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Acute Stress Disorder Vs. PTSD: What’s The Difference?

Acute Stress Disorder vs. PTSD
Written by:

Rabia Khaliq

MSc in Applied Psychology

Umar Javed



Experiencing a traumatic event can have a long-lasting effect on your emotional, psychological, and physical well-being. But there is no clear-cut way to tell when the event occurs and how it will entirely impact your life. For example, two people could experience the same traumatic event. Still, only one might develop psychological trauma while the other can simply move on without any lasting effects. The difference between the two often depends on each person’s mental stability and how he or she is able to process the traumatic event. It is normal to be upset and shaken up after a distressing or traumatic encounter. But in some cases, trauma can lead to psychological consequences such as developing a mental condition like acute stress disorder (ASD) or post-traumatic stress disorder (PTSD).
It can be difficult to distinguish between acute stress disorder and PTSD because they both share similarities. Knowing the differences between these two mental disorders is crucial to prevent being misdiagnosed and not receiving proper treatment. The purpose of this guide is to explain what acute stress disorder and post-traumatic stress disorder are and how they differ.

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What Is Acute Stress Disorder?

Acute stress disorder (ASD) first appeared as a new diagnosis in 1994 in the DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, fourth edition (DSM-IV). The most current version, the DSM-V [1*] , has since been released. ASD is a trauma-related disorder that occurs within one month of a traumatic event. It presents as severe psychological distress immediately following a traumatic event that significantly impacts a person’s life. ASD can last between three days up to a maximum of one month. Stress is a common symptom after trauma. However, the reason for introducing ASD in the diagnostic and statistical manual (DSM) as a mental health illness was to serve two goals.

  • To account for severe acute stress reactions that happen during the initial months after a trauma.
  • To identify acutely traumatized people who are not experiencing a transient stress reaction but are at risk of or will develop PTSD disorder.

Acute Stress Reactions Vs. Normal Stress Reaction

It is normal for humans to experience stress and emotional breakdown after any traumatic incident or grief. But what turns normal stress reactions acute? Acute means “present or experienced to a severe or intense degree.” Typically, stress has three stages. Once a person completes these three stress [2*] stages, they enter into the recovery phase. However, if he/she fails to emerge from these stages, they may develop acute or chronic stress. It is essential to understand these stages and how the body responds. Therefore, it’s easier to identify signs of chronic stress in yourself.

The three stages of stress are:

1. Alarm reaction stage:

This stage refers to the first symptoms the body experiences when under stress. Known as the physiological response of “fight-or-flight,” this natural reaction will either prepare you to protect (fight) or flee (flight). Physiological changes that happen during this process include:

  • An increase in heart rate
  • The release of cortisol (a stress hormone)
  • A boost of adrenaline (to increase energy)

2. Resistance stage:

In this stage, the body starts to repair itself. These changes include releasing less cortisol, and the heart rate and blood pressure begin to return to normal. Even though the body enters this recovery phase, it remains on high alert for a while. Some stressful situations continue for lengthened periods. If the stress is not resolved and your body remains on high alert, it eventually adapts and learns to live with a higher stress level.

3. Exhaustion stage:

Struggling with stress in the long term can drain your physical, emotional, and mental resources to the point where your body doesn’t have the strength to fight stress. You might feel your situation is hopeless and just give up. Signs of exhaustion include:

Risk Factors and Cause of ASD

The triggering of acute stress disorder lies in the traumatic event either experienced or witnessed by the person. According to the survey [3*] -based studies, 20 to 90% of the overall population has experienced one or more extremely stressful events in their life. Despite this large number, only 1.3 to 11.2% of those with acute stress disorder developed the long-term symptomatic disease, such as PTSD.

Possible traumatic events that can lead to ASD include:

  • Death of a loved one
  • The threat of death or severe injury
  • Natural disasters
  • Motor vehicle accidents
  • Sexual assault, rape, or domestic abuse
  • Receiving a terminal diagnosis
  • Surviving a traumatic brain injury

The following risk factors may lead to acute stress disorder:

  • Female gender
  • Intellectual disability
  • Lack of education
  • History of traumatic events
  • History of psychiatric disorder(s)
  • Personality disorder(s)
  • Genetics
  • Trauma severity
  • Disability

What Is Post-traumatic Stress Disorder?

Post-traumatic stress disorder, previously known as shell shock or battle fatigue syndrome, is a severe trauma-related disorder. It happens when a memory of a traumatic event like war or sexual assault causes reoccurring physical distress. The DSM-5 categorized PTSD as a trauma and stressor-related disorder. Post-traumatic stress disorder happens when acute stress response symptoms persist for longer than a month. The majority of people who experience a traumatic occurrence will experience shock, rage, anxiousness, and often guilt. These reactions are common, and for most, they fade away with time. However, for those with PTSD, these feelings persist and even intensify. These feelings can become so strong that they prevent people from living normal lives. People with PTSD have symptoms that last longer than a month and are unable to function properly after the trauma. Additionally, symptoms of PTSD can lead to general irritability and anger outbursts.

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PTSD Causes and Risk Factors

Traumatic events hit everyone differently. Each person has a unique ability to manage the fears, stress, or threats of a traumatic event. Not everyone who experiences trauma will develop PTSD. The severity of PTSD symptoms is linked to the help and support that is received from friends, family members, and professionals.

The risk of PTSD is greater when the person has:

  • Experienced abuse as a child.
  • Repeatedly exposed to life-threatening situations.
  • A feeling of helplessness or intense fear.
  • Seen another person in pain or a dead body.

How Does PTSD Look Like in Children?

Children and teens are more sensitive than adults. Therefore, they can have extreme reactions to trauma. The symptoms of children can resemble adults, but with some differences or variations. The children can exhibit the symptoms as early as six years.

Children can exhibit PTSD symptoms by:

  • Wetting the bed after having learned to use the toilet
  • Forgetting how to or being unable to talk
  • Acting out the scary event during playtime
  • Being unusually clingy with a parent or other adult

Older children and teens can also exhibit PTSD symptoms similar to that of adults. They tend to develop disruptive, disrespectful, or destructive behaviors.

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Post-traumatic stress disorder (PTSD)

Acute Stress Disorder Vs. PTSD: Symptoms

Acute stress disorder and post-traumatic stress disorder symptoms often appear soon after a trauma. For an acute stress disorder diagnosis, symptoms must be present for three to thirty days. For PTSD, symptoms must be present for at least a month. Acute stress disorder and PTSD are experienced after a trauma. People typically feel a sense of extreme terror and helplessness, thus developing psychological and physical symptoms. The physical symptoms are typically caused by stress hormones like adrenaline (epinephrine) and overactivity of the nervous system.

Symptoms of Acute Stress Disorder In DSM-V

Acute stress disorder(ASD) symptoms usually appear right after a traumatic event. They must be present for three to thirty days to be diagnosed with ASD. Within minutes or hours after a traumatic event, physical symptoms typically occur and may resolve within a few hours or days. However, in some cases, the symptoms last for several weeks. A person may experience the following symptoms:

  • Palpitations, i.e., a pounding heart
  • Difficulty breathing
  • Chest pain
  • Headache
  • Stomach pain
  • Nausea
  • Sweating

Intrusion symptoms: These take place when someone’s mind is unable to stop rewinding a tragic experience through flashback scenes, remembrances, or dreams.

Negative mood: Sadness, negative thoughts, and a bad mood.

Avoidance symptoms: People who are experiencing these symptoms will deliberately avoid thoughts, people, feelings, or places associated with their traumatic event.

Arousal symptoms: Insomnia and other sleep problems, trouble concentrating, and mood swings or aggression, either physical or verbal, may be symptoms. You might also feel tight or on edge, and you might be frightened.

Dissociative symptoms: These signs will include a disrupted sense of reality, loss of recognition of one’s surroundings, and an inability to recall trauma details.

PTSD Symptoms In DSM-V

PTSD symptoms are generally grouped into four types. Symptoms may vary over time or from person to person. PTSD symptoms should last for more than one month for a proper diagnosis.

1. Intrusion symptoms (one required)

The traumatic incident is repeatedly relived in the following ways:

  • Unwanted or upsetting memories
  • Flashbacks of events
  • Nightmares
  • Distressed emotions after experiencing traumatic memories
  • Physio Chemical response after exposure to traumatic memories

2. Avoidance (one required)

Aversion to the trauma-related situation after experiencing trauma, including:

  • Thoughts or feelings related to trauma
  • Avoiding external events related to trauma

3. Negative alterations in cognitions and mood (two required)

Unpleasant thoughts as well as feelings that start or deteriorate as a result of the trauma in one or more of the following ways:

  • Unable to remember important details of the trauma
  • Increased unpleasant thoughts and inferences about self or other people
  • Self-blame (mostly exaggerated) or blame on other people responsible for trauma
  • Lack of interest in activities
  • Negative affect
  • Feeling of isolation
  • Unable to feel positive effects

Acute stress disorder and PTSD both require immediate treatment. Seek treatment with stress management licensed expert before it gets worse.

Arousal and Reactivity Changes

Trauma-related arousal and reactivity that began or worsened after the trauma in the following way(s):

  • Aggression or Irritability
  • Dangerous or destructive behavior
  • Sleep difficulties
  • Hypervigilance
  • Concentration difficulties
  • Heightened startle reaction

The symptoms, as mentioned earlier, can cause significant problems in social or work situations and relationships. They often also interfere with your ability to go about your regular daily tasks.

Acute Stress Disorder (ASD)

Acute Stress Disorder Vs. PTSD: Differences and Similarities

When someone survives a traumatic experience, they may struggle to process their distress and move past the body’s and mind’s automatic stress response. Acute stress disorder develops immediately after the source of trauma. Sometimes, post-traumatic stress disorder develops as a long-term result of that trauma. The symptoms of these disorders are very similar. Both require early intervention and treatment for the best outcomes for recovery. Despite their similarities, ASD and PTSD do still differ in several ways.

The symptoms of ASD and PTSD can be identical at times. Early assistance to know what exactly is the problem and to overcome it is the smart move. Click on the button below to get your symptoms checked.

How Acute Stress Disorder and PTSD Differ

The symptoms of acute stress disorder and PTSD are very similar. However, the difference between the two conditions is their duration. Acute stress disorder persists for no more than a month. Meanwhile, PTSD lasts for over a month and sometimes even years. According to DSM-V’s estimate, half of the patients experiencing PTSD initially had acute stress disorder. The second distinction between ASD and PTSD is the emphasis on dissociative symptoms present in acute stress disorder. The dissociative symptoms shortly after trauma involve feeling numb or inability to remember traumatic incidents that impede the victim’s ability to deal with the problem. These dissociative symptoms are a predictor of PTSD [4*] .

The primary distinctions between ASD and PTSD are as follows:


Acute Stress Disorder


Symptom Onset

Symptoms appear hours or days after the traumatic event.

Symptoms may appear immediately or within a few days of the trauma, or they may appear months or even years later.

Duration of Symptoms

The onset of symptoms lasts no less than three days and no more than four weeks.

Symptoms of PTSD should last at least four weeks.

The Number and Nature of Symptoms

You may have nine or more symptoms from any of the five groups. (For example, intrusion, bad mood, avoidance, dissociation, and arousal).

Having PTSD, you will have one or more overbearing and avoidant symptoms, as well as two or even more symptoms of negative mood changes and increased arousal.

Recommended Treatment

Cognitive-behavioral therapy (CBT), exposure therapies(ERP), and, in some cases, medication are recommended treatments for acute stress disorder.

CBT, eye movement desensitization, prolonged exposure therapy, and reprocessing (EMDR), imagery rehearsals, stress inoculation therapy, and, in some cases, medication are all recommended treatments for PTSD.

What Acute and Posttraumatic Stress Disorders Have in Common

Acute stress disorder and PTSD are both trauma-related disorders that develop as a result of a trauma experienced or witnessed. The symptoms of acute stress disorder and post-traumatic stress disorder (PTSD) are very similar. Both disorders cause difficulty functioning in one or more areas of a person’s life (for example, work and family).

ASD and PTSD have many symptoms in common. These common symptoms include:

  • Extreme mental and physical distress as a result of traumatic event flashbacks.
  • Difficulty feeling positive feelings, for example, happiness, peace, contentment, or affection.
  • Inability to recall the entire or a portion of traumatic memory.
  • You’re doing everything to avoid anything that reminds you of the trauma (e.g., thoughts, places, feelings, people, and objects).
  • Heightened irritability and rage
  • Hard to relax or “letting down your guard.”
  • Intense fear reaction
  • Sleep-related problems
  • Difficulty concentrating

Is It Possible for Acute Stress Disorder to Develop Into PTSD?

Not everyone with ASD will get PTSD, but research shows that over 80% of people with ASD have PTSD six months later. Because of their similar nature and close relatedness, acute stress disorder can lead to PTSD. Still, several factors would decide if it happens or not. According to the resource, most who experience acute stress disorder recover on their own after or within four weeks after the trauma has passed. In addition, if a patient participates or takes CBT for ASD, they may lower their chances of developing PTSD.

The following factors may contribute to the fact that acute stress disorder progresses to PTSD or not:

  • Additional stressors encountered following the traumatic experience
  • Use of maladaptive coping mechanisms
  • Negative explanations of their traumatic stress reactions
  • People who avoid situations may develop PTSD

Acute Stress Disorder Vs. PTSD: Treatment

Going through a traumatic event and then bearing all the emotional pain isn’t an easy thing. There can be times when you’ll feel like all of your energy is drained out. So, it is essential to address the emotional pain as early as possible to prevent it from worsening. When treating acute stress disorder and PTSD, a mental health professional keeps specific goals in mind. For ASD, the goal is to stop symptoms from worsening and prevent PTSD. In addition, the chances of recovery are higher in ASD than in PTSD because of less severity of symptoms. In contrast, the treatment of PTSD is more structured to overcome the long-lasting effects of trauma.

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Below are the most common treatment approaches for ASD and PTSD.

Cognitive Behavioral Therapy (CBT)

CBT for ASD and PTSD is provided by a trained professional. These sessions typically last for over six weekly sessions of 60 to 90 minutes. The number of sessions can be increased depending on the severity, especially when treating PTSD. When using CBT for ASD, it is delivered at least two weeks after trauma exposure. The initiation or start of therapy should be timed with respect to other stressful events stemming from the trauma. For instance, the patient may find it difficult to focus attention on treatment if they are distracted by trauma-related events or experiences, such as pain, surgery, legal proceedings, relocation, or other stressors. Trauma-focused CBT typically includes patient education, cognitive restructuring, and exposure.

Acute Stress Disorder and PTSD

Exposure Therapy

Exposure is also a component of trauma-focused CBT. Patients are helped to confront their feared memories and situations through exposure therapy. Reliving the trauma through exposure allows it to be emotionally processed, thus making it less painful. By repeatedly engaging in traumatic memories in a safe environment or manner, the individual can experience traumatic experiences until they no longer cause such strong emotions, and the individual can see that they are not dangerous. Exposure therapy entails both imaginal and in vivo exposure. To achieve extinction learning, the patient provides a detailed narrative of their traumatic experience. Then, the patient orally relives the traumatic experience with the therapist (usually for at least 30 minutes). Thus, the patient can learn that the salient reminder of the trauma (e.g., the memory) is no longer a threat and does not result in adverse outcomes by reliving the memory repeatedly. In vivo exposure is performed using a similar mechanism to ensure that the patient avoids feared situations in their daily life, thereby consolidating the learning signal that flashbacks are no longer a cause for concern.

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The Eye Movement Desensitization and Reprocessing Therapy (EMDR)

EMDR [5*] therapy is a stress-reduction technique. It is used to treat both trauma and post-traumatic stress disorder (PTSD). You re-experience triggering or traumatic experiences in brief intervals during EMDR therapy sessions while the therapist instructs you on how to move your eyes. Because most of the time, remembering traumatic events is less emotionally burdening when your attention is diverted, EMDR is thought to be effective. It enables you to relive thoughts or memories without experiencing a strong mental reaction. This technique is thought to lessen the impact that memories or thoughts have on you over time.

Narrative Exposure Therapy

Narrative exposure therapy [6*] is a treatment for trauma disorders, particularly for people who have experienced complex or multiple traumas. It has been used most frequently in community settings and with people who have suffered trauma due to political, cultural, or social forces (such as refugees). Small groups of people are often given four to ten NET sessions at a time. However, it can also be offered individually. It is widely acknowledged that the story a person tells themself about their life influences how the person perceives their experiences and wellbeing. Framing one’s life story around traumatic experiences results in the sense of ongoing trauma and distress. By expressing the narrative, the memory of a traumatic event is refined and comprehended.


Selective serotonin reuptake inhibitors (SSRIs) and other antidepressants, benzodiazepines, propranolol, morphine, hydrocortisone, and docosahexaenoic acid have all been tested to treat symptoms of acute stress disorder (ASD) and/or prevent the development of post-traumatic stress disorder (PTSD). Several randomized trials on pharmacological interventions for PTSD and ASD reveal the effectiveness of SSRIs and other antidepressants in treating these conditions. It is best to consult with your healthcare provider to determine the best medication for your condition.

FAQs About ASD and PTSD

Can you have PTSD and acute stress disorder at the same time?

PTSD is a complication of ASD. A person with ASD may continue to experience symptoms that may eventually lead to PTSD. As a result, instead of occurring concurrently, acute stress disorder can progress to PTSD.

What is the difference between stress and traumatic stress?

Stress is a normal bodily reaction to any life challenge. It is less dramatic and harmful, and it usually subsides once the challenge is completed. However, traumatic stress can be fatal and has a significant impact on a person’s functioning.

Acute stress disorder Vs. PTSD what is the timeline?

Acute stress disorder persists in the initial period after a traumatic event, and PTSD is the long-term effect of a traumatic event.

Does acute stress disorder go away?

Yes! Generally, acute stress disorders do go away. On-time detection and treatment prevent it from worsening or turning into PTSD.

Takeaways From This Guide

We all go through several traumas in our life. Still, the odds of developing ASD or PTSD can be high in those who experience drastic, life-changing, or life-threatening traumas. There are some distinct characteristics between acute stress disorder and post-traumatic stress disorder. Regardless of whatever one person has, early medical assistance will help them improve. Thanks to the new understanding and work on these conditions, treatments are more effective in treating them. Get professional help today!


6 sources
  1. A review of acute stress disorder in DSM-5. (2011)
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  2. Physiology, Stress Reaction. (2022)
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  3. Determinants of the development of post-traumatic stress disorder, in the general population. (2014)
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  4. Acute stress disorder as a predictor of posttraumatic stress disorder: a systematic review. (2011)
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  5. The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences. (2014)
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  6. The effectiveness of narrative exposure therapy: a review, meta-analysis and meta-regression analysis. (2019)
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Written by:

Rabia Khaliq

MSc in Applied Psychology

Umar Javed



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