Acute Stress Disorder
Although acute stress disorder is classified among the anxiety dis-orders in DSM-IV-TR mention is made because half of the symptoms of this disorder are dissociative in nature. These diagnostic criteria would designate approximately a third of individuals exposed to serious trauma as symptomatic. As noted, dissociative symptoms occurring at the time of the trauma are strongly predictive of later development of PTSD and are associated with higher cortisol levels during expo-sure to uncontrollable stress. Similarly, the occurrence of PTSD is predicted by intrusion, avoidance and hyperarousal symptoms in the immediate aftermath of rape and combat trauma. Although most individuals experiencing serious trauma are initially symp-tomatic, the majority recover without developing PTSD. Most studies demonstrate that 25% or less of those who experience serious trauma later become symptomatic.
This diagnostic category is useful not only for research on the normal and abnormal processes of adjusting to trauma, but also as a means of providing an important opportunity for early intervention and thus prevention of later psychopathology. Even though dissociation has a role at the time of trauma, if the defense persists too long it may interfere with the working through of traumatic material. Lindemann (1944) described the term grief work, referring to process needed to put traumatic experience into perspective and reduce the likelihood of later symptoms. In this context, psychotherapy, aimed at helping individuals ac-knowledge, bear and put into perspective a traumatic experience shortly after the trauma, should be helpful in reducing the inci-dence of later PTSD.