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7 - Acute stress disorder and post-traumatic stress disorder in the disaster environment

from Part III - Clinical care and interventions

Published online by Cambridge University Press:  09 August 2009

By
David M. Benedek
Edited by
Robert J. Ursano ,
Carol S. Fullerton ,
Lars Weisaeth  and
Beverley Raphael
David M. Benedek
Affiliation:
Associate Professor Center for the Study of Traumatic Stress
Robert J. Ursano
Affiliation:
Uniformed Services University of the Health Sciences, Maryland
Carol S. Fullerton
Affiliation:
Uniformed Services University of the Health Sciences, Maryland
Lars Weisaeth
Affiliation:
Universitetet i Oslo
Beverley Raphael
Affiliation:
University of Western Sydney
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Summary

Introduction

Post-traumatic stress disorder (PTSD) is an often severe, chronic, and disabling mental disorder that may develop after exposure to a traumatic event (or events) as may occur in disasters. Acute stress disorder (ASD) is characterized by similar – but transient – symptoms. Given their potential to result in widespread distress and dysfunction, PTSD and ASD deserve special consideration in disaster preparedness and response plans.

Beyond duration of symptoms, ASD is distinguished from PTSD by a diagnostic requirement for symptoms of peritraumatic dissociation. While ASD does not inevitably portend the later development of PTSD, dissociation may be the best predictor of the subsequent development of PTSD (Harvey & Bryant, 1998). Both PTSD and ASD are characterized by specific symptoms organized into core clusters of re-experience, hyperarousal, and avoidance/numbing. The common and distinguishing characteristics of the two disorders are described in the following section of this chapter, “Clinical presentation.” Since other mental disorders (e.g., depression, substance abuse), stress reactions, and both acute and chronic distress-related behavioral changes not amounting to diagnosable disorders contribute greatly to the public health burden of disaster and often co-occur, the differential diagnosis and features associated with ASD and PTSD are also reviewed.

The atmosphere of chaos, disruption, unanticipated injury, loss, and death created by any disaster will establish a population meeting the traumatic exposure threshold criterion necessary – but not sufficient – for the development of ASD or PTSD. The section of this chapter entitled “Epidemiology” highlights the idea that many individuals exposed to significant trauma do not develop ASD or PTSD and describes subgroups that may be at greater risk for these conditions in the aftermath of disaster.

Keywords

acute stress disorderclinical interviewcognitive-behavioral therapydisasterselective serotonin reuptake inhibitorsneurobiological mechanismsPTSD
Type
Chapter
Information
Textbook of Disaster Psychiatry , pp. 140 - 163
Publisher: Cambridge University Press
Print publication year: 2007

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