Acute stress disorder: When does trauma become a mental disorder?

According to a South African stress and health study, one in 7 South Africans will experience a traumatic event in their lifetime, placing them at high risk of developing acute stress disorder which can become a more serious, long-term mental illness if left untreated.

The country’s high rates of crime, road accidents and interpersonal violence, as well as highly public violent events such as the July 2021 unrest and looting in KZN and Gauteng, also heighten the risk for South Africans of developing acute stress disorder, SA Society of Psychiatrists spokesperson Dr Gagu Matsebula said.

According to Psychology Today, acute stress disorder affects up to 20% of people who experience or witness traumatic events such as death, serious injury, or physical or sexual violence, and about half of those will go on to develop post-traumatic stress disorder (PTSD) with a debilitating impact on their work and life opportunities.

On World Mental Health Day (10 October 2022), Dr Matsebula said it was just as important to have a mental health check-up as a physical health check after a traumatic event.

He said rates of acute stress disorder had also likely increased due to the isolation, experiences of the deaths of loved ones and daily reports of deaths, fear of infection, and the personal and financial stresses of the Covid-19 pandemic.

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What is acute stress disorder?

Acute stress disorder has similar symptoms to PTSD, but is shorter-term, lasting from three days up to a month.

If symptoms last longer than a month, the diagnosis becomes PTSD, making it important to seek help and treatment as soon as symptoms appear.

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What causes acute stress disorder?

Acute stress disorder can develop in response to a personal experience of trauma, such as the unexpected death of a loved one, being a victim of physical violence, or being involved in an accident, but can also result from witnessing or hearing about death, serious injury or violence, personally or via the media.

“Different people experience and respond to trauma differently. Sometimes it is not the victim of the traumatic event who develops acute stress disorder – it could be someone who witnessed the event, or even the perpetrator,” he said.

Those with existing mental health conditions, such as anxiety, depression, or a substance use disorder; and those with a family history of mental illness or who have previously experienced mental or physical trauma, are at higher risk of developing acute stress disorder after a traumatic event.

First responders, journalists covering violent events, and researchers studying conflict, are also at higher risk.

Symptoms to look out for

Acute stress disorder symptoms include “intrusive symptoms” of recurring memories, flashbacks, and nightmares, and “avoidance symptoms” of trying to avoid thinking about or remembering the event, and avoiding people, places, or conversations that spark reminders of the event.

“The flashbacks are involuntary and intrusive, in that the memories keep coming back even though you don’t want them to, and they lead to feelings of distress, feelings that one is re-experiencing the trauma.

“In order to avoid thinking about or remembering the event, people tend to exercise or work themselves to exhaustion so that they don’t have time to think about it and can just go to bed and sleep,” he said.

Other symptoms include “hyperarousal”, a state of being always on alert, constantly afraid, and easily startled; as well as difficulty concentrating, thinking, or sleeping; difficulty remembering parts of the event, and difficulty feeling positive emotions.

“People think they just have to cope like they have seen other people do in the past, but there are often warning signs in the coping – a person becoming more irritable and short-tempered, socially withdrawn, increasing their use of alcohol or recreational or prescription drugs. This is ‘abnormal healing’ where the trauma is not processed and dealt with and the person instead develops unhelpful coping mechanisms which place them at greater risk of more serious mental health conditions that are more difficult to treat,” he said.

Stress itself can be traumatic, Dr Matsebula said, leading to the development of mental illnesses such as depression and anxiety, as well as physical illnesses such as hypertension and diabetes.

“In extreme cases, excessive stress levels can lead to the development of acute stress disorder, making it important to care for one’s mental health and ask for help when it is needed,” he said.

At the first sign of symptoms, he recommends first consulting a general practitioner, family doctor or local clinic to identify the symptoms and for referral to a psychiatrist or psychologist, or to access mental health, counselling, or social work services available in the workplace or educational institution.

Treatment involves psychotherapy, with the addition of medication in more severe cases.

“It is vital to seek help after a traumatic event, to avoid the development of complications, unhealthy coping mechanisms such as alcohol or drug abuse, and longer-term mental illness,” he said.