Post Traumatic Stress Disorder vs. Acute Stress Disorder: What’s the Difference?

If you’ve experienced a very traumatic incident in your life, you are not alone. While trauma is something that many people go through, it affects everyone differently, and some may be more deeply affected than others. For example, some individuals can experience a normal trauma response and then bounce back, but others may experience longer-lasting mental health outcomes, including conditions such as post traumatic stress disorder (PTSD) and acute stress disorder (ASD).

PTSD and ASD are both trauma-related disorders that occur due to exposure to a traumatic event or events. These two disorders can be very distressing, impacting your quality of life and making it hard to function at school or work.

There are many similarities but also some key differences when it comes to PTSD vs acute stress disorder. Here’s what you need to know about both mental health conditions.

What is acute stress disorder?

Put simply, acute stress disorder refers to the disruptive trauma-response symptoms and negative mental health effects in the direct aftermath of a traumatic event. It’s estimated that anywhere between 6% to 33% of trauma survivors develop ASD. 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) says that acute stress disorder is defined by specific symptoms that last for at least three days or up to a month after the trauma exposure. That means symptoms will pop up rather quickly after a traumatic event, and resolve in a relatively short-term manner, too.

The DSM-5 notes 14 possible symptoms across five distinct categories that are associated with acute stress disorder. In order to get formally diagnosed with ASD, you must experience at least nine of these symptoms across the categories. 

The categories and subsequent symptoms are:

Intrusion symptoms

• Recurring distressing memories
• Recurring nightmares or negative dreams
• Intense flashbacks of the traumatic event
• Experiencing significant distress when exposed to triggers related to the traumatic event

Negative mood symptoms 

• Having a low mood overall, struggling to feel any pleasant emotions

Dissociative symptoms

• Dissociating, having an altered perception of yourself or your surroundings
• Having trouble remembering certain aspects of the traumatic event 

Avoidance symptoms

• Trying to internally avoid memories or feelings that remind you of the traumatic event
• Trying to externally avoid anything that reminds you of the traumatic incident, including situations, people, or places that could trigger you 

Arousal symptoms 

• Having trouble falling asleep or staying asleep
• Feeling irritability or aggressive 
• Being on edge and hypervigilant
• Having trouble concentrating
• Getting startled easily

What is post traumatic stress disorder? 

Post traumatic stress disorder is a chronic, long-term mental health condition that can affect your quality of life and functioning for months or years. It can develop soon after a traumatic event, however, some people don’t develop PTSD symptoms until months or potentially years after a traumatic event or events have occurred. About one-third of people that have experienced intense trauma develop PTSD.

The DSM-5 outlines specific diagnostic criteria for PTSD. To be diagnosed, you must have a certain number of symptoms for over one month, and the symptoms must be significantly affecting your life. According to the DSM-5, the categories and subsequent symptoms of PTSD are:

Intrusion symptoms (must have at least one): 

• Repeated distressing memories of the traumatic event
• Recurring nightmares associated with the trauma
• Intense flashbacks of the traumatic event
• Feeling emotional distress when you’re reminded of the traumatic incident
• Feeling physical symptoms when you’re reminded of the traumatic incident

Avoidance symptoms (must have at least one):

• Avoiding or attempting to avoid internal reminders (such as memories or thoughts) of the traumatic event
• Avoiding or attempting to avoid external reminders (such as people, places, or situations) that make you think of the traumatic event

Cognitive/mood symptoms (must have at least two):

• Having difficulty remembering the traumatic incident
• Having persistent and drastic negative beliefs about yourself or others  
• Continuously blaming yourself or others for the trauma 
• Continuously experiencing negative emotions
• Losing interest in activities you used to like
• Feeling detached from other people
• Not being able to feel positive emotions 

Arousal and reactivity symptoms (must have at least two):

• Anger, aggression, and irritability
• Being reckless or self-destructive 
• Being hypervigilant
• Getting easily startled
• Having difficulty concentrating
• Having trouble sleeping 

While it isn’t part of the necessary diagnostic criteria, some people who have PTSD also experience dissociative symptoms. Two categories of these symptoms are depersonalization and derealization. Depersonalization involves feeling like you’re detached from yourself or having out-of-body experiences. Derealization is when your surroundings seem unreal or distorted.

What are the main similarities and differences between PTSD vs acute stress disorder?

As you can see, there is a lot of overlap between post traumatic stress disorder and acute stress disorder. General similarities include:

Cause: Both disorders occur due to exposure to a traumatic event.
Types of symptoms: Both ASD and PTSD involve distressing symptoms that interfere with functioning and quality of life. The symptoms for both fall under the categories of intrusion, avoidance, mood, and arousal. Both may cause dissociative symptoms, as well.

Complications: Both can increase your risk and lead to the development of other mental health conditions such as depression, anxiety disorders, or substance use disorder. 

But how does acute stress disorder differ from PTSD? Here are some key differences to help you set them apart:

Onset of symptoms: ASD always has an early onset after a traumatic event, since the symptoms come on relatively quickly and last for at least three days or up to a month after the trauma exposure. With PTSD, symptoms might crop up within three months after the trauma exposure. However, it’s possible for PTSD to not develop until much later –– after months or years.

Mood symptoms: The DSM-5 only outlines one general symptom related to mood (having a low mood and inability to feel pleasant emotions). The diagnostic criteria for PTSD lists more mood and cognitive symptoms that can affect your functioning and quality of life. 

Duration of symptoms: As the name acute stress disorder suggests, the condition is acute, or short-term. The symptoms will last up to a month only. On the other hand, PTSD is more long-term and chronic. To be diagnosed with PTSD, your symptoms have to have been occurring for at least a month. After that, symptoms can last for months or years.

Precursor to the other disorder: Acute stress disorder can potentially lead to PTSD, but PTSD does not lead to acute stress disorder. The American Psychiatric Association says around 50% of people who have ASD will subsequently develop PTSD.

Duration of treatment: Since ASD is acute and short-term, mental health treatment will be less time extensive. However, someone with ASD might choose to remain in therapy after their ASD symptoms resolve to work on other aspects of themselves or address any other mental health conditions. People with PTSD will need more treatment long term since their symptoms last much longer. It is more likely for someone with PTSD to need long-term medication. 

What are the treatment options for PTSD and acute stress disorder?

You do not have to go through trauma alone. Getting help from qualified trauma-informed mental health professionals can make a world of difference.

Regardless if you have PTSD or ASD, the treatment is similar. Therapy and psychiatric medications are the main two treatment options for trauma-related disorders. Everybody is different, but in many cases, a combination of both therapy and medication is used to help someone feel their best.

When working with a therapist, it’s key to choose someone who is trauma-informed. This means that they are familiar with the signs and symptoms of trauma, understand how impactful trauma can be, validate your experience, and know the best and safest ways to support you.

Some common types of therapy for PTSD and ASD are:

• Cognitive behavioral therapy (CBT): CBT is commonly used for many mental health struggles, including trauma. This type of therapy can help you become more conscious and aware of your thoughts and feelings, allowing you to reframe negative beliefs and address unhealthy behaviors. You will learn coping skills to deal with distorted thoughts and stress. Plus, there’s even a special type of CBT called trauma-focused CBT (TF-CBT) which is specifically for children and teens who are trauma survivors. 
• Exposure therapy: Trauma can make you avoid people, places, situations, or memories which remind you of the traumatic event. To combat this, exposure therapy with the help of a trusted mental health professional can help you safely revisit these triggers. When you expose yourself to these triggers with a therapist, you will work towards desensitizing yourself to your triggers so they don’t cause such a strong emotional or physical reaction going forward. 
• Eye movement desensitization and reprocessing (EMDR): EMDR is a unique form of therapy that utilizes your eye movements to help you process your triggering emotional memories, often associated with trauma. When done correctly with a therapist, this method can help you process trauma more quickly.

Your therapist may refer you to a psychiatrist, a mental health professional who can prescribe medications, if they think you could benefit from them. The most common medications that psychiatrists prescribe for ASD and PTSD are antidepressants and anti-anxiety medications. These drugs can help to manage and reduce your symptoms, alongside your work in therapy.

However, it’s important to note that it can take a few weeks, at least, for antidepressants to kick in and for you to feel a difference, so be patient and make sure to bring up any concerns with your provider. It may also take some trial and error to figure out what the best medication or combination of medications is for your PTSD or ASD. Your doctor will also consider any other co-occurring mental health condition such as an anxiety disorder or depression when coming up with your treatment plan.

On top of therapy and meds, it’s crucial to take care of yourself post-trauma. Making some little changes to your lifestyle and practicing self-care can make a positive impact on how you feel.

Here are some ways you can do this: 

• Stay active and get at least 15 minutes of physical activity every day 
• Eat a healthy and balanced diet
• Get enough good quality sleep
• Refrain from drugs and alcohol
• Maintain a strong social support system
• Use a creative outlet for your emotions such as art or music 
• Meditate or practice mindfulness

How can Charlie Health help?

If you’re a trauma survivor and you believe you have PTSD or ASD, Charlie Health may be able to help you.

Our personalized virtual intensive outpatient program provides mental health treatment for teens, young adults, and families dealing with a variety of struggles, including trauma-related disorders and any co-occurring conditions. All of our clinicians are trauma-informed and trained to help you process your trauma and cope with your symptoms in a non-judgemental safe space.

Coping with trauma can be tough –– but with trauma-informed care and a supportive community, you can begin to feel better. Start your healing journey with Charlie Health today.