of the event
  • Recurrent nightmares related to the event
  • Flashbacks
  • Intense distress or bodily reactions to reminders of the event

Negative Mood

  • Ongoing negative mood and inability to experience positive emotions

Dissociative Symptoms

  • Altered sense of surroundings, such as feeling dazed or slowing of time
  • Amnesia or inability to recall important details of the event

Avoidance Symptoms

  • Avoidance of upsetting memories and thoughts associated with the event
  • Avoidance of people, places, or situations that bring memories of the event

Arousal Symptoms

  • Difficulty sleeping
  • Irritability and aggression
  • Hypervigilance or feeling on high alert
  • Difficulty concentrating
  • Heightened startle response

Risk Factors

Although it is normal to experience a psychological response immediately after a traumatic event, in many people the symptoms go away within a few days.

Certain risk factors can increase the chance of developing acute stress disorder. When those symptoms continue to last beyond a month, they can lead to post-traumatic stress disorder (PTSD).

Risk factors for ASD and PTSD can be thought of in terms of the trauma itself, pre-trauma factors, and post-trauma factors.

Traumatic events that are very severe, cause bodily injury, or involve a mass trauma are more likely to cause acute stress disorder. People who have a history of previous trauma, or a pre-existing diagnosis of a mood or anxiety disorder, are more likely to develop ASD.

After a trauma, a lack of social support or an environment of blame can also contribute to increased risk of developing ASD.

Help Is Available

If you or a loved one is struggling with acute stress disorder or post-traumatic stress disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.


The diagnosis of acute stress disorder, like that of other psychiatric disorders, is based on criteria listed in the DSM-5.

According to the diagnostic criteria, ASD is diagnosed when a person experiences nine or more of the previously listed symptoms that occur and resolve within one month of experiencing or witnessing trauma, and last for longer than two days.

The experience of trauma could be from directly experiencing injury or assault, witnessing trauma occurring to someone else, or hearing of a traumatic event occurring to a family member or close friend.

Trauma could also be experienced by repeated exposure to details of traumatic events in a job, such as first responders or police officers.

Prevalence of Acute Stress Disorder

ASD prevalence ranges based on the severity and nature of the trauma. It is thought to affect 6% to 50% of trauma-exposed people, depending on the specific type of trauma.


The primary treatment method for acute stress disorder includes a variety of trauma-focused psychotherapies, including cognitive behavioral therapy (CBT).

People with ASD can also benefit from social support from loved ones and community resources.

The benefit of medications for ASD is unclear at this time, although they can be helpful when symptoms continue beyond one month, as in PTSD. Certain medications may help to treat the symptoms of anxiety associated with ASD.


Experiencing acute stress disorder can affect a person's day-to-day life, making it difficult to perform activities and work without constantly being reminded of and distressed by the trauma. It is completely normal to have an initial psychological response to trauma, and for many people, symptoms get better with time.

People who are distressed after a traumatic event can benefit from the support of loved ones and by joining support groups. In general, making time for sleep, eating a healthy diet, exercising, and doing enjoyable activities can be helpful.

Avoiding caffeine and using relaxation techniques such as breathing exercises can be helpful for those experiencing difficulty sleeping.

A Word From Verywell

If you or a loved one is experiencing psychological distress after a trauma, know that you are not alone. These feelings are a very common response to trauma.

Experiencing symptoms of acute stress disorder may feel like you are losing control, but this often gets better with time. Leaning on loved ones for emotional support and seeking professional help through therapy can help you feel better.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Association

  2. Department of Veterans Affairs/Department of Defense. VA/DoD clinical practice guideline for management of post-traumatic stress.

  3. Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 changes on the national survey on drug use and health. Substance Abuse and Mental Health Services Administration

  4. American Psychological Association. What is cognitive behavioral therapy?

  5. UpToDate. Treatment of acute stress disorder in adults.

By Angela Ryan Lee, MD
Angela Ryan Lee, MD, is board-certified in cardiovascular diseases and internal medicine. She is a fellow of the American College of Cardiology and holds board certifications from the American Society of Nuclear Cardiology and the National Board of Echocardiography. She completed undergraduate studies at the University of Virginia with a B.S. in Biology, medical school at Jefferson Medical College, and internal medicine residency and cardiovascular diseases fellowship at the George Washington University Hospital. Her professional interests include preventive cardiology, medical journalism, and health policy.