Acute stress disorder: symptoms in the first month after trauma

Acute stress disorder is a distress reaction that follows exposure to a traumatic event. NICE, in its guideline on PTSD, notes that acute stress disorder is a DSM-5 diagnosis that applies in the first month after a traumatic event. After that period, if symptoms persist, the picture may be assessed as PTSD.

The NHS describes PTSD as a mental health condition caused by very stressful, frightening or distressing events, and lists causes such as a serious or life-threatening accident, physical or sexual assault, abuse, certain jobs, serious health problems such as being in intensive care, a difficult birth and war. You may have experienced the event yourself, seen it happen to someone else or heard about it happening to someone close to you.

Reactions in the days and weeks after something terrible are common, and many people find they ease with time and support. A diagnosis of acute stress disorder recognises that the reaction is severe enough to deserve attention.

The NHS says the main symptom of PTSD is keeping on having distressing thoughts about a traumatic event, experienced as flashbacks, vivid or intrusive images or thoughts, and recurring dreams or nightmares. Acute stress disorder shares much of this picture, within the first month.

• Avoiding people or places that remind you of the event.

• Not being able to fully remember the traumatic event.

• Negative thoughts or beliefs about yourself and not doing the things you used to enjoy.

• Feeling disconnected from yourself and the world around you (dissociation).

• Difficulty controlling feelings, or not experiencing emotions at all.

• Low mood, irritability or anger.

• Difficulty sleeping and feeling very anxious and looking for danger all the time (hypervigilance).

• Headaches, tummy problems or pain with no physical cause.

The NHS lists symptoms of PTSD in children such as dreams about the traumatic event that can become nightmares, re-enacting the trauma through play, sleep problems, wetting the bed even if they did not before, losing interest in things they used to enjoy, talking about death or dying, and lots of tummy aches and headaches.

NICE says to consider active monitoring or individual trauma-focused CBT within 1 month of a traumatic event for children and young people under 18 with a diagnosis of acute stress disorder or clinically important symptoms of PTSD.

NICE guidance for professionals says that people exposed to a traumatic event should be told about the possible symptoms, such as nightmares, intrusive thoughts, avoidance, hypervigilance and difficulty sleeping, and advised to contact their GP if symptoms persist beyond 1 month. Do not wait that long if symptoms are severe or you feel unsafe.

The NHS says to see a GP if you think you have symptoms of PTSD or if treatment is not helping. If you are having a mental health crisis, the NHS says support is available no matter what you are going through, through NHS 111 and urgent mental health routes; call 999 or go to A&E if you are in immediate danger.

The NHS says that if you go to a GP because you think you may have PTSD, they will ask about your symptoms and refer you to a mental health specialist such as a talking therapies service or a psychiatrist. The specialist will ask about mood, behaviour, health and family history.

NICE says that when assessing for PTSD, professionals should ask people with symptoms whether they have experienced one or more traumatic events, which may have occurred many months or years before.

NICE guideline NG116 recommends that adults who have acute stress disorder or clinically important symptoms of PTSD and have been exposed to one or more traumatic events within the last month should be offered an individual trauma-focused CBT intervention. For people with milder, subthreshold symptoms in that first month, active monitoring may be considered.

For PTSD that persists, the NHS lists trauma therapy such as trauma-focused CBT, eye movement desensitisation and reprocessing (EMDR) and medicines, usually an antidepressant. NICE says EMDR may be considered for people presenting between 1 and 3 months after a non-combat-related trauma if they prefer it, and offered after 3 months.

The NHS suggests talking to someone about how you are feeling, keeping a diary to spot triggers for flashbacks, trying breathing exercises, staying active, eating a healthy balanced diet and getting enough sleep. It advises not taking recreational drugs, not smoking and not drinking too much alcohol.

The NHS also notes that PTSD usually gets better for most people, though symptoms can be more severe and last longer for some. Early support makes it easier to recognise that these reactions are understandable responses to something frightening.

On the NHS, adults can self-refer to NHS talking therapies or see a GP, who can refer on to a mental health specialist. Trauma-focused CBT and EMDR are available through NHS services, though waiting times vary by area.

Some people choose private therapists, particularly to start earlier. NICE recommends trauma-focused approaches, so it is reasonable to ask a private therapist whether they are trained in them, and to keep your GP informed.