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PTSD and acute stress disorder are both trauma-related diagnoses, but though they share many symptoms and are both triggered by trauma, they have some key differences, as well.

Though it's well-documented that people who have lived through a trauma 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. That, research emphasizes, isn't pathological. It's a normal reaction to abnormal circumstances we find difficult to cope with. 

Some people will, however, experience signs and symptoms that lead them to "qualify" for a particular diagnosis. We'll examine the differences between post-traumatic stress disorder and the lesser-known acute stress disorder that can show up in the first month after trauma, as well as taking a look at symptoms people often experience even if they don't end up with either of these diagnoses. 

What are the most common reactions to trauma?

In the aftermath of trauma, people often experience:

  • Changes in the way they feel emotions. Some people 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. It's common for the effects of trauma to manifest physically as well, through symptoms like headaches, upset stomachs, general aches and pains, a racing heartbeat, sweating, and even skin problems. Sleep dysfunction is also incredibly common. 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. 
  • Changes in thought patterns. This can include perceiving safe situations as dangerous, 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. You may try to cope by keeping extremely busy, overeating, abusing alcohol, doing risky things, or trying to control what happened by becoming aggressive.

It is possible, and indeed pretty common, for people 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. 

Not having a trauma-related diagnosis doesn't mean, by the way, that you can't or shouldn't see a therapist — doing so can benefit nearly everyone who is open to it. 

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, 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, it 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 they 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.

This diagnosis was initially introduced partly to identify trauma survivors at risk of going on to develop PTSD early on. However, research makes it clear that acute stress disorder is a normal reaction to trauma, and many people who do have nine or more of these symptoms will not later have PTSD. Receiving counseling and social support in the first month after a trauma can reduce your risk of post-traumatic stress disorder.

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. 

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. These 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. 

The bottom line

Though we all deal differently with trauma, nearly everyone will have some sort of reaction after living through something traumatic, and most people will initially have a hard time coping. In the immediate aftermath, 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 groups. 

As the initial shock and fog wear off, a minority of people — especially those who have already lived through other traumas in the past — will go on to develop post-traumatic stress disorder, a longer-lasting trauma-related disorder than acute stress disorder. If you recognize yourself in the symptoms but weren't diagnosed so far, know that it can be very difficult to heal from PTSD on your own. Therapy, and sometimes medications, can offer a path towards symptom relief and a more content and functional life.

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