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Accordingly, it is possible for an individual to satisfy criteria for ASD and to not satisfy PTSD diagnostic criteria after 1 month has transpired, even if the symptomatology has remained unchanged. Whereas PTSD requires three avoidance or numbing symptoms and two arousal symptoms, the ASD criteria require “marked” avoidance and arousal. There are other additional, albeit minor, differences, which mainly involve less stringent requirements to meet ASD avoidance and arousal clusters relative to PTSD. In terms of dissociation, the diagnosis of ASD requires that the individual has at least three of the following: (a) a subjective sense of numbing or detachment, (b) reduced awareness of one's surroundings, (c) derealization, (d) depersonalization, or (e) dissociative amnesia. ASD refers to symptoms manifested during the period from 2 days to 4 weeks posttrauma, whereas PTSD can only be diagnosed from 4 weeks. The primary difference between ASD and PTSD is the duration of the symptoms and the former's emphasis on dissociative reactions to the trauma. Table 1 presents the DSM-IV criteria for ASD. It is possible that this article's recommendations will be revised as additional data and input from experts and the field are obtained.
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Recommendations provided in this article should be considered preliminary at this time they do not necessarily reflect the final recommendations or decisions that will be made for DSM-5, as the DSM-5 development process is still ongoing. In the course of this review, the DSM-IV Source Book and DSM-IV Options Book were also reviewed. It represents the work of the authors for consideration by the work group. This article was commissioned by the DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Post-Traumatic, and Dissociative Disorders Work Group. This review addresses (a) the definition of ASD, (b) the distinction between ASD and ASRs, (c) the overlap between ASD and Adjustment Disorder, (d) the capacity of ASD to predict subsequent PTSD, (e) the role of dissociation in ASD, (f) the benefits of the ASD to enhance early intervention, (g) the range and utility of emotional responses in the A2 definition, (h) cross-cultural considerations for ASD, (i) the utility of an ASD diagnosis, and (i) finally, a proposal for the modified ASD definition in DSM-V. At the time of its introduction, there was far less evidence than we have now to support the definition of the diagnosis ( 3). The ASD diagnosis was introduced for two primary reasons: to describe ASRs that occur in the initial month after trauma exposure, which have earlier gone unrecognized or were labeled adjustment disorders, ( 1) and to identify trauma survivors who are high risk for developing subsequent PTSD ( 2). In the prelude to DSM-5, it is appropriate to review the utility of ASD as a diagnosis and to determine the extent to which it adds value to the current diagnosis of PTSD. This Article first appeared in epub ahead of print.)Īcute stress disorder (ASD) was introduced in DSM-IV as a new diagnosis to describe acute stress reactions (ASRs) that may precede posttraumatic stress disorder (PTSD). (This Article is being co-published by Depression & Anxiety and the American Psychiatric Association. It is proposed that ASD may be better conceptualized as the severity of acute stress responses that does not require specific clusters to be present. The evidence suggests that the current emphasis on dissociation may be overly restrictive and does not recognize the heterogeneity of early posttraumatic stress responses. It is proposed that ASD be limited to describing severe ASRs (that are not necessarily precursors of PTSD). This review presents a number of options and preliminary considerations to be considered for DSM-5. The evidence suggests that ASD does not adequately identify most people who develop PTSD. This review considers ASD in relation to other diagnostic approaches to acute stress responses, critiques the evidence of the predictive power of ASD, and discusses ASD in relation to Adjustment Disorder. Acute stress disorder (ASD) was introduced into DSM-IV to describe acute stress reactions (ASRs) that occur in the initial month after exposure to a traumatic event and before the possibility of diagnosing posttraumatic stress disorder (PTSD), and to identify trauma survivors in the acute phase who are high risk for PTSD.