Acute Stress Response

What is an Acute Stress Response?

An acute reaction to stress is a transient disorder of significant severity that develops in individuals without a visible mental disorder in response to exceptional physical and psychological stress, and which usually disappears within hours or days. Stress can be a strong traumatic experience, including a threat to the safety or physical integrity of an individual or loved one (for example, a natural disaster, accident, battle, criminal behavior, rape) or an unusually abrupt and threatening change in the patient’s social status and / or environment, for example, loss of many loved ones or a fire in the house. The risk of developing the disorder increases with physical exhaustion or the presence of organic factors (for example, in elderly patients).

Causes of Acute Stress Response

It occurs with a strong traumatic experience (natural disaster, accident, rape, loss of loved ones). At the time of stress, there is a fixation on such defense mechanisms as extreme identification, crowding out. As a result, changes in consciousness, impaired perception and behavior are possible.

Symptoms of an Acute Stress Response

In the occurrence and severity of acute reactions to stress, individual vulnerability and adaptive abilities play a role; This is evidenced by the fact that this disorder does not develop in all people who have experienced severe stress. Symptoms reveal a typical mixed and changing picture and include an initial state of “stunned” with some narrowing of the field of consciousness and a decrease in attention, inability to adequately respond to external stimuli and disorientation. This condition can be accompanied by either a further departure from the surrounding situation (up to a dissociative stupor), or agitation and hyperactivity (flight or fugue reaction). Partial or complete dissociative amnesia of the episode may be present. Often there are vegetative signs of panic anxiety (tachycardia, sweating, redness). Symptoms usually develop within minutes after exposure to stressful stimuli or events and disappear within two to three days (often hours). The risk of developing the disease increases with physical exhaustion or in the elderly. After the loss of loved ones as a result of earthquakes, there is a conviction that the victims are actually alive, an escape from the place of tragedy, behavior with traits of infantility (puerilism), freezing at the place of the tragedy and refusal to leave it. Similar reactions occur with the sudden death of a loved one.

Diagnosis of Acute Stress Response

To make a diagnosis, there must be a mandatory and clear temporary relationship between the effects of an unusual stressor and the onset of symptoms; the onset is usually immediate or after a few minutes. In addition, symptoms:

have a mixed and usually changing picture; in addition to the initial state of being stunned, depression, anxiety, anger, despair, hyperactivity and fencing can occur, but none of the symptoms prevails for a long time;
stop quickly (at most within a few hours) in those cases where stress relief is possible. In cases where stress continues or cannot by its nature stop, symptoms usually begin to disappear after 24-48 hours and are minimized within 3 days.

If the symptoms persist, then the question arises of changing the diagnosis (and management of the patient).

This diagnosis cannot be used to indicate sudden exacerbations of symptoms in individuals who already have symptoms that meet the criteria for any mental disorder, excluding specific personality disorders. However, a previous history of mental disorder does not make inappropriate use of this diagnosis.