The person has been exposed to a
traumatic event in which both of the following were present:
The person experienced, witnessed, or was confronted with an event
or events that involved actual or threatened death or serious injury,
or
a threat to the physical integrity of self or others.
The person's response involved intense fear, helplessness, or horror.
Either while experiencing or after
experiencing the distressing event, the individual has three (or more) of the following
dissociative symptoms:
A subjective sense of numbing,
detachment, or absence of emotional
responsiveness.
A reduction in awareness of his or her surroundings (e.g., "being in a daze").
Depersonalization - dissociative amnesia (i.e., inability to recall an important aspect of
the trauma).
The patient persistently re-experienced the traumatic event
in at least one or
more of the following ways: recurrent images, thoughts, dreams,
illusions,
flashback episodes, or a sense of reliving the experience; or distress
on exposure
to reminders of the traumatic event.
Marked avoidance of stimuli that arouse recollections of the
trauma (e.g., thoughts,
feelings, conversations, activities, places, people).
There are marked symptoms of anxiety or increased arousal
(e.g., difficulty
sleeping, irritability, poor concentration, hypervigilance, exaggerated
startle
response, motor restlessness).
At least 1of the following applies:
The patient feels marked distress
from the symptoms.
They interfere with usual social, job or personal functioning.
They block the patient from doing something important such as getting legal or medical
help or telling family or other supporters about the experience.
The disturbance lasts for a minimum of 2 days and a maximum
of 4 weeks
and occurs within 4 weeks of the traumatic event.
The disturbance is not due to the direct physiological
effects of a substance
(e.g., a drug of abuse, a medication) or a general medical condition, is
not
better accounted for by Brief
Psychotic Disorder, and is not merely an
exacerbation of a preexisting mental disorder.
Associated Features:
These symptoms may occur and are
more commonly seen in association with an interpersonal stressors such as childhood sexual
or physical abuse, domestic violence, impaired affect, self-destructive and impulsive
behavior, dissociative symptoms, somatic complaints or a change from the individuals
previous personality characteristics.
Differential Diagnosis:
Some disorders display similar or sometimes even the same symptom. The clinician,
therefore, in his diagnostic attempt has to differentiate against the following disorders
which one needs to be ruled out to establish a precise diagnosis.
Mental Disorder Due to a General
Medical Condition;
Substance-Induced Disorder;
Brief Psychotic Disorder;
Major Depressive Episode;
Posttraumatic Stress Disorder;
Adjustment Disorder;
Malingering.
Cause:
When an individual who has been
exposed to a traumatic event develops anxiety symptoms, re-experiencing of the event, and
avoidance of related stimuli lasting less than four weeks they may develop acute stress
disorder.
Treatment:
Counseling and Psychotherapy
Anxiety disorders are responsive to counseling and to a wide variety of
psychotherapies. More severe and persistent symptoms also may require pharmacotherapy.
Psychotherapies include focused,
time-limited therapies that address ways of coping with anxiety symptoms more directly
rather than exploring unconscious conflicts or other personal vulnerabilities These
therapies typically emphasize cognitive and behavioral assessments.
It is possible that more traditional
forms of therapy based on psychodynamic or interpersonal theories of anxiety also may be
used However, these therapies have not yet received extensive empirical support
Pharmacotherapy
Antidepressants:
Clomipramine
Benzodiazepines:
Alprazolam;
Clonazepam
Diazepam
Lorazepam
SSRI class:
Fluoxetine
Sertraline
Paroxetine
Fluvoxamine
Citalopram
Combinations of Psychotherapy and
Pharmacotherapy:
Some patients with this disorder may benefit from both psychotherapy and
pharmacotherapy treatment modalities, either combined or used in sequence