Acute Stress Disorder
This patient meets diagnostic criteria for Acute Stress Disorder (ASD), not PTSD, because her symptoms are occurring at 16 days post-trauma, which falls within the 3-day to 1-month window specific to ASD. 1
Diagnostic Reasoning
The critical distinguishing factor here is timing:
- Acute Stress Disorder requires symptoms between 3 days and 1 month after trauma exposure 1
- PTSD requires symptoms persisting for ≥1 month after the traumatic event 1
- At 16 days post-trauma, this patient is still within the acute phase (less than 1 month), making ASD the correct diagnosis 1
Symptom Profile Consistent with ASD
This patient demonstrates the classic symptom clusters required for ASD diagnosis 2:
Intrusive/Re-experiencing symptoms:
- Nightmares and flashbacks of the car accident 3
- These intrusive memories are central symptoms in acute trauma reactions 4
Dissociative symptoms:
- Partial memory loss (amnesia for aspects of the trauma) 3
- This dissociative component is a key feature distinguishing ASD from other anxiety disorders 2, 5
Hyperarousal symptoms:
- Exaggerated startle response to loud noises (horns) with extreme reactions ("screaming and falling to the ground") 3
- Difficulty concentrating 3
Mood alterations:
- Sense of "surliness" (irritability) 3
Why Other Diagnoses Are Incorrect
Post-Traumatic Stress Disorder is ruled out because the 1-month threshold has not been met—PTSD specifically requires symptoms persisting beyond 1 month, and this patient is only at 16 days 1
Adjustment Disorder is incorrect because adjustment disorder involves emotional/behavioral symptoms in response to a stressor but lacks the specific intrusive re-experiencing, dissociative features, and marked hyperarousal seen here 3. Adjustment disorder is a less severe diagnosis that doesn't capture the intensity of trauma-related symptoms this patient exhibits 3
Generalized Anxiety Disorder is ruled out because GAD requires excessive worry about multiple events/activities for at least 6 months, not acute trauma-linked symptoms with flashbacks and dissociation 3
Clinical Implications and Management
This patient is at high risk for developing PTSD if symptoms persist beyond 1 month 2, 6. Key risk factors present include:
- Severity of acute symptoms 2
- Dissociative features 5, 6
- Intense fear during the traumatic event (believing she would die) 3
Immediate intervention is warranted:
- Cognitive behavioral therapy is effective in reducing ASD symptoms and decreasing future PTSD incidence 2
- Psychological first aid should be provided, including ensuring safety, providing information about stress reactions, and connecting with social support 2
- Avoid Critical Incident Stress Debriefing, as it may impede natural recovery 2
Pharmacologic considerations:
- There is insufficient evidence for routine medication use in ASD 2
- Short-term pharmacotherapy may address specific symptoms like insomnia if present 2
Common Pitfall
Do not wait passively for the 1-month mark to reassess—early intervention with trauma-focused therapy during the ASD phase can prevent progression to chronic PTSD 2, 6. The patient should be actively monitored and treated now, not simply observed 7.