To meet the diagnosis of acute stress disorder, patients must have symptoms from any of the five categories:

{{c1::Intrusion}}
{{c1::Negative mood}}
{{c1::Dissociation}}
{{c1::Avoidance}}
{{c1::Arousal}}

To meet the diagnosis of acute stress disorder, patients must have symptoms from any of the five categories:<br><br>{{c1::Intrusion}}<br>{{c1::Negative mood}}<br>{{c1::Dissociation}}<br>{{c1::Avoidance}}<br>{{c1::Arousal}}

• A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
  1. Directly experiencing the traumatic event(s)
  2. Witnessing, in person, the event(s) as it occurred to others
  3. Learning that the event(s) occurred to a close family member or close friend
     • Note: In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
  4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (eg, first responders collecting human remains, police officers repeatedly exposed to details of child abuse)
     • Note: This does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related.
• B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:
  • Intrusion symptoms
    1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
       • Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
    2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s).
       • Note: In children, there may be frightening dreams without recognisable content.
    3. Dissociative reactions (eg, flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)
       • Note: In children, trauma-specific reenactment may occur in play.
    4. Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
  • Negative mood
    5. Persistent inability to experience positive emotions (eg, inability to experience happiness, satisfaction, or loving feelings).
  • Dissociative symptoms
    6. An altered sense of the reality of one's surroundings or oneself (eg, seeing oneself from another's perspective, being in a daze, time slowing).
    7. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
  • Avoidance symptoms
    8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
    9. Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
  • Arousal symptoms
    10. Sleep disturbance (eg, difficulty falling or staying asleep, restless sleep)
    11. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects
    12. Hypervigilance
    13. Problems with concentration
    14. Exaggerated startle response
• C. Duration of the disturbance (symptoms in Criterion B) is three days to one month after trauma exposure.
  • Note: Symptoms typically begin immediately after the trauma, but persistence for at least three days and up to a month is needed to meet disorder criteria.
  • Generally it is suggested that the diagnosis should be delayed until at least a weak after the event (to avoid misdiagnosing transient stress reaction)
• D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • Symptoms of ASD should be present at a severe level to warrant diagnosis. As an example, many people will display some form of avoidance in the month after trauma; however, to meet the avoidance criterion for ASD, the patient needs to be engaging in effortful avoidance that reflects a pattern of actively not engaging with reminders of the event.
• E. The disturbance is not attributable to the physiological effects of a substance (eg, medication or alcohol) or another medical condition (eg, mild traumatic brain injury) and is not better explained by brief psychotic disorder.

<ul><li>A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:<ol><li>Directly experiencing the traumatic event(s)</li><li>Witnessing, in person, the event(s) as it occurred to others</li><li>Learning that the event(s) occurred to a close family member or close friend<ul><li>Note: In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.</li></ul></li><li>Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (eg, first responders collecting human remains, police officers repeatedly exposed to details of child abuse)<ul><li>Note: This does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related.</li></ul></li></ol></li><li>B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:<ul><li>Intrusion symptoms<ol><li>Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).<ul><li>Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.</li></ul></li><li>Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s).<ul><li>Note: In children, there may be frightening dreams without recognisable content.</li></ul></li><li>Dissociative reactions (eg, flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)<ul><li>Note: In children, trauma-specific reenactment may occur in play.</li></ul></li><li>Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).</li></ol></li><li>Negative mood<br>5. Persistent inability to experience positive emotions (eg, inability to experience happiness, satisfaction, or loving feelings).</li><li>Dissociative symptoms<br>6. An altered sense of the reality of one's surroundings or oneself (eg, seeing oneself from another's perspective, being in a daze, time slowing).<br>7. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).</li><li>Avoidance symptoms<br>8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).<br>9. Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).</li><li>Arousal symptoms<br>10. Sleep disturbance (eg, difficulty falling or staying asleep, restless sleep)<br>11. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects<br>12. Hypervigilance<br>13. Problems with concentration<br>14. Exaggerated startle response</li></ul></li><li>C. Duration of the disturbance (symptoms in Criterion B) is three days to one month after trauma exposure.<ul><li>Note: Symptoms typically begin immediately after the trauma, but persistence for at least three days and up to a month is needed to meet disorder criteria.</li><li>Generally it is suggested that the diagnosis should be delayed until at least a weak after the event (to avoid misdiagnosing transient stress reaction)</li></ul></li><li>D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.<ul><li>Symptoms of ASD should be present at a severe level to warrant diagnosis. As an example, many people will display some form of avoidance in the month after trauma; however, to meet the avoidance criterion for ASD, the patient needs to be engaging in effortful avoidance that reflects a pattern of actively not engaging with reminders of the event.</li></ul></li><li>E. The disturbance is not attributable to the physiological effects of a substance (eg, medication or alcohol) or another medical condition (eg, mild traumatic brain injury) and is not better explained by brief psychotic disorder.</li></ul>

UpToDate Acute stress disorder in adults: Epidemiology, clinical features, assessment, and diagnosis https://www.uptodate.com.acs.hcn.com.au/contents/acute-stress-disorder-in-adults-epidemiology-clinical-features-assessment-and-diagnosis?search=acute stress disorder&source=search_result&selectedTitle=1~44&usage_type=default&display_rank=1 Last updated February 7 2025. Accessed 11 April 2025

UpToDate&nbsp;Acute stress disorder in adults: Epidemiology, clinical features, assessment, and diagnosis&nbsp;<a href="https://www.uptodate.com.acs.hcn.com.au/contents/acute-stress-disorder-in-adults-epidemiology-clinical-features-assessment-and-diagnosis?search=acute stress disorder&amp;source=search_result&amp;selectedTitle=1~44&amp;usage_type=default&amp;display_rank=1">https://www.uptodate.com.acs.hcn.com.au/contents/acute-stress-disorder-in-adults-epidemiology-clinical-features-assessment-and-diagnosis?search=acute stress disorder&amp;source=search_result&amp;selectedTitle=1~44&amp;usage_type=default&amp;display_rank=1</a>&nbsp;Last updated February 7 2025. Accessed 11 April 2025