Understanding the role of Acute Stress Disorder in trauma

Dr. Trina Hall

Police Psychologist

Dallas Police Department

Lessons Learned: Unfolding the story of PTSD

NAMI 2014 Fall Conference

Trauma and Stressor Related disorders

• Acute stress disorder

• Post traumatic stress disorder

Prevalence of Exposure to Traumatic Events

50%-90% of general population are exposed to

traumatic events during their lifetime.

75% of law enforcement personnel are exposed to traumatic events in their career.

Most do not develop ASD or PTSD

What is the normal response to a traumatic event?

• anxiety,

• feeling “revved up;”

• emotional instability

• fatigue

• irritability

• hyper-vigilance

• trouble sleeping

• exaggerated startle response

• change in appetite

• feeling overwhelmed

• impatience

• isolation from family and friends

• shock

• nightmares

• somatic complaints

Acute Stress Disorder

• Criterion A: Directly experiencing the traumatic event

• Criterion B: Presence of at least 9 (or more)of the following symptoms from any of the 5 categories of: Intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred.

Acute Stress Disorder

• Criterion C: Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure.

• Looks at emotional reactions to a distressing event other than looking primarily at fear.

Intrusion

• Recurrent, involuntary, and intrusive distressing memories of the traumatic event

• Recurrent, distressing dreams of the event

• Dissociative reactions (flashbacks) where individual feels or acts as if the event were recurring

• Intense psychological or physiological distress in response to internal/external cues that represent aspects of the event

Negative Mood

• Persistent inability to experience positive emotions

Disassociation

• A subjective sense of numbing, detachment, or absence of emotional responsiveness

• A reduction in awareness of his/her surrounding

Disassociation

• Derealization

• Depersonalization

• Dissociative amnesia

Avoidance • Avoids thoughts, feelings, or conversations associated

with the trauma

• Avoids activities, places, or people that arouse recollection of the trauma

• Inability to recall an important aspect of the trauma

• Feelings of detachment or estrangement from others

Arousal

• Difficulty falling asleep

• Irritability or outbursts of anger

• Difficulty concentrating

• Hypervigilience

• Exaggerated startle response

Prevalence Rates for ASD

• Identified in less than 20% of cases following traumatic events that do not involve interpersonal assault

• Higher rates (20%-50%) are reported following interpersonal traumatic events, including assault, rape, and witnessing/involved a shooting

Prevalence Rates for ASD

• More prevalent in females than males

• Risk factors include: prior mental disorder, high levels of negative affectivity (neuroticism), greater perceived severity to traumatic experience, and avoidant coping styles.

Initial Assessment

Factors affecting risk of onset of traumatic-associated illness

• Proximity to traumatic event

• Similarity to victim (actual versus vicarious experience)

• How helpless did the individual feel

• Extent of social support will greatly influence prognosis

• Exposure to stressors in past 6 months

• History and family history of mental illness

Difference between Acute Stress Disorder and PTSD

• ASD is more immediate, short term response to trauma.

• ASD is more associated with dissociative symptoms such as:

– Extreme emotional disconnection

– Difficulty experiencing pleasure

– Temporary or Dissociative Amnesia

Difference between Acute Stress

Disorder and similar disorders

Traumatic Grief

• Sudden unanticipated loss

• Distressing thoughts often related to longing

• Duration is a minimum of 2 months

Difference between Acute Stress Disorder and similar disorders

Adjustment Disorder

• Identifiable stressor within 3 months

• Depression, anxiety, and/or conduct are primary emotional and behavioral characteristics

Treatment of Acute Stress Disorder

• Treatment for acute stress disorder usually includes a combination of antidepressant medications and short-term psychotherapy.

• Alternative treatment options include:

– Yoga

– Meditation

Questions

References

• Kessler, R.C., Sonnega, A., Bromet, E. Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060.

• Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.

• Kulka, R.A., Schlenger, W.E., Fairbank, J.A. Hough, R.L., Jordan, B.K., Marmar, C.R., & Weiss, D.S. (1990). Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study, New York: Brunner/Mazel.

• Tanielian, T. & Jaycox, L. (Eds.)(2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation.

• www.counseling.org • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th

ed., text revision). Washington, DC: • Benner, A. (2000). Cop Docs. Psychology Today Nov/Dec2000, Vol. 33 Issue 6, p36, 4p, 1c • Beutler, L. E., Nussbaum, P., & Meredith, K. (1988). Changing personality patterns of police officers.

Professional Psychology: Research and Practice. Vol. 19 (5), 503-507. • Bisson, J. I., McFarlane, A. C., & Rose, S. (2000). Psychological debriefing. In E. F. Foa, T. M. Keane, &

M. J. Friedman (Eds.) Effective treatments for PTSD (pp. 39-59, 317-319). New York: Guilford. • Bohl, N. (1995). Professionally administered critical incident debriefing for police officers. In M. I.

Kurke, & E. M. Scrivner (Eds.), Police psychology into the 21st century (pp. 169-188). Hillsdale, NJ: Erlbaum.