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.
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