What is Acute Stress Disorder ?

Acute stress reaction signs are similar to Acute Stress Disorder, these signs develop quickly over minutes or hours because you are responding to that stressful event but these signs settle fairly quickly. 

No treatment may be needed, as signs usually go once the stressful event is over and you deal with it. 

Understanding the cause of symptoms and talking things over with a friend or family member, may help. 

Acute stress can be easily managed because it occurs and then it's over.

You need to experience Acute Stress Disorder (ASD)  signs for at least 3 days and up to, but no longer than one month to meet the ASD disorder DSM 5 criteria.

Photo by Clark Van Der Beken on Unsplash

Harry was driving home from work. It was a frosty evening, the light was fading and the road home was long and windy. For Harry, it had been an exhausting day, he felt satisfied because he had successfully completed a particularly difficult project. His line manager had sent a glowing email. Harry relaxed and started to think of seeing his family. As he approached a sharp bend, he felt his tyres lose their grip, the car started sliding sideways to the other side of the road.Out of the corner of his eye, he glimpsed an old stone wall. The world seemed to slow down, like one of those slow-motion sequences in an all-action Hollywood movie. He tried to steer the car away from the wall, but felt out control. A lorry appeared out of the bend from nowhere, Harry felt very frightened, horrified on what will happen. The lorry hit the side of his car, flipping it upside down, forcing full impact into the stone wall. Harry's thalamus, immediately shut down. This part of his limbic brain controls all sensory input. It was a basic biological response to protect Harry from impending emotional trauma. Harry descended into a numb strange world as the car smashed into the wall.

Every 22 minutes, someone is killed or seriously injured on UK roads. In 2021 there were 1,390 UK road deaths and 119,850 road accident casualties. With the rapid increase in the number of motor vehicles in the past few decades, road traffic accidents (RTA) have become a public health problem. An unexpected traumatic event, may not only lead to death and serious physical injuries, but also could put survivors at an increased risk to acute stress disorder (ASD). Estimates of the prevalence of ASD among RTA survivors ranges from 1.6 to 41.1% depending on the car accident circumstances and the person.

Harry was driving at some speed. He unexpectedly drove into a wet slippery part of the road. As he started to turn into the corner, the car skidded. Immediately, his driving sense of the world switched into a dream-like detachment experience: as if he was a robot remotely mechanically steering the car. In this dream fog like world, appeared a lorry some distance away. In realty it was just a few feet away. After spinning round several times, the car upended, facing in the opposite direction. Harry felt calm, when the lorry driver bent down to speak to him in the upside-down car, Her voice seemed muffled to Harry, the surrounding country-side appeared remote and unreal. Whilst Harry was speaking to the lorry driver Jane, he felt his world appeared strange, peculiar and foreign. He could see the lorry but it appeared to be diminished in size, two dimensionally flat like a picture without depth. Jane's voice appeared to come from far away. Harry was not experiencing physical pain, just numbness.

The thalamus was doing it "safety protection" job. It is a relay station, a gatekeeper, controlling all sensory information (with the exception of smell) filtering that information before sending to other parts of the brain. Harry's amygdala, the fight/flight centre, was receiving restricted information from his thalamus. Harry was experiencing dissociation. Dissociation has two components: "depersonalisation", a detached sense of himself, such as seeing yourself from the other side of the room and "derealisation", where you experience a distorted view of your surroundings such as sensing that things are moving in slow motion. To understand ASD, it is helpful to imagine what Harry was experiencing.

Harry was not trapped in his car seat, Jane helped him out of the car. Whilst she phoned for the ambulance, Harry sat on the grass kerbside. Harry looked around, he found what he saw was odd. The roadside trees seemed smaller, they had lost their three-dimensionality, the colour of the leaves seemed faded, an absence of colour sharpness. Sitting there, Harry felt an unearthly stillness. The world was standing still; he felt there was no point in it. A bus drove past without purpose. It did not feel real. The branches of the trees were swaying without purpose.

When you are experiencing ASD you are likely to experience dissociation. Your actions feel robotic. You are on automatic pilot a `spectator' of your own activities. It is like watching a movie or TV program of your own life. Your voice may sound unfamiliar, your thoughts, speech and actions, no longer feel spontaneous. You may feel an inability to feel emotion, even towards those close who are close to you. You know should feel sad, but in reality, you may feel nothing whatsoever. It is like a feeling of being cut off from your own self, looking at yourself in the mirror seems unfamiliar. This can lead to you feeling confused about your own identity, a fear you have lapsing into a an empty void. You have no personal identity.

The ambulance arrived, taking Harry to A/E. Whilst he was waiting to be seen, the dissociation stopped. Harry was acutely self-aware: he was perspiring, his body trembling and his heart was pounding at a rapid rate. Out of the blue, he was transported back into the crash experience, he was not sitting in A/E seat. In real time, he was experiencing the sensation of the car sliding out of control, He could see his hands on the steering wheel , hear the roar of the engine and feel the scariness ofthe car going out of control. As he felt being flipped by the lorry, his mind was flooded with horror at the prospect of what was going to happen to him. Harry felt utterly helpless, there was nothing he could do to stop the crash. A nurse approached him to check out what was happening, he seemed terrified, she touched his shoulder, are you OK ? Tom was now back in A/E. Confused on what he had experienced, but seeing the safe A/E room around him, Harry replied I am fine.

When Harry became aware of his heart pounding and other physical stress signs, his thalamus had been re-activated, allowing Harry to sense his surroundings in A/E. At the same time, his amygdala was very active, firing up fight and flight messages throughout his body. When he was transported back to the crash event, Harry experienced a flashback. During the crash flashback experience, his hippocampus (Harry's short term memory processing centre) was on "super recording" mode. Very fine detail of the crash (sound, smell, vision, touch senses) are rapidly encoded and locked into Harry's long-term memory. Like ultrafast broadband speed. But unlike other experiences, they are distributed in unusual fragments, so conscious recall of the crash is hazy and in unstructured pieces. When Harry was experiencing the flashback in A/E, it was for him, like watching the crash on a ultra-high definition TV with the most expensive sound bar speakers surrounding you.Flashbacks in ASD, are usually brief but are extremely distressing because you feel the traumatic event is occurring right now. This is very different to remembering the traumatic event as a past event. You know you are in and feel the present: you make a conscious effort to recall the event, feeling safe because you also experiencing the present situation. You are in control.

The physical injuries were minor. Harry called his partner Val, explaining he was in A/E, because of a car accident, reassuring Val that he was OK, "just a few scratches and bruises which will heal quickly". On the car journey home, Val felt relieved, A/E staff had explained the crash: there could have been much more serious injuries. Val spent the evening asking what had happened. Harry seemed more interested in watching TV and drinking a bottle of wine.

For people experiencing ASD, you may feel uncomfortable to talk about the traumatic experience with your loved one, people you are close to at work or with others who have shared the same traumatic experience, instead, you say nothing. If someone reminds you of the trauma, it might edge you towards flashback emotions. You may use alcohol to blot things out or protect yourself by avoiding watching news coverage of the traumatic experience or refuse to return to a workplace where that trauma occurred.

Harry could not get to sleep that night. He went downstairs and watched a streaming Netflix drama, episode after episode, throughout the night. Val was getting concerned, although Harry was still working on shift at work, he chose not to mention the accident. His Line Manager noticed his concentration was poor, he was making mistakes. He seemed startled when the phone rang. At home, Harry was struggling to sleep, waking up with nightmares of the accident.

It is very common with ASD, to experience problems getting to sleep. Sometimes it can be because of the fear of nightmares or they are so hyper stimulated with physical stress signs. Concentration difficulties are common. This can include difficulty in remembering daily events or routine knowledge such as forgetting your telephone number Attention is affected, concentration is difficult when engaged in focused tasks. An example would be struggling to follow a conversation for a sustained period of time. Individuals with ASD may be very reactive to unexpected sounds or unexpected movements.Rather than simply calmly noticing the sound or movement, instead you are in "jumpiness" mode. Your amygdala is supersensitive, responding with a "high octane" startle response , The startle response is our biological automatic defensive response to sudden or threatening sudden noises or sharp movements. In ASD, this response is heightened. The sound feels loud, unexpected and threatening. For example: you may jump in the response to a telephone ringing.

It was now two weeks since the accident. Harry was driving much carefully to and from work. He would annoy other motorists when he saw lorries approaching him braking too hard.

Motor vehicle accident victims may be especially sensitive to the threat potentially caused by any cars or lorries) not related to the traumatic event.

In the third week, Val was insisting that he let someone know at worj. I feel much better now, was Harry's reply. But Val was not so sure. Please let someone know at work ? Harry felt the most safe and empathetic person to contact was a Mental Health First Aider at work he knew. Harry shared with Tom what had happened at the accident and some of his experiences. Harry was surprised how it was now much easier to share. Tom did not encourage Harry to reveal the trauma event. This would be risky if Harry was experiencing Post Traumatic Stress Disorder. Harry explained to Tom that he noticed at A/E that his mouth went dry, his muscles were unusually tense. He was covered with sweat. Harry pointed out that back at home that night, although he not eaten much that day, was wan not hungry that evening.

What Harry could not describe are the hidden ASD effects. Harry's brain was preparing his body for action. A surge of adrenaline was being released into his bloodstream. His blood pressure rose. Harry's liver released glucose to provide energy for muscles, but his digestion slowed right down. Cortisol was also released which in the last two weeks has been depressing his immune system.Tom's three parts of his brain all have different functions. His brainstem: the ancient brain, regulates basic living processes such as heartbeat and breathing. His limbic system help Harry control his emotions, assessing unexpected serious events (are they good or bad ?) which are then chunked into various memory centres. His cerebral cortex: thinking, imagining, combining facts and experiences, creating his unique meaning of the car accident.

Harry went to say to Tom. Before the accident, I knew I had had a tiring day at work, I was enjoying the relaxing drive home and was driving carefully. When the accident happened, I believe I hit an unexpected wet patch of the road, maybe some cows had been there earlier he laughed. I do not believe I could have done anything better. I felt grateful I was in one piece, sitting upside down talking to Jane. She was very helpful at the time, while we were waiting for the ambulance. We chatted about life in Cumbria, this was distracting for me, but also I felt safe. The A/E staff explained that I might be experiencing an acute stress reaction, pointing out what signs might happen if I then experience ASD, Tom said that could indeed be as A/E suggested, ASD. Tom then explained to Harry, the signs of Post Traumatic Stress Disorder, suggesting that if he may go onto experience these signs four or more weeks since the accident, it would help for Harry to check this out with his GP or work Occupational Health. Harry said he would but added he would also let Tom know. Harry never felt the need to see his GP but did let Tom know he was OK. Tom did check up with Harry three months later. He was fine, work and home life was good.

Trauma is at the centre of ASD. You can experience nine or more ASD signs. They can be clumped into five clusters.

• Intrusive unwanted experiences : such as repeating distressing memories or dreams of the traumatic event. You may feel or act as if the traumatic event was recurring to such an extent that you lose a complete loss of awareness your present surroundings. These experiences can keep you in a state of intense and prolonged distress.
• Negative mood : From day to day you may be unable to have positive thoughts, or find that the things that have gave you pleasure, now do not. This includes not enjoying your work routines or your personal loving relationships.
• Dissociative signs : Dissociation is a survival strategy that helps you to switch off from painful traumatic experiences You may feel you are walking around in a daze, time feels slowed down or you cannot remember an important aspect of the traumatic event. Individuals with ASD usually experience at least three dissociative signs,
• Avoidance : To protect yourself and feel safe, there is compelling urge to avoid distressing thoughts, or feelings about the traumatic event. You make huge efforts to avoid being reminded by avoiding people, places, conversations, activities, objects or situations.
• Arousal Signs : Sleep is disturbed, such as difficulty falling or staying asleep. You may be on hypervigilant alert, getting more Irritable than usual or have a lowered threshold for unprovoked angry outbursts. The consequences are concentration at work is difficult and you are easily startled by sounds around you.

How can I support someone who may be experiencing ASD ?

• Allow the person the space to talk if they wish to do so but do not push them to talk before they are ready
• Be aware that they may initially be irritable, angry, flat, lacking in concentration or hyper-alert
• Encourage them to look after their physical health and to keep to their usual routines as much as possible
• .Be available in a non-judgmental, open manner and let them know that this will improve with time