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Acute Stress Disorder in Teens

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Acute stress disorder is a response to a traumatic event. Teens who experience a school shooting, natural disaster, death, car accident or other traumatic event are at risk for acute stress disorder. In fact, up to one-third of people who experience a traumatic event develop acute stress disorder, according to the US Department of Veterans Affairs.

Acute stress disorder (ASD) typically develops within one month of a traumatic incident. Consequently, teens with ASD experience a variety of distressing symptoms. These symptoms may last just a few days or as long as a month.

The diagnosis of acute stress disorder was originally developed in the early 20th century to identify soldiers susceptible to post-traumatic stress disorder (PTSD). More recently, the definition has been expanded to include anyone with an extreme psychological reaction to trauma.

Moreover, symptoms of acute traumatic stress are similar to those of post-traumatic stress disorder (PTSD). And if ASD is left untreated, it can progress into PTSD.

Risk Factors for Acute Stress Disorder

Traumatic events that can cause ASD include death, threat of death to oneself or others, and threat of serious injury to oneself or others. As a result, such events create feelings of intense fear, horror, and/or helplessness.

Teens who directly experience a traumatic event are at risk for ASD. Furthermore, teenagers who witness such an event are also at risk. The likelihood of a teen developing ASD depends on the extent of their exposure to the event.

For example, if they are injured in a school shooting or car accident, teens are more likely to experience symptoms of acute stress disorder. If they observed violence or disaster firsthand, but weren’t injured, they may also develop ASD. But the symptoms will probably be less severe.

In fact, even teens who simply hear about a traumatic event can develop ASD. Therefore, parents should be aware of the effect of disaster or violence on children and teens. Such events can have an impact even if kids only hear about them online or see them on television.

Newport Academy Mental Health Resources: Acute Stress Disorder

Diagnosing an Acute Stress Disorder in Teens

For a teen to receive an ASD diagnosis, symptoms must occur within four weeks of the traumatic event. Moreover, symptoms must last for a minimum of three days and a maximum of four weeks. In addition, the criteria exclude symptoms caused or exaggerated by substance use or abuse, a preexisting medical condition, or a brief psychotic disorder.

Furthermore, for ASD to be diagnosed, symptoms must cause significant distress or impairment in a teen’s life. That includes school, work, socializing, and relationships with family and friends.

Moreover, teens with ASD experience three or more of the following signs of acute stress:

  • Feelings of numbness and detachment
  • Lack of emotional response
  • Being in a daze, with reduced awareness of one’s surroundings
  • Derealization—when your environment seems strange or unreal
  • Depersonalization—when your thoughts or emotions don’t seem real or don’t seem as if they belong to you
  • Dissociative amnesia—inability to remember an important aspect of the traumatic incident.

Symptoms of Acute Stress Disorder

The symptoms of ASD fall into four main categories. Moreover, these symptoms are common among many types of stress disorders.

1. Intrusion Symptoms

  • Distressing memories of the traumatic event
  • Recurring dreams about the event
  • Flashback episodes that create a sense of reliving the event
  • Distress when exposed to reminders of the event

2. Negative Mood

  • Inability to experience positive emotions, such as happiness or love
  • Finding it difficult or impossible to enjoy activities that were previously pleasurable Feeling guilty about doing everyday tasks as if things were normal

3. Dissociative Symptoms

  • A sense of time slowing down
  • Seeing oneself from the outside, as if from another person’s perspective
  • Being in a daze or fog
  • Feeling detached from one’s body
  • Experiencing the world as unreal or dreamlike
  • Difficulty recalling specific details of the traumatic event.

4. Arousal Symptoms

  • Anxiety
  • Trouble sleeping
  • Irritability
  • Difficulty concentrating
  • Inability to stop moving or to sit still
  • Being constantly tense or on guard
  • Easily startled, sometimes for no particular reason
  • Physical restlessness

5. Avoidance Symptoms

  • Avoiding anything associated with the traumatic event, including:
  • Memories
  • Thoughts
  • Feelings
  • Conversations
  • Objects
  • People
  • Places.
Newport Academy Mental Health Resources: Acute Stress Disorder

Acute Stress Disorder and the “Fight or Flight” Response

Stress is an automatic response in the face of a perceived danger. It triggers a surge of stress hormones, including adrenaline and cortisol. Consequently, these hormones temporarily activate and heighten the part of the nervous system known as the sympathetic nervous system. This is called the acute stress response, or the “fight-or-flight” response.

Here’s what happens in the body when an acute stress reaction occurs:

  • The heart starts beating faster than normal
  • Pulse rate and blood pressure go up
  • Breath becomes more rapid and the chest feels tight
  • Muscles tense
  • Mouth gets dry
  • You may feel flushed and sweaty
  • Vision may narrow
  • Hearing may become more sensitive.

When individuals have ASD, they experience this acute stress reaction more frequently, as a result of memories, flashbacks, or other triggers.

Acute Stress Disorder vs. PTSD in Teens

Acute stress disorder and post-traumatic stress disorder have many symptoms in common. In the first four weeks, these symptoms are diagnosed as ASD. Subsequently, experts diagnose PTSD in teenagers when symptoms last for more than a month and cause significant distress. Therefore, many people with ASD are later diagnosed with PTSD.

Moreover, PTSD encompasses several symptoms that are not part of an ASD diagnosis. These include risky or destructive behavior, extremely negative thoughts about oneself or the world, and exaggerated blame of oneself or others for causing the trauma.

Early treatment of ASD may reduce a teen’s chances of developing PTSD. And treatment immediately after a PTSD diagnosis also improves recovery time. According to the American Psychiatric Association, approximately 50 percent of PTSD cases resolve within six months with treatment. However, others may last for years.

Newport Academy Mental Health Resources: Acute Stress Disorder

Read “Trauma and PTSD in Teens: Signs, Symptoms, and Treatment.”

Effective Treatments for Acute Stress Disorder 

Teens should receive medical treatment within a few hours of experiencing a traumatic event. Therefore, their likelihood of developing ASD is reduced.

If teens do develop acute stress disorder, a variety of treatment approaches can help.

Cognitive behavioral therapy (CBT) is considered the most effective treatment for acute stress disorder. CBT helps teens to shift their thought patterns surrounding the traumatic incident. Moreover, teens learn new coping mechanisms to use in anxiety-provoking situations. In addition, CBT attempts to prevent PTSD from developing. Research suggests that CBT treatment in the first month after trauma has long-term benefits for people who are at risk of developing PTSD. 

In psychological debriefing, individuals undergo an intense therapeutic intervention immediately following the traumatic event. The goal is for them to process the event fully and let it go. However, some individuals relive the trauma during this process. As a result, their distress increases.

Research—including a 2018 review study—has found that mindfulness practices are effective for reducing stress-related symptoms. Mindfulness meditation encourages teens to witness their emotions from a distance rather than getting caught up in them. In addition, researchers believe that the slow, conscious breathing practiced in yoga and meditation calms the sympathetic nervous system. Therefore, it slows the “fight or flight” response produced by acute stress disorder.

In conclusion, early treatment is key to resolving acute stress disorder. Moreover, ASD can affect teens even when they indirectly experience a traumatic incident. Therefore, teenagers who manifest acute stress disorder symptoms need immediate attention from a healthcare professional—even if they were not injured or didn’t observe the event firsthand.

As a result, they have a better chance of recovering from the trauma and finding pleasure and meaning in life once again.

Images courtesy of unsplash


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Curr Psychiatry Rep. 2016; 18: 20. 

US Department of Veterans Affairs

American Psychiatric Association