Psychiatry

Answer 1 Acute Stress Disorder. Acute stress disorder (ASD) is characterized by a constellation of symptoms that occur in the acute aftermath of a trauma, such as the rape experienced by this young woman. A traumatic event is described in the DSM-IV-TR as one in which "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."1 The patient’s response to the traumatic event involves "intense fear, helplessness, or horror." Following the traumatic event, patients typically experience symptoms of dissociation (eg, numbing, detachment, or absent emotional responsiveness), persistent re-experiencing of the trauma (eg, flashbacks, nightmares), avoidance of stimuli that arouse recollections of the trauma, and marked symptoms of anxiety and hyperarousal. ASD can occur at any time, up to a month following the traumatic event. After a month, patients who experience these symptoms are diagnosed as having posttraumatic stress disorder (PTSD). One might be tempted to diagnose her with adjustment disorder, but the stress of a rape is one that is considered extreme. The adjustment disorder diagnosis could be assigned if she had the same symptoms from a lesser stress, such as losing a job, or if the rape evoked distressing symptoms but not ones of sufficient severity to meet the criteria for ASD. This patient is at high risk for developing a depressive episode but does not meet the criteria of major depression at this time, since her symptoms began only 10 days ago. Approximately 50% of patients with PTSD will develop major depression. REFERENCE 1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision. Washington, DC: American Psychiatric Association, 2000:463-486. Click here to return to the questions

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