What Are The Differences And Similarities Between Acute And Post-Traumatic Stress Disorders?

Though it's well-documented that people who have lived through or witnessed a trauma can react in an incredibly broad variety of ways, almost nobody immediately simply continues with their lives completely unaffected by what happened to them.

We're not robots, after all, but human beings — so trauma changes how we feel stuff, think stuff, and react to stuff. The fact that experiencing a trauma changes our lives at least for a time, research emphasizes, isn't pathological or the sign of a mental illness. It's a normal reaction to abnormal circumstances we find difficult to cope with. 

What are the most common physical, emotional, and cognitive reactions to trauma?

In the aftermath of trauma, people often experience changes in their daily functioning, behavior, and thought patterns:

• Changes in the way you feel emotions are common after living through a trauma. Some people who have recently lived through something traumatic are really overwhelmed by feelings like fear, horror, anger, shame, guilt, sadness, and anxiety, to the point where these emotions are just "too loud" to cope with effectively. Others rather experience emotional numbing after trauma, a phenomenon that blunts their feelings or causes them to feel very little at all. 
• Physical symptoms can be expected after trauma, too. It's common for the effects of trauma to manifest physically, through symptoms like headaches, upset stomachs, general aches and pains, a racing heartbeat, sweating, and even skin problems. Sleep dysfunction is also incredibly common, along with fatigue or low energy levels. In some cases, these physical reactions are a result of perceived or actual danger. In other cases, your body "feels" the stuff you can't emotionally process at the moment, and your physical symptoms may point to alexithymia, wherein you are unaware what emotions you are experiencing. 
• Changes in thought patterns are common after trauma. These changes can include perceiving safe situations as dangerous because the trauma conditioned you to see threatens around every corner, blaming yourself or others for a trauma even when that blame doesn't stand up to reason, or idealizing a person who played a part in rescuing you from the situation. 
• Changes in behavior are also only to be expected after you have experienced something incredibly distressing. You may try to cope with the mental struggles resulting from trauma by keeping extremely busy, overeating, abusing alcohol, doing risky things, or trying to control your environment by becoming aggressive.

It is possible, and indeed pretty common, for people who survived a traumatic event to have some of the more characteristic symptoms of trauma-related disorders without meeting the full diagnostic criteria, and so without having a diagnosable disorder. You may, for instance, have flashbacks, intrusive thoughts, be hypervigilant, or feel very detached from the world and yourself (dissociative features like depersonalization and derealization) without having PTSD or acute stress disorder, because you just so happen to respond to trauma in a way that doesn't neatly tick all the diagnostic boxes. 

Regardless of whether a person meets the diagnostic criteria for a particular disorder, signs that you're coping in a healthy way include successfully carrying on with important relationships, relying on loved ones for emotional and practical support, enjoying seeing people, being able to self-regulate your emotions, and having the ability to carry out all the tasks that you need to. (Some people assume that you need to be able to talk about your trauma to be emotionally healthy, but research has shown that that's not necessarily the case.)

So, what's acute stress disorder?

Acute stress disorder is a diagnostic category that can apply to people experiencing its symptoms within the first three days to a month following a trauma. Like its more long-term companion, PTSD, acute stress disorder features reexperiencing, dissociative, avoidance, and arousal symptoms:

• Intrusive and distressing memories of the traumatic event. 
• Distressing trauma-related dreams (nightmares). 
• Dissociative symptoms like flashbacks, in which the person feels as if they're living through the trauma again. 
• Profound distress when reminded of the trauma in some way.
• An inability to experience positive emotions. 
• Derealization and/or depersonalization — you may feel as if you move through your environment as if it's a fog, not really there, or you're on autopilot. 
• You're unable to remember important parts of the trauma. 
• You try your best to avoid memories, thoughts, or feelings about the trauma that will upset you. 
• You try your best to avoid circumstances — like people, places, things, or ideas — that will remind you of the trauma. 
• Your sleep is disturbed in some way. 
• You feel angry or irritable a lot of the time. 
• You're hypervigilant — always "on guard", ready for new danger or threats.
• You can't concentrate well.
• Your startle response has been fine-tuned to react to a lot of things. 

If you recognize yourself in nine of more of these symptoms, and those symptoms can't be attributed to things other than trauma reactions, it is likely that a psychologist would diagnose you with acute stress disorder if it's been three days to a month since you experienced a trauma.

How does post-traumatic stress disorder differ from acute stress disorder?

Though the symptoms of PTSD are actually very similar to those of acute stress disorder, they're subtly different. They also occur longer after the trauma — at least a month after, but it is also possible for symptoms not to show up until (well) after six months after your life circumstances become safe. 

The symptoms someone diagnosed with PTSD will have are (and yes, we'll try to keep them as brief as possible while still conveying them):

• At least one intrusion symptom. Intrusion symptoms of PTSD can include intrusive memories, nightmares, and flashbacks. 
• Avoiding thoughts, feelings, or memories related to the trauma, external reminders of the trauma (people, places, things...), or both. 
• At least two changes in mood and thought patterns. These include being unable to remember an important aspect of the trauma, chronic and unrealistic negative beliefs about yourself, others, or the whole world, ruminations that cause you to unrealistically blame yourself or others for the trauma, chronic negative emotions (fear, anger, horror, sadness), loss of interest in significant activities, feelings of detachment from others, and the persistent inability to feel positive emotions. 
• At least two changes in the way you react to things. You may have angry outbursts, engage in reckless behavior, be hypervigilant, have an exaggerated startle response, have trouble concentrating, or trouble sleeping. 

The collection of symptoms someone diagnosed with post-traumatic stress disorder is saddled with are more long-term, and have a profound impact on their daily functioning, emotions, and coping. Rather than helping them process the trauma they lived through, the symptoms of PTSD keep the sufferer in a perpetual orbit around trauma. 

The bottom line

Though we all deal differently with trauma, nearly everyone will have some sort of reaction after living through a traumatic event, and most people will initially have a hard time coping, or recovering from the trauma they experienced.

In the immediate aftermath of trauma, some people will have feelings and reactions that mean they can be diagnosed with acute stress disorder. Others, meanwhile, have subclinical symptoms that mean they don't get the diagnosis. Counseling, support, and healthy coping mechanisms like exercising, journaling, and meditating can benefit both people diagnosed with a trauma-related disorder and those who don't quite qualify.