Acute Stress Disorder in the Elderly
Acute stress disorder (ASD) occurs after a traumatic event of some kind. It can occur when someone either witnessed or experience d an event or situation. Acute stress disorder is characterized by recurring recollections of the event.
One of the more common reasons for acute stress disorder in the elderly is witnessing the death of a friend or loved one. Even when a death is anticipated, such as after a prolonged illness, the actual death can be traumatizing. Many people with ASD will avoid the setting where the death occurred. When this is the hospital, it may be easy to do that. However, if the death took place at home, entering the room can cause recurring memories, not of the person, but of the death itself. Even without the reminders of the place of death, survivors can relive the event over and over.
Symptoms of acute stress disorder
Acute stress disorder is similar to post traumatic stress disorder (PTSD), however, symptoms in acute stress disorder do not last more than four weeks. If they last longer, the diagnosis would be changed to PTSD. According to the diagnostic criteria, symptoms must begin within four weeks of the traumatic event and last at least three days, but not more than four weeks.
Symptoms of acute stress disorder
ASD diagnostic criteria were changed substantially in 2013 with the publication of DSM-5. A diagnosis of ASD now requires:
A. Exposure to actual or threatened death, serious injury, or sexual violation.
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:
Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s).
Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.
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).
Persistent inability to experience positive emotions.
An altered sense of the reality of one’s surroundings or oneself.
Inability to remember an important aspect of the traumatic event(s).
Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
Problems with concentration.
Exaggerated startle response.
Treatment of acute stress disorder
The main aim of treatment is to prevent ASD developing into PTSD. However, the general consensus seems to be that a diagnosis of ASD is not an especially good predictor in this regard. According to the Merck Manual of Geriatrics, most people recover once they are removed from the situation or place the event took place. Further treatment may include:
Allowing the person to describe what happened and their emotional reaction to the event
Offering empathy to the individual
Medication to help aid sleep
Medications for anxiety are not always needed as other treatments can be quite effective.
Studies do indicate that the early use of cognitive behavioral therapy helps to effectively treat ASD and may help to prevent post traumatic stress disorder from occurring. This study also indicated that the use of hypnotherapy may be helpful. Recognizing and treating ASD quickly helps to prevent PTSD.
Bryant, R. A. (2011). Acute stress disorder as a predictor of posttraumatic stress disorder: A systematic review. The Journal of Clinical Psychiatry, 72, 233-239.