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
individual’s 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 [ See
Therapy Section ]:
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
[ See Psychopharmacology
Section ] :
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.
