Acute Stress Disorder: Essential Diagnostic Feature According to DSM-5
The correct answer is Option C: Symptoms typically begin immediately after the traumatic event and persist for 3 days to one month to meet criteria for acute stress disorder. 1
Temporal Criteria for Acute Stress Disorder
The DSM-5 defines acute stress disorder (ASD) with specific temporal boundaries that distinguish it from both normal acute stress reactions and PTSD:
- Symptoms occur 3 days to 1 month after traumatic exposure 1
- Symptoms typically begin immediately following the trauma 2
- If symptoms persist beyond one month, the diagnosis shifts to PTSD 1, 2
This temporal window is critical for clinical decision-making and represents a reconceptualization of ASD as "an intense stress syndrome with a clear need of acute treatment during the early course after traumatic exposure." 3
Why Other Options Are Incorrect
Option A is incorrect because the 3-month upper limit applies to distinguishing acute PTSD from chronic PTSD, not to acute stress disorder. 4 The one-month boundary is what separates ASD from PTSD. 1, 2
Option B is incorrect because symptoms beginning one month after trauma would not meet criteria for ASD at all—this would represent delayed-onset PTSD if diagnostic criteria are otherwise met. 2
Option D is incorrect because adjustment disorder is a separate diagnostic entity that involves maladaptive responses to non-traumatic stressors and does not follow the same temporal progression as ASD. 3
Clinical Significance of the Temporal Criteria
The DSM-5 criteria for ASD identify approximately 14% of trauma-exposed individuals in the acute period, compared to 8% using older DSM-IV criteria. 5 This broader identification serves an important triage function:
- More than half of individuals meeting DSM-5 ASD criteria will develop a subsequent psychiatric disorder 5
- Between 24-43% of those with ASD will develop PTSD 5
- Early identification allows for targeted intervention during the critical window when brief cognitive behavioral therapy (4-5 sessions starting approximately 2 weeks post-trauma) can speed recovery 1
Common Diagnostic Pitfalls
Do not wait passively for the one-month mark before screening high-risk populations. Active screening and monitoring should begin in the early period after trauma exposure, particularly in children and other vulnerable groups. 6 Approximately 10% of children develop PTSD by 3-5 months after medical procedures, highlighting the importance of early intervention rather than watchful waiting. 6
Do not confuse the 3-day minimum with immediate symptom onset. While symptoms typically begin immediately after trauma, the 3-day minimum exists to distinguish pathological responses from normal acute stress reactions that resolve quickly. 1, 2