Acute Stress Reaction (ASR)
When people are faced with a traumatic event they often experience changes in their body, in their cognitive functions, in their feelings and in their behavior. These physical, cognitive, emotional and behavioural changes after a traumatic event are called traumatic reactions .
Acute Stress Reaction is the diagnosis which is used by WHO International Classification of Diseases ICD 10, F43.0 (8) to describe typical examples of traumatic reactions which are experienced in and following a critical incident.
Acute stress reaction is a temporary severe disturbance as a reaction to extraordinary physical or psychic stress. It develops in mentally and emotionally normal individuals who have been exposed to an overwhelming traumatic event (critical incident). During the event they respond with fear, helplessness or horror .
Frequently the concept of trauma phases is used to describe what people may experience during, immediately following, and for some time after a traumatic event. This concept implies three phases:
- Impact phase
- Recovery phase
Fig. 1:Chronological order of trauma processing (adopted from (30))
This figure which was adopted from Lucas (30) describes the trauma phases, the reactions pertinent to the phases, and the processes of recovery (return to equilibrium) and of development of post-traumatic stress disorder (PTSD), respectively.
This phase starts with the very beginning of the traumatic event and may last for an hour to one week. Affected individuals are overwhelmed, dazed; their consciousness may be constraint, attention may be limited (tunnel vision); they have difficulty to process the excessive amount of information; disorganization, feelings of helplessness, anxiety, fear of death and fainting occur. The individual may lose control over the situation. A broad range of physical reactions may appear, such as tachycardia, sweating, paleness, diarrhea, nausea. The mind may try to distance itself from the experience (dissociation). On the one hand, there may be total withdrawal form the surrounding situation, agitation and over-activity (fugue) on the other.
The impact phase follows the shock phase and may last up to two weeks. Although the most intense arousal has subsided, individuals may have problems to concentrate on the work they are doing, and they may suffer from sleep disturbances. Individuals may have a subjective sense of numbing and detachment. They may lack in emotional responsiveness, in awareness of their surroundings, they may feel unsecure. Their interest in friends, colleagues, or in activities they have liked before the event may decrease. Depressed moods and hopelessness may occur; individuals have a higher risk of committing suicide or taking aggressive actions towards themselves or others. Also anger may occur. Affected people often have doubts about the correctness of what they have done. They may state accusations against themselves or against other people who may have been responsible for what has happened. Their attention and judgment may be reduced. They may ignore own risks and may also constitute a risk for others. It is possible that commands are not obeyed to and skills cannot be applied. Affected individuals are still absorbed from the event they have experienced. Many of them feel a strong compulsion to talk about the events again and again; however, others don’t want to talk at all.
After a period between two and four weeks affected individuals start to recover from the trauma. Further depressing events or stressful work and life situations may interfere with the recovery. Interest in friends and in formerly preferred activities returns.
All the reactions which have been described for the three phases are considered as normal reactions to an event which was outside the everyday realm of experience.
If the adverse effects of the trauma last longer than one month a state occurs in which symptoms develop that are attributed to the clinical diagnosis post-traumatic stress disorder (PTSD, see 17.2.3).
A large part of the population is able to deal with the trauma by means of their own self-healing-power in a few weeks. Protective factors (see below) like social support or relief of additional work or life stress foster the healing process.
Methods of crisis intervention are applied to give help to individuals in the three trauma phases, in particular to support the third phase of the trauma process, the recovery phase, in which the individual can recuperate from this emotionally and mentally disturbing state.
Post Traumatic Stress Disorder (PTSD)
PTSD develops as a delayed or protracted reaction to a distressing event (of either brief or long duration) or to an extraordinary situation with excessive threat which would provoke deep desperation in almost everyone (8, F 43.1). Typical symptoms are:
Reexperiencing the trauma: The traumatic event is persistently reexperienced, e.g. through recurrent and intrusive distressing recollections of the event (flashbacks), through recurrent distressing dreams of the event or through intense psychological distress at exposure to cues that symbolize or resemble aspects of the event.
Avoidance and numbing: Persistent avoidance of stimuli associated with the trauma, and numbing of general responsiveness as indicated by e.g. efforts to avoid thoughts, feelings, or conversations associated with the trauma, by efforts to avoid activities, places or people that arouse recollections of the trauma, or by feeling of detachment or estrangement of others, or by restricted range of affect. Individuals often are not able to experience pleasure from usually pleasurable life events such as eating, exercise, and social interaction. Thoughts of suicide which are also symptoms of the acute stress reaction are not infrequent.
Arousal: Persistent symptoms of arousal as indicated by e.g. difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hyper vigilance or exaggerated startle response.
These disturbances follow the traumatic event with a latency ranging from one to six months
Not every ASR is followed by a PTSD. However, PTSD sometimes has a delayed onset. Even in individuals who did not develop ASR symptoms, PTSD may occur .