Acute stress reaction (post-traumatic symptoms of under one month)

What it is

Acute stress disorder is named by six features taken together:

• Presence of a traumatic event
• Avoidance behavior
• Sleep disturbance
• Nightmares
• Irritable behavior and angry outbursts
• Duration of symptoms is less than one month

How it presents

A described example is a housewife of 32 brought to the psychiatric clinic by her relatives. For the past 3 weeks she had been extremely anxious, with attacks of palpitations and difficulty breathing. She avoids getting into the car and refuses to go out of the house. Her sleep was disturbed by nightmares. She lost the interest in her children and her hobbies, and recently she became very irritable and aggressive toward her husband. From the history, she had been in a road traffic accident one month ago in which 2 of her cousins died, and her past history also indicated 2 episodes of postpartum depression.

Note in it the temporal relationship between the symptoms and the traumatic event. That scenario is not a classical description of acute stress disorder, and it does not need to be: the presence of sleep disturbance, nightmares, avoidance behavior and anger outbursts in the background of a traumatic event makes acute stress disorder the most likely diagnosis.