A review of acute stress disorder in DSM-5

Depress Anxiety. 2011 Sep;28(9):802-17. doi: 10.1002/da.20737. Epub 2010 Nov 3.


Acute stress disorder (ASD) was introduced into DSM-IV to describe acute stress reactions (ASRs) that occur in the initial month after exposure to a traumatic event and before the possibility of diagnosing posttraumatic stress disorder (PTSD), and to identify trauma survivors in the acute phase who are high risk for PTSD. This review considers ASD in relation to other diagnostic approaches to acute stress responses, critiques the evidence of the predictive power of ASD, and discusses ASD in relation to Adjustment Disorder. The evidence suggests that ASD does not adequately identify most people who develop PTSD. This review presents a number of options and preliminary considerations to be considered for DSM-5. It is proposed that ASD be limited to describing severe ASRs (that are not necessarily precursors of PTSD). The evidence suggests that the current emphasis on dissociation may be overly restrictive and does not recognize the heterogeneity of early posttraumatic stress responses. It is proposed that ASD may be better conceptualized as the severity of acute stress responses that does not require specific clusters to be present.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Arousal
  • Cross-Cultural Comparison
  • Diagnosis, Differential
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Dissociative Disorders / classification
  • Dissociative Disorders / diagnosis
  • Dissociative Disorders / psychology
  • Emotions
  • Humans
  • Life Change Events
  • Psychometrics
  • Stress Disorders, Post-Traumatic / classification
  • Stress Disorders, Post-Traumatic / diagnosis
  • Stress Disorders, Post-Traumatic / psychology
  • Stress Disorders, Traumatic, Acute / classification*
  • Stress Disorders, Traumatic, Acute / diagnosis*
  • Stress Disorders, Traumatic, Acute / psychology